Thomas Hardie

Depression in Internet and face-to-face cancer support groups: a pilot study.

PURPOSE/OBJECTIVES To examine depression in Internet cancer support groups as compared to traditional (face-to-face) cancer support groups and to explore the relationship between Internet use and levels of depression. DESIGN Exploratory, descriptive. SETTING Traditional (face-to-face) and Internet cancer support groups. SAMPLE Convenience sample of 40 patients with cancer, 14 from traditional face-to-face groups and 26 from an Internet support group, with different cancer diagnoses. METHODS Traditional paper or Internet surveys consisting of an investigator-developed questionnaire including demographic information, brief medical history, support group history, and the Center for Epidemiologic Studies Depression Scale (CES-D). MAIN RESEARCH VARIABLE Depression scores on the CES-D. FINDINGS Participants in the face-to-face groups were 100% male. The online group was 56% male and 44% female. Groups did not differ significantly by income, health insurance status, or days since initial diagnosis. Groups differed significantly on level of depression. The traditional (face-to-face) group had a CES-D mean score of 1.86 (SD = 2.69), and the online group had a mean score of 29.27 (SD = 11.89, p less than 0.000). A comparison of CES-D scores of men in the face-to-face and Internet groups revealed that they differed significantly on level of depression. Men in the traditional group had a mean score of 1.86 (SD = 2.69), and men in the online group had a mean score of 27.42 (SD = 112.69, p less than 0.000). CONCLUSIONS These data suggest that more depressed patients with cancer use Internet support groups instead of face-to-face support. Before online interventions can be implemented effectively, their efficacy needs to be evaluated. IMPLICATIONS FOR NURSING Patients with cancer are at increased risk for developing depression. This should be a consideration during nursing assessments. Traditional cancer support groups can help people cope with their cancer, but the efficacy of Internet cancer support groups in providing psychoeducation and psychotherapeutic intervention remains to be proven.

Lesbians' Disclosure of Sexual Orientation and Satisfaction With Care

The overarching aim of this study was to explore demographic variables and their association with a womans disclosure of sexual orientation to a health care provider (HCP). This descriptive correlation study used a convenience sample of 96 women recruited at gay and lesbian community events held in Delaware. A self-report survey of 35 questions was used to obtain the data. None of the women identified themselves as exclusively heterosexual. The results indicate that a womans self-identified sexual orientation is significant in predicting whether she has shared her orientation with her HCP. The more a womans self-reported orientation moves toward the heterosexual end of the preference scale, the less likely she is to share her orientation with her HCP. Culturally competent care and a nondiscriminatory atmosphere will provide this population with the trust needed to enable open rapport with their HCPs.

Does adverse family environment or sex matter in the salivary cortisol responses to anticipatory stress

We previously reported that in anticipation of a modest stressor, preadolescent sons of drug-dependent fathers (HR) demonstrated a diminished salivary cortisol response relative to comparison boys. No data were available concerning anticipatory salivary cortisol responses in preadolescent daughters of HR fathers. Additionally, we hypothesized that diminished stress responses in HR youth might be an adaptation to a stressful family environment. Consequently, in this report we have examined the role of family environment in the anticipatory salivary cortisol responses in both HR boys and girls as well as their association with a measure of distress in the family environment. Independent of sex, HR children had diminished anticipatory cortisol responses. Girls had significantly higher salivary cortisol concentrations, pre- and post-stressor. However, contrary to our expectation, we could not demonstrate an association between salivary cortisol responses and the measures of the family environment. These results suggest that there may be a sex difference in salivary cortisol dynamics in preadolescent children; however, the functional status of the current family environment does not appear to be related to cortisol reactivity.

What’s Age Got to Do With It? Partner Age Difference, Power, Intimate Partner Violence, and Sexual Risk in Urban Adolescents:

Adolescent girls with older male main partners are at greater risk for adverse sexual health outcomes than other adolescent girls. One explanation for this finding is that low relationship power occurs with partner age difference. Using a cross-sectional, descriptive design, we investigated the effect of partner age difference between an adolescent girl and her male partner on sexual risk behavior through the mediators of sexual relationship power, and physical intimate partner violence (IPV), and psychological IPV severity. We chose Blanc’s framework to guide this study as it depicts the links among demographic, social, economic, relationship, family and community characteristics, and reproductive health outcomes with gender-based relationship power and violence. Urban adolescent girls (N = 155) completed an anonymous computer-assisted self-interview survey to examine partner and relationship factors’ effect on consistent condom use. Our sample had an average age of 16.1 years with a mean partner age of 17.8 years. Partners were predominantly African American (75%), non-Hispanic (74%), and low-income (81%); 24% of participants reported consistent condom use in the last 3 months. Descriptive, correlation, and multiple mediation analyses were conducted. Partner age difference was negatively associated with consistent condom use (−.4292, p < .01); however, the indirect effects through three proposed mediators (relationship power, physical IPV, or psychological IPV severity) were not statistically significant. Further studies are needed to explore alternative rationale explaining the relationship between partner age differences and sexual risk factors within adolescent sexual relationships. Nonetheless, for clinicians and researchers, these findings underscore the heightened risk associated with partner age differences and impact of relationship dynamics on sexual risk behavior.

Preadolescent Children of Substance-Dependent Fathers with Antisocial Personality Disorder: Psychiatric Disorders and Problem Behaviors

We compared psychiatric disorders and problem behavior scores in pre-adolescent children of fathers with alcohol or other drug dependence and ASP (SD+/ASP+), children whose fathers had substance dependence without ASP (SD+/ASP-), and children whose fathers were without either disorder (SD-/ASP-). SD+/ASP+ children showed elevated rates of major depression, conduct disorder, attention deficit hyperactivity disorder, oppositional defiant disorder, and separation anxiety disorder when compared to SD+/ASP- and SD-/ASP- children. SD+/ASP+ children had higher internalizing and externalizing problem behavior scores than the other two groups of children. The results suggest that SD+/ASP+ children are at significant risk for internalizing and externalizing psychopathology.

Affiliation with deviant peers among children of substance dependent fathers from pre-adolescence into adolescence: associations with problem behaviors

OBJECTIVE Affiliation with delinquent peers has been shown to be a major risk factor for the development of antisocial and substance abuse behaviors in adolescence. However, little data are available concerning the developmental trajectories of deviant peer affiliation. METHOD In this study, we have prospectively examined the density of deviant peers among the social networks of children of drug dependent fathers at age 10, and at 2 and 5 year follow-ups, and compared them with those of controls. Measures of internalizing and externalizing psychopathology were employed as time varying covariates, while socioeconomic status (SES) was used as a time invariant covariate. A pattern mixture analysis of missing data was conducted. RESULTS Using mixed effects models, we found significant main effects of time, group, externalizing psychopathology, and to lesser extent, SES on the magnitude of affiliation with deviant peers. Greater deviant peer affiliation among the high-risk children was found at each time point. Externalizing psychopathology augmented the magnitude of deviant peer affiliation in both high-risk and comparison children. CONCLUSION Offspring of drug dependent fathers have heightened affiliation with deviant peers from pre-adolescence through mid-adolescence. This social developmental process may be a component of the familial risk for substance abuse and antisocial behaviors.

Symbiosis--undergraduate research mentoring and faculty scholarship in nursing.

Although teaching is the major focus of academia, research and professional publications frequently determine faculty eligibility for promotion and tenure. In universities where funded research is scarce, faculty need creative means to accomplish research goals. Research is an essential part of baccalaureate nursing education. The goal of research education at the baccalaureate level is to prepare knowledgeable consumers in nursing research. The purpose of this article is to describe an undergraduate nursing research course that provide students with hands-on experience in the conduct of nursing research and provide faculty with assistance in moving their research agenda forward. Faculty members were solicited to work with 5-10 students in a research project that was either in the planning stages or actively in progress. After one year of program implementation, faculty and students were involved in presenting poster and oral presentations at state, regional, and international research conferences. Manuscripts and proposals for funding are in the process of submission.

Competence in caregivers of adolescent and young adult childhood brain tumor survivors.

OBJECTIVE Caregivers of adolescents and young adults (AYA) with complex medical conditions, including brain tumor survivors, have protracted and often complex roles, yet a gap exists in understanding their perceived competence. The aim of this study is to test a hypothesized model based on the theoretical and empirical literature: better caregiver health, better survivor health, and better family functioning contribute directly to fewer caregiving demands, which in turn contribute to greater caregiver competence. METHOD Telephone interviews using structured self-report questionnaires were conducted in this cross-sectional study with a sample of 186 caregivers (mothers) of childhood brain tumor survivors aged 14-40 years old who live with at least one parent. Structural equation modeling (SEM) was used to test the hypothesized model. RESULTS The final SEM model suggests that survivor health and family functioning directly predict caregiver competence. Caregiver health indirectly predicts caregiver competence through caregiver demands and then family functioning. Family income directly predicts family functioning. The model showed adequate fit (CFI = 0.905, TFI = 0.880, and RMSEA = 0.081). Overall, the model accounted for 45% of variance in caregiver competence. CONCLUSIONS For this sample of caregivers of AYA with medically complex conditions, family functioning and the health of survivors are both important to how they evaluate their skills as caregivers. The results of this study underscore the crucial role of care models that focus on optimizing the health of the survivor, caregiver, and family, along with supporting a family centered approach to their care.

Associations among Depressive Symptoms, Dating Violence, and Relationship Power in Urban, Adolescent Girls

OBJECTIVE To explore the associations among dating violence (DV), aggression, relationship power, and depressive symptoms. DESIGN A cross-sectional survey secondary analysis. SETTING An urban, school based health center, October, 2009 through May, 2009. PARTICIPANTS Low income, adolescent girls (n = 155), ages 14-18. METHODS Descriptive and bivariate analyses were conducted to illustrate patterns and associations among variables. Key variables included depressive symptoms, DV victimization and aggression, and relationship power. We used mediation analyses to determine the direct and indirect effects among variables. RESULTS Both DV victimization and aggression were reported frequently. Furthermore, DV victimization had a significant direct effect on depression and an indirect effect through relationship power. Depressive symptoms and relationship power were associated with DV aggression. Although relationship power did have a significant inverse effect on depressive symptoms, it was not through DV aggression. CONCLUSIONS Complex associations remain between mental health and DV; however, relationship power partially accounts for DV victimizations effect on depressive symptoms. Depressive symptoms are associated with DV victimization and aggression; therefore, nurses should address relationship power in clinical and community interventions.

Sensory stimuli as obstacles to emergency care for children with autism spectrum disorder.

Visits to the emergency department (ED) are stressful for any patient and pose special challenges and potential barriers to care for those with autism spectrum disorder (ASD). In addition, people (both children and adults) with ASD differ in their perception of, or responses to, environmental stimuli. Some people with ASD present with sensory defensiveness that is environmentally moderated, but there is a gap in our knowledge about patterns or thresholds of stimulation that kindle behavioral responses. We systematically recorded visual and auditory stimuli in an ED. Data were collected in four areas, hallway, doorway of waiting room, chair in waiting room, and treatment room, over several weeks and times of day. The mean light intensity ranged from 127 to 184 lux. There were significant differences (F = 16.77, df = 3, p > 0.001) between the five ED locations. Mean sound levels ranged from a high of 63.291 dB in the waiting room chair to a low of 51.289 dB in the treatment room. The highest consistent level of noise was recorded while sitting in the waiting room chair (60.657–63.291 dB). The findings suggest significant differences in light and sound intensity in common ED locations, with the highest mean readings of light and noise in the waiting areas. The differences and descriptions of light and sound patterns support the need for additional studies in both the measurement of the ED environment and its role in stimulating sensory defensiveness in people with ASD.