Mood Distress Research Articles

Effects of a home-based walking program on perceived symptom and mood status in postoperative breast cancer women receiving adjuvant chemotherapy

This paper is a report of a study analysing the effect of a home-based walking exercise program on symptoms and mood distress among breast cancer women receiving chemotherapy postoperatively. Treatment-related symptoms, mood distress and decline in physical activity have been identified as major complaints among cancer patients. Studies on the efficacy of home-based walking exercise for symptoms and mood did not fully describe the exercise prescriptions that could be safe and beneficial for women with breast cancer, especially these receiving adjuvant chemotherapy. This is a prospective, randomized clinical trial. In 2008-2009, participants were recruited from the oncology outpatient clinic of a medical center in Taiwan, and were assigned to either the exercise group (n=19) or the control group (n=21). Women in the exercise group participated in a moderate-intensity home-based walking program for 12 weeks during their chemotherapy treatments. Symptoms, mood status and physical activity level were measured at baseline, 6- and 12-week follow-up. Data were analysed by two-way repeated-measures analysis of variance. Women in the exercise group reported significantly lower symptom severity scores and mood disturbance compared with those in the control group throughout the study period. Regular moderate-intensity exercise can play an important role in improving treatment-related symptoms and mood in women with breast cancer. A home-based walking exercise program can be easily incorporated into care for women with breast cancer undergoing chemotherapy.

Correlation of cognitive symptoms with cognitive performance among brain cancer patients after radiation therapy.

2084 Background: Cognitive symptoms can occur among cancer patients, though the incidence and severity vary across cancer type, location, treatment and time. Some have argued that subjective cognitive symptoms reflect patients' mood or fatigue more than objective cognitive functioning per se and there are studies showing no correlation between complaints and performance. Methods: The present study describes the correlations at baseline between subjective cognitive symptoms (FACT-Brain symptoms subscale), fatigue (FACT-Fatigue) and mood (Profile of Mood States) and objective cognitive performance (Controlled Oral Word Association Test, Hopkins Verbal Learning Test-Revised, Digit Span Test, Trail Making Test, Grooved Pegboard and summary Cognitive Composite Score [CCS]), among 82 brain cancer survivors who are ≥ 6 months post partial or whole brain irradiation participating in a phase III clinical trial of an acetylcholinesterase inhibitor, donepezil. Results: The sample (mean age = 52 yrs.; 50% female; 83% > HS) had primary (n = 52, 63%) and metastatic (n = 30, 37%) brain tumors. Significant bivariate correlations between the FACT-Br and the CCS (r = 0.42, p < 0.0001) and 7 of 10 cognitive tests (range:-0.26 to 0.44, p < 0.05) indicate that more symptoms predicted poorer performance. Neither overall fatigue (r = 0.19, p = 0.08) nor distressed mood (r = -0.05, p = 0.67) was associated with CCS. Adjusting for tumor type (primary vs. metastatic), age, education, fatigue, QOL, sex and race revealed a very similar pattern. Conclusions: Among 6+ month survivors of brain irradiation, there is an association between objective cognitive performance and subjective cognitive symptoms while mood and fatigue are minimally related to performance. Self-reported cognitive problems are not a substitute for cognitive performance measures, however they can be a valid and useful indicator of well-being and used as a clinical outcome in this population. This study was supported by Eisai, Inc., and NIH grants NCI/DCP 2 U10 CA 81851-09-13 and NINR 5R01NR009675. Author Disclosure Employment or Leadership Position Consultant or Advisory Role Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Eisai Pfizer Eisai Eisai, Pfizer

Heightened pain perception in illicit substance–using patients in the ED: implications for management

Background Substance users are commonly perceived to overstate their pain. Few data exist comparing pain intensity, perception, and related psychiatric comorbidities in the emergency department (ED) population. Objective To compare pain severity, duration, interference with function, and psychiatric and mood disturbance in substance-using (SU) and non–substance-using (NSU) patients in the ED. Methods This is a cross-sectional study. The setting is in an urban ED. Participants are SU and NSU patients in moderate to severe pain (numerical rating scale, 5-10). Outcome measures are as follows: pain intensity and duration, other painful conditions, pain-related functional interference (0-10), psychiatric disorders, and mood distress (profile of mood scale, 0-44). Results Of the 148 patients who enrolled, 28 (19%) reported recent illicit substance use (SU) and 120 (81%) did not (NSU). The SU patients' mean pain intensity was 8.96 (confidence interval [CI], 7.47-8.14) vs 7.81 (CI, 8.48-9.45) for NSU ( P = .003). The SU patients reported higher levels of pain interference. Fifty-four percent of SU patients vs 31% of NSU patients reported a psychiatric illness ( P = .02). Mean Profile of Mood State score was higher in SU (32.3; CI, 27.4-37.1) than in NSU (22.5; CI, 20.2-24.8; P < .001). Chronic pain was reported by 29% of SU patients vs 16% of NSU patients, and 75% of SU patients vs 58% of NSU patients reported another concurrent painful condition ( P = .10). Conclusions The SU patients report more severe pain and functional interference, more psychiatric illness and mood distress, and more chronically painful conditions. Given the complex interplay between pain, substance use, and mood disorders, increased attention should be paid to identifying patients with these associated conditions and to facilitating appropriate referrals. Effective treatment of this challenging patient population requires treating the entirety of their medical, psychiatric, and addictive diseases.

Impact of yoga on chronic pain—A review

Purpose Mind–Body therapies are considered as adjunctive treatments to help ameliorate or at least cope with chronic pain conditions. Despite a lack of scientific acceptance, these approaches are of interest to patients which widely use relaxation techniques, biofeedback, imagery, hypnosis, etc. We intended to analyze the scientific literature with respect to the impact of yoga on chronic pain conditions. Methods In January 2009 we searched the databases Medline, Pubmed and CAMbase. The search terms were >yoga pain Results We found 15 studies which addressed the impact of yoga on chronic pain conditions. The studies enrolled patients with chronic low back pain ( n =6), headache/migraine ( n =2), various other chronic pain conditions ( n =6), and one experimental study with healthy individuals. Fourteen studies addressed pain perception or disability, 6 mood states (anxiety/depression) and distress, and one study health-related quality of life. Nine studies were randomized, 2 controlled, and 3 had a single arm design; one study was an experimental study with yoga trained and non-trained individuals. The number of patients in the randomized or controlled studies ranged from 15 to 101. The randomized and controlled studies described positive effects in terms of decreased pain frequency and intensity, decreased anxiety/depression, and improvement of fatigue- and health-related quality of life. Conclusions There is reasonable evidence that yoga practices may have positive effects on pain perception and mood states. The overall positive findings in the identified studies indicate that yoga may enhance patients’ self-efficacy, inner balance, adjustment and coping abilities. Nevertheless, there are several research questions, which have to be addressed in future studies, i.e., adequate control interventions; patients’ positive expectations; patients’ ability and will to change behavior, etc. Several of the unspecific effects of distinct mind–body therapies are nevertheless critical aspects (i.e., expectancy, sense of control, mindfulness, etc.) which cannot be ignored as they contribute to the intended treatment effect. Mind–body interventions such as yoga may become important adjunctive interventions in the multi-modal treatment of patients with chronic pain conditions as they foster self-control and self-management.

A new US–UK diagnostic project: mood elevation and depression in first‐year undergraduates at Oxford and Stanford universities

To investigate differences in prevalence of mood elevation, distress and depression among first-year undergraduates at Oxford and Stanford universities. An online survey was sent to Oxford and Stanford first-year undergraduate students for two consecutive years in the winter of 2005 and 2006. Students completed a survey that assessed mood symptoms and medication use. Both universities had similar rates of distress by General Health Questionnaire (Oxford - 42.4%; Stanford - 38.3%), depression by Primary Care Evaluation of Mental Disorders (Oxford - 6.2%; Stanford - 6.6%), and psychotropic and non-psychotropic medication usage (psychotropic: Oxford - 1.5%; Stanford 3.5%; nonpsychotropic: Oxford - 13.3%; Stanford - 18%). Oxford had higher rates of mood elevation by Mood Disorder Questionnaire (MDQ) (Oxford - 4%; Stanford - 1.7%). Oxford and Stanford students have similar rates of mood distress, depression and general medication usage. Students at Oxford have a higher prevalence of MDQ scores that possibly indicate a bipolar disorder, while Stanford students are prescribed more psychotropics.

Using the Minimum Data Set to Determine Predictors of Terminal Restlessness Among Nursing Home Residents

The aim of this study was to determine predictive variables of terminal restlessness that were selected from the Minimum Data Set (MDS) among nursing home residents. A descriptive, cross-sectional design was used to retrospectively review decedents' Minimum Data Set records. Four independent variables from the MDS (distressed mood, problem conditions, pain, and medications) were examined as to whether they were predictive variables of terminal restlessness by utilizing path analysis statistical method. Residents from a nursing home located in the northwestern United States who died during 2000 and 2001, had at least one MDS record and no comatose in their MDS cognitive patterns were selected. A total of 84 decedents' records were consequently recruited for use in this study. A path analysis result showed (a) 44.6% of the variance in distressed mood is predicted by two variables: problem conditions (beta = .557) and pain (beta = .193) and (b) 34% of the variance in terminal restlessness is predicted by two variables: pain (beta = .370) and distressed mood (beta = .313). Results indicate that residents who (a) had more problem conditions and more pain are more likely to have distressed moods and (b) experienced more pain and had more distressed moods have a higher incidence of terminal restlessness. These findings provide important and valuable clinical implications. A careful evaluation of pain is necessary, especially as many elders are not able to communicate well during the terminal phase of their lives. How to access residents' moods and provide appropriate and immediate interventions, comfort, and even just being there for them are imperative for nursing home care providers.

Substance Users Experience Similar Pain Intensity, But More Mood Distress Than Non-Substance Users

Substance Users Experience Similar Pain Intensity, But More Mood Distress Than Non-Substance Users

Coping and quality of life among women extensively treated for gynecologic cancer

The current study examined the use of engagement and avoidant coping strategies among advanced-stage gynecologic cancer patients who were facing the long-term stressors of extensive chemotherapy and advanced disease. Patients were compared to a reference group of early-stage patients who had received more limited treatment. Compared to the reference group, extensively-treated women more frequently utilized both engagement and avoidant strategies including active coping, seeking social support, and mental disengagement. Use of engagement coping strategies such as active coping and seeking social support were not significantly related to quality of life or mood. However, avoidant coping strategies, including disengagement and cognitive avoidance, were strongly associated with poorer well-being and more distressed mood. Moreover, relationships between coping and quality of life differed between the extensively-treated patients and patients in the limited treatment reference group. The use of avoidance and seeking instrumental support were associated with poorer outcomes among extensively-treated patients but not among the limited treatment group. Results of the current study suggest that coping patterns and outcomes may be more pronounced among cancer patients contending with severe disease and extensive treatment and that avoidant coping strategies may be particularly detrimental with respect to these patients' mood and quality of life.

Major life stress, coping styles, and social support in relation to psychological distress in patients with systemic lupus erythematosus

The objective of this study was to examine psychological processes in systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) patients in relation to measures of life stress, coping styles, social support and cognitive ability. Fifty-two SLE patients without overt neuropsychiatric symptoms, 29 RA patients and 27 healthy controls completed measures of depression, mood, disease activity, perceived health, stressful life events, coping, and social support. Variables entered into the multiple regression analysis following principal component analysis were: group, major difficult event, major life threatening event, disengaging coping, emotional coping, social support, and cognitive impairment. Depressive symptoms were associated with SLE group status (P < 0.001), major life-threatening events (P < 0.01), disengage coping (P < 0.001) and emotional coping (P < 0.05). SLE group status (P < 0.05), disengage coping (P < 0.05) and emotional coping (P < 0.05) were associated with current distressed mood. SLE patients without overt, major neuropsychiatric symptoms had greater psychological distress compared to RA and control subjects. Increased depressive symptoms and distressed mood state in SLE patients were related to use of disengaging and emotional coping styles. These findings are limited to SLE patients with no overt neuropsychiatric illness and low disease activity, suggesting the need for future studies with a greater variety of SLE patients. Interventions aimed at improving active coping and minimizing emotional response to stress may lower psychological distress in SLE patients with mild disease.

Low self-directedness (TCI), mood, schizotypy and hypnotic susceptibility

Relationships between personality and mood variables in a non-clinical sample were investigated using 80 medical students divided into two groups according to their Self-directedness (SD) scores from Cloninger’s Temperament and Character Inventory (TCI). Those with low SD proved to have significantly raised scores on hypnotisability, absorption, Self-transcendence and significantly lower scores on Co-operativeness. Both the schizotypal variables of Cognitive Activation and Withdrawal were raised. Further, the combination of low SD, low Co-operativeness and high Self-transcendence points also towards a schizotypal personality style. These results corroborate a previously established link between schizotypy and hypnotic susceptibility. Low scorers on SD also had significantly higher mood distress, anxiety and perceived stress. Low SD, with its history of identifying personality disorders, in this data set appeared to be identifying those medical students who were distressed in all measured aspects of mood as well as having indications of higher levels of absorption, hypnotic susceptibility and aspects of schizotypy. The generality of distress shown by these students raises important questions about their eventual competency in communication skills and, indeed, decision making when they graduate as doctors involved in the treatment of patients.

Comportamento de restrição alimentar e obesidade

A obesidade é uma doença de alta prevalência no mundo e é responsável por sérias repercussões orgânicas e psicossociais, desde a infância até a vida adulta. O comportamento alimentar tem bases biológicas e sociais e, associado, à obesidade, torna-se um processo ainda mais complexo pelos aspectos psicológicos envolvidos, os quais se expressam por meio de humor depressivo, ansiedade, sentimento de culpa e, também, por mecanismos fisiológicos, como a resistência ao jejum na vigência de dietas restritivas. Há evidências de que, em indivíduos obesos, comportamentos de compulsão alimentar e ou restrição são mais freqüentes e parecem ser, em parte, responsáveis pelos fracassos observados no tratamento da obesidade. As restrições e auto-imposições das pessoas que fazem dieta, parecem ter um efeito rebote, resultando em compulsão alimentar, a qual pode associar-se a conseqüências psicológicas, como a perda da auto-estima, mudanças de humor e distração. As reflexões desta revisão sugerem que os programas para redução de peso corporal devem enfocar as bases do comportamento alimentar e desenvolver, efetivamente, ações interdisciplinares que permitam obter resultados eficazes no tratamento da obesidade.

P.8.019 Daytime sleepiness is associated with mood distress in taiwan's young adult

P.8.019 Daytime sleepiness is associated with mood distress in taiwan's young adult

Pre-treatment factors related to cognitive functioning in women newly diagnosed with breast cancer.

Women treated for breast cancer have shown cognitive deficits with reduced capacity to focus and concentrate or to direct attention. This study examined the relationship between cognitive function prior to any treatment for breast cancer and individual factors including age, education, menopausal status, chronic health problems, and distress. Women newly diagnosed with breast cancer (N=184), ages 27-86 years, were assessed with standardized attention tests, self-reports of effectiveness in cognitive functioning, and measures of distress at about 18 days before surgery. Measured performance on the cognitive tests was not significantly correlated to self-reports of effectiveness in cognitive functioning. Age, education, presence of a chronic health problem, and menopausal status, but not distress, were associated with performance on the cognitive tests. Only age and education, however, were significant (p<0.001) predictors of overall performance on the cognitive tests, when controlling covariates. In contrast, symptom and mood distress significantly (p<0.001) predicted perceptions of effectiveness in cognitive functioning. Thus, different factors were associated with measured performance versus self-reports of cognitive functioning. Individual factors that predispose to lowered effectiveness in cognitive functioning prior to treatment in women newly diagnosed with breast cancer are discussed.

Quality of life of long-term survivors of non-small-cell lung cancer.

To describe the quality of life (QOL) among survivors of non-small-cell lung cancer (NSCLC). One hundred forty-two 5-year minimum self-reported disease-free survivors of NSCLC completed QOL instruments (QOL-Survivor and Medical Outcomes Study 36-Item Short Form [SF-36]) and assessments of emotional distress (Center for Epidemiologic Studies Depression Scale [CES-D]), comorbid disease, and tobacco use. Pulmonary function was assessed with a hand-held spirometer. Multivariate regression methods were used on total QOL-Survivor scores and physical (PC) and mental (MC) component scores of the SF-36. The majority (71%) of survivors described themselves as hopeful, and 50% viewed the cancer experience as contributing to positive life changes (QOL-Survivor). Comorbidity was common (60% >or= one condition); 22% had distressed mood (CES-D >or= 16). Most were former smokers (76%); 13% continued to smoke. Half had moderate/severe pulmonary distress (forced expired volume in 1 second [FEV1] < 70% of predicted). Regression models including the set of variables (age, sex, living alone, education, smoking status, pulmonary function category, distressed mood, time since diagnosis, and comorbidity) accounted for 37%, 48%, and 29% in the QOL-total, MC, and PC scores, respectively. Primary predictors of lower QOL scores were white ethnicity and distressed mood (CES-D >or= 16) (34% of the variance explained). The primary predictor of lower MC scores was distressed mood (R(2) = 0.45). Lower PC scores were associated with older age, living alone, FEV1 less than 70% of predicted, distressed mood, time since diagnosis, and more comorbid diseases (R(2) = 0.28). These findings provide the first description of the QOL of long-term survivors of lung cancer. Risk factors for poorer QOL are strongly linked to distressed mood, which is a potential target for intervention.

The effect of risk notification on mood in long-term survivors of Hodgkin's disease

Risk notification was the initial step in a larger study to determine (1) the prevalence of cardiovascular disease as a late effect of mediastinal irradiation, and (2) whether a brief support group intervention would mitigate any negative effects of risk notification.323 HD survivors attended a 45 minute risk notification session prior to a routine follow-up medical visit. When they arrived at the clinic and following the risk notification session, they completed surveys that included measures of mood dysphoria, sense of coherence, knowledge of late effects of treatment, and demographic factors. Two analytic models were proposed to look at the effects of risk notification: (1) psychosocial state when arriving at the clinic, and (2) psychosocial change in state following risk notification session.Pre-intervention mood distress was not significantly affected by time since the initial diagnosis, age, education, or gender. Person's who worked and those with better coping skills had lower initial mood distress. Knowledge of the late effects of treatment was not related to mood distress. Following the intervention, the more distressed a person was initially, the better the coping skills, the greater the decrease in mood distress. Partnered survivors experienced less of a decrease in distress. Knowledge of the late effects of treatment (regardless of their knowledge of cardiovascular disease as a consequence), did not effect change in mood distress.Findings were contrary to expectations. Findings are consistent with Self-Regulation theory and the Health Belief Model and are not explained by anxiety related to the medical visit itself. Limitations of the study design are discussed.The method through which risks are conveyed can reduce the psychosocial impact of risk notification.

Salivary Cortisol and Social Status among Dominican Men

Studies of nonhuman primates indicate that social subordinance associates with chronic elevated cortisol, but this finding has not been replicated among humans. This topic was examined in a study of 31 healthy adult male Dominican villagers ages 17 to 49 years. Each subject's mean cortisol level was calculated using multiple time-standardized salivary cortisol samples (minimum = 6, mean = 14.8 samples per subject) determined by radioimmunoassay. Semistructured ethnographic interviews were used to collect several measures of social status. Data were analyzed with a backward stepwise multivariate linear regression model. Partial regression statistics revealed four significant associations with cortisol: (i) men with reputations for illicit social behavior had higher cortisol; (ii) men who reported more frequent distressed mood had higher cortisol; (iii) men rated as less trustworthy, agreeable, influential, and helpful by their peers had higher cortisol; and (iv) men whose fathers were absent as a childhood caretaker had higher cortisol. No associations were found between cortisol and (a) a composite of educational attainment, income, and material wealth; (b) frequency of tobacco consumption; (c) frequency of perceived social stressors; or (d) a composite of number of children and dependents.

General and AIDS-Specific Stress, Coping, and Psychological Distress in the Biracial Coping & Change Study Cohort of Gay Men

The emotional well-being of persons living with HIV/AIDS is thought to be affected by a number of factors, including stage of disease progression and presence of physical symptoms, social support, stressors (both general and AIDS-specific), appraisals of control over stressful situations, and coping behaviors. The literature has been unclear regarding the role that coping mechanisms play in mediating or buffering the effects of stressors, and continued efforts to clarify the role of coping are important in order to inform clinical interventions. The current study was based on the responses of 297 White and African-American gay men with and without HIV/AIDS participating in the Chicago Multicenter AIDS Cohort Study (MACS) and Coping & Change Study (C&CS) from 1992 to 1994. We found that the amount of detachment- versus involvement-oriented coping strategies used to deal with stressors was unrelated to the level of reported depressed mood and AIDS-specific distress, except among the most severely depressed men (upper 15%), for whom greater reliance on involvement coping strategies was associated with decreased depression. Implications of these findings and suggestions for future research are discussed.

Psychophysiological stress reactions in female and male urban bus drivers.

Male and female urban bus drivers were studied at work during everyday bus driving in urban traffic (work condition) and watching educational programs (comparison condition). The results showed that (a) both sexes had significantly higher adrenaline, noradrenaline, and cortisol excretion levels during work than during the comparison session; (b) during work and inactivity, there were no significant sex differences in hormone excretion for either hormone; (c) the percentage increase during work compared with control levels for all hormones was equally high in the female group as in the male group; and (d) there were no significant sex differences in self-reported mood (distress, well-being, control) during bus driving. The results are discussed in terms of type and intensity of stressors, gender differences in costs of adaptation, preventive measures, and the role of social influences in psychoneuroendocrine regulation.

Family caregiving in cases of hip fracture.

The growing incidence and cost and the serious nature of hip fracture in the elderly require a closer examination of the family's role in the rehabilitation process and how it can be assisted in that role. In this prospective study, 57 family caregivers provided information before the hospital discharge of the patient with hip fracture and at 2, 8, and 14 weeks postdischarge. They were asked about caregiving demands and problems, caregiver mood, expectations about recovery, and advice to future caregivers. A brief follow-up was conducted at 6 months. The care recipients were all women and had been living at home before injury. The postdischarge location of the patient (e.g., in a residence shared with the caregiver, in a different residence, or in a nursing home) was a major factor in the types of caregiving activities but not in total demand. Nonspouses cited the most problems. Mood distress did not change over time. Caregivers appeared to have unrealistic expectations about the length of the recovery period; by 14 weeks, 35% judged the care recipient's mobility to be worse than expected, and 20% felt that the patient had more pain than expected. The most frequent advice to future caregivers was to have patience and to give encouragement.

Perception of fault in patients with chronic pain

The beliefs and expectancies of chronic pain patients have been shown to be critical cognitive facilitators or impediments to the recovery process. In the present study patients presenting to an outpatient pain center were classified according to their response to the questionnaire item “Who do you think is at fault for your pain?”. Patients were then grouped according to the responses ‘employer’, ‘other’, or ‘no one’. The resulting 3 groups of patients did riot differ in current pain intensity or activity limitation, but the fault conditions, relative to the no-fault patients, reported greater concurrent mood distress and behavioral disturbance, as well as poorer response to past treatments, and lessor expectations of future benefits. The negative effects were more pronounced in the Employer-Fault group, than for the Other-Fault group (primarily ‘doctors’ and ‘other drivers’). On balance, the present data suggest: that attribution of blame may be an under-recognized cognitive correlate of pain behavior, mood disturbance, and poor response to treatment.