Emotional Distress In Patients Research Articles

Limited English proficient Hmong- and Spanish-speaking patients’ perceptions of the quality of interpreter services

BackgroundLanguage barriers are a large and growing problem for patients in the US and around the world. Interpreter services are a standard solution for addressing language barriers and most research has focused on utilization of interpreter services and their effect on health outcomes for patients who do not speak the same language as their healthcare providers including nurses. However, there is limited research on patients’ perceptions of these interpreter services. ObjectiveTo examine Hmong- and Spanish-speaking patients’ perceptions of interpreter service quality in the context of receiving cancer preventive services. MethodsTwenty limited English proficient Hmong (n=10) and Spanish-speaking participants (n=10) ranging in age from 33 to 75 years were interviewed by two bilingual researchers in a Midwestern state. Interviews were audio taped, transcribed verbatim, and translated into English. Analysis was done using conventional content analysis. ResultsThe two groups shared perceptions about the quality of interpreter services as variable along three dimensions. Specifically, both groups evaluated quality of interpreters based on the interpreters’ ability to provide: (a) literal interpretation, (b) cultural interpretation, and (c) emotional interpretation during the health care encounter. The groups differed, however, on how they described the consequences of poor interpretation quality. Hmong participants described how poor quality interpretation could lead to: (a) poor interpersonal relationships among patients, providers, and interpreters, (b) inability of patients to follow through with treatment plans, and (c) emotional distress for patients. ConclusionsOur study highlights the fact that patients are discerning consumers of interpreter services; and could be effective partners in efforts to reform and enhance interpreter services.

Spirituality and Religiosity during the Perioperative Period for Cancer Patients and their Family: An Integrative Systematic Review

Background: Religion and Spirituality (R/S) may influence patient's emotional distress, mental health and healing throughout their diagnosis and treatment. Objective: This systematic review examines studies exploring R/S of patients and their family in the perioperative period. Design: We completed a systematic review of the databases MEDLINE, EMBASE, CINAHL, SCOPUS, the Web of Science, and Cochrane library concerning the terms religion and spiri- tuality and cancer surgery. Inclusion criteria included qualitative or quantitative studies evaluating R/S of patients or their family members within the perioperative period (one month pre- and post-surgery). Exclusion criteria included review articles, grey literature, edito- rials, case studies and studies evaluating R/S of healthcare providers. Results: Seven publications met criteria for analysis. Five studies described cross-sectional surveys, one used a focus-group approach, and one utilized in-person interviews. Studied popu- lations predominantly were female breast patients. There were considerable heterogene- ity in survey instruments, variables, and outcomes. Based on these studies: 1) Faith and religious beliefs were used as coping mechanisms during the perioperative pe- riod; 2) Evangelical Christians tended to differ in religious coping compared to Catholics; 3) R/S correlated with coping styles and distress; 4) There was increased religious coping and religious involvement during the perioperative period; Conclusions: Studies evaluating R/S of patients and their families in the perioperative period are few and heterogeneous in design. Direct comparison is difficult, but data suggests that R/S during the perioperative period may increase as compared to R/S during other stages of diagnosis and treatment.

The use of expressive writing in the course of care for cancer patients to reduce emotional distress: analysis of the literature

The emotional distress represents one of the symptoms most frequently reported in the cancer patient in therapy, increasing the risk of developing a disease depressive. Through the analysis of the literature we want to assess whether the use of expressive writing on cancer patients in their care pathway compared to the use of writing neutral reduces emotional distress. The bibliographic search was conducted using the databases CINAHL, PubMed, Cochrane Library and PsycInfo. The results of research conducted on 7 randomized controlled trials, including 3 pilot studies have shown after expressive writing sessions (experimental group) versus neutral writing (control group) a significant reduction in distress in the experimental group early stages of cancer (p = 0,0183); in patients with a diagnosis of metastatic assigned to the group expressive writing there was a statistically significant relevance in the reduction of mood disorders (p = 0,03).Were determined statistically significant group differences also with respect to some measure on the quality of sleep (p = 0,04). The expressive writing did not produce significant reductions in psychological distress and improvements in physical health (p > 0,20) in patients diagnosed with metastatic disease of long duration and, in the palliative care there have been results of feasibility for poor adherence at follow-up. From the results it is evident that the strategies of expressive writing improves the management of the disease, reduce the physical and psychological symptoms related to the tumor while reducing the emotional distress in patients at an early stage of the disease.

Doctor - Patient Relation a Study of Communication

The patient-physician relationship is the very heart of health care delivery. The Doctor-patient relationship not only gives patients access to health care but also can promote healing. Having good communication skills is essential for doctors to establish good doctor -patient relationship. Good doctor patient communication was shown to have a positive impact on health outcomes. Improvements in doctors' communication skills were shown to be associated with increases in the emotional distress of patients. Better doctor -patient communication was shown to be associated with better control of chronic diseases. Patient-centred visits are associated with more diagnostic tests and referrals in the subsequent months. Low compliance with prescribed medical interventions is associated with reduced medical costs. The doctors' attitudes towards their patients, their ability to elicit and respect the patients' concerns, the demonstration of empathy and the development of patient trust are the key determinants of good compliance with medical interventions. Effective doctor-patient communication is highly associated with increased patient satisfaction. Doctors' satisfaction with their professional life are associated with greater patient trust and confidence. Communication problems are important factors in medical litigation. Adequate research has been done to evaluate doctor-patient relationship and doctor-patient communications. “Doctor -patient relation: A study of communication” is an interdisciplinary research work in medico social communication.

An Unguided Music Therapy Listening Experience of Luigi Nono's Fragmente-Stille, an Diotima: A Case Report

IntroductionMusic therapy literature affirms that adolescence can be a transformational stage between discovery and disorientation (McFerran, 2010), questioning self-identity, society, and issues of independence (Derrington, 2005). Moreover, adolescence can be a time for novelty-seeking and risk-taking behaviors, experimentation, and emotional responses to stress due to rapid changes in the limbic system and the frontal lobes (Lahey, 2004; Spear, 2000), areas of the brain involved in emotion and regulating emotion. Research suggests that music plays a major role in shaping the impressionable adolescent mind (McFerran, 2010; Levitin, 2006), opening up new doors for discovery, expression, creativity, and connectedness (Aldridge, 1996; Henderson, 1991; Robbins & Robbins, 1991; Lefebvre, 1991; Dvorkin, 1991).Taking this literature into consideration, an integrative mindfulness-based receptive music therapy listening experience of one of Luigi Nono's most demanding compositions (Morton, 1996), Fragmente-Stille, an Diotima, was conducted with Nancy, a motivated, artistically curious, intelligent, and novelty-seeking adolescent female patient diagnosed with depression and post-traumatic stress disorder. Luigi Nono's string quartet was perceived by Nancy as being something elusive, indescribable, and transient, associating the music with the impermanence of her own memories and thoughts. Here, unexpectedly, when deeply listening to Luigi Nono's music, Nancy was experiencing the beginning of a spiritual or transpersonal awakening, concerning the impermanence of all things, a therapeutic and insightful teaching found in Buddhism (Yen, 1993).Buddhism and ImpermanenceBuddhist teachings on impermanence are profound and reveal a unique way of understanding phenomena as something arising, dwelling, and passing away (Schmidt, 2002). Buddhist scriptures conclude that all phenomena are impermanent and are subject to constant change (Walshe, 1995). When examining human psychology from a Buddhist perspective, Wallace (2007) reveals that the ordinary human mind is dysfunctional, prone to conative, attentional, cognitive, and affective imbalances. The mind is in constant flux, able to move from sadness, happiness, and/or anger as quick as a flash of lightning. According to Buddhist teachings, suffering is the result when one attempts to cling to impermanent emotions, feelings, thoughts, and/or memories as something permanent or fixed (Walshe, 1995). Moreover, we lose the true meaning of the present moment when we compare it to memories of past experiences, engrossed in defining, naming, and analyzing the here and now (Fenner, 2007). Furthermore, one is in a delusional state of mind when concluding that memories are permanent, existing in the present moment (Wallace, 2007). Watts (1951) equates memories to a corpse of an experience, from which the life has vanished (p. 92).Various psychotherapists who have incorporated Buddhist philosophy into clinical practice reveal some interesting insights regarding the patient's emotional distress due to their attachment to past experiences. For example, Epstein (2007), a psychiatrist who has written extensively about Buddhism and psychotherapy, reveals that when a patient is emotionally and physically immobilized due to having fixed ideas about past events, especially past tragic life experiences, they become victim to the ignorant mind. Here, the patient is falsely experiencing memories as something permanent, lasting, and unchanging, having a substantial existence of their own (Fenner, 2007). Moreover, when the patient accustoms his/herself to understanding the present in terms of memory, the more unfulfilled and joyless life becomes, causing the patient to live in a delusional, dualistic state of mind (Welwood, 2003; Berkow; 2003), because they are missing the beauty of this present moment (Hunt, 2003, pp.164-184; Hunt, 2007, pp.99-120), where the unconditioned mind is able to experience a state of absolute and total simplicity (Fenner, 2003; Prendergast, 2003; Prendergast & Bradford, 2007). …

Information provision, satisfaction and emotional distress in patients with an implantable cardioverter-defibrillator

The implantable cardioverter-defibrillator (ICD) is the treatment of choice for primary and secondary prevention of sudden cardiac death due to ventricular arrhythmias [ 1 Moss A. Hall W. Cannom D. et al. Improved survival with an implanted defibrillator in patients with coronary disease at high risk for ventricular arrhythmia. N Engl J Med. 1996; 335: 1933-1940 Crossref PubMed Scopus (3569) Google Scholar , 2 Bardy G.H. Lee K.L. Mark D.B. et al. Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure. N Engl J Med. 2005; 352: 225-237 Crossref PubMed Scopus (5302) Google Scholar , 3 The Antiarrhythmics versus Implantable Defibrillators (AVID) Investigators A comparison of antiarrhythmic-drug therapy with implantable defibrillators in patients resuscitated from near-fatal ventricular arrhythmias. N Engl J Med. 1997; 337: 1576-1584 Crossref PubMed Scopus (3004) Google Scholar ]. Although the majority of patients adapts well to living with an ICD, 1 in 4 patients report anxiety and depression [ [4] Sears S.F. Conti J.B. Quality of life and psychological functioning of ICD patients. Heart. 2002; 87: 488-493 Crossref PubMed Google Scholar ]. Sufficient understanding of the reasons for ICD implantation, its benefits, side effects, and impact on daily life plays a major role in adaptation. Adequate information provision and psycho-education may facilitate adaptation and reduce emotional distress [ 5 Vazquez L.D. Conti J.B. Sears S.F. Female-specific education, management, and lifestyle enhancement for implantable cardioverter defibrillator patients: the FEMALE-ICD study. Pacing Clin Electrophysiol. 2010; 33: 1131-1140 Crossref PubMed Scopus (38) Google Scholar , 6 Dunbar S.B. Dougherty C.M. Sears S.F. et al. Educational and psychological interventions to improve outcomes for recipients of implantable cardioverter defibrillators and their families: a scientific statement from the American Heart Association. Circulation. 2012; 126: 2146-2172 Crossref PubMed Scopus (158) Google Scholar , 7 Dunbar S.B. Langberg J.J. Reilly C.M. et al. Effect of a psychoeducational intervention on depression, anxiety, and health resource use in implantable cardioverter defibrillator patients. Pacing Clin Electrophysiol. 2009; 32: 1259-1271 Crossref PubMed Scopus (81) Google Scholar , 8 Eads A.S. Sears S.F.J. Sotile W.M. Conti J.B. Supportive communication with implantable cardioverter defibrillator patients: seven principles to facilitate psychosocial adjustment. J Cardiopulm Rehabil Prev. 2000; 20: 109-114 Crossref Scopus (22) Google Scholar ]. Paradoxically, recent surveys indicate that many patients have insufficient knowledge about their ICD and associated challenges [ 9 Cinar F.I. Tosun N. Kose S. Evaluation of an education and follow-up programme for implantable cardioverter defibrillator-implanted patients. J Clin Nurs. 2013; 22: 2474-2486 Crossref PubMed Scopus (15) Google Scholar , 10 Groarke J. Beirne A. Buckley U.N.A. et al. Deficiencies in patients' comprehension of implantable cardioverter defibrillator therapy. Pacing Clin Electrophysiol. 2012; 35: 1097-1102 Crossref PubMed Scopus (23) Google Scholar ].

Health-related quality of life and emotional distress in patients with dizziness: a cross-sectional approach to disentangle their relationship.

BackgroundDizziness is frequently encountered in medical practice, often takes a chronic course and can impair the health related quality of life (HRQoL). However results on the extent of this impairment of HRQoL are mixed. Furthermore, the relationship between dizziness and the HRQoL is only partially understood. The role of clinical symptoms of dizziness and psychosocial factors such as emotional distress on this relationship is for the most part unknown.MethodsThe cross-sectional study evaluated the HRQoL in 203 patients suffering from dizziness, using the Medical Outcomes Studies 36-Item Short-Form Health-Survey (SF-36). The results were correlated with the severity of dizziness, using the Dizziness Handicap-Inventory (DHI), with emotional distress, using the Hospital Anxiety and Depression-Scale (HADS) and with further clinical symptoms and psychosocial parameters. In a multivariate hierarchical regression analysis associated variables which explain significant variance of the mental and physical HRQoL (MCS-36, PCS-36) were identified.ResultsPatients suffering from dizziness showed a markedly reduced mental and physical HRQoL. Higher DHI and HADS scores were correlated with lower MCS-36 and PCS-36 scores. Taken together DHI and vertigo characteristics of dizziness explained 38% of the variance of PCS-36. Overall explained variance of PCS-36 was 45%. HADS and living with a significant other explained 66% of the variance of MCS-36 (overall variance explained: 69%).ConclusionBoth the physical and mental HRQoL are significantly impaired in patients with dizziness. While the impairment in PCS-36 can be explained by clinical symptoms of the dizziness, MCS-36 impairment is largely associated with psychosocial factors. To improve the patient’s overall well-being significantly and permanently doctors have to keep in mind both, the clinical symptoms and the psychosocial factors. Therefore, in addition to the physical examination doctors should integrate a basic psychological examination into the daily routine with dizziness patients.

Linguistic characteristics of patients with bulimic symptomatology in an online post-treatment program: an exploratory study.

BackgroundNo former investigation has been performed related to the linguistic characteristics of patients with eating disorders using online synchronous communication mediums like chats.ObjectiveThe purpose of this study was to investigate the linguistic predictors of improvement in eating disorder-related attitudes, behaviours and emotional distress of patients with eating disorders.MethodsThirty-nine women, who had received treatment for bulimia nervosa or related eating disorders not otherwise specified, utilized the moderated therapeutic group chats of an Internet-based program for 4 months. The main themes of 134 session transcripts were created using a general inductive approach. The frequency of dictionary words in the text corpus was processed by the NooJ linguistic software. Eating Disorder Examination Questionnaire and Depression Anxiety Stress Scale were administered at the beginning and at the end of 4 months. No valid questionnaire data could be obtained from 11 participants, so the statistical analyses were performed in a sample of 28 subjects.ResultsAccording to the results of multiple linear regression analyses, higher ratio of words related to “family of origin” was associated with improvements in eating disorder-related attitudes, emotional distress, and reduction in the frequency of binge eating episodes (β = 0.73, p < 0.001; β = 0.67, p = 0.002; β = 0.53, p = 0.039, respectively).DiscussionThe expression of “family of origin” words following treatment termination was a linguistic predictor of improvement during group chat communication of patients with bulimic symptomatology. The results show the importance of family issues in enhancing the treatment outcome and provide preliminary evidence to address this topic during online chat moderation.

Withholding Tragic Knowledge May Lead to a Tragic Death: A Palliative Care Perspective

I read with interest the article by Suri et al. [1] on the harms and benefits of sharing ‘‘tragic knowledge’’ with patients. However, I want to clarify that there have been no good studies to indicate that unrealistically optimistic patients benefit at the end of life. In fact, a study looking at patients with advanced cancer found that those who were overly optimistic were more likely to receive aggressive treatments and die while on a ventilator—all without survival benefit [2]. Studies that have pointed to the psychological benefits of unrealistic optimism in cancer patients are flawed because they are overwhelmingly cross-sectional in their design and do not take into account the emotional distress of patients and families when death is imminent. As a palliative care physician, I have seen this lastminute realization be accompanied by the awareness that there is no longer the opportunity to put affairs in order or to engage in meaningful legacy work. Take the 40-year-old woman with widely metastatic breast cancer who refuses to acknowledge that she only has weeks to live. She does not talk to her children about why she is becoming frailer by the day. Some may argue that this avoidance is allowing her to live more fully in the moment with her children. However, her last days may be filled with fear and regret. Not only is this difficult for the patient, but the last memories her family have of her will be marred by her existential distress. This is important to acknowledge for two reasons. First, it emphasizes the need to move beyond the traditional dyadic physician–patient model of medicine. When appealing to the ethical principles of beneficence and non-maleficence, we need to shift to a more relational model of care—taking into the consideration the wellbeing of not only the patients, but also of those closest to them. Second, recent findings looking at what makes us happy have revealed that there is a marked difference between our experiences and our memory. As noted by the Nobel Prize-winning psychologist Daniel Kahneman in his 2010 TED talk [3], there is a ‘‘difference between being happy in [one’s] life and being happy about [one’s] life.’’ A so-called ‘bad death’ can negate all the good that death avoidance provided, but good prognosis and goals-of-care discussions can help people shift from the former to the latter. However, until surgical curriculums view these discussions as a skill that is as important to teach and evaluate as the dissection of anatomical planes, physicians will continue to cause iatrogenic harm through the omission or ‘mis-sharing’ of information with patients. The challenge in teaching such a skill is that it cannot be approached in a prescriptive way, but rather must be viewed as a delicate dance—ever evolving and often times circuitous. But learn it we must, because, as the anti-hero surgeon of Abraham Verghese’s novel Cutting for Stone [4] so adroitly put it, ‘‘What treatment in an emergency is administered by ear?’’ The answer is ‘‘Words of comfort.’’ I. Ying (&) Division of Palliative Care, University of Toronto, Toronto, ON, Canada e-mail: irene.ying@utoronto.ca

Quality of life, fatigue and local response of patients with unstable spinal bone metastases under radiation therapy - a prospective trial

BackgroundTo evaluate the local response according to stability after radiotherapy (RT) with a special focus on quality-of-life (QoL), fatigue, pain and emotional distress in patients with unstable spinal bone metastases.MethodsIn this prospective trial, 30 patients were treated from September 2011 until March 2013. The stability of osteolytic metastases in the thoracic and lumbar spine was evaluated on the basis of the Taneichi-score after three and six months. EORTC QLQ-BM22, EORTC QLQ-FA13, and QSC-R10 were assessed at baseline, and three months after RT.ResultsAfter 3 months, 25% (n = 6) and after 6 months 33.3% (n = 8) were classified as stable. QoL, fatigue, and emotional distress showed no difference over the course. The pain response 3 months after RT showed a significant difference (p < 0.001). Pathological fractures occurred in 8.3% of the patients (n = 2) within six months following RT.ConclusionsOur trial demonstrated that RT can improve stability in one third of patients over a 6-months period with unstable spinal metastases. Importantly, for these patients pain relief was detected but RT had no impact on QoL, fatigue, and emotional distress.Trial registrationClinical trial identifier NCT01409720.

Regimen-Related Distress, Medication Adherence, and Glycemic Control in Rural African American Women With Type 2 Diabetes Mellitus.

Regimen-related emotional distress in patients with type 2 diabetes mellitus (T2DM) is associated with poor glycemic control, but the mediators of this relationship are not well described. This cross-sectional study at baseline examines these relationships, including the specific role of medication adherence in rural African American women. At baseline in the EMPOWER randomized trial, the investigators collected the following data: Regimen-Related Distress (RRD; subscale of the validated Diabetes Distress Scale), diabetes medications, medication adherence using the Morisky Medication Adherence Scale, and hemoglobin A1C (A1C). The study enrolled 189 rural African American women with T2DM (mean age = 53 ± 11 years, A1C = 9.1% ± 1.8%, body mass index = 37.7% ± 8.2%; 61% on insulin); 56% reported elevated RRD (mean ≥ 3.0), and this was associated with significantly lower medication adherence (4.4 vs 6.4, P < 0.001) and significantly higher A1C (9.5% vs 8.6%, P < 0.001). In multivariate modeling, both elevated RRD (exp β = 2.1; 95% CI = 1.1-4.2; P < 0.05) and lower medication adherence (exp β = 3.3; 95% CI = 1.1-9.6; P < 0.05) were independently associated with higher A1C values. In mediation analysis, medication adherence was a significant mediator of the effects of RRD on A1C. Among rural African American women with T2DM, elevated levels of RRD were common and were associated with higher A1C values, in part via effects on medication adherence. Complex treatment regimens accompanied by psychological distress may be associated with poorer glycemic control.

The contributors of emotional distress in painful diabetic neuropathy.

To examine the contribution of demographic, social, clinical and psychological factors to emotional distress in patients with painful diabetic neuropathy (DN). In total, 142 patients with confirmed painful DN underwent detailed clinical and self-assessment measures (Neuropathic Pain Scale, Hospital Anxiety and Depression Scale, Pain Acceptance Questionnaire and Pain Catastrophizing Scale). The prevalence of emotional distress was 51.4% in this cohort. Age, sex, marital status, employment history, pain intensity, duration of diabetes and the presence of diabetic and non-diabetic complications were significantly correlated to anxiety and depressive symptom scores. Multiple regression analysis confirmed that the presence of catastrophic thinking was an independent contributor to greater symptoms of anxiety and depression. Being young, single and unemployed significantly contributed to greater anxiety symptoms. Pain-related restriction of quality of life was associated with greater depression symptom scores. This study found a high prevalence of emotional distress in patients with painful DN. It highlights that the differing independent contributors to anxiety and depressive symptoms are based on an individual's circumstances and experience. We conclude by highlighting the importance of adopting a holistic approach to pain management, incorporating interventions to increase psychological flexibility alongside conventional pharmacological treatments to improve emotional distress in painful DN.

Physicians' perceptions of the value of prognostic models: the benefits and risks of prognostic confidence.

The communication of prognosis in end-of-life (EOL) care is a challenging task that is limited by prognostic uncertainty and physicians' lack of confidence in their prognostic estimates. Clinical prediction models (CPMs) are increasingly common evidence-based tools that may mitigate these problems and facilitate the communication and use of prognostic information in EOL care; however, little is known about physicians' perceptions of the value of these tools. To explore physicians' perceptions of the value of CPMs in EOL care. Qualitative study using semi-structured individual interviews which were analysed using a constant comparative method. Convenience sample of 17 attending physicians representing five different medical specialties at a single large tertiary care medical centre. Physicians perceived CPMs as having three main benefits in EOL care: (i) enhancing their prognostic confidence; (ii) increasing their prognostic authority; and (iii) enabling patient persuasion in circumstances of low prognostic and therapeutic uncertainty. However, physicians also perceived CPMs as having potential risks, which include producing emotional distress in patients and promoting prognostic overconfidence in EOL care. Physicians perceive CPMs as a potentially valuable means of increasing their prognostic confidence, communication and explicit use of prognostic information in EOL care. However, physicians' perceptions of CPMs also indicate a need to establish broad and consistent implementation processes to engage patients in shared decision making in EOL care, to effectively communicate uncertainty in prognostic information and to help both patients and physicians manage uncertainty in EOL care decisions.

The association of resilience and age in individuals with colorectal cancer: An exploratory cross-sectional study

Studies generally report lower emotional distress in older patients with cancer than in younger patients with cancer. The personality construct of resilience was previously found to be higher with age, but has not been assessed in relation to emotional distress in older patients with cancer. To assess the mediating effect of resilience on the associations between age and emotional distress in patients with colorectal cancer (CRC). An exploratory cross-sectional study of 92 individuals, aged 27-87 years, diagnosed with CRC stage II-III, 1-5 years prior to enrollment in the study. They completed the Wagnild and Young's resilience scale and Brief Symptoms Inventory-18, cancer-related problem list, and demographic and disease-related details. Older age, male gender, and less cancer-related problems were associated with higher resilience and lower emotional distress. A Structural Equation Modeling (SEM) analysis and mediation tests showed that, while controlling for cancer-related problems, resilience mediated the effects of age and gender on emotional distress. The study enlarges the explanation for the consistent previous findings on the better adjustment of older patients with cancer. Increased professional support should be provided for patients with low resilience levels.

Symptom Number and Severity as a Sign of Emotional Distress in Patients With Cardiovascular Disease

Symptom Number and Severity as a Sign of Emotional Distress in Patients With Cardiovascular Disease

Measurement Properties of the Norwegian Version of the Neck Disability Index in Chronic Neck Pain

Cross-sectional study. Neck pain is common in adults and often follows a chronic course accompanied by considerable functional reduction. Longstanding neck pain is often associated with problems engaging in work, emotional distress, and fear of movement. These issues add to the pain-associated disability. The neck disability index (NDI) is the most commonly used instrument to evaluate neck-associated pain. Our aim was to test the unidimensionality and scaling of the Norwegian version of NDI across sex, age, work status, education, pain intensity, pain distribution, and different levels of emotional distress in patients referred to specialized care. A total of 249 patients with neck pain, aged 16 years or older were included. All patients were referred to the Neck and Back Outpatient Clinic at Oslo University Hospital. Demographic factors, pain intensity and distribution, emotional distress, and fear of movement were recorded. A Rasch analysis was used to evaluate the unidimensionality, scaling, and invariance of NDI across sex, age, education, and work status. RESULTS.: The data did not fit the Rasch model (X = 63.18, P < 0.0003). Three items (lifting, reading, driving) had disordered response thresholds. The pain, headache, and sleep items also did not fit the Rasch model. Differential item function was detected for work status. Unidimensionality and interval scaling was obtained for a 7-item version (NDI-7) by converting the ordinal score to Rasch-weighted interval scores. The NDI matched the distribution of the patients' disability, with a slightly higher disability level reflected by the NDI compared with the patients. The Rasch analysis lends support to the unidimensionality of the 7 items of the NDI, to its usefulness in capturing the disability in patients with neck disorder and it being generally robust to external factors.

Health Status and Emotional Distress in Patients with a Left Ventricular Assist Device and Their Partners: A Comparative Study

Purpose As left ventricular assist devices (LVADs) therapy is becoming an indispensible tool for patients with advanced heart failure, and may have a significant impact on the health status and well-being of patients and their partners. We compared the health status and emotional distress levels of LVAD patients and their partners, and examined factors that contribute to a poor health status and well-being in patients and partners separately. Methods and Materials Health status (Short Form Health Survey-12), anxiety, depression (Hospital Anxiety and Depression Scale) and post-traumatic stress (PTSD; Post Traumatic Stress Diagnostic Scale) were assessed at baseline and 3 months follow-up in 40 LVAD patients (77% male, mean age=54±9 years) and 28 partners (29% male, mean age=55±8 years). Results Analysis of variance showed a significant differences between LVAD patients vs. partners on anxiety at baseline (5.6±3.0 vs. 7.5±2.1, p=.03) and follow-up (3.7±3.0 vs. 5.8±2.1, p=.05), and on the physical health status at baseline (30.1±8.8 vs. 50.8±7.9, p .05). Linear regression analyses indicated significant predictors of anxiety, PTSD and poor mental health status at baseline to be Type D personality (ps PCS =.04 and p MCS =.02, respectively), in addition to the partner being female (p=.04). Conclusions LVAD partners had higher levels of anxiety but not depression than LVAD patients. Partner distress was associated with the health status score of the LVAD patients. Emotional distress of LVAD partners should gain more attention, as partners are an important source of support of LVAD patients.

Emotional Distress in Patients Newly Diagnosed with Late Stage Cancers

Emotional Distress in Patients Newly Diagnosed with Late Stage Cancers

Prevalence and risk factors of depression and diabetes- related emotional distress in patients with type 2 diabetes: A cross-sectional study

Objective : The purpose of this study was to investigate the prevalence of depression and diabetes-related distress, and their associated risk factors, in patients with type 2 diabetes attending a diabetes center of a Dutch general hospital. Methods : A cross-sectional study of 147 adults with insulin-treated type 2 diabetes during the period January-May 2011. Data on depression and diabetes-related distress rates were collected using the WHO-5 and PAID self-reported questionnaires. Hierarchical multiple regression analyses were performed. Results : The prevalence of poor well-being (WHO-5 score ) was 9.6 % and that of depression (WHO-5 score ≤ 28) was 12.9 %. Significant risk factors for depression were diabetes-related distress, stress due to life events in the past 12 months, female gender, and educational level. The prevalence of diabetes-related distress (PAID score ≥ 33) was 8.8 %, and significant risk factors were well-being and HbA1C levels. Conclusions: While the prevalence of depression in the overall Dutch population is approximately 6.2%, the prevalence of depression or diabetes-related distress in patients with insulin-treated type 2 diabetes attending a Dutch diabetescenter , is approximately 20%. Findings support the routine screening of patients with diabetes for depression and diabetes-related distress. In addition to well-known demographic, clinical, and psychosocial factors, stress due to life events in the past 12 months was identified as a risk factor of depression. The diabetes nurse specialists (DNSs) play a key role in counseling the process of behavioral change and supporting self-management in their patients. Paying attention to significant risk factors may be valuable for DNSs to detect and monitor psychological distress; which may improve treatment outcomes.

Anxiety and Depression in Patients with an Implantable Cardioverter Defibrillator and Their Partners: A Longitudinal Study

Little is known about the relation between emotional distress of patients with an implantable cardioverter defibrillator (ICD) and distress of their partners. This longitudinal study aimed to determine the association between patient and partner distress, and to explain distress in patients and partners using demographic, clinical, and psychological characteristics of patients and partners. In total, 343 patients (84% male, mean age = 63.2 ± 9.2 years) and partners (18% male, mean age = 60.3 ± 9.4 years) completed self-report measures on anxiety and depressive symptoms at the time of implantation and at 2, 12, and 18 months follow-up. Type D personality (DS14; nonexpression of negative emotions) was assessed at baseline. Clinical information was gathered from medical records. Multilevel modeling was applied. The correlations between distress in patients and partners were positive (range r = 0.19-0.43; all P's < 0.001). Generally, partners experienced more anxiety and patients more depression. Patient and partner characteristics explained about half of the variance of distress of patients and partners. As expected, psychological characteristics had the strongest effect on distress. Patient anxiety was associated with patient depression and Type D, and to the corresponding distress variable of the partner (anxiety). Similar results were found for patient depression, partner anxiety, and partner depression. Distress of ICD patients is associated with distress of their partners. Future studies need to investigate mechanisms of these patient-partner dynamics, such as communication and behavioral issues. It may be timely to not only focus emotional support on patients, but also on their partners.