Greater Psychosocial Well-being Research Articles

Religious-service attendance and subsequent health and well-being throughout adulthood: evidence from three prospective cohorts.

BackgroundReligious-service attendance has been linked with a lower risk of all-cause mortality, suicide and depression. Yet, its associations with other health and well-being outcomes remain less clear.MethodsUsing longitudinal data from three large prospective cohorts in the USA, this study examined the association between religious-service attendance and a wide range of subsequent physical health, health behaviour, psychological distress and psychological well-being outcomes in separate cohorts of young, middle-aged and older adults. All analyses adjusted for socio-demographic characteristics, prior health status and prior values of the outcome variables whenever data were available. Bonferroni correction was used to correct for multiple testing.ResultsEstimates combining data across cohorts suggest that, compared with those who never attended religious services, individuals who attended services at least once per week had a lower risk of all-cause mortality by 26% [95% confidence interval (CI): 0.65 to 0.84], heavy drinking by 34% (95% CI: 0.59 to 0.73) and current smoking by 29% (95% CI: 0.63 to 0.80). Service attendance was also inversely associated with a number of psychological-distress outcomes (i.e. depression, anxiety, hopelessness, loneliness) and was positively associated with psychosocial well-being outcomes (i.e. positive affect, life satisfaction, social integration, purpose in life), but was generally not associated with subsequent disease, such as hypertension, stroke, and heart disease.ConclusionsDecisions on religious participation are generally not shaped principally by health. Nevertheless, for individuals who already hold religious beliefs, religious-service attendance may be a meaningful form of social integration that potentially relates to greater longevity, healthier behaviours, better mental health and greater psychosocial well-being.

Spiritually Motivated Self-Forgiveness and Divine Forgiveness, and Subsequent Health and Well-Being Among Middle-Aged Female Nurses: An Outcome-Wide Longitudinal Approach.

Background: Interest in the relationship between forgiveness and health is steadily growing across disciplines within the research community. While there are multiple forms of forgiveness, past research has focused principally on studying forgiveness of others, whereas longitudinal evidence on the associations between other forms of forgiveness and health remains scarce.Methods: Using longitudinal data from the Nurses’ Health Study II (from the 2008 Trauma Exposure and Post-traumatic Stress Supplementary Survey to 2015 questionnaire wave), this study employed an outcome-wide analytic approach to prospectively examine the association between two forms of religiously or spiritually motivated forgiveness, namely, self-forgiveness and divine forgiveness, and a wide array of subsequent psychosocial well-being, mental health, health behavior, and physical health outcomes among middle-aged female nurses (N = 54,703 for self-forgiveness; N = 51,661 for divine forgiveness). All models controlled for sociodemographic factors, prior religious service attendance, and prior values of all outcome variables wherever data were available. Bonferroni correction was used to account for multiple testing.Results: Self-forgiveness was strongly associated with greater psychosocial well-being (e.g., for top vs. bottom level of self-forgiveness, β = 0.23, 95% CI: 0.20, 0.25 for positive affect) and lower psychological distress (e.g., β = −0.21, 95% CI: −0.23, −0.18 for depressive symptoms). To a lesser extent, divine forgiveness was also associated with higher levels of psychological well-being and lower psychological distress. For both forgiveness types, there was little evidence of association with physical health or health behavior outcomes, though possible marginal evidence for an association of self-forgiveness with increased mortality.Discussion: This study provides novel evidence that religiously or spiritually motivated self-forgiveness and divine forgiveness are both positively related to several indicators of psychosocial well-being and inversely associated with psychological distress outcomes, whereas the associations with physical health and health behaviors are less clear. Further longitudinal investigation of the dynamics between these types of forgiveness and health and well-being is warranted.

Distinctiveness as a marker of identity formation

Individual distinctiveness is theorized to characterize an adaptive identity, but its importance remained underexplored. In two studies, we investigated the nomological networks of two common conceptualizations of distinctiveness: general and comparative distinctiveness. We compared these to the network of identity formation’s best-validated marker: commitment. Findings from two samples of young adults living in the Netherlands (n = 320) and in the US (n = 246) both revealed that general distinctiveness marked adaptive identity formation and greater psychosocial well-being. Moreover, general distinctiveness had unique predictive value over commitment strength. Comparative distinctiveness from important others uniquely indicated lowered social well-being. Our findings illustrate that careful attention should be paid to the conceptualization of distinctiveness, because distinctiveness is an important but complex concept.

Long-term Patient-Reported Outcomes in Postmastectomy Breast Reconstruction

ImportancePrevious outcome studies comparing implant and autologous breast reconstruction techniques have been limited by short-term follow-up, single-center design, and a lack of rigorous patient-reported outcome data. An understanding of the expected satisfaction and breast-related quality of life associated with each type of procedure is central to the decision-making process.ObjectiveTo determine outcomes reported by patients undergoing postmastectomy breast reconstruction using implant or autologous techniques 2 years after surgery.Design, Setting, and ParticipantsPatients were recruited from 11 centers (57 plastic surgeons) across North America for the Mastectomy Reconstruction Outcomes Consortium study, a prospective, multicenter trial, from February 1, 2012, to July 31, 2015. Women undergoing immediate breast reconstruction using implant or autologous tissue reconstruction after mastectomy for cancer treatment or prophylaxis were eligible. Overall, 2013 women (1490 implant and 523 autologous tissue reconstruction) met the inclusion criteria. All patients included in this analysis had 2 years of follow-up.ExposuresProcedure type (ie, implant vs autologous tissue reconstruction).Main Outcomes and MeasuresThe primary outcomes of interest were scores on the BREAST-Q, a validated, condition-specific, patient-reported outcome instrument, which were collected prior to and at 2 years after surgery. The following 4 domains of the BREAST-Q reconstruction module were evaluated: satisfaction with breasts, psychosocial well-being, physical well-being, and sexual well-being. Responses from each scale were summed and transformed on a 0 to 100 scale, with higher numbers representing greater satisfaction or quality of life.ResultsOf the 2013 women in the study (mean [SD] age, 48.1 [10.5] years for the group that underwent implant-based reconstruction and 51.6 [8.7] years for the group that underwent autologous reconstruction), 1217 (60.5%) completed questionnaires at 2 years after reconstruction. After controlling for baseline patient characteristics, patients who underwent autologous reconstruction had greater satisfaction with their breasts (difference, 7.94; 95% CI, 5.68-10.20; P < .001), psychosocial well-being (difference, 3.27; 95% CI, 1.25-5.29; P = .002), and sexual well-being (difference, 5.53; 95% CI, 2.95-8.11; P < .001) at 2 years compared with patients who underwent implant reconstruction.Conclusions and RelevanceAt 2 years, patients who underwent autologous reconstruction were more satisfied with their breasts and had greater psychosocial well-being and sexual well-being than did those who underwent implant reconstruction. These findings can inform patients and their clinicians about expected satisfaction and quality of life outcomes of autologous vs implant-based procedures and further support the adoption of shared decision making in clinical practice.

Patient-Reported Outcomes 1 Year After Immediate Breast Reconstruction: Results of the Mastectomy Reconstruction Outcomes Consortium Study

Purpose The goals of immediate postmastectomy breast reconstruction are to minimize deformity and optimize quality of life as perceived by patients. We prospectively evaluated patient-reported outcomes (PROs) in women undergoing immediate implant-based or autologous reconstruction. Methods Women undergoing immediate postmastectomy reconstruction for invasive cancer and/or carcinoma in situ were enrolled at 11 sites. Women underwent implant-based or autologous tissue reconstruction. Patients completed the BREAST-Q, a condition-specific PRO measure for breast surgery patients, and Patient-Reported Outcomes Measurement Information System-29, a generic PRO measure, before and 1 year after surgery. Mean changes in PRO scores were summarized. Mixed-effects regression models were used to compare PRO scores across procedure types. Results In total, 1,632 patients (n = 1,139 implant, n = 493 autologous) were included; 1,183 (72.5%) responded to 1-year questionnaires. After analysis was controlled for baseline values, patients who underwent autologous reconstruction had greater satisfaction with their breasts than those who underwent implant-based reconstruction (difference, 6.3; P < .001), greater sexual well-being (difference, 4.5; P = .003), and greater psychosocial well-being (difference, 3.7; P = .02) at 1 year. Patients in the autologous reconstruction group had improved satisfaction with breasts (difference, 8.0; P = .002) and psychosocial well-being (difference, 4.6; P = .047) compared with preoperative baseline. Physical well-being of the chest was not fully restored in either the implant group (difference, -3.8; P = .001) or autologous group (-2.2; P = .04), nor was physical well-being of the abdomen in patients who underwent autologous reconstruction (-13.4; P < .001). Anxiety and depression were mitigated at 1 year in both groups. Compared with their baseline reports, patients who underwent implant reconstruction had decreased fatigue (difference, -1.4; P = .035), whereas patients who underwent autologous reconstruction had increased pain interference (difference, 2.0; P = .006). Conclusion At 1 year after mastectomy, patients who underwent autologous reconstruction were more satisfied with their breasts and had greater psychosocial and sexual well-being than those who underwent implant reconstruction. Although satisfaction with breasts was equal to or greater than baseline levels, physical well-being was not fully restored. This information can help patients better understand expected outcomes and may guide innovations to improve outcomes.

Community-based organizations for vulnerable children in South Africa: Reach, psychosocial correlates, and potential mechanisms

Community-based organizations (CBOs) have the potential to provide high quality services for orphaned and vulnerable children in resource-limited settings. However, evidence is lacking as to whether CBOs are reaching those who are most vulnerable, whether attending these organizations is associated with greater psychosocial wellbeing, and how they might work. This study addressed these three questions using cross-sectional data from 1848 South African children aged 9–13. Data were obtained from the Young Carers and Child Community Care studies, which both investigated child wellbeing in South Africa using standardized self-report measures. Children from the Child Community Care study were all CBO attenders, whereas children from Young Carers were not receiving any CBO services, thereby serving as a comparison group. Multivariable regression analyses were used to test whether children attending CBOs were more deprived on socio-demographic variables (e.g., housing), and whether CBO attendance was in turn associated with better psychosocial outcomes (e.g., child depression). Mediation analysis was conducted to test whether more positive home environments mediated the association between CBO attendance and significantly higher psychological wellbeing. Overall, children attending CBOs did show greater vulnerability on most socio-demographic variables. For example, compared to children not attending any CBO, CBO-attending children tended to live in more crowded households (OR 1.22) and have been exposed to more community violence (OR 2.06). Despite their heightened vulnerability, however, children attending CBOs tended to perform better on psychosocial measures: for instance, showing fewer depressive symptoms (B=−0.33) and lower odds of experiencing physical (OR 0.07) or emotional abuse (OR 0.22). Indirect effects of CBO attendance on significantly better child psychological wellbeing (lower depressive symptoms) was observed via lower rates of child abuse (B=−0.07) and domestic conflict/violence (B=−0.03) and higher rates of parental praise (B=−0.03). Null associations were observed between CBO attendance and severe psychopathology (e.g., suicidality). These cross-sectional results provide promising evidence regarding the potential success of CBO reach and impact but also highlight areas for improvement.

Abstract P2-19-02: Do older women benefit from post-mastectomy breast reconstruction?

Abstract Purpose: Despite evidence that post-mastectomy breast reconstruction (PMBR) decreases psychological morbidity and improves body image, older women (aged 65 and above) receive it six times less often than younger women. It is unclear whether this difference represents a disparity or reflects informed patient choices since the outcomes of PMBR in older women have never been rigorously studied. We hypothesized that in older women, the use of PMBR is associated with greater psychosocial well-being and breast satisfaction than mastectomy alone. Patients and Methods: The Dillman method was used to survey 299 older women with stage 0-III breast cancer who underwent a mastectomy from 2006-2011. The response rate was 75.3%. The survey incorporated demographic questions and measured satisfaction and health-related quality of life outcomes using the Duke health profile and the BREAST-Q mastectomy module. Patients who underwent PMBR were compared to those who did not (no-PMBR) to determine differences in patient characteristics, satisfaction, and quality-of-life outcomes between groups. Satisfaction and outcome results were risk adjusted using multivariable logistic regression to account for differences between PMBR and no-PMBR groups. Results: The median age of respondents was 72. Of these, 77/214 (36%) elected to undergo PMBR. Marital status, education level, race, and tumor stage were similar in PMBR and no-PMBR groups. Those in the PMBR group were generally younger and more affluent than those in the no-PMBR group (p&amp;lt;0.001 and p&amp;lt;0.05, respectively). There were no significant differences in age-adjusted physical health, anxiety, or depression scores between PMBR and no-PMBR groups. Both groups reported high levels of decisional satisfaction. However, after adjusting for age and income, PMBR was associated with greater breast satisfaction (BREAST-Q score 69 vs. 57, p&amp;lt;0.001) and greater psychosocial well-being (BREAST-Q score 83 vs. 76, p&amp;lt;0.001). These differences in scores compared favorably to those seen in younger women. Conclusions: This is the first study to compare psychosocial outcomes and breast satisfaction between older women who undergo PMBR and those who do not. These findings show that older women have the potential to benefit from PMBR at least as much as younger women do. PMBR can be performed in a significant proportion of older women with high levels of satisfaction. Older women who are appropriate candidates should be encouraged to consider breast reconstruction, and efforts should be made to narrow the disparity in the delivery of PMBR between older and younger women. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P2-19-02.

Correlates of psychosocial well-being among overweight adolescents: The role of the family.

An ethnically diverse sample of at-risk-for-overweight and overweight youths (body mass index greater than the 85th percentile for age and gender; n = 667 male participants, and n = 684 female participants) completed a school-based survey measuring family variables (connectedness, mealtime environment, and weight commentary), psychosocial well-being (depressed mood, body satisfaction, and self-esteem), and unhealthy weight-control behaviors; all measures were assessed concurrently. Hierarchical linear regression analyses revealed that measures of general family connectedness, priority of family meals, and positive mealtime environment were significantly positively associated with psychological well-being and inversely associated with depressive symptoms and unhealthy weight-control behaviors. Familial weight commentary (i.e., weight-based teasing and parental encouragement to diet) was associated with many indicators of poor psychological health. The authors conclude that greater psychosocial well-being and fewer unhealthy weight-control behaviors are associated with making family time at meals a priority, creating a positive mealtime atmosphere, and refraining from weight commentary.