Improvements In Psychological Well-being Research Articles

Counselling in primary care: A study of the psychological impact and cost benefits for four chronic conditions

Primary care counselling services have expanded rapidly over the last twenty years. Their principal focus has been to manage the demands placed on general practitioners by high service users, such as frequent attenders and patients with mental health problems. To date, very little research has been conducted to ascertain the impact of counselling for other patient groups in terms either of psychological outcomes or of cost-benefits. This study looked at the effect of short-term counselling on both the uptake of health services and the psychological states of four patient groups – frequent attenders and patients with diabetes, hypertension and asthma. All patients on the chronic disease register for these conditions and all patients who had made at least eight GP appointments over the previous twelve months were invited to take part in the study. The participants received eight 90-minute small-group counselling sessions, conducted by trained counsellors. The counselling followed a cognitive behavioural therapy (CBT) approach, with an emphasis on developing personal responsibility. Psychological outcomes were assessed using three proprietary measures (SF 36, HADS and CORE) immediately following counselling and at six months post-intervention. Health service uptake was assessed for each group over the twelve months post-intervention, using number of GP consultations, home visits, hospital referrals and test/investigations requested as outcome indicators. These data were compared with those for comparable control groups for each condition. The results suggested that, overall, all patient groups showed a significant improvement in psychological well-being, and that these gains were maintained for the six-month study period. The intervention groups also significantly reduced their uptake of primary and secondary care services, by comparison with their comparable control groups. The results suggest that the psychological and fiscal benefits of counselling provision within a primary care setting can extend to other patient categories.

Evaluation of a Brief Group Based Psychological/Educational Treatment Programme for Women with an Iatrogenic Chronic Hepatitis C Virus Infection

Thirty-two women with an iatrogenic chronic hepatitis C virus (HCV) infection were assigned to a treatment or waiting list control group and completed the SF-36, GHQ30, Battles SE, and two in-house questionnaires. A series of mixed model ANOVAs indicated a significant Group × Time effect for SF-36 physical functioning (F = 9.01, p < .01) and a series of repeated measures ANOVAs (treatment group only) indicated a significant time effect for a sustained improvement in psychological well-being (F = 8.01, p < .01) at 3 months posttreatment. Furthermore, most women posttreatment felt more positive and informed about their illness, had more confidence, and reported a greater ability to control and cope with their lives. Psychological/educational treatment programmes show promise for increasing adjustment and coping in women with an iatrogenic HCV infection and may be modified for use in other HCV cohorts.

Phase II trial of vinorelbine and oxaliplatin as first-line therapy in malignant pleural mesothelioma

The incidence of malignant pleural mesothelioma (MPM) is increasing. Treatment options are limited, although recently published data have offered cause for optimism. We reported a response rate of 24% with low toxicity for single agent vinorelbine. Here we report a phase II trial of vinorelbine with oxaliplatin (VO) in patients with untreated MPM. Chemotherapy consisted of vinorelbine 30 mg/m(2), days 1 and 8 of a 21-day-cycle, and oxaliplatin 130 mg/m(2), day 1. Treatment continued up to six cycles. The primary endpoint was objective response. Secondary endpoints were toxicity, progression-free and overall survival. Responses were assessed by modified RECIST criteria. Twenty-six patients were enrolled. There were six partial remissions, 17 patients with stable disease, and three patients with PD. Response rate was 23% (95% confidence interval 9-44%). Median number of cycles delivered was four. Progression-free survival from first treatment was 4.7 months, and overall survival was 8.8 months. One-year-survival was 27%. Toxicity (% of patients with at least one episode of grade 3 or 4 toxicity): neutropenia 18%, phlebitis 12%, malaise 12%, anorexia 12%, nausea and vomiting 12%, constipation 6%. Quality of life assessed by Rotterdam symptom checklist was associated with stabilization or improvement of psychological well-being and lung symptoms in the majority of patients, but deterioration in physical symptoms. VO has activity in MPM with most patients responding or having stable disease, although this doublet is associated with significant toxicity.

Health-related quality of life improves with treatment-related GERD symptom resolution after adjusting for baseline severity

Severity and frequency of gastroesophageal reflux disease (GERD) related symptoms are associated with impaired health-related quality of life (HRQL). This study evaluated the association between baseline heartburn severity and endpoint HRQL of patients treated for heartburn and the relationship between complete resolution of heartburn symptoms and HRQL outcomes after controlling for baseline severity. We completed a secondary analysis of clinical symptom and HRQL data from three clinical trials in adult patients receiving either omeprazole or ranitidine treatment for GERD. HRQL was assessed using the Psychological General Well-Being Index (PGWB) in each of the three clinical trials, and two of the trials also included the Medical Outcomes Study Sleep disturbance scale. Gastrointestinal symptoms were evaluated using either the Gastrointestinal Symptom Rating Scale or a modified version of the scale. Baseline heartburn severity (none/minor, mild, moderate or severe) was defined based on patient-reported symptoms. Analysis of covariance (ANCOVA) models were used to compare mean HRQL scores by baseline level of heartburn symptom severity and whether or not patients experienced complete heartburn resolution. At baseline, PGWB scores were significantly worse (p < 0.05) for patients with more severe heartburn symptoms. There were no statistically significant baseline severity by symptom resolution interactions in any of the ANCOVA models. For all three trials and across all follow-up assessments, mean PGWB scores were statistically significantly higher for patients with completely resolved heartburn symptoms versus those whose symptoms were unresolved (all p-values < 0.05). Few significant effects were observed for sleep disturbance scores. While the severity of heartburn symptoms at the start of medical treatment for GERD is not associated with improvements in HRQL in subsequent weeks of treatment, complete resolution of symptoms is associated with improvements in psychological well-being.

Effects of a Care Protocol on Care Outcomes in Older Nursing Home Patients with Chronic Obstructive Pulmonary Disease

To evaluate the effects of a care protocol used by community nurses to support nursing home staff in the care of patients with chronic obstructive pulmonary disease (COPD). Matched, randomized case-control trial. Forty-five nursing homes of the New Territories South (NTS) cluster of Hong Kong. Eighty-nine older people (> or =65, present resident of a nursing home in the NTS region, main diagnosis of COPD, at least one hospital admission in previous 6 months) discharged to the nursing homes from the geriatric units of two hospitals. Using a care protocol, community nurses followed up older patients in the experimental group for 6 months after their discharge from the hospitals to the nursing homes. Data on functional, respiratory, and psychological parameters were collected at entry to study and 6 months later with standard measures. Data on hospital service utilization, nursing home staff, and patient satisfaction were also collected at 6 months. Experimental group participants had significant (P =.008) improvements in psychological well-being. Nursing home staff and experimental group patients were highly satisfied with the use of the protocol. There was no significant difference between the two groups in functional and respiratory outcomes or hospital service utilization. Psychological well-being as an important factor in rehabilitation in chronic illness has been much neglected in the literature. Supporting nursing home staff in the care of COPD patients through community nursing visits can enhance older residents' psychological well-being. Psychological aspects of care should be emphasized and incorporated into the delivery of regular nursing home care.

Reducing Health Risks and Psychological Distress Among Older Black Residents of Naturally Occurring Retirement Communities

Studies indicate that living alone, or living in anonymous housing complexes-such as Naturally Occurring Retirement Communities (NORCs)-can produce feelings of isolation and loneliness, which can negatively affect psychological well-being and physical health. Little is known about how NORCs, occupied by relatively poor older minorities may provide a context for low-cost interventions directed at enhancing well-being and therefore health. Given that traditional health education interventions have been ineffective among minority seniors, the goal of this study is to introduce a low-cost, on-site psycho-educational health intervention program to older NORC residents, that includes: (1) a formal health education component to encourage good health (health behavior), and (2) an informal recreational component focusing on peoples' psychological well-being (social facilitation). The research question is: “Would social facilitation improve psychological well-being and health?” Forty-five aging Black residents of two NORCs were assigned to either an intervention condition for 8-weeks (group 1, n = 26) or a control condition (group 2, n = 19). Group 1 was expected to show improvement in psychological well-being and health, and such improvements were expected to be retained well after the sessions. Data were gathered from both groups, at baseline, post intervention, and 2 months following the intervention. Results indicate that there was a significant time by treatment effect for well-being. There was no significant time by treatment effect, but there was a significant treatment effect for health behaviors. This shows that short-term psycho-educational intervention can positively affect the quality of life of older minority residents of NORCs.

Effects of increasing expenditure of energy during exercise on psychological well-being in older adults.

The purpose of present study was to examine the effects on psychological well-being of energy expended as a result of the exercise intervention. 33 older adults (M age=68.6 yr., SD=4.7) participated in three supervised water-based exercise sessions per week for 12 wk. Based on the relative changes in daily energy expenditure as measured by questionnaire between pre- and posttraining, the subjects were split into three groups. This classified each subject as either having experienced a relatively low change (n=11), moderate change (n= 11), or high change (n= 11) in daily energy expenditure. Our data showed that the group with the greater increase in energy expenditure as a result of exercise, when compared pre- and posttraining, improved only on Depression-Dejection on the Profile of Mood States more than did the group with low change. Consequently, we concluded that the amount of energy expended was partially related to improvement in psychological well-being.

EFFECTS OF INCREASING EXPENDITURE OF ENERGY DURING EXERCISE ON PSYCHOLOGICAL WELL-BEING IN OLDER ADULTS

The purpose of present study was to examine the effects on psychological well-being of energy expended as a result of the exercise intervention. 33 older adults (M age = 68.6 yr., SD = 4.7) participated in three supervised water-based exercise sessions per week for 12 wk. Based on the relative changes in daily energy expenditure as measured by questionnaire between pre- and posttraining, the subjects were split into three groups. This classified each subject as either having experienced a relatively low change (n=11), moderate change (n=11), or high change (n = 11) in daily energy expenditure. Our data showed that the group with the greater increase in energy expenditure as a result of exercise, when compared pre- and posttraining, improved only on Depression–Dejection on the Profile of Mood States more than did the group with low change. Consequently, we concluded that the amount of energy expended was partially related to improvement in psychological well-being.

Attributional Style, Efficacy, and the Enhancement of Well-Being Among Housebound Older People

This study examines the effects of an intervention that involves the compilation of a book of wartime experiences on a group of housebound older people who live in the community with the support of social services. Using the theoretical framework of the Hopelessness Theory of Depression (Abramson, Metalsky, & Alloy, 1989), we examine the impact of attributional style (Abramson et al., 1989) and efficacy (Bandura, 1977; Houston, 1995) on changes in psychological well-being following the intervention. Prior to the intervention, participants completed a newly constructed Extended Attributional Style Scale for the Elderly and the General Health Questionnaire (Goldberg & Hillier, 1979). Following the intervention there was a significant improvement in psychological well-being across the sample-those with depressogenic styles and low efficacy and those with high efficacy and nondepressogenic styles reported most improvement. The findings indicate that a relatively small-scale intervention can have a significant impact on the well-being of older people living alone in the community.

Attributional Style, Efficacy, and the Enhancement of Well-Being Among Housebound Older People

This study examines the effects of an intervention that involves the compilation of a book of wartime experiences on a group of housebound older people who live in the community with the support of social services. Using the theoretical framework of the Hopelessness Theory of Depression (Abramson, Metalsky, & Alloy, 1989), we examine the impact of attributional style (Abramson et al., 1989) and efficacy (Bandura, 1977; Houston, 1995) on changes in psychological well-being following the intervention. Prior to the intervention, participants completed a newly constructed Extended Attributional Style Scale for the Elderly and the General Health Questionnaire (Goldberg & Hillier, 1979). Following the intervention there was a significant improvement in psychological well-being across the sample-those with depressogenic styles and low efficacy and those with high efficacy and nondepressogenic styles reported most improvement. The findings indicate that a relatively small-scale intervention can have a significant impact on the well-being of older people living alone in the community.

Randomized trial of the effects of cholesterol-lowering dietary treatment on psychological function

PURPOSE: Epidemiological studies have suggested that cholesterol lowering could affect psychological functioning. This study was designed to test whether cholesterol-lowering diets adversely affect mood and cognitive function. SUBJECTS AND METHODS: We randomly assigned 176 adults with elevated serum cholesterol levels (>5.2 mM [198 mg/dL]) to either a low-fat diet, a Mediterranean diet, or a waiting-list control. Cholesterol levels, psychological well-being (depression, anxiety, hostility), and cognitive function were assessed at baseline, 6 weeks, and 12 weeks. RESULTS: Total serum cholesterol levels fell significantly more in the intervention groups (8.2% reduction) than in the control group ( P <0.001). All three groups showed a modest improvement in psychological well-being during the 12-week treatment period, but there were no differences among the groups. There were no between-group differences on three measures of cognitive function, but for a fourth measure, which involved the task with the greatest processing load, the two intervention groups did significantly worse ( P <0.001) than the control group. The change in performance was correlated with the change in total serum cholesterol level ( r = 0.21, P = 0.01). CONCLUSIONS: Two dietary interventions that successfully lowered serum cholesterol levels had no adverse effect on mood. There was some evidence for a relative impairment in cognitive function in the treated groups in one of four cognitive tests, but additional studies will be required to determine the relevance of this finding.

Treatment outcome of chronic non-malignant pain patients managed in a Danish multidisciplinary pain centre compared to general practice: a randomised controlled trial

This randomised controlled study investigated the effect of outpatient multidisciplinary pain centre treatment (MPT) compared with treatment by a general practitioner after initial supervision by a pain specialist (GP-group) and with a group of patients waiting for 6 months before treatment was initiated (WL-group). One-hundred-and-eighty-nine chronic non-malignant pain patients were studied. At referral, and after 3 and 6 months patients filled in questionnaires evaluating pain intensity, health related quality of life (HRQL) and use of analgesics. HRQL was evaluated using the Medical Outcome Study-Short Form (SF-36), the Hospital Anxiety and Depression scale (HAD) and the Psychological General Well-being Scale (PGWB). After 6 months patients allocated to MPT (n=63) reported statistically significant reduction in pain intensity (VAS-score, P<0.001), improvement in psychological well-being (PGWB, P<0.001), quality of sleep (P<0.05) and physical functioning (SF-36-Phycical Functioning, P<0.05). No improvements were seen in the GP-group (n=63). In the WL-group (n=63) a statistically significant deterioration was observed in PGWB-scores, HAD-scores and in 6 of 8 SF-36-subscores (P ≤ 0.05). A reduction in use of opioids administered on demand was obtained in the group receiving MPT (P<0.001). In the MPT- and GP-groups a decrease in the use of short acting opioids was observed (P<0.01). No change in use of analgesics was seen in the WL-group. The study showed that (i) in the MPT-group there was a significant reduction in pain intensity and improvement of HRQL compared to the WL-group, and (ii) the mere establishment of a pain diagnosis and a pain management plan by a pain specialist was not sufficient to enable the referring GP to manage severely chronic pain patients.

Growth Hormone Deficiency in Adults

Adults with Growth hormone (GH) deficiency is now being recognised to display many distinct clinical, metabolic and psychological abnormalities. It has been demonstrated that GI-I deficient (GHD) adults display features of multiple insulin resistant syndrome (MIRS) which predispose the GHD adults to increased cardiovascular morbidity and mortality. These features include central obesity, insulin resistance and glucose intolerance, hypertension, dyslipidaemia that includes a reduced level of high density lipoprotein cholesterol, an elevated triglyceride level and small low density lipoprotein cholesterol size. Furthermore, GHD adults are found to have a lower bone mass and a reduced sense of well-being. Replacement of GH in these GHD adults has brought about a major improvement inpsychological well-being and central obesity. The improvement of some of the lipid abnormalities is however more modest. Insulin resistance, the corner stone of MIRS, is however not altered by GH replacement. Long term data is as yet unavailable to assess if GH replacement reduces cardiovascular mortality and morbidity in these subjects.

Intensive rehabilitation of emotionally distressed patients after coronary by-pass grafting.

To evaluate whether the status of emotionally distressed post coronary by-pass surgery patients can be improved by a comprehensive, in-patient rehabilitation programme. Cross-sectional. Rehabilitation hospital. One hundred and fifty-two post coronary by-pass surgery patients referred to an intensive rehabilitation programme. The study group was divided into two subgroups, according to the level of emotional distress. Forty-three (30%) out of 142 patients who completed the Nottingham Health Profile were considered to be distressed. The comprehensive 4-week inpatient rehabilitation programme consisted of daily physical exercise, lectures about coronary disease and risk factors, psychological support and nutrition counselling. Physical fitness, blood lipids and quality of life questionnaires. The two-way analysis of variance showed that emotionally distressed patients achieved equally good results as those obtained by nondistressed patients in performance regarding the maximal exercise stress test, maximum rate pressure product achieved, or the level of resting heart rate. Significant improvement in psychological well-being as assessed by a seven-point rating scale was observed in both groups. Both groups of patients were also equally successful in weight reduction and lowering of total cholesterol and triglycerides. Of all the patients who were employed at admission, twice the number of patients in the distressed group were in receipt of a permanent disability pension and half the number of patients was employed, compared to the initially nondistressed group, at 1-year follow-up. Distressed patients were very successful in improving their functional status and reducing risk factors when offered an intensive rehabilitation programme but they were much less successful in returning to work. Secondly, patients who were emotionally distressed after surgery did not differ in regard to disease status or physical capacity from nondistressed patients. They did, however, experience more angina pectoris both in daily life and when exposed to a maximal exercise stress test. Finally, the presence of emotional distress was easily detected by any measure of psychological status.

Breast Reduction Techniques and Outcomes: A Meta-analysis

Background: Although sequelae such as visible scarring often are an expected result of reduction mammaplasty, successful aesthetic outcomes depend on the surgeon’s thorough understanding of the available techniques. Objective: A literature review was undertaken to compare published outcome data for the five classical reduction mammaplasty techniques as described by Pitanguy, Skoog, McKissock, Goldwyn, and LeJour. Methods: Complication rates, patient satisfaction, and symptom relief are reviewed. Management of common pitfalls is discussed. Results: Reported complication rates range from 6.5% to 22% for reduction mammaplasty, whereas reported patient satisfaction rates range from 80% to 95%. Reported rates of symptom improvement range from 70% to 100%, with a dramatic improvement in psychological well-being. Conclusion: It is hoped that an understanding of the principles and caveats published by the originators of these five techniques will promote enhanced skill in performing reduction mammaplasty.

Gender difference in the response of growth hormone (GH)-deficient adults to GH therapy

While individual hypopituitary patients undoubtedly benefit from growth hormone (GH) therapy, there is considerable variability in the response to treatment. Given the expense, possible lack of benefit, and potential risks associated with long-term therapy, we sought to identify characteristics potentially associated with a favorable response to GH replacement. Twelve GH-deficient adults (seven men and five women aged 35.4 ± 2.5 years, mean ± SEM) participated in a 12-month open study of GH replacement (0.125 IU/kg/wk for 4 weeks and 0.25 IU/kg/wk thereafter) designed to examine the impact of GH on body composition, lipid profile, and psychological well-being. Using bioelectrical impedance analysis (BIA), there was a reduction in body fat (BF) and an increase in lean body mass (LBM) and total body water (TBW) ( P < .05) following 12 months of GH treatment. In addition, there was a significant improvement in psychological well-being as indicated by a decrease in the Nottingham Health Profile (NHP) score ( P < .05) and a decrease in both total cholesterol ( P = .005) and low-density lipoprotein (LDL) cholesterol ( P < .03). GH therapy was associated with an increase in fasting plasma glucose ( P = .008) and hemoglobin A 1c (HbA 1c ( P = .06). When analyzed by gender, the beneficial effect of GH was greater in men versus women for the increment in insulin-like growth factor-1 ([IGF-1] 375 ± 59 v 148 ± 73 μg/L, mean ± SEM), increase in LBM (6.8 ± 2.5 v −0.06 ± 1.6 kg), reduction in BF (5.6 ± 1.6 v 1.0 ± 1.9 kg), and increase in TBW (5.0 ± 1.6 v 0.14 ± 1.29 L) ( P < .05). HbA 1c increased significantly in women ( P < .05). The beneficial effect of GH tended to be greatest in those with the most significant abnormality in baseline values ( P < .05). The duration of hypopituitarism showed an indirect correlation with the change in total cholesterol ( P < .005). Baseline IGF-1 levels correlated directly with changes in TBW ( P < .05). These data indicate that men with GH deficiency appear more responsive to GH therapy than women with respect to the increase in IGF-1 levels and improvement in body composition. In general, patients with the most significant abnormality in baseline values, the highest IGF-1 levels, and the shortest duration of hypopituitarism respond best. With long-term GH therapy, careful monitoring of glucose tolerance is indicated.

Reduction mammaplasty in patients with bulimia nervosa.

Women with eating disorders have been disqualified as candidates for plastic surgery. We present a group of 6 young women with bulimia nervosa who presented with clinically symptomatic evidence of macromastia. All patients reported that dysfunctional eating habits, at least in part, where due to breast enlargement. Five patients underwent bilateral reduction mammaplasty. Patients were interviewed postoperatively and reported relief of physical symptoms and improvement in psychological well-being. Symptoms of eating disorders were completely eliminated or greatly reduced. This series has supported the contention that macromastia can produce a distortion of body image and become a secondary cause of eating disorders. Surgical correction of large breasts has improved body image, leads to the amelioration of associated eating disorders, and may in part represent a surgical treatment for a psychological abnormality. The presence of an eating disorder should not, therefore, automatically exclude a patient from surgical consideration. Routine preoperative evaluation of young women seeking plastic surgery should include a set of standard questions regarding eating behaviors.

Improvement in psychological well-being of people with aphasia and their families: Evaluation of a community-based programme

The York-Durham Aphasia Centre comprises a community-based programme for people with aphasia and their families. It offers long-term support and service at any time post-stroke or head injury. This evaluation focused on improvement in psychosocial well-being in the clients and their family members as a measure of programme effectiveness. Trained programme volunteers administered Ryff's Psychological Well-being Scale to 35 clients twice, at 6 months apart. Twelve family members also self-administered the scale twice. Voluuteers handled the administration well, and aphasic clients were able to complete the scale with little difficulty. Both clients and family members showed positive change in five of six dimensions of psychological well-being. This improvement in both groups may be related to the direct attention the programmes give to psychosocial well-being and communication, the overall environment of the centre, and the test administration itself. The positive change in these aphasic clients of varying ages and time post-stroke means that imporovement in psychological well-being is possible regardless of time post-stroke and age. There are important implications for health and social service system planning, and more specifically for programme planning for people with aphasia and their families.

Links between growth hormone deficiency, adaptation and social phobia.

Children referred for growth hormone (GH) treatment have increased school achievement problems, lack appropriate social skills and show several forms of behavior problems. A multicenter study in the United States has revealed that many GH-impaired children exhibit a cluster of behavioral symptoms involving disorders of mood and attention. Anxiety, depression, somatic complaints and attention deficits have been identified. These symptoms decline in frequency over a period of 3 years, beginning shortly after GH replacement therapy is started. Many of the patients who have received GH and had good growth responses show lower than average quality of life in young adulthood after treatment is completed. GH-deficient adults placed on GH therapy report improvement in psychological well-being and health status, suggesting that GH might have a central neuroendocrine action. Among a group of adults who were GH deficient as children, we find a high incidence of social phobia, a psychiatric disorder linked to GH secretion and usually accompanied by poor life quality. An ongoing study of non-GH-deficient short individuals suggests that short stature is not the cause of this outcome. We conclude that the origins of psychiatric comorbidities, such as social phobia and depression, in GH deficient adults are likely to be neuroendocrine as well as psychosocial.

The psychological impact of hip arthroplasty.

The impact of total hip arthroplasty on psychological functioning was examined in 51 patients; 25 females and 26 males with a mean age of 65 years (range 42-81 years). Assessments of psychological well-being and distress were made with the Mental Health Inventory. Life satisfaction, self-rated health, and pain ratings were also obtained. Assessments were made prior to surgery, immediately after surgery, and at a 2 month follow-up. The operation produced significant improvements in psychological well-being (P < 0.001), psychological distress (P < 0.001), life satisfaction (P < 0.01), self-rated health (P < 0.001), and pain (P < 0.001). It is concluded that the changes in medical and functional status following hip arthroplasty documented in previous research are accompanied by substantial improvements in psychological state, and that the inclusion of psychological factors in hip arthroplasty research will provide a more comprehensive assessment of outcome.