Levels Of Psychological Morbidity Research Articles

Understanding what affects psychological morbidity in informal carers when providing care at home for patients at the end of life: a systematic qualitative evidence synthesis.

Informal carers are central in supporting patients at the end of life, but this has substantial negative impacts on carers' own mental health. When carers are unable to cope, this may affect their ability to support the patient and increase the likelihood of patient hospital admissions. Further, demographic changes mean demands for care at and before end of life are increasing and existing services will struggle to meet these demands. It is important to recognise carers as a vital resource and prevent adverse health outcomes from caregiving (and thereby limit their consequences). Large individual variation in the level of psychological morbidity from end-of-life caregiving suggests there is scope for interventions to improve carer mental health if we can understand the underlying factors. This meta-synthesis of qualitative studies aims to identify factors reported by carers as important to their mental health. Searches of MEDLINE, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Social Science Citation Index, EMBASE, Cochrane Central Register of Controlled Trials, Database of Abstracts of Reviews of Effects, and Cochrane Qualitative Reviews 1 January 2009 to 24 November 2019 for empirical publications from Organization for Economic Cooperation and Development countries in English/Scandinavian on factors affecting adult carer mental health during end-of-life caregiving in home settings. Systematic qualitative meta-synthesis in collaboration with a Public Patient Involvement carer Review Advisory Panel, included thematic synthesis, followed by a best-fit framework synthesis, informed by principles of meta-ethnography. Critical Appraisal Skills Programme Qualitative Studies Checklist was used. Thirty-three eligible studies identified six themes encompassing factors perceived by carers to affect their mental health during end-of-life caregiving. These were: (1) the patient condition (including patient decline); (2) impact of caring responsibilities (including exhaustion, lack of time for own needs, isolation); (3) relationships (including quality of the patient-carer relationship); (4) finances (including financial concerns, impact on work); (5) carers' internal processes (including loss of autonomy, lack of confidence, coping strategies); and (6) support (including lack of informal support, inadequacies in formal support information and care provision, limited collaboration, disjointed care). Reported strategies to improve mental health were linked to the final two themes, with suggestions on how to manage carers' internal processes and build appropriate support. Findings correspond with literature 1998-2008, indicating consistency in factors affecting carers and adding validity to findings. The review was limited to caregiving in the home setting and studies from Organization for Economic Cooperation and Development countries published in English and Scandinavian. Identified papers predominantly considered carers of people with cancer, with little research into ethnic-minority perspectives. The review may therefore not fully encompass factors affecting carers of people with longer-term conditions, or those within other care settings, countries and population groups. A wide range of both internal and contextual factors may lead to psychological morbidity when caring for someone at the end of life. Future work within practice therefore requires a broad-based rather than narrow approach to sustaining and improving carer mental health. Future work within research requires collaboration between researchers and stakeholders within policy, commissioning, practice and carer organisations to develop solutions and assess their effectiveness. Further, researchers need to develop better models for factors affecting carer mental health and their interaction, to build a stronger evidence base and better guide interventions. This study is registered as PROSPERO CRD42019130279. This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme as award number HSDR 18/01/01 and will be published in full in Health and Social Care Delivery Research. See the NIHR Journals Library website for further project information.

Correlates and Predictors of Psychological Morbidity in HIV-Infected Persons: A Cross Sectional Study

Introduction: HIV-infection is associated with many factors including: physical, social, cultural and psychosocial factors. Physiological changes associated with HIV infection may generate psychological morbidity. However, specific psychosocial factors contributing to psychological morbidity remain unclear. Identifying factors contributing to psychological morbidity may help in prevention and planning intervention. Aims/Objectives: 1) To identify significant predictors of psychological morbidity from specific dysfunctional coping traits/dimensions among HIV-infected persons; 2) To assess/determine the association between predictor variables (specific coping dysfunctional traits) and psychological morbidity; 3) To identify other correlates of psychological morbidity; 4) To make recommendations on how to reduce levels of dysfunctional coping and psychological morbidity. Methods: This cross-sectional descriptive study was conducted to examine data collected from 110 participants, HIV patients receiving HAART services from Ahmadu Bello University Teaching Hospital (ABUTH), Zaria, Kaduna State, Nigeria. Results: Results indicate that HIV-patients with high levels of psychological morbidity were more likely to use dysfunctional coping more frequently. Therefore, greater psychological distress and symptoms reporting may be associated with dysfunctional coping. Conclusion/Recommendation: The study recommends that specific dysfunctional coping dimensions should also be targeted in interventions designed to reduce psychological morbidity in HIV patients.

Cuidados paliativos oncológicos em contexto de internamento e domiciliário: Necessidades, morbilidade psicológica e luto antecipatório nos familiares do doente terminal e impacto na qualidade de vida familiar

A doença oncológica na fase terminal tem um importante impacto na família e seus elementos. Por este motivo, os cuidados paliativos pressupõem o suporte à família. No entanto, são escassos os estudos que visam determinar as necessidades das famílias em cuidados paliativos. O presente estudo teve como objetivos determinar quais as necessidades dos familiares dos doentes terminais, a presença de morbilidade psicológica e experiência de luto antecipatório, distinguindo dois contextos de prestação de cuidados (internamento e domicílio), e examinar a influência de uma satisfação inadequada das necessidades, luto antecipatório e contexto de prestação de cuidados na perceção de qualidade de vida familiar. Para tal, procedeu-se a um estudo exploratório junto de uma amostra de 40 familiares de doentes oncológicos terminais em cuidados paliativos. Verificou-se que as necessidades de suporte psicossocial são menos satisfeitas em contexto de cuidados domiciliários. Independentemente do contexto de prestação de cuidados, os familiares apresentam níveis clinicamente significativos de morbilidade psicológica e luto antecipatório com impacto na perceção da qualidade de vida familiar. A satisfação inadequada das necessidades, a presença de morbilidade psicológica e a experiência de luto antecipatório influenciam a perceção de qualidade de vida familiar. Este estudo vem demonstrar a importância de atender às necessidades dos familiares em cuidados paliativos, numa perspetiva holística e multidisciplinar.

57 Hypertension in pregnancy: Gaining insight into women’s mental health and birth experience 6–12 months postpartum

Background Pregnancy and childbirth are usually joyful experiences. However, when medical complications occur, these experiences can be more traumatic, leading to depression, anxiety and posttraumatic stress disorder (PTSD). The most common complication in pregnancy is hypertension, but the literature around the psychological consequences of this is limited and inconsistent. There is also a scarcity of research reporting on the woman’s perspective of her experience and whether the care she received influenced her experience. Objective To compare the level of depression, anxiety and PTSD symptoms amongst women who were normotensive and hypertensive in pregnancy, at six months postpartum and to gain insight into women’s experiences of hypertension in pregnancy (HIP). Methods A mixed methods study was undertaken using prospective observational and qualitative descriptive methods. Eligible women who were normotensive or hypertensive (gestational hypertension or preeclampsia) in pregnancy completed the Edinburgh Postnatal Depression Scale (EPDS), General Anxiety Disorder (GAD) scale and Posttraumatic Stress Diagnostic Scale six months postpartum. Questionnaire scores from each group were compared using an independent t-test, with additional chi squared tests to compare levels in each group reaching thresholds for caseness. 20 women who experienced hypertension in their pregnancy were interviewed 10–12 months postpartum. Thematic analysis was used to analyse interview data. Results A total of 210 women participated in this study, of which 49 had HIP. The mean EPDS score was 4 in both groups (p = 0.7); 6% of the HIP group scored above the established threshold for postnatal depression (EPDS ⩾ 12) compared to 4% in the normal (p = 0.47). The mean GAD score was 2 in both groups (p = 0.3) with moderate or high anxiety reported by 4% in the HIP group versus 3% (p = 0.74). 10% of the HIP group reported their birth experience as a traumatic event, compared to 1% of the normotensive group (p = 0.003). In spite of this difference, the mean PTSD symptom scores were low and not significantly different between the two groups (3 in the HIP group, 4 in the normal, p = 0.7). The themes identified from the interviews were reacting to the diagnosis, being a mother in adversity, processing the situation and ‘moving on’ from the experience. Factors that helped improve the woman’s experience were feeling safe and trusting the care providers, continuity of care and having social support. Conclusions The study shows that women who experience HIP are more likely to report their birthing experience as traumatic. Despite this, by six months postpartum, levels of psychological morbidity are reassuringly low and not significantly different from women who were normotensive during pregnancy. Women who experienced HIP reported that with time, they could process the experience and move on with being a mother. The care of women with HIP often focusses on the immediate physical health issues, but their care should also include emotional and social support. Trust and continuity of care are important mediating factors for improving the woman’s birth experience.

Psychological health and stress among Czech medical students

Cardiovascular diseases are the most frequent cause of death in developed countries. Our purposes were to evaluate the burden of cardiovascular risk behaviours (especially stress) among students of the Faculty of Medicine and Dentistry in Olomouc, Czech Republic. A questionnaire survey was carried out in a total of 180 first and fifth year General Medicine students. The 12-item General Health Questionnaire (GHQ-12) for assessing subjective well-being and the Medical Student Stressor Questionnaire (MSSQ) were used. The obtained data were analyzed using Fisher's exact test and the non-parametric Mann–Whitney U test. Frequencies were compared with the chi-square test. Using the GHQ-12, first year students were found to have higher Likert scores (level of psychological morbidity) than fifth year students. The percentages of students' psychological morbidity (Likert score ≥ 3) were 89.9% and 67.8%, and Likert scores ≥ 5 49.4% and 32.2%, respectively. The MSSQ showed higher levels of stress in first year students. Significant differences between first and fifth year students were found in all domains with the exception of Domains 4 (social-related stressors) and 5 (drive- and desire-related stressors). With the 12-item General Health Questionnaire (GHQ-12) for assessing psychological morbidity levels and the Medical Student Stressor Questionnaire (MSSQ) for stress evaluation, high levels of these parameters were found in both first and fifth year students of the Faculty of Medicine and Dentistry in Olomouc. Psychological morbidity and stress levels in Olomouc students were higher than those reported in the literature. Higher levels of stress in first year students were revealed. The findings suggest the need for curriculum changes, improvements to the adaptation process and psychosocial counselling for medical students in order to decrease the risk of cardiovascular disease in would-be health professionals.

Supportive Care Needs following Cancer Treatment: A Comparison of Breast and Brain Cancer in an Australian Cohort

Objective. To assess and identify patient-reported supportive care needs following definitive treatment in persons with breast cancer (BC) and primary brain tumours (gliomas) (BT) in an Australian community cohort and to assess the commonalities and/or discrepancies of the reported needs in these oncological populations. Methods. A prospective cross-sectional survey of persons with BC (n=85) and BT (n=106) using questionnaires for supportive care needs, psychological morbidity, and quality of life. Results. BT participants were younger than BC patients (mean ages 51 and 57 years). The median time since diagnosis for both groups was over 2 years. The level of psychological morbidity, mainly depression, was high in both groups: BC (22%) and BT (20%). Participants in both groups reported at least one need (“met” or “unmet”). The BC patients reported higher numbers of “needs” and “unmet” needs compared with BT patients (mean 13.7 versus 11.6 needs; “unmet” needs mean 6.0 versus 4.1). The common “met” and “unmet” needs highlighted by both groups were comparable; the domain for most “met” needs included comprehensive cancer care, while “unmet” needs related to existential survivorship issues. Conclusion. Despite successful treatment many cancer survivors experience unmet supportive care needs in longer term. Understanding the impact of these beyond the acute phase is important as care shifts to community settings. More research in existential survivorship issues is needed.

Caregiving appraisal in schizophrenia: A study from India

This study evaluated caregiving experience in the caregivers of patients with schizophrenia within the framework of the stress-appraisal-coping model. By purposive random sampling, 100 Indian patients with schizophrenia and their primary caregivers were assessed. The patients were assessed on Positive and Negative Symptom Scale (PANSS). Caregivers completed the Scale for Positive Aspects of Caregiving Experience (SPACE), Involvement Evaluation Questionnaire (IEQ), Family Burden Interview (FBI) Schedule, Coping Checklist, Social Support Questionnaire, and General Health Questionnaire (GHQ-12). Path analysis showed that psychological morbidity is mainly determined by subjective experience of burden, which in turn is significantly influenced by severity of psychopathology, time spent per day (in hours) in caregiving and the coping strategies used. Although coping strategies and PANSS do influence objective burden, objective burden itself has no influence on the level of psychological morbidity. Total PANSS score has no direct influence on subjective burden, but acts indirectly through total time spent in caregiving and coping. Caregiver's gain in positive experiences on SPACE scale positively influences subjective burden. The present findings suggest that better control of patients' symptoms would lead to less demand on the caregivers in the form of time and strain on coping abilities and would thus reduce subjective burden and psychological morbidity in the caregivers.

Low priority? A cross sectional study of appearance anxiety in 500 consecutive referrals for cosmetic surgery

Low priority treatment guidance is used in the National Health Service to manage requests for cosmetic surgery where there is no associated functional impairment. Provision is made in this guidance to provide surgery on exceptional grounds, and this may include significant psychological distress. However, without a good understanding of the common factors that underpin requests for surgery, ideally in the local population, it is very difficult to define an exception in a clear and consistent way. A prospective study of consecutive referrals for cosmetic surgery in an NHS plastic surgery unit was therefore completed over a five-year period. Five hundred and one men and women aged between 16 and 79 (mean 34.5 years) were assessed using standardised questionnaires and clinical interview carried out by two clinical psychologists specialising in the field. Results indicated very marked impact of appearance-related anxiety with significant withdrawal from social activities particularly intimate behaviour. Coping behaviours ranged from use of concealing clothing and complete social avoidance to ominous high riskstrategies such as repeated pregnancy with late termination to maintain breast size. Treatment goals were predominantly psychosocial. High levels of psychological morbidity can be characterised as typical of people requesting cosmetic procedures in the NHS rather than exceptional, making the achievement of equitable access to limited resources impossible. Rather than define this population as ‘low-priority’, a constructive approach is to examine the utility of psychological interventions in a design which evaluates the comparative benefits of surgical and psychological approaches to management of appearance anxiety.

Primary Health and Supportive Care Needs of Long-Term Cancer Survivors: A Questionnaire Survey

There are 1.2 million long-term cancer survivors in the United Kingdom. Existing research on the health and supportive care needs of these survivors is sparse and inconclusive. This study investigated health status, psychological morbidity, and supportive care needs in long-term cancer survivors in the United Kingdom. Five to 16 years after diagnosis, 1,275 eligible survivors of breast, colorectal, and prostate cancers were approached to participate in a questionnaire survey. The questionnaire explored health status (European Quality of Life-5 Dimensions), psychological morbidity (Hospital Anxiety and Depression Scale), and supportive care needs (Cancer Survivors' Unmet Needs Measure). Data were analyzed by type of cancer and time since diagnosis. Logistic regression was used to identify predictors of unmet supportive care needs. The response rate was 51.7% (659 survivors). Overall health status and levels of psychological morbidity were consistent with population norms. At least one unmet supportive care need was reported by 47.4% of survivors, but overall numbers of unmet needs were low (mean, 2.8; standard deviation, 4.8). The most frequently endorsed unmet need was for help to manage concerns about cancer recurrence. Trait anxiety (P < .001), nondischarged status (P < .01), dissatisfaction with discharge (P < .01), and receipt of hormonal therapy (P < .01) were predictive of unmet supportive care needs. The findings suggest a majority of long-term breast, colorectal, and prostate cancer survivors who have no signs of recurrence report good health and do not have psychological morbidity or large numbers of unmet supportive care needs. A minority of long-term survivors may benefit from ongoing support. The identification and support of those long-term survivors with ongoing needs is a key challenge for health care professionals.

Body-image disturbance in adult dialysis patients

Purpose. An increasing number of individuals in the UK develop end-stage renal failure and receive dialysis to prolong their lives. Dialysis-users report elevated levels of psychological morbidity which are associated with poorer quality of life, adjustment to illness and increased mortality. Circumscribed evidence has also identified body-image (BI) changes occurring in dialysis-users which are already known to be associated with psychological morbidity in other chronically ill populations. This study aimed to identify the prevalence of body-image disturbance (BID) in a dialysis population, correlation with psychological distress, and to identify any variables associated with increased BID and psychological morbidity. Particular attention was given to cognitive models of emotion which postulate a key role for self-consciousness and appearance-related beliefs.Method. Between May and August 2007, 97 adult haemodialysis and peritoneal dialysis patients from a UK regional specialist centre responded to a questionnaire survey. Outcome measures comprised the Body Image Disturbance Questionnaire, Hospital Anxiety and Depression Scale, Self-consciousness Scale and the Appearance Schemas Inventory-Revised.Results. Prevalence of anxiety and depression was 24.7% and 18.6%, respectively, with levels of BID significantly above community norms for both male and female respondents. Significant associations were found between psychological morbidity and BID and with specific aspects of appearance-schematisation and self-focus.Conclusions. Patients should be educated regarding the likely physical consequences of dialysis-types to aid decision-making and prepare them for impacts once dialysis is commenced. Clinicians may wish to monitor dialysis-users for distress and BI difficulties at follow-up appointments. Interventions that target appearance-related beliefs and BID may be of benefit to this population.

Emotional burden in caregivers of patients with obsessive-compulsive disorder

The objective of this study was to evaluate the emotional burden, psychological morbidity, and level of family accommodation in caregivers of obsessive-compulsive disorder (OCD) patients, according to sociodemographic and clinical factors. Fifty Brazilian DSM-IV OCD patients and their caregivers were evaluated using the Family Accommodation Scale, the Zarit Burden Interview (ZBI), the Self-Report Questionnaire (caregivers), the Yale-Brown Obsessive-Compulsive Scale, and the Beck Depression Inventory (patients). Most caregivers (80%) were aged between 30 and 59 years and lived with the patient (88%). Forty-two percent presented a common mental disorder and their mean ZBI score was 28.9. Family accommodation was moderate in 26% and severe or very severe in 24%. Caregivers' levels of psychological morbidity, accommodation, and emotional burden were associated with each other and with the severity of patient obsessive-compulsive and depressive symptoms. The results suggest that caregivers of OCD patients have important levels of burden and psychological morbidity and should receive orientation and support to minimize this emotional impact.

Emotional burden and psychological morbidity in caregivers of patients with obsessive-compulsive disorder

Introduction:The objective of this study was to evaluate the emotional burden, psychological morbidity and level of family accommodation in caregivers of obsessive-compulsive disorder (OCD) patients, according to sociodemographic and clinical factors.Method:Fifty Brazilian DSM-IV OCD patients and their caregivers were evaluated using the Family Accommodation Scale, the Zarit Burden Interview (ZBI), the Self Report Questionnaire (caregivers), the Yale-Brown Obsessive-Compulsive Scale and the Beck Depression Inventory (patients).Results:Most caregivers (80%) were aged between 30 and 59 years-old and lived with the patient (88%). Forty-two percent presented a common mental disorder and their mean ZBI score was 28.9. Family accommodation was moderate in 26% and severe or very severe in 24%. Caregivers' levels of psychological morbidity, accommodation and emotional burden were associated with each other and with the severity of patient obsessive-compulsive and depressive symptoms.Conclusion:The results suggest that caregivers of OCD patients have important levels of burden and psychological morbidity and should receive orientation and support to minimize this emotional impact.

Health-related quality of life of stroke survivors attending the volunteer stroke scheme

The Volunteer Stroke Scheme (VSS) provides patients with the opportunity to participate in community-based therapeutic activities and physiotherapy sessions. To provide the first profile of VSS attendees in terms of their functioning across the range of recommended WHO International Classification of Functioning, Disability and Health (ICF) outcomes. A convenience sample of 41 VSS patients completed standardised measures of cognitive functioning (MMSE), activity levels [Frenchay Activity Index (FAI), and Barthel Index (BI)], depression [Hospital Anxiety and Depression Scale (HADS)] and Quality of Life (SF-36). A total of 37% met the criteria for mild cognitive impairment and 44% met the criteria for clinical depression. Scores on the BI (M = 79.5) and FAI (M = 18.4) incidated limitations in activity levels. Quality of life levels was low. High levels of psychological morbidity, severe disability across a range of domains and poor quality of life were reported.

Study comparing two types of screening provision for people with von Hippel-Lindau disease

Patients diagnosed with von Hippel-Lindau disease (vHL) require life-long surveillance for this multi-system disease. It is therefore important to assess the comprehensiveness of screening provision, as well as identify what type of screening service is most likely to encourage regular patient attendance. This descriptive study reports on two types of screening service: single appointment One Stop (OS) clinics and multiple appointment Ad Hoc (AH) clinics. One hundred and seventeen vHL patients from eight regional genetics centres were approached to take part. Seventy-two (61.5%) returning a completed study questionnaire: fifty-four (75%) were screened at OS clinics and eighteen (25%) at AH clinics. Comprehensiveness of screening, attendance rates, patient ratings of quality of care and levels of psychological morbidity were compared between the two types of service. While levels of disease severity were similar in patients screened at OS and AH clinics, those seen at OS clinics were screened for twice as many site-specific vHL manifestations compared to those seen at AH clinics (P < 0.0001). More patients at OS clinics regularly attended their screening appointments compared to those at AH clinics (P = 0.0045). There was no difference in the quality of care reported by patients attending the two types of screening service and few problems were reported. Twenty-nine percent of respondents were categorised as clinically anxious and 13% as clinically depressed. These findings suggest that an optimum vHL screening service is one based on OS clinics offering regular comprehensive surveillance and psychological support.

Are investigations anxiolytic or anxiogenic? A randomised controlled trial of neuroimaging to provide reassurance in chronic daily headache

Objectives: Aims were to investigate (a) whether neuroimaging in patients with chronic daily headache reassures patients or fails to reassure them and/or worsens outcome, impacting on service use, costs, health...

Dealing with Post-Traumatic Stress Disorder: The Psychological Sequelae of Bloody Sunday and the Response of State Services

Objective This article describes the political context of health and social care services in Northern Ireland at a time of intense social conflict. Method Concepts from post-traumatic stress disorder (PTSD) and other relevant international psychological literature are then used to study the experience of the Bloody Sunday families, victims of a traumatic event that happened in Derry in January 1972. Results High levels of psychological morbidity within this population are reported, alongside some evidence that families had not received services that may have helped resolve the trauma. Conclusions The authors noted that new services planned as a result of the current peace process may offer social workers and other professionals new ways to address the unmet needs of people traumatized by the Troubles.

Marital and family functioning: different measures and viewpoints.

Dysfunctional relationships have been considered to play an important part in the onset and maintenance of psychiatric disorders, particularly depression. Influential factors appear to be perception of low social support and emotional warmth and/or high levels of criticism and control by the recipient. The IBM was developed for use as a simple self-report measure to rate important components of the relationship between marital partners, described as the constructs of care and control. The aim of this study was to test the validity of the IBM. The IBM was compared with data from a structured marital interview based on the Self-Evaluation of Social Support Schedule (SESS). Data were also obtained from a nominated adult offspring witness. Family functioning was assessed using the General Functioning component of the McMaster Family Assessment Device (FAD). The General Health Questionnaire (GHQ) was used to determine levels of psychological morbidity. The witness data for sons and daughters were analysed to gauge gender effects in reporting. The results show that 'care' and 'control' were identifiable constructs discerned by partners and witnesses with 'care' rated more consistently than 'control'. Care between parents was an indicator of the overall quality of the family environment. Care received by the wife from her husband seemed to set the emotional tone for the family. Daughters seemed to be more 'in tune' with perceived care by both parents. Sons were less so, overall, but were more 'in tune' with their fathers' perceived care than with their mothers'. Both the IBM, a self-report measure, and the structured marital interview provided consistent information about the quality of marital relationships, particularly perceptions of care. Perceptions of control were less consistently reported, which may suggest that 'control' is a less robust construct. This may suggest that 'control' is a more subjective experience, as the cues are more directed at the partner than other family members.

Psychological morbidity in caregivers is associated with depression in patients with dementia.

The relationship between psychological morbidity in caregivers and depression in patients with dementia was examined using data collected on 193 patient-caregiver dyads attending a memory disorders clinic. Caregivers had high rates and levels of psychological morbidity which were associated with the severity of dementia (but neither the type nor duration), with the caregiver being a spouse and female and living with the person with dementia. A logistic regression analysis identified clinician-rated patient depression score and demanding problem behaviors as being independently and significantly associated with caregiver psychological morbidity. This new finding of a link between patient depression and caregiver psychological morbidity has implications for more focused treatment programs for both caregivers and patients.

Psychological morbidity and coping skills in patients with brittle and non-brittle asthma: a case-control study.

An association between psychological morbidity and asthma is well recognized and an increase in negative psychosocial factors in brittle asthma has been previously reported. Such factors, apart from affecting patient perceptions, may alter patients' self-management of their condition. We have undertaken a case-control study on 29 well characterized brittle and non-brittle asthmatics in the West Midlands Region to assess their level of psychological morbidity, using the General Health Questionnaire (GHQ) and the living with asthma questionnaire, and their responses to changes in asthma symptoms, using the Asthma Symptom Checklist and a taped interview. Significant differences in GHQ (mean score brittle 19.5 vs non-brittle 7.2, P = 0.0002) and living with asthma (mean score brittle 1.30 vs non-brittle 1.00, P = 0.002) reinforced the presence of psychological factors in this group of patients with severe asthma. Interviews regarding responses to hypothetical asthma attacks showed that patients with brittle asthma delayed seeking medical attention more often than those with non-brittle asthma and instead preferred to self-administer beta-agonist medication. Sixteen (55.2%) of the 29 patients with brittle asthma would have delayed 7 days before seeking medical attention in a slow onset attack compared with 6/29 (20.7%) in the non-brittle group. In a fast onset attack 14 (48.3%) patients with brittle asthma would not have summoned help, despite finding it difficult to walk to the kitchen for a drink whereas in the non-brittle group 24 out of 29 (82.8%) would have summoned help. Levels of family support tended to be lower in patients with brittle asthma (mean family APGAR 7.3 vs 8.65 P = 0.09). Brittle asthma is associated with greater psychological morbidity and altered strategies for coping with deteriorating asthma symptoms. Attention should be paid to the presence of such factors in the management of patients with brittle asthma.

Psychosocial impact of testing (by linkage) for the BRCA1 breast cancer gene: An investigation of two families in the research setting

Data are reported on an investigation of the impact of genetic testing in two families with a >95% probability of linkage to the BRCA1 Breast/Ovarian cancer predispostion gene. Levels of psychological morbidity and cancer specific concerns in this highly selected group were not unusually high. At least half of the sample had no specific prior expectation regarding their gene carrier status. However, there was an indication that an unanticipated unfavourable genetic test result can cause subsequent psychological distress. Uptake of testing in this research sample was 41% overall and was higher (59%) in females. This is likely to have important resource implications if this level of uptake is found when genetic testing is extended outside such research cohorts.