Long-term Psychological Adjustment Research Articles

Gender Differences in Depressive Symptoms Following Child Death in Later Life.

This study examined short- and long-term psychological adjustment to parental bereavement in later life for mothers and fathers. Using 9 waves of data from the United States (1998-2014 Health and Retirement Study), I estimated trajectories of mothers' and fathers' depressive symptoms surrounding child death in later life, highlighting gender differences in adjustment. Moderation analyses were performed to uncover heterogeneous trajectories across parental characteristics. Mothers were more likely to experience child death and reported higher depressive symptoms prior to parental bereavement than fathers. Mothers and fathers who lost a child reported an increase in depressive symptoms that diminished over time. The short-term elevation in depressive symptoms was marginally greater for mothers than fathers, but depressive symptoms declined at a faster rate for mothers than fathers in the years following the death. These counterbalancing changes resulted in mothers and fathers returning to their respective prebereavement levels of depressive symptoms between 2 and 4 years postbereavement. Parental age moderated trajectories distinctly by gender, and the presence of surviving children buffered the impact of child death on depressive symptoms for mothers but not fathers. Mothers more often experience child death in later life and their adjustment process differs from that of fathers, underscoring the salience of gender in shaping how older parents respond to the death of a child. Older parents and mothers without surviving children are vulnerable to prolonged elevations in depressive symptoms following the death of a child in later life.

Long-Term Impact of Diagnosed Fetal Anomaly on Parental Traumatic Stress, Resilience, and Relationship Satisfaction.

Knowledge regarding the long-term psychological adjustment of parents to children with prenatal diagnosis of congenital malformation is scarce. The aim of this study is to examine traumatic stress trajectories, resilience, and relationship satisfaction among parents to children with prenatal diagnosis of a congenital malformation, and to compare this to a sample of non-affected parents. A prospective longitudinal cohort study was conducted at a tertiary perinatal referral center. Ninety-three mothers and 80 fathers who received a diagnosis of fetal anomaly during obstetric ultrasound examination (study group), and 110 mothers and 98 fathers with normal ultrasound findings (comparison group), reported their traumatic stress at four timepoints during pregnancy (T1-T4), 6 weeks after birth (T5), and 10-12 years after birth (T6). Resilience and relationship satisfaction was reported at 10-12 years after birth. Parents to children with a congenital malformation experienced significantly elevated traumatic stress levels over time, compared with parents of children without congenital malformation. The difference between groups was largest acutely after diagnosis and remained significant 10-12 years after the birth of the child. Resilience and relationship satisfaction levels were similar in both groups. Despite experiencing high levels of traumatic stress over time, parents to children with a congenital malformation reported resilience and relationship satisfaction at similar levels to non-affected parents. This suggests that despite ongoing long-term distress, parents are still able to maintain positive psychological coping resources.

To persist or not to persist? The dilemma of goal adjustment in chronic pain.

To persist or not to persist? The dilemma of goal adjustment in chronic pain.

Long-term effects and psychological adjustment: study protocol of a large register-based study on quality of life among survivors of hematological malignancies

BackgroundBoth incidence and survival rates of hematological cancers are increasing, leading to a growing number of survivors with specific late and long-term effects. However, relevant research in physical, psychological and social aspects of quality of life is scarce. Existing literature shows that a considerable number of cancer survivors report a relatively high quality of life despite a variety of adverse and persistent symptoms. To date, the reasons for this phenomenon as well as moderating and mediating factors are widely unknown. Given these research gaps, we aim to investigate the different domains of quality of life among long-term survivors of hematological cancers and to identify factors predicting high quality of life.Methods/DesignThis is a large cross-sectional study among hematological cancer survivors at a minimum of 3 years after diagnosis. We will collect 1000 survivors completing a set of self-report-questionnaires encompassing physical, psychological and social domains of quality of life. Participants are clustered in groups according to time since diagnosis and compared with each other. Furthermore, survivors will be compared with the general population. Factors predicting high quality of life will be identified via multiple regression analyses and structure equation modeling.DiscussionOur study will help to inform health care providers about the specific long-term burden among survivors with hematological malignancies. Identification of factors predicting high quality of life will help to develop adequate intervention strategies to enhance well-being in hematological cancer survivors. Our methodological advantages including the large sample as well as the assessment of different domains of quality of life will ensure novel and robust results. A limitation of the study is the cross-sectional design.

Trajectories of quality of life, life satisfaction, and psychological adjustment after prostate cancer.

BackgroundTo describe trajectories of health‐related quality of life (QoL), life satisfaction, and psychological adjustment for men with prostate cancer over the medium to long term and identify predictors of poorer outcomes using growth mixture models.MethodsOne‐thousand sixty‐four (82.4% response) men diagnosed with prostate cancer were recruited close to diagnosis and assessed over a 72‐month (6‐year) period with self‐report assessment of health‐related QoL, life satisfaction, cancer‐related distress, and prostate specific antigen anxiety. Urinary, bowel, and sexual function were also assessed using validated questionnaires.ResultsPoorer physical QOL was predicted by older age, lower education, lower income, comorbidities, and receiving hormone therapy. Lower life satisfaction was related to younger age, lower income, not being partnered, and comorbidities. Poorer psychological trajectories were predicted by younger age, lower income, comorbidities, and receiving radical prostatectomy or brachytherapy. Better urinary, bowel, and sexual function were related to better global outcomes over time. Anxiety about prostate specific antigen testing was rare.ConclusionsDistinct trajectories exist for medium‐ to long‐term QoL, life satisfaction, and psychological adjustment after prostate cancer; with age and socioeconomic deprivation playing a differential role in men's survivorship profile and the impact of functional status on outcomes increasing over time. These results reinforce the need for an appraisal of men's life course in addition to treatment side effects when planning survivorship care after cancer.

Migration and changes in loneliness over a 4-year period: the case of older former Soviet Union immigrants in Israel.

Both older adult and immigrant populations are at a high risk of loneliness. The current research compares older veteran Israelis to older immigrants who arrived in Israel from the former Soviet Union (FSU) after 1989. Early studies have found high levels of loneliness among older FSU immigrants; however, little is known regarding changes in loneliness among this group over time. The present study examines change in loneliness among older FSU immigrants and older veteran Jewish Israelis and its potential predictors. A prospective association between immigrant's status and loneliness over time was examined using the second (2009/2010) and third (2013) waves of SHARE-Israel. The sample consisted of 208 FSU immigrants and 1080 veteran Jewish Israelis. Bivariate analyses indicated that in 2009/2010, older FSU immigrants were significantly lonelier than older veteran Jews, and more disadvantaged on all social and health variables measured. Yet, no significant differences emerged between the two groups with regard to loneliness in 2013. In the adjusted model, older immigrants presented positive change in loneliness (less loneliness over time) compared with veteran Jewish Israelis. Depressive symptoms explained a large part of the variance in change in loneliness. Potential explanations suggest that the long-term psychological adjustment process and the characteristics of the FSU immigrants in Israel as a large and relatively strong immigrant group have served as protective factors with regard to changes in loneliness over time.

Six years after the wave. Trajectories of posttraumatic stress following a natural disaster

BackgroundThe characteristics of long-term trajectories of distress after disasters are unclear, since few studies include a comparison group. This study examines trajectories of recovery among survivors in comparison to individuals with indirect exposure. MethodsPostal surveys were sent to Swedish tourists, repatriated from the 2004 Indian Ocean tsunami (n=2268), at 1, 3, and 6 years after the tsunami to assess posttraumatic stress (PTS) and poor mental health. Items were used to ascertain high and moderate disaster exposure groups and an indirect exposure comparison group. ResultsLong-term PTS trajectories were best characterized by a resilient (72.3%), a severe chronic (4.6%), a moderate chronic (11.2%) and a recovering (11.9%) trajectory. Trajectories reported higher levels of PTS than the comparison group. Exposure severity and bereavement were highly influential risk factors. ConclusionsThese findings have implications regarding anticipation of long-term psychological adjustment after natural disasters and need for interventions after a single traumatic event with few secondary stressors.

A Literature Review to Determine the Impact of Sexuality and Body Image Changes Following Burn Injuries

The purpose of this study was to perform a review of the existing literature to (a) determine the impact of sexuality and body image changes following burn injuries in an adult population and (b) identify if there is a relationship between the two variables and the impact this potentially has on burns survivors’ quality of life. A total of 16 research articles; sexuality (n = 5) and body image (n = 8), sourced from online databases were reviewed. Both quantitative and qualitative studies that investigated adult burn survivors in both inpatient and outpatient settings were included in this review. The literature suggests there is an interaction between body image dissatisfaction, sexual satisfaction and long-term psychological adjustment, particularly for female burn survivors. However, methodological limitations of the studies reviewed limits the transferability of the findings to clinical practice. Three themes were identified throughout the literature; satisfaction/dissatisfaction, adjustment issues and stigmatisation. Changes in body image and sexuality have a potential negative effect on burn survivors’ long-term quality of life. Further collaborative empirical research is required to understand the incidence and prevalence of these issues as well as intervention studies evaluating treatment programs for best practice.

Recalled Social Experiences and Current Psychological Adjustment among Adults Reared by Gay and Lesbian Parents

Children of gay and lesbian parents are a diverse group, but existing studies offer limited information about individual differences in their social experiences and subsequent psychological outcomes. In this study, 91 adults reared by gay and lesbian parents responded to measures of recalled social experiences as well as current depressive symptoms, positive and negative affect, and life satisfaction. Participants reported differing social experiences (e.g., stigma) as a function of their sex, family type, gay/lesbian parent's sex, and age at which they learned that a parent was gay or lesbian. Despite such diverse experiences, participants reported no significant differences in long-term psychological adjustment. It could be the case that children of gay and lesbian parents learn to cope with difficult social experiences, leading to positive adjustment overall. Indeed, the current sample perceived their social experiences as becoming significantly more positive over the life course, with less stigma and more benefits related to their family situation during adulthood than during earlier developmental periods. Future studies of adaptive coping processes and longitudinal changes in social experiences among offspring of gay and lesbian parents are warranted.

Coping in long‐term survivors of childhood cancer: relations to psychological distress

The goal of this study was to describe coping strategies and their associations with psychological distress in young adult survivors of childhood cancer. One hundred and sixty-four childhood cancer survivors, at least 7 years after diagnosis, completed questionnaires assessing demographics, health information, psychological distress, and different ways of coping (return rate: 61%). The Brief Symptom Inventory-18 (BSI-18) and the Post-traumatic Diagnostic Scale's (PDS) eight-item short form were used to measure psychological distress. Coping was assessed with the Cognitive Control Strategies Scale (CCSS), the Illness Perception Questionnaire-Revised (IPQ-R), and the White Bear Suppression Inventory (WBSI). Higher levels of distress were associated with the female sex, not being in a relationship, and with the presence of medical late effects. These predictors explained 12% of the variance in psychological distress. When coping variables were also entered into the equation, the amount of explained variance increased to 50%. The most important determinants of psychological distress in our sample were a tendency to suppress negative thoughts and a low level of optimism. These results contribute to a better understanding of the correlates of difficulties in long-term psychological adjustment after childhood cancer. Cognitive strategies, which are associated with or may increase the risk for concurrent psychological distress, in specific, avoidance of negative thoughts and a lack of positive future expectations, should be addressed in psychological counseling with survivors suffering from symptoms of distress.

Les expériences vécues par les enfants de Duplessis institutionnalisés : les conséquences après plus de 50 ans

In this article, the authors present qualitative results, derived from questionnaires and semi-structured interviews, to describe past and present experiences of the Duplessis children. Examples representative of their experience and a detailed description of two cases are provided. Results indicate that childhood abuse and negligence are related to poorer long-term psychological adjustment. The findings also demonstrate that reporting at least four strengths in childhood can have long-term protective effects.

Psychological adjustments made by postburn injury patients: an integrative literature review

Psychological adjustments made by postburn injury patients: an integrative literature review. This paper is a report of a review examining the variables that predispose individuals to significant psychological maladjustment following burn injury. The psychological sequelae of burn injury are well documented; however, the variables that influence individuals' adjustment following burn injury lack consideration. MEDLINE, Cumulative Index of Nursing and Allied Health, and Psychological Abstracts were searched using the keywords burn injury, psychological, psychosocial, rehabilitation, premorbid psychopathology, adjustment, reintegration, body image, post-traumatic stress disorder, depression, coping. Other sources were found from a manual search of nursing, medical and psychological literature and references of identified and related papers. The search strategy was limited to English-language research published between 1997 and 2008. An integrative review of the studies was conducted over a 6-month time period during 2007-2008. Burn patients are a heterogeneous group and typically have comorbidities. While preburn personality and coping strategies can influence long-term psychological adjustment, the relationship between postburn adjustment and burn size and severity, and gender are poorly understood. Much of the literature focuses on the prevalence of psychological maladjustment rather than on identifying variables that influence psychological adjustment. The diversity and complexity that characterize burn patients lead to unique adjustment difficulties. Recognizing these difficulties is the first step to offering appropriate intervention and treatment for this unique patient group.

Social support and psychological adjustment to SARS: The mediating role of self-care self-efficacy

The study tested the model of perceived support from medical staff and family/friends on severe acute respiratory syndrome (SARS) survivors’ mental health as mediated by self-care self-efficacy. One hundred and forty-three SARS survivors recruited from the Hong Kong Hospital Authority following 18 months recovery were surveyed by trained interviewers using structured questionnaires. Based on structural equation modeling, findings showed that self-care self-efficacy completely mediated the effects of perceived medical staff support and perceived family/friends support on mental health status. The model achieved a satisfactory fit, CFI = 0.98, NNFI = 0.98, RMSEA = 0.06, and explained 75.2% of the variance in mental health status. The study is the first attempt in understanding long-term psychological adjustment of SARS survivors. Findings may be applicable to other infectious disease outbreaks in informing psychosocial factors that are important to long-term recovery.

Psychological adjustment and quality of life in children and adolescents following open-heart surgery for congenital heart disease: a systematic review

BackgroundChildren with congenital heart defects (CHD) requiring open-heart surgery are a group at high risk for health-related sequelae. Little consensus exists regarding their long-term psychological adjustment (PA) and health-related quality of life (QoL). Thus, we conducted a systematic review to determine the current knowledge on long-term outcome in this population.MethodsWe included randomized controlled trials, case control, or cohort studies published between 1990–2008 evaluating self- and proxy-reported PA and QoL in patients aged between two and 17 years with a follow-up of at least two years after open heart surgery for CHD.ResultsTwenty-three studies assessing psychological parameters and 12 studies assessing QoL were included. Methodological quality of the studies varied greatly with most studies showing a moderate quality. Results were as follows: (a) A considerable proportion of children experienced psychological maladjustment according to their parents; (b) studies on self-reported PA indicate a good outcome; (c) the studies on QoL suggest an impaired QoL for some children in particular for those with more severe cardiac disease; (d) parental reports of psychological maladjustment were related to severity of CHD and developmental delay.ConclusionA significant proportion of survivors of open-heart surgery for CHD are at risk for psychological maladjustment and impaired QoL. Future research needs to focus on self-reports, QoL data and adolescents.

Cancer-Related Depression and Potential Pharmacologic Therapies

Depression in stem-cell transplant and chemotherapy-treated oncology patients has received increased attention in psychooncology research during the past decade. Depression is believed to negatively impact quality of life, long-term psychological adjustment, and survival rates. With the occurrence of depression in oncology patients reaching 15%—2 to 3 times greater than in the general population—improved diagnostic methods are needed, as well as interventions that are both timely and effective (1). Patients and health care providers may be reluctant to initiate therapy, as many of the symptoms can be explained as natural responses to the diagnosis and treatment of cancer. Physical depressive symptoms (e.g., sleep and appetite disturbances, psychomotor retardation, decreased energy) are common in oncology patients and act as confounders to such early diagnoses. Studies of hematopoietic stem cell transplant patients show that physical limitations peak around 90 days after transplant and improve about 1 year after transplant but do not significantly change throughout the 3- to 5-year full-recovery process. Physical recovery often occurs before emotional stability, yet complete recovery is a slow process that may worsen before improving. Further stem cell study results show that during a 5-year time period, 22% of patients report symptoms consistent with clinical depression, and an additional 31% could be classified as having mild depression (2). There are currently no recommendations concerning the preferred pharmacologic class or dosage to be used in oncology patients. Appropriate strategies for intervention and treatment should include both pharmacological and psychological therapies, much like regimens used in patients with other significant medical problems (1). It is difficult to study the effects of psychopharmacologic agents in oncology patients since full results may be delayed by 6 to 8 weeks. Furthermore, due to inadequate studies representative of the oncology population, dosing of antidepressants must be highly individualized. Practice trends favor screening all oncology patients for depression and providing treatment to a wide spectrum, including patients with depressive disorders and those with clinically diagnosed depression (1). Current pharmacological treatment options mimic therapies utilized in the primary care setting and include tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), serotonin norepinephrine reuptake inhibitors, and psychostimulants. Most data are anecdotal from small cohort studies in patients with a variety of malignancies.

Psychological Adjustment of Adolescents 18 Months After the Terrorist Attack in Beslan, Russia

Children exposed to terrorism are at high risk for developing emotional and behavioral problems, but only a few studies have examined adolescents' long-term psychological adjustment after a terrorist attack. We aimed to assess psychological distress, problem behaviors, and coping in adolescents who survived the terrorist attack on School No. 1 in Beslan, Russia. Seventy-one youths aged 14 to 17 years held as hostages by terrorists completed self-reported measures of psychological symptoms, emotional and behavioral difficulties, and coping behaviors 18 months after the traumatic event. They were compared with 100 adolescents who were not directly exposed to the attack. Data were collected during a 1-month period in May 2006. No significant differences were found between the 2 groups in overall levels of psychological symptoms as well as in emotional and behavioral problems. Girls in both groups reported significantly more psychological distress (p = .0001) and total difficulties (p = .0001) than boys. In the directly exposed group, avoidant coping was related to worse psychological functioning for girls (r = 0.54, p < .001) and boys (r = 0.50, p < .01), whereas in the indirectly exposed group this strategy was associated with psychological distress (r = 0.43, p < .01) and total difficulties (r = 0.40, p < .01) for girls only. More than 1 year after a terrorist attack, adolescents may experience psychological distress regardless of being directly or indirectly exposed. Professionals working with adolescents affected by terrorism should be sensitive to developmental level and gender, consider the cultural context, and foster coping skills that may be differentially effective for girls and boys.

Fifty years later: the long-term psychological adjustment of ageing World War II survivors.

Most studies of the long-term after-effects of war have focused on survivors seeking treatment or financial compensation. The present study examined the current psychological adjustment of a community sample of ageing World War II (WW II) survivors, including survivors of bombardments, persecution, resistance, combat and other violence. A community sample of 4057 Dutch WW II survivors answered a 4-page postal questionnaire. Of these, 1461 survivors answered a second follow-up questionnaire. Even 50 years after World War II, a statistically significant but modest relationship was found to exist between exposure to shocking war events and current psychological adjustment in terms of symptoms of post-traumatic stress disorder (PTSD), anxiety and anger. A total of 66 respondents (4.6%) met the criteria for PTSD. The highest level of current PTSD (13%) was found among survivors of persecution. The lowest level of PTSD (4%) was found among civilian war victims and resistance participants, while military veterans had an intermediate score (7%). With regard to absolute numbers, civilian war victims represented the largest proportion of PTSD sufferers. In a study of a community sample of WW II survivors, we found that most of these survivors had no severe symptoms of PTSD. Nevertheless, probably tens of thousands of Dutch individuals are still suffering from long-term after-effects from World War II. For these vulnerable survivors, the ageing process will complicate the coping process.

Feminising genitoplasty: long-term psycosexual adjustment, social behaviour and post-operative outcomes

Purpose To assess the long-term psychological adjustment, social behaviour and psychosexual outcome in patients submitted to feminising genitoplasty. Material and methods Twenty-tree patients submitted to an early Passerini-Glazel feminising genitoplasty entered the study. We distinguished 2 groups composed of 13 and 10 patients with a mean age of 13 and 25 years, group 1 and 2 respectively. All patients were investigated about family relationships, social relationships, hobbies and self body image. In group 1 personality was investigated with the Draw-a-tree test. Group 2 was evaluated with: Centre for Epidemiologic Studies Depression Scale (CES-D), Beck Depression Inventory (BDI) Test, Female Sexual Function Index (FSFI), Sexual Distress Scale (SDS), Dyadic Adjustment Scale (DAS), and a questionnaire assessing masturbation. Results Group 1 described a good family situation, easy relationships. 54% patients indicated sufficient satisfaction with self body image. The Draw-a-tree test was significant for anxiety. Group 2 described a good family situation, many friendly relationships. Four patients indicated poor satisfaction with self body image. At CES-D 3 patients were at risk of depression. At BDI test 5 patients presented mild/severe depression. FSFI showed a complete sex life in 5 patients. SDS evidenced satisfactory sexual intercourse in 4 of them. At DAS 6 patients showed a stable relationship. Conclusions All patients described good family and social relationships. Depressive symptoms are widely diffuse in adult patients. In contrast with the current literature most patients of our study population reported a satisfactory sexual activity.

Psychological adjustment of survivors of localised prostate cancer: investigating the role of dyadic adjustment, cognitive appraisal and coping style

The aim of this study was to identify the factors that contribute to psychological adjustment in prostate cancer patients two or more years post-treatment. One hundred and sixty-seven men who had undergone treatment for localised prostate cancer participated in this study. In the sample 63 participants had undergone external beam radiotherapy (EBRT), 55 radical prostatectomy (RP), 27 EBRT plus hormone therapy (EBRT/HT), and the remainder a combination of treatments. Patients completed the UCLA-PCI, the POMS, CISS, DAS and a threat appraisal questionnaire. The majority of patients reported relatively positive adjustment in most domains except sexual functioning. For those who reported ongoing psychological difficulty mood disturbance was associated with sexual bother, dyadic adjustment, threat appraisal, self-efficacy appraisal and emotion-focussed coping. Lower levels of urinary bother were associated with the use of more task-focussed coping. Emotion-focussed coping and threat appraisal mediated the relationship between sexual bother and mood disturbance. Emotion-focussed coping moderated the influence of dyadic adjustment on mood disturbance. Dyadic adjustment, threat appraisal and coping style play a significant role in the long-term psychological adjustment of prostate cancer patients. The results of the current study indicate that the use of emotion-focussed coping to manage sexual bother appears to result in poor psychological adjustment, which indicates the need for further education or intervention to manage sexual dysfunction. ETHICS CLEARANCE: Human ethics approval was granted from Southern Health, Peter MacCallum Cancer Centre and the Monash University Ethics Committee before commencement of data collection.

Long-term psychological adjustment to IVF/ICSI treatment in women

The aim of this study was to gain more insight into long-term psychological adjustment to IVF in women. In a prospective cohort study, 298 women entering their first IVF treatment cycle (including ICSI) completed standardized psychological questionnaires before the start of the treatment, just after the last treatment cycle, and 6 months and 3-5 years after the last treatment cycle. The main outcome measures were state anxiety, depression and mode of adaptation to unsuccessful IVF. Anxiety and depression were found at follow-up to return to baseline levels following treatment not resulting in a live birth, after an initial increase during treatment. On the contrary, treatment resulting in a live birth was found to lead to a more positive long-term emotional status. Women who focused on new life goals as a mode of adaptation 3-5 years after IVF without a live birth showed lower levels of anxiety and depression compared with those who persisted in their attempts to get pregnant. Treatment that resulted in a live birth led to more positive emotional adjustment. In addition, most women who did not give birth to a child after treatment adjusted well psychologically. Positive adjustment was related to developing new life goals rather than persisting in attempts to get pregnant. Helping women to change life goals after abandoning treatment might have beneficial effects on the adaptation process.