Measures Of Symptom Severity Research Articles

PROGNOSTIC ACKNOWLEDGEMENT IN OLDER ADULT CANCER PATIENTS

Abstract Even with improved prognostic transparency (Chochinov et al., 2000) individuals struggle to acknowledge a serious-terminal prognosis. Patients who acknowledge their condition, however, show less distress and increased end-of-life planning (Ray et al., 2006). Aims were to: (1) examine extent older adults with serious cancer acknowledge their illness, and (2) identify factors predicting acknowledgement. Individuals receiving outpatient palliative care (N=204; Mage=65.78 years; SDage=7.43) completed measures of Symptom Severity, the Patient Dignity Inventory (DPI; Chochinov et al., 2008), and Illness Acknowledgement (i.e., healthy, seriously ill, terminally ill). Participants with Stage 4 cancer were more likely to acknowledge serious or terminal illness than Stage 1-3 patients, X2 (2,181)=12.93, p <.01), though only 31% of Stage 4 patients reported being terminally ill. In addition, ANOVA showed Symptom Severity, F(2, 190) = 9.86, p < .001 differed by level of acknowledgement. Those rating themselves as relatively healthy had less severe symptoms than seriously or terminally ill groups. To further predict acknowledgement, DPI subscales were examined. Dependency predicted acknowledgement of serious-terminal illness (Odds Ratio = .75, p <.05). A final model, controlling for age and education, showed Symptom Severity (OR = 1.03, p <.01) and DPI Dependency (OR = .79, p <.05) predicted acknowledging serious-terminal illness versus lack of acknowledgement. Though often relied on in communicating to patients, cancer stage alone may not help older adults with cancer to acknowledge their prognosis. By identifying influences leading to illness acknowledgement, future research can examine positive and negative outcomes during end-of-life coping.

Efficacy of Hypnosis and Catalepsy Induction in Functional Neurological Disorders.

Patients with Functional Neurological Disorder (FND) experience complex patterns of motor and/or sensory symptoms. Treatment studies of psychological interventions are promising but limited. The aim of the current pilot study is to investigate the effect of treatment consisting of a combination of hypnosis and catalepsy induction on FND symptom severity. A within-subject waiting list-control design was used with 46 patients diagnosed with FND. The treatment consisted of 10 sessions. The primary outcome measure was FND symptom severity (The Psychogenic Movement Disorder Rating Scale; PMDRS). The secondary outcome measures were psychological distress and quality of life. The repeated measures (RM) ANOVA for the PMDRS as outcome measure revealed a significant effect for time with a large effect size (η2 = 0.679). Pairwise comparisons indicated that the effect of time in the treatment period was significant for the measure of FND symptom severity, whereas the waiting list period was not. The effect remained stable even at 8 weeks post treatment. As for the additional measurement, general psychological distress and quality of life, no statistically significant differences between individual time points were found. This pilot study showed that eight sessions of treatment consisting of a combination of hypnosis and catalepsy induction was effective in reducing FND symptom severity. Some explanations and limitations are provided in the paper as well as several avenues of future research.

Impact of text reminders on pneumatic compression device (PCD) compliance in patients with breast cancer-related lymphedema

PurposeDo cell phone text reminders impact the rate of compliance with pneumatic compression device (PCD) therapy among women with breast cancer-related lymphedema (BCRL)?MethodsA prospective, randomized, 2-group feasibility study conducted at 2 centers. Participants were adult females (≥18 years old) with unilateral BCRL who had the capability of receiving reminder text messages. All participants underwent PCD therapy. Participants were randomized 1:1 to control (no text messages) or test group (received text message reminders if the PCD had not been used for 2 consecutive days). The rate of compliance between treatment groups was the main outcome measure. Secondary outcome measures were changes in arm girth, quality of life (QOL), and symptom severity.ResultsTwenty-nine participants were enrolled and randomized, 25 were available for follow-up at 60 days (14 test, 11 control). Overall, 52.2% (12/23) of all participants were completely compliant, an additional 43.5% (10/23) were partially compliant, and 1 patient (4.3%) was noncompliant. The test and control groups did not differ in device compliance. In the pooled population, weight, BMI, and arm girth were improved. Overall disease-specific QOL and symptom severity were improved. Regression analysis showed benefits were greater among participants with higher rates of compliance.ConclusionsAutomated text reminders did not improve compliance in patients with BCRL as compliance rates were already high in this patient population. Improvements in weight, BMI, arm girth, disease-specific quality of life, and symptom severity measures were observed regardless of the treatment assignment. Full compliance resulted in greater functional and QOL benefits.Trial registrationThe study was registered at www.clinicaltrials.gov (NCT04432727) on June 16, 2020.

Treatment of schizophrenia evaluated via the pharmacopsychometric triangle—An integrative approach with emphasis on well-being and functioning

Quantification of treatment response is crucial to optimize outcomes for patients with schizophrenia. In this study, we evaluated the relationship between quantitative measures of clinician-rated symptom severity and self-rated side effects, well-being, and functioning among inpatients with schizophrenia using the six-item version of the Positive and Negative Syndrome Scale (PANSS-6), the Glasgow Antipsychotic Side-effect Scale (GASS), the WHO-Five Well-being Index (WHO-5), and the Sheehan Disability Scale (SDS). All measurements were conducted as close to admission and discharge as possible. Well-being and functioning were found to be most strongly associated with the additive effect of symptoms and side effects, while changes in side effects, well-being, and functioning appeared to be relatively independent from changes in symptom severity. The use of both symptom and side effect measures should inform clinical decision-making in the treatment of schizophrenia, as it has the potential to optimize functioning and well-being.

Risankizumab Induction Therapy Achieves Early Symptom Improvements That Are Associated With Future Clinical and Endoscopic Outcomes in Crohn's Disease: Post Hoc Analysis of the ADVANCE, MOTIVATE, and FORTIFY Phase 3 Studies.

Crohn's disease [CD] symptoms are a main driver for impaired quality of life, and fast relief is important for patient care. Stool frequency [SF] and abdominal pain score [APS] are patient-reported outcomes [PROs] measuring symptom severity, which are supported as treatment targets by the STRIDE-II consensus. This post hoc analysis examined the efficacy of risankizumab [RZB], a humanised monoclonal antibody with high specificity for interleukin-23 p19, for providing early symptom relief, along with the prognostic value of early symptom relief for achieving future clinical and endoscopic endpoints. Individual and combined measures of SF and AP at Weeks 1, 2, and 3 were assessed in patients with moderate to severe CD who received 600 mg intravenous RZB or placebo [PBO] in the ADVANCE or MOTIVATE induction studies. Multivariate logistic regression was used to examine the predictiveness of early symptom improvement for clinical and endoscopic outcomes following RZB induction and maintenance. Higher rates of SF/APS clinical remission and enhanced clinical response were observed as early as Week 1 with RZB vs PBO. A larger proportion of patients achieved clinical endpoints with RZB vs PBO, irrespective of prior bio-failure status. Early PRO improvement was associated with a greater likelihood of achieving clinical and endoscopic improvement following 12-week induction and 52-week maintenance RZB dosing. After the first intravenous RZB induction dose, significantly greater rates of symptom improvement vs PBO were achieved. Improvements could be observed as early as Week 1 and were predictive of Weeks 12 and 52 clinical and endoscopic improvement.

Depression and looming cognitive style: Examining the mediating effect of perceived control

BackgroundIndividuals with a looming cognitive style (LCS) bias display a tendency to interpret threat representations as rapidly approaching and rising in risk. The present study is the first to investigate whether the relationship between LCS and depression is mediated by perceived control (over evading threats). MethodsAfter completing mood questionnaires, participants recorded future-self threats (feared possible selves) and rated their threat representations on a measure of perceived control. LCS was measured using an adapted version of the looming maladaptive style questionnaire. In total 74 participants were recruited through university research participation. ResultsPerceived control was significantly related to depression (r = -.3, p = .011) and LCS (r =-.27, p = .019) but not to anxiety (r =-.14, p = .223). Mediation analyses revealed that control mediated the relationship between depression and LCS, when anxiety was entered as a covariate 95 % CI [.03, .79]. LimitationsThe present study used a measure of symptom severity rather than clinical diagnoses of anxiety and depression. Also, the sample consisted of 81 % female and 100 % university students which limits the generalisability of the findings. Finally, the cross-sectional study design does not imply causation. ConclusionThe present study provided evidence for a potential mechanism through which LCS maintains depression. The analyses have important implications for interventions designed to prevent depression comorbidity. Future studies should apply longitudinal methods to investigate how changes in perceived control influences depression.

A cognitive behavioural group treatment for somatic symptom disorder: a pilot study

BackgroundSomatic symptom disorder (SSD) presents challenges to the healthcare system, including frequent medical visits, lack of symptom relief experienced by individuals with this condition, high associated medical costs, and patient dissatisfaction. This study examined the utility of a novel, low-barrier, brief cognitive behavioural therapy (CBT) group intervention for individuals with SSD.MethodsParticipants were referred by their mental health providers or self-referral. Each participant underwent a telephone screen and in-person psychological and neuropsychological screen. Two cycles of the CBT-based group (n = 30), each consisting of six weekly two-hour sessions, were facilitated at a large outpatient mental healthcare facility in Ontario, Canada. The final sample consisted of 13 individuals of whom 11 completed the treatment. Clinical outcome measures were administered pre-, mid- and post-group, including the Generalized Anxiety Disorder–7, Perceived Stress Scale–4, Pain Self-Efficacy Questionnaire, Pain Disability Index, Revised Illness Perception Questionnaire, and sections of the Patient Health Questionnaire. Six healthcare utilization metrics were collected from electronic medical records at six months pre- and post-group. Paired samples t-tests were used to examine pre- to post-group differences in participants’ somatic symptoms, psychological functioning, health, and degree of healthcare utilization.ResultsWhen comparing pre- and post- group, we observed reductions in the mean scores for somatic symptom severity, depressive symptomatology, anxiety, perceived stress, and perceived disability related to pain. The change in depressive symptomatology yielded a small effect size (d = 0.30). Further, we observed downward trends across participants’ pre- to post-group healthcare utilization, with small effect sizes observed for hospital admission (d = 0.36), days admitted to hospital (d = 0.47), and inpatient consults (d = 0.42). Differences between pre- and post-group measures of somatic symptom severity, psychological functioning, health, or healthcare utilization did not reach significance.ConclusionsCurrent findings provide support for the potential effectiveness of an abbreviated CBT group for individuals with SSD in reducing psychiatric symptomatology. Further research is recommended, including randomized control trials, cost-benefit analyses, and comparisons between abbreviated versus longer-duration treatment programs for SSD.Trial registrationNot applicable.

Validation of the hypoglycemia awareness questionnaire to assess hypoglycemia awareness in patients with type 2 diabetes treated with insulin

AimsGiven the implications of impaired hypoglycemia awareness in patients with type 2 diabetes (T2D), it is necessary to identify reliable and valid instruments for its measurement. The Hypoglycemia Awareness Questionnaire (HypoA-Q) measures impaired awareness, symptom severity, and symptom frequency. The present study evaluated the HypoA-Q validity for assessing awareness of hypoglycemia in patients with T2D treated with insulin. MethodsThe questionnaire was administered to 406 patients diagnosed with T2D on insulin treatment at four centers in Bogotá, Colombia. The internal structure of the questionnaire was analyzed using exploratory and confirmatory factor analyses, internal consistency and test–retest reliability were evaluated, and criterion validity was rated by assessing its correlation with the Clarke scale. ResultsFactor analysis identified an empirical structure of four domains that adequately represented the construct. Cronbach's alpha and McDonald's Omega coefficients yielded values between 0.75 and 0.79 for the impaired awareness scale. Lin and intraclass correlation coefficients were 0.86 and 0.85, respectively. The correlation between the impaired awareness subscale and Clarke scale was 0.654, and differences were found between patients with good and poor awareness of hypoglycemia. ConclusionsThe HypoA-Q is a valid and reliable tool for measuring the awareness of hypoglycemia in patients with T2D who are treated with insulin.

A narrative review of digital biomarkers in the management of major depressive disorder and treatment-resistant forms

IntroductionDepression is the leading cause of worldwide disability, until now only 3% of patients with major depressive disorder (MDD) experiences full recovery or remission. Different studies have tried to better understand MDD pathophysiology and its resistant forms (TRD), focusing on the identification of candidate biomarkers that would be able to reflect the patients’ state and the effects of therapy. Development of digital technologies can generate useful digital biomarkers in a real-world setting. This review aims to focus on the use of digital technologies measuring symptom severity and predicting treatment outcomes for individuals with mood disorders.MethodsTwo databases (PubMed and APA PsycINFO) were searched to retrieve papers published from January 1, 2013, to July 30, 2023, on the use of digital devices in persons with MDD. All papers had to meet specific inclusion criteria, which resulted in the inclusion of 12 articles.ResultsResearch on digital biomarkers confronts four core aspects: (I) predicting diagnostic status, (II) assessing symptom severity and progression, (III) identifying treatment response and (IV) monitoring real-word and ecological validity. Different wearable technologies have been applied to collect physiological, activity/sleep, or subjective data to explore their relationships with depression.DiscussionDepression’s stable rates and high relapse risk necessitate innovative approaches. Wearable devices hold promise for continuous monitoring and data collection in real world setting.ConclusionMore studies are needed to translate these digital biomarkers into actionable interventions to improve depression diagnosis, monitoring and management. Future challenges will be the applications of wearable devices routinely in personalized medicine.

4 TBI and Blast Disrupt Normal Relationships Between Brain Function, Cognitive Performance, and Psychiatric Symptom Severity

Objective:Determine how characteristics of deployment mild traumatic brain injury (TBI) and blast exposure influence the relationship between the functional brain connectome with cognitive outcomes and symptom severity.Participants and Methods:N = 181 Iraq and Afghanistan combat veterans completed structured clinical interviews, cognitive testing, self-report questionnaires, and magnetoencephalography (MEG). MEG data were acquired in the resting-state with eyes open. MEG data were beamformed to identify brain regions active at rest. Functional brain connectomes representing the unique network present for a given individual were created using active brain regions identified for each participant. Network metrics describing these connectomes were calculated at the participant level. Cognitive tests included the WAIS-IV, Trail Making Test Parts A&B, and the Controlled Oral Word Association test. Due to differences in normative data across tests, raw scores were used in analyses. Symptom measures included the PTSD Checklist - 5 (PCL-5), Patient Health Questionnaire (PHQ-9), Neurobehavioral Symptoms Inventory (NSI), Quality of Life After Brain Injury (QOLIBRI), Pittsburgh Sleep Quality Index (PsQi), the Distress Tolerance Scale (DTS), and the PROMIS Pain Interference Scale (PROMIS-PI).Results:Hierarchical linear regression analyses revealed that several network metrics were significantly related to both cognitive outcomes and symptom severity after adjusting for demographic covariates and clinical characteristics.The relationship between Global Efficiency (GE) and cognitive outcomes was moderated by deployment TBI on the WAIS-IV Full Scale Index (FSI), Perceptual Reasoning Index (PRI), and General Ability Index (GAI). In all cases, when deployment TBI was absent, greater GE was associated with poorer cognitive scores. The relationship between GE and symptom severity was moderated by the severity of blast exposure. Greater GE was associated with lower symptom severity at lower blast severities for the PHQ-9 and QOLIBRI A (thinking) and E (negative emotions). Moderation effects were also observed for the PSQI. In the absence of deployment TBI, greater GE was associated with better sleep quality; however, in the presence of deployment TBI, greater GE was associated with poorer sleep quality. Other connectome-outcome relationships were not consistently moderated by Deployment TBI or blast historyConclusions:Results demonstrated relationships between several aspects the functional connectome of the brain with both cognitive outcomes and symptom severity beyond effects of common demographic and clinical variables. Moderation analyses revealed that the relationship between GE of the connectome and outcomes is frequently disrupted by deployment TBI and blast. GE is a measure of the ease of information transfer through the network. These results identified consistent relationships between GE and outcomes in the absence of deployment TBI or blast, but these relationships disappear when deployment TBI or blast are present. Participants in this study were on average 11 years post-TBI or blast exposure, suggesting these are chronic rather than acute effects. GE was significantly correlated with most symptom severity measures as well as the WAIS-IV PRI, GAI, VCI, and FSI. Future efforts to normalize the relationship between GE and outcomes following TBI may improve rehabilitation outcomes and directly affect areas of concern commonly reported by service members following TBI or blast exposure.

Peer support for discharge from inpatient to community mental health care: the ENRICH research programme

Peer support for discharge from inpatient to community mental health care: the ENRICH research programme

The Impact of Intermittent Fasting on Patients With Suspected Gastroesophageal Reflux Disease.

The aim was to investigate the short-term impact of time restricted feeding on patients with suspected gastroesophageal reflux disease (GERD). Lifestyle modifications are often suggested, but the role of diet in GERD is unclear. Intermittent fasting is popular in the media and has demonstrated potential benefits with weight loss and inflammatory conditions as well as alterations in gastrointestinal hormones. Patients who were referred for 96-hour ambulatory wireless pH monitoring off proton pump inhibitor to investigate GERD symptoms were screened for eligibility. Patients were instructed to maintain their baseline diet for the first 2 days of pH monitoring and switch to an intermittent fasting regimen (16 consecutive hour fast and 8h eating window) for the second 2 days. Objective measures of reflux and GERD symptom severity were collected and analyzed. A total of 25 participants were analyzed. 9/25 (36%) fully adhered to the intermittent fasting regimen, with 21/25 (84%) demonstrating at least partial compliance. Mean acid exposure time on fasting days was 3.5% versus 4.3% on nonfasting days. Intermittent fasting was associated with a 0.64 reduction in acid exposure time (95% CI: -2.32, 1.05). There was a reduction in GERD symptom scores of heartburn and regurgitation during periods of intermittent fasting (14.3 vs. 9.9; difference of -4.46, 95% CI: -7.6,-1.32). Initial adherence to time restricted eating may be difficult for patients. There is weak statistical evidence to suggest that intermittent fasting mildly reduces acid exposure. Our data show that short-term intermittent fasting improves symptoms of both regurgitation and heartburn.

Associations between sleep problems and posttraumatic stress symptoms, social functioning, and quality of life in refugees with posttraumatic stress disorder.

Many patients with posttraumatic stress disorder (PTSD) suffer from sleep problems, leading to impairments in social functioning and quality of life. Refugees are at high risk for sleep problems due to stressful life circumstances and a high PTSD prevalence. However, limited data on the frequency of sleep problems in refugees with diagnosed PTSD exist. This study examined the frequency of sleep problems in refugees with PTSD and their associations with symptoms of PTSD. Additionally, we investigated the contribution of sleep problems to social functioning and quality of life. Participants (N = 70) were refugees from different countries of origin currently living in Germany. All participants met the criteria for PTSD and completed measures of PTSD symptom severity, subjective sleep problems, social impairment, and quality of life. There was a very high frequency of sleep problems in the sample (100%), and sleep problems were significantly associated with both clinician-rated, r = .47, and self-rated, r = .30, PTSD symptom severity after controlling for overlapping items. Contrary to expectations, sleep problems did not predict social impairment, d = 0.16, nor quality of life, d = 0.13, beyond the effect of other PTSD symptoms. The findings highlight the widespread frequency of sleep problems among refugees. Future studies should assess the causal nature of the association between sleep problems and measures of psychosocial functioning in more detail and examine its dynamic change over time.

Evaluating the Appropriateness of Existing Health-Related Quality of Life Measures in Lichen Planus.

Lichen planus (LP) is an inflammatory skin disorder that can present in various forms across the body, including lesions on the skin (cutaneous LP [CLP]), scalp (lichen planopilaris [LPP]) and mucosal regions (mucosal LP [MLP]). Several existing patient-reported outcome measures (PROMs) were identified for potential use in LP clinical development programs. This study aimed to assess the content validity and psychometric measurement properties of the Dermatology Life Quality Index (DLQI), Epworth Sleepiness Scale (ESS), Scalpdex and Oral Lichen Planus Symptom Severity Measure (OLPSSM) in an LP population. Patients completed the PROs at various time points as part of an international Phase 2 clinical study in adults with MLP (n = 37), LPP (n = 37) and CLP (n = 37). Test-retest reliability, construct validity and sensitivity to change were assessed. In addition, qualitative cognitive debriefing interviews were conducted with adults with MLP (n = 20), LPP (n = 19) and CLP (n = 19) in the USA and Germany to examine the PROM content validity. The DLQI demonstrated adequate reliability and validity, although its ability to detect change was modest and most items were considered not relevant in qualitative interviews. The ESS had good reliability but limited evidence of validity and ability to detect change. Conceptual relevance varied according to the qualitative interview data. The Scalpdex was miscellaneous across domains, but the 'Symptoms' domain performed well overall. Overall, Scalpdex concepts were reported as relevant by most LPP patients interviewed. The OLPSSM demonstrated good psychometric properties and strong evidence of content validity. The psychometric and qualitative findings support the use of the OLPSSM and Scalpdex within specific LP subtypes but cautioned use of the DLQI. Administration of the ESS is not recommended in LP because of its poor psychometric performance. Given these limitations, further validation of non-specific disease measures is needed and/or the development of additional LP-specific PROMs. NCT04300296.

Self-Management in Allergic Rhinitis: Strategies, Outcomes and Integration into Clinical Care.

Allergic rhinitis (AR) is a common disease, characterized by typical symptoms and type 2 inflammation. Standard treatment is usually effective and safe, and most medications are available as over-the-counter (OTC). Therefore, AR patients, mostly at the AR onset or if symptoms are mild, prefer to manage symptoms themselves. However, self-management could be associated with problems, including inadequate control or medication abuse. Therefore, this paper aimed at presenting and discussing this issue. Ideally, self-management should be conducted under medical supervision. In this regard, telemedicine could represent a valuable tool for implementing self-management. Visual analog scale (VAS) is a perfect parameter to measure symptom severity, medications use, and AR control. In addition, VAS is easily monitored over time. Presently, a mobile application allows to AR patients of self-managing themselves. Therefore, mobile healthcare may supply fundamental support in communication and decision-making. In this regard, VAS represents the best tool to monitor symptoms' severity and control over time. Finally, pharmacological and non-pharmacological remedies are numerous and effective but should be used wisely.

Genetic bases of resistance to the rice hoja blanca disease deciphered by a quantitative trait locus approach.

Rice hoja blanca (RHB) is one of the most serious diseases in rice-growing areas in tropical Americas. Its causal agent is RHB virus (RHBV), transmitted by the planthopper Tagosodes orizicolus Müir. Genetic resistance is the most effective and environment-friendly way of controlling the disease. So far, only 1 major quantitative trait locus (QTL) of Oryza sativa ssp. japonica origin, qHBV4.1, that alters the incidence of the virus symptoms in 2 Colombian cultivars has been reported. This resistance has already started to be broken, stressing the urgent need for diversifying the resistance sources. In the present study, we performed a search for new QTLs of O. sativa indica origin associated with RHB resistance. We used 4 F2:3-segregating populations derived from indica-resistant varieties crossed with a highly susceptible japonica pivot parent. Besides the standard method for measuring disease incidence, we developed a new method based on computer-assisted image processing to determine the affected leaf area (ALA) as a measure of symptom severity. Based on the disease severity and incidence scores in the F3 families under greenhouse conditions and SNP genotyping of the F2 individuals, we identified 4 new indica QTLs for RHB resistance on rice chromosomes 4, 6, and 11, namely, qHBV4.2WAS208, qHBV6.1PTB25, qHBV11.1, and qHBV11.2, respectively. We also confirmed the wide-range action of qHBV4.1. Among the 5 QTLs, qHBV4.1 and qHBV11.1 had the largest effects on incidence and severity, respectively. These results provide a more complete understanding of the genetic bases of RHBV resistance in the cultivated rice gene pool and can be used to develop marker-aided breeding strategies to improve RHB resistance. The power of joint- and meta-analyses allowed precise mapping and candidate gene identification, providing the basis for positional cloning of the 2 major QTLs qHBV4.1 and qHBV11.1.

The lived experience of major and treatment-resistant depression in England: a mixed-methods study

IntroductionMajor depressive disorder (MDD) is a common, frequently recurrent condition associated with decreased well-being and increased healthcare-related costs. Mixed-methods research provides multiple ways of illustrating the phenomenon to better understand patient experience, including where treatment is not working, referred to here as treatment-resistant depression (TRD). MethodsA mixed-methods study investigated the experiences of people with symptomatic MDD, symptomatic TRD or TRD in remission, surveying 148 adults recruited from English clinical sites to measure symptom severity (Patient Health Questionnaire-9 [PHQ-9]), HRQoL (EQ-5D-5L/World Health Organisation Brief Assessment of QoL [WHOQOL-BREF]) and work productivity/activity impairment (WPAI:D). Interviews with 26 survey respondents were analysed thematically. Integrated datasets explored areas of convergence and divergence, with concepts mapped against the EQ-5D-5L. ResultsQualitative data explained low WHOQOL-BREF domain scores and the interrelation of psychological, emotional, cognitive and physical difficulties. Tiredness, lack of energy and motivation impacted daily activities, socialising and career goals. Low work performance scores were explained by poor concentration, decision-making and motivation. Participants also described the influence of social support and housing insecurity. Only 19 % of HRQoL qualitative codes mapped to the EQ-5D-5L. Themes dominant in patients with TRD were inability to cope, self-care challenges, dissatisfaction with mental health services and treatment pessimism. LimitationsLimited data collected on people with TRD in remission. ConclusionsThe EQ-5D-5L and WPAI:D likely underestimate how depression impacts the HRQoL and work of people with MDD or TRD. Qualitative data suggest increased distress for people with TRD compared to those with MDD. Clinical management and treatment access decisions should consider the broader impacts of depression and environmental factors affecting the patient's experience.

Differences in Symptom Severity and Quality of Life among Patients with Cancer Using Conventional Therapies with/without Herbal Medicines in Uganda: A Cross-Sectional Study.

Patients with cancer experience numerous symptoms related to cancer and treatment side effects that reduce their quality of life (QOL). Although herbal medicine (HM) is used to manage such symptoms by patients in sub-Saharan Africa, data on patients' perceived clinical outcomes are limited. We compared differences in QOL and symptom severity between patients with cancer using HM plus conventional therapies (i.e., chemotherapy, hormonal therapy, radiotherapy, surgery) and those using conventional therapies alone. This cross-sectional study included patients with cancer aged >18 years who were consecutively sampled and completed a researcher-administered questionnaire between December 2022 and January 2023. Specifically, data was collected using The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and the MD Anderson Symptom Inventory for Traditional Chinese Medicine (MDASI-TCM). Data were analyzed using descriptive statistics and chi-square and logistic regression analyses. Of 400 participants (67.5% female), 49% (n=195) used HM plus conventional therapies and 51% (n=205) used conventional therapies alone. Most participants were aged >38 years (73.3%; median age 47 years). A univariate analysis showed the HM plus conventional therapies group had better mean scores for most QOL and symptom severity measures than the conventional therapies alone group. However, only role functioning significantly differed (p=0.046) in the bivariate analysis. There were no statistically significant differences between the two groups after confounder adjustment for all others measures of symptom severity and QOL. HM plus conventional therapies may offer minimal benefits or differences for clinical outcomes among patients with cancer. However, our findings have clinical, research, and public health implications for Uganda and other sub-Saharan African settings.

Higher baseline emotion dysregulation predicts treatment dropout in outpatients with borderline personality disorder.

Treatment dropout is high among outpatients with borderline personality disorder (BPD) and is associated with myriad negative therapeutic and psychosocial outcomes. Identifying predictors of treatment dropout can inform treatment provision for this population. The present study investigated whether symptom profiles of static and dynamic factors could predict treatment dropout. Treatment-seeking outpatients with BPD (N = 102) completed pre-treatment measures of BPD symptom severity, emotion dysregulation, impulsivity, motivation, self-harm, and attachment style to determine their collective impact on dropout prior to 6 months of treatment. Discriminant function analysis was used to classify group membership (treatment dropout vs. nondropout) but did not produce a statistically significant function. Groups were distinguished by baseline levels of emotion dysregulation with higher dysregulation predicting premature treatment dropout. Clinicians working with outpatients with BPD might benefit from optimizing emotion regulation and distress tolerance strategies earlier in treatment to reduce premature dropout. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Using adaptive behavior scores to convey level of functioning in children with autism spectrum disorder: Evidence from the Study to Explore Early Development.

Autistic people are often described as "low-" or "high-functioning" based on their scores on cognitive tests. These terms are common in publications and in everyday communication. However, recent research and feedback from the autistic community suggests that relying on cognitive ability alone to describe functioning may miss meaningful differences in the abilities of autistic children and adults and in the kinds of support they may need. Additional methods are needed to describe "functioning" in autistic children. We examined whether scores from a test measuring adaptive behaviors would provide information on the functional abilities of children with autism that is different from cognitive ability and autism symptom severity. Adaptive behaviors include age-appropriate skills that allow people to function in their everyday lives and social interactions. We found that a large amount of the variation in adaptive behavior scores was not explained by cognitive development, autism symptom severity, and behavioral and emotional problems. In addition, there was a wide range of adaptive ability levels in children with autism in our study, including in those with low, average, or high cognitive scores. Our results suggest that adaptive behavior scores could provide useful information about the strengths and support needs of autistic children above and beyond measures of cognitive ability and autism symptom severity. Adaptive behavior scores provide important information on the needs of autistic people.