Mental Health Outcomes In Patients Research Articles

Optimism, social support, and mental health outcomes in patients with advanced cancer

Optimism and social support serve as protective factors against distress in medically ill patients. Very few studies have specifically explored the ways in which these variables interact to impact quality of life (QOL), particularly among patients with advanced cancer. The present study examined the role of optimism as a moderator of the relationship between social support and anxiety, depression, hopelessness, and QOL among patients with advanced cancer. Participants (N = 168) completed self-report assessments of psychosocial, spiritual, and physical well-being, including social support, optimism, hopelessness, depressive and anxious symptoms, and QOL. Hierarchical multiple regression analyses were conducted to determine the extent to which social support and optimism were associated with depressive and anxious symptomatology, hopelessness and QOL, and the potential role of optimism as a moderator of the relationship between social support and these variables. Higher levels of optimism were significantly associated with fewer anxious and depressive symptoms, less hopelessness, and better QOL. Higher levels of perceived social support were also significantly associated with better QOL. Additionally, optimism moderated the relationship between social support and anxiety, such that there was a strong negative association between social support and anxiety for participants with low optimism. This study highlights the importance of optimism and social support in the QOL of patients with advanced cancer. As such, interventions that attend to patients' expectations for positive experiences and the expansion of social support should be the focus of future clinical and research endeavors.

Design and rationale of a randomized controlled trial to reduce cardiovascular disease risk for patients with bipolar disorder

BackgroundPersons with bipolar disorder (BD) experience a disproportionate burden of medical comorbidity, notably cardiovascular disease (CVD), contributing to decreased function and premature mortality. We describe the design, rationale, and baseline findings for the Self-Management Addressing Heart Risk Trial (SMAHRT), a randomized controlled effectiveness trial of an intervention (Life Goals Collaborative Care; LGCC) designed to reduce CVD risk factors and improve physical and mental health outcomes in patients with BD. MethodsPatients with BD and at least one CVD risk factor were recruited from a VA healthcare system and randomized to either LGCC or usual care (UC). LGCC participants attended four weekly, group-based self-management sessions followed by monthly individual contacts supportive of health behavior change and ongoing medical care management. In contrast, UC participants received monthly wellness newsletters. Physiological and questionnaire assessments measured changes in CVD outcomes and quality of life (QOL) over 24months. ResultsOut of the 180 eligible patients, 134 patients were enrolled (74%) and 118 started the study protocols. At baseline (mean age=54, 17% female, 5% African American) participants had a high burden of clinical risk with nearly 70% reporting at least three CVD risk factors including, smoking (41%) and physical inactivity (57%). Mean mental and physical HRQOL scores were 1.5 SD below SF-12 population averages. ConclusionSMAHRT participants experienced substantial CVD morbidity and risk factors, poor symptom control, and decreased QOL. LGCC is the first integrated intervention for BD designed to mitigate suboptimal health outcomes by combining behavioral medicine and care management strategies.

Predictors of longitudinal substance use and mental health outcomes for patients in two integrated service delivery systems

Aim Individuals who have both substance use disorders and mental health problems have poorer treatment outcomes. This study examines the relationship of service utilization and 12-step participation to outcomes at 1 and 5 years for patients treated in one of two integrated service delivery systems: the Department of Veterans Affairs (VA) system and a health maintenance organization (HMO). Methods Sub-samples from each system were selected using multiple criteria indicating severity of mental health problems at admission to substance use disorder treatment (VA = 401; HMO = 331). Separate and multiple group structural equation model analyses used baseline characteristics, service use, and 12-step participation as predictors of substance use and mental health outcomes at 1 and 5 years following admission. Results Substance use and related problems showed stability across time, however, these relationships were stronger among VA patients. More continuing care substance use outpatient visits were associated with reductions in mental health symptoms in both groups, whereas receipt of outpatient mental health services was associated with more severe psychological symptoms. Participation in 12-step groups had a stronger effect on reducing cocaine use among VA patients, whereas it had a stronger effect on reducing alcohol use among HMO patients. More outpatient psychological services had a stronger effect on reducing alcohol use among HMO patients. Conclusion Common findings across these two systems demonstrate the persistence of substance use and related psychological problems, but also show that continuing care services and participation in 12-step groups are associated with better outcomes in both systems.

Suicidal Ideation in the Palliative Care Patient: Considerations for Health Care Practice

For the clinician who works in a palliative health care setting, the suicidal ideation of palliative care patients is a challenge. How are patients with a life-limiting illness who wish to hasten their death, and who express this suicidal ideation, understood in the context of Palliative Care? The present article is a systematic literature review of published research to determine how this issue has been addressed in palliative care and the implications for social work practice. Because suicidal ideation and depression tend to be undertreated in the medically ill, the article examines whether there may, indeed, be barriers in the psychosocial environment of care for palliative patients. Attention was paid to determine how suicidal ideation has been variously interpreted and whether it has been linked to hopelessness. Of the relevant studies, which were primarily from leading services in the field, there is little evidence of approaches to suicidal ideation in palliative care to improve mental health outcomes for patients.

Effects of Good Versus Bad Mood and Optimistic Versus Pessimistic Outlook on Social Acceptance Versus Rejection

Previous studies show that depressed persons are rejected more than nondepressed. This research examined how two reflections of depression-negative mood and pessimistic outlook-influence social acceptance (willingness to engage in social interaction). Subjects read transcripts of an interview of another college student, then made ratings about this person. In one study, expressed bad mood led to rejection, expressed good mood led to acceptance. When mood was neutral (but not otherwise), statements about outlook also had an influence, with pessimism causing more rejection than optimism. In another study, in which cues of chronicity were removed from the manipulation of mood, mood and outlook had independent effects on acceptance, with that of outlook being stronger than that of mood

Great Expectations: Perceived Social Support in Couples Experiencing Cardiac Surgery

This study compares patient and spousal perceived support during the cardiac surgery recovery period (1 and 3 months after surgery) and explores the effects of social support on patient/spouse subjective mood states. Significant differences in levels of perceived social support were reported by patients and spouses over time. Social support buffered the impact of caregiving burden on mood disturbance for caregiving spouses but did not significantly impact physical or mental health outcomes for patients.