Multivariable Mediation Analyses Research Articles

The Contribution of Physician-System Integrating Structure to Select Health System Outcomes.

Physician groups are increasingly being vertically integrated with hospitals and health systems; yet, the evidence on the impact of physician-system integration on health system outcomes is mixed. The objective of this study was to examine the impact of increased physician-system integration on select health system outcomes. We used a mixed-methods approach: (1) a fixed-effects multivariate mediation analysis; and (2) a qualitative analysis of interviews with health executives (n = 25). Our findings showed that hospitals spent $633 375.22 to $827 110.24 for each "level" increase in integration. This relationship was attenuated, however, by the presence of care coordination mechanisms.

Willingness to use PrEP among female university students in Lesotho.

Oral pre-exposure prophylaxis (PrEP) for HIV-negative individuals at high risk was introduced in Lesotho in April 2016. To assess the feasibility and acceptability of PrEP in Lesotho and to study the attitudes and beliefs around HIV risk and prevention measures among young women, between September and December 2016 we asked 302 female university students at fourteen higher education institutions in Lesotho about their sexual behavior, experiences of sexual coercion and abuse, HIV risk perception, willingness to use PrEP, as well as their attitudes toward condom use and self-administration of daily medications. Overall, 57.3% of the sample reported perceiving themselves at risk of acquiring HIV and 32.1% reported being strongly willing to use PrEP if it were available in their community. In a multivariate mediation analysis, perceived HIV risk was associated with 11.5 percentage points increase in likelihood of using PrEP (p = 0.041). Multiple concurrent sexual partnership was associated with 16.1 percentage points increase in likelihood of self-perceived HIV risk (p = 0.007), while having sexual partners in polygamous relationships was associated with 17.8 percentage points increase in likelihood of self-perceived HIV risk (p = 0.002) and the mediated indirect effect accounted for 18.2% of its total effect. Those who reported strong adherence to antibiotics were 23.1 percentage points more likely to express willingness to use PrEP than those who did not (p = 0.004), and those who reported to dislike condoms were 19.1 percentage points more likely to be willing to use PrEP than those who did not report aversion to condom use: these effect were direct and not mediated by HIV risk perception. Intimate partner violence (IPV) in the network of peers was also directly associated with willingness to use PrEP and its effect was not significantly mediated by HIV risk perception: those who had friends who experienced intimate partner violence were 14.9 percentage points more likely to be willing to use PrEP than those who did not report IPV in their network of peers (p = 0.009). These findings support the inclusion of individuals with multiple concurrent sexual partners among the key populations for PrEP provision and confirm that willingness to use PrEP is not solely driven by HIV risk perception. They also indicate that the presence of IPV in peer networks is related to one’s willingness to use PrEP. PrEP service provision may generate synergies with IPV prevention programs when offered within this framework.

Cervicovaginal microbiome and natural history of HPVin a longitudinal study.

BackgroundHuman papillomavirus (HPV) infection is one of the most common sexually transmitted infections. However, only a small percentage of high-risk (HR) HPV infections progress to cervical precancer and cancer. In this study, we investigated the role of the cervicovaginal microbiome (CVM) in the natural history of HR-HPV.MethodsThis study was nested within the placebo arm of the Costa Rica HPV Vaccine Trial that included women aged 18–25 years of age. Cervical samples from two visits of women with an incident HR-HPV infection (n = 273 women) were used to evaluate the prospective role of the CVM on the natural history of HR-HPV. We focus specifically on infection clearance, persistence, and progression to cervical intraepithelial neoplasia grade 2 and 3 (CIN2+). The CVM was characterized by amplification and sequencing the bacterial 16S V4 rRNA gene region and the fungal ITS1 region using an Illumina MiSeq platform. OTU clustering was performed using QIIME2. Functional groups were imputed using PICRUSt and statistical analyses were performed using R.ResultsAt Visit 1 (V1) abundance of Lactobacillus iners was associated with clearance of incident HR-HPV infections (Linear Discriminant Analysis (LDA)>4.0), whereas V1 Gardnerella was the dominant biomarker for HR-HPV progression (LDA>4.0). At visit 2 (V2), increased microbial Shannon diversity was significantly associated with progression to CIN2+ (p = 0.027). Multivariate mediation analysis revealed that the positive association of V1 Gardnerella with CIN2+ progression was due to the increased cervicovaginal diversity at V2 (p = 0.040). A full multivariate model of key components of the CVM showed significant protective effects via V1 genus Lactobacillus, OR = 0.41 (0.22–0.79), V1 fungal diversity, OR = 0.90 (0.82–1.00) and V1 functional Cell Motility pathway, OR = 0.75 (0.62–0.92), whereas V2 bacterial diversity, OR = 1.19 (1.03–1.38) was shown to be predictive of progression to CIN2+.ConclusionThis study demonstrates that features of the cervicovaginal microbiome are associated with HR-HPV progression in a prospective longitudinal cohort. The analyses indicated that the association of Gardnerella and progression to CIN2+ may actually be mediated by subsequent elevation of microbial diversity. Identified features of the microbiome associated with HR-HPV progression may be targets for therapeutic manipulation to prevent CIN2+.Trial registrationClinicalTrials.gov NCT00128661.

Abstract 41: The Effect Of Maternal Weight On Offspring Blood Pressure At 18 Years Of Age: A Causal Natural-effects Mediation Analysis

Objectives: Examine the relationship between maternal pre-pregnancy body mass index (BMI) and offspring systolic blood pressure (SBP) at 18 yrs old. Methods: We performed multivariate regression and causal mediation analysis within 3700 mother - offspring pairs from a prospective birth cohort. The main exposure was maternal pre-pregnancy BMI categorized as healthy weight, overweight, or obese according to international criteria. The main outcomes were high-normal BP and hypertension defined as SBP between the 90-95 th centile and >95 th centile for height and sex at 18 years, respectively, as per 2017 AAP guidelines. Analyses were adjusted for social class, pre-eclampsia, sex, and maternal tobacco use during pregnancy. The Canadian Pediatric Endocrine Group R Shiny app was used to obtain age-standardized BMI Z-scores and latent class analysis (LCA) was used to quantify the mediating factor of offspring BMIZ trajectories from 7 to 18 yrs. Results: Before pregnancy 14% of women were overweight and 5% were obese. At 18 yrs, SBP (122 ± 12 vs 118 ±11mmHg, p < 0.001), DBP (67 ± 7 vs 63 ± 6mmHg, p < 0.001) and the odds of elevated BP (aOR: 1.6; 95% CI: 1.1-2.3) and hypertension (aOR: 2.1; 95% CI: 1.4-3.1) were higher in offspring from women that were obese prior to pregnancy compared to those that were normal weight. LCA identified five distinct offspring BMIZ trajectories shown in the figure. SBP (125 ± 12 vs 117 ± 10 mmHg, p < 0.001) and the odds of hypertension (aOR: 3.8; 95% CI: 2.8-5.1) at 18 years were significantly higher in offspring with sustained high BMIZ (teal) compared to sustained low normal BMIZ (green). Casual mediation analysis revealed that maternal BMI directly (OR: 1.14; 95% CI: 1.03-1.25) and indirectly through offspring BMIZ trajectories (OR: 1.12; 95% CI: 1.08-1.15) increased offspring SBP at 18 years of age. Conclusion: Maternal obesity prior to pregnancy is associated with an increased risk of hypertension in offspring at 18 yrs of age, partly mediated by an elevated BMIZ score trajectory throughout childhood and adolescence.

Effect of Charitable Behavior on Life Satisfaction: a Parallel Multivariable Mediation Model

We aimed to determine how charitable behavior affects life satisfaction through the multiple mediating roles of self-acceptance and positive affect. We recruited 4,048 adults in China who voluntarily completed a survey on the frequency of their charitable behavior, self-acceptance, positive affect, and life satisfaction. Results of a parallel multivariable mediation analysis showed that more frequent charitable behavior was positively associated with greater life satisfaction. Also, self-acceptance and positive affect mediated the relationship between charitable behavior and life satisfaction. Implications for the mediating effect of charitable behavior on life satisfaction are discussed.

Functional limitations and employment among disability benefit recipients with musculoskeletal conditions: A mediation analysis

This paper uses the National Beneficiary Survey to study the relationship between functional limitations, health conditions and employment among disability beneficiaries with musculoskeletal conditions in a multivariate mediation analysis.

Childhood abuse and late-life depression: Mediating effects of psychosocial factors for early- and late-onset depression.

Childhood abuse makes people vulnerable to developing depression, even in late life. Psychosocial factors that are common in late life, such as loneliness or lack of a partner, may explain this association. Our aim was to investigate whether the association between childhood abuse and depression in older adults can be explained by psychosocial factors. Cross-sectional data were derived from the Netherlands Study of Depression in Older Persons (aged 60-93), including 132 without lifetime depression, 242 persons with an early-onset depression (<60years), and 125 with a late-onset (≥60years) depression. Childhood abuse (yes/no) and a frequency-based childhood abuse index were included. Multinomial regression and multivariable mediation analyses were used to examine the association between childhood abuse and the onset of depression, and the influence of loneliness, social network, and partner status. Multinomial regression analyses showed a significant association between childhood abuse and the childhood abuse index with early- and late-onset depression. Multivariable mediation analyses showed that the association between childhood abuse and early-onset depression was partly mediated by social network size and loneliness. This was particularly present for emotional neglect and psychological abuse, but not for physical and sexual abuse. No psychosocial mediators were found for the association between childhood abuse and late-onset depression. A smaller social network and feelings of loneliness mediate the association between childhood abuse and early-onset depression in older adults. Our findings show the importance of detecting childhood abuse as well as the age at depression onset and mapping of relevant psychosocial factors in the treatment of late-life depression.

Short sleep duration as a contributor to racial disparities in breast cancer tumor grade

Although African Americans (AAs) are less likely to get breast cancer than European Americans (EAs), they get more aggressive forms. We previously showed that short sleep is associated with higher tumor grade. It is well documented that AAs get less sleep, on average, than EAs. We studied the contribution of short sleep to racial disparities in breast cancer aggressiveness among 809 invasive breast cancer patients who responded to a survey on their lifestyle. Multivariable regressions and mediation analyses were performed to assess the effect of sleep duration on the association of race with tumor grade. AAs reported shorter average sleep (mean [standard deviation] 6.57 [1.47] h) than EAs (mean [standard deviation] 7.11 [1.16] h; P

Exploring racial disparity in obesity: A mediation analysis considering geo-coded environmental factors

Research shows aconsistent racial disparity in obesity between white and black adults in the United States. Accounting for the disparity is a challenge given the variety of the contributing factors, the nature of the association, and the multilevel relationships among the factors. We used the multivariable mediation analysis (MMA) method to explore the racial disparity in obesity considering not only the individual behavior but also geospatially derived environmental risk factors. Results from generalized linear models (GLM) were compared with those from multiple additive regression trees (MART) which allow for hierarchical data structure, and fitting of nonlinear and complex interactive relationships. As results, both individual and geographically defined factors contributed to the racial disparity in obesity. MART performed better than GLM models in that MART explained a larger proportion of the racial disparity in obesity. However, there remained disparities that cannot be explained by factors collected in this study.

Childhood Abuse and the Two-Year Course of Late-Life Depression

Late-life depression often has a chronic course, with debilitating effects on functioning and quality of life; there is still no consensus on important risk factors explaining this chronicity. Cross-sectional studies have shown that childhood abuse is associated with late-life depression, and in longitudinal studies with chronicity of depression in younger adults. We aim to investigate the impact of childhood abuse on the course of late-life depression. Two-year longitudinal cohort study. Data were derived from the Netherlands Study of Depression in Older Persons (NESDO). 282 participants with a depression diagnosis in the previous 6 months (mean age: 70.6 years), of whom 152 (53.9%) experienced childhood abuse. Presence of childhood abuse (yes/no) and a frequency-based childhood abuse index (CAI) were calculated. Dependent variable was depression diagnosis after 2 years. Multivariable mediation analysis showed an association between childhood abuse and depression diagnosis at follow-up. Depression severity, age at onset, neuroticism, and number of chronic diseases were important mediating variables of this association, which then lost statistical significance. For childhood abuse (yes/no), loneliness was an additional, significant mediator. Depression severity was the main mediating variable, reducing the direct effect by 26.5% to 33.3% depending on the definition of abuse (respectively, 'yes/no" abuse and CAI). More depressive symptoms at baseline, lower age at depression onset, higher levels of neuroticism and loneliness, and more chronic diseases explain a poor course of depression in older adults who reported childhood abuse. When treating late-life depression it is important to detect childhood abuse and consider these mediating variables.

Effects of gender stereotypes on performance in mathematics: A serial multivariable mediation model

We aimed to determine how gender stereotypes about mathematics affect high school students' performance in this subject through examining the multiple mediating roles of competence belief, type of achievement goal, and effort. Chinese high school students (N = 267) completed measures to assess their gender stereotypes, competence belief, achievement goals, effort, and performance in mathematics. The results of a serial multivariable mediation analysis partly supported the idea that competence belief, achievement goals, and effort act as mediators in the relationship between gender stereotypes and mathematics performance. Specifically, gender stereotypes about mathematics had a negative direct and indirect effect on Chinese female students' mathematics performance: the girls with a stronger gender stereotype were serially associated with less competence belief, lower performance-approach goals, and less effort, all of which, in turn, were associated with poorer performance in mathematics. However, gender stereotypes about mathematics did not predict the level of Chinese male students' performance at mathematics. The theoretical and practical implications of these findings are discussed.

Structure and function of social networks, loneliness, and their association with mental disorders among older men and women in Ireland: A prospective community-based study

IntroductionInterpersonal stressors and social isolation are detrimental for emotional health, but how these factors are related to loneliness and altogether influence risk for mental disorders is not well understood.ObjectivesTo examine the mediating role of loneliness in the associations of relationship quality and social networks with depressive symptoms, anxiety, and worry among a sample of Irish men and women in late-life.AimsTo determine the gender-specific risk for mental disorder associated with poor social relationships and loneliness among older adults.MethodsData came from the Irish Longitudinal Study on Ageing (TILDA). Nationally representative data on 6105 community-dwelling adults aged &gt; 50 years were analyzed. Follow-up data was obtained two years after cohort inception. Multivariable linear regressions and mediation analyses were used to assess the associations. Analyses were stratified by gender.ResultsBetter spousal relationship quality was protective against depressive symptoms and worry for men. For both genders, support from friends was protective against depressive symptoms, and better relationship quality with children was protective against depressive symptoms and worry. Social network integration was inversely related to depressive symptoms for men. Loneliness significantly mediated most associations (Tables 1–3).ConclusionsHigh quality spousal relationships and social integration appear to play a more central role for mental health among men than for women. For both genders, poor social relationships increase feelings of loneliness, which in turn worsens mental health. Interventions to improve relationship quality and social networks, with a focus on reducing loneliness, may be beneficial for the prevention of mental disorders among older adults.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Health changes of refugees from Afghanistan, Iran and Somalia: the role of residence status and experienced living difficulties in the resettlement process.

Worldwide, refugees show a poorer mental and physical health than the populations among which they resettle. Little is known about the factors influencing health after resettlement. We examined the development of mental and physical health of refugees. As experienced living difficulties might decrease with obtaining a residence permit, we expected this to play a central role in health improvement after resettlement. A two-wave study conducted in the Netherlands among a cohort of 172 recent (n = 68) and longstanding (n = 104) permit holders from Afghanistan, Iran and Somalia between 2003 and 2011. Multivariate mediation analyses were conducted for the effect of changes in living difficulties on the association between change in status and changes in health. Health outcomes were self-reported general health, number of chronic conditions, PTSD and anxiety/depression. Recent permit holders had larger decreases in PTSD score (-0.402, CI -0.612; -0.192) and anxiety/depression score (-0.298, CI -0.464; -0.132), and larger improvements in self-rated general health between T1 and T2 (0.566, CI 0.183; 0.949) than longstanding permit holders. This association was not significant for changes in number of chronic conditions. Mediation analyses showed that the effect of getting a residence permit on health improvements transited through an improvement in living conditions, in particular employment and the presence of family/social support. These results suggest that change in residence permit is beneficial for health mainly because of the change in living difficulties. These results add up to the evidence on the role of social circumstances for refugees upon resettlement, and point at labour participation and social support as key mechanisms for health improvements.

Depression, adherence and attrition from care in HIV-infected adults receiving antiretroviral therapy

BackgroundA better understanding of the relationship between depression and HIV-related outcomes, particularly as it relates to adherence to treatment, is critical to guide effective support and treatment of individuals with...

Attention Deficit Hyperactivity Disorder and Personality Characteristics in Older Adults in the General Dutch Population

The authors wanted to examine the association between attention deficit hyperactivity disorder (ADHD) and personality characteristics and the potential mediating role of these characteristics in the relationship between ADHD and depression in older adults in the general Dutch population. Data from the Longitudinal Aging Study Amsterdam in 2008/2009 were used in a cross-sectional design on 231 participants with and without ADHD aged 60-94 years. Questionnaires assessing self-esteem, self-efficacy, mastery, neuroticism, and social inadequacy were administered. ADHD was measured by means of ADHD diagnosis and level of ADHD symptoms. Linear regression analyses were performed to assess the association between ADHD (symptoms) and personality characteristics. Single and multivariate mediation analyses were performed to examine the mediating role of personality characteristics in the relationship between ADHD (symptoms) and depressive symptoms. ADHD was significantly negatively associated with sense of mastery (B=-2.44, t=-3.14, df= 228, p= 0.002), self-esteem (B=-1.16, t=-2.27, df=228, p= 0.02), and self-efficacy (B=-2.33, t=-2.02, df= 228, p= 0.045) and positively associated with neuroticism (B= 0.99, t= 4.90, df= 228, p<0.001) and social inadequacy (B= 0.65, t= 3.32, df= 229, p= 0.001). In the single mediation analyses, all personality characteristics were mediators in the relationship between ADHD symptoms and depressive symptoms. In the multivariate analysis only mastery and self-esteem were mediators. Older adults with ADHD reported lower self-esteem and sense of mastery and higher levels of neuroticism and social inadequacy than older adults without ADHD. Mastery and self-esteem partly explained the association between ADHD and depressive symptoms in old age. The results implicate that in treatment clinicians should pay attention to the personality characteristics of older adults with ADHD.

Racial identity mediates the association between ethnic-racial socialization and depressive symptoms.

Ethnic-racial socialization has been positively linked with psychological adjustment; however, the mechanisms underlying this association remain unclear. In this study, the authors examined the mediating role of racial identity in the association between racial socialization and depressive symptoms. Participants were 211 African American young adults (62% female; mean age = 20.73, SD = 1.90) recruited from a predominately White southeastern university. Multivariate mediation analyses revealed an indirect effect of racial pride messages on depressive symptoms through private regard such that individuals who reported receiving more frequent racial pride messages were more likely to feel positively about their race, and, in turn, less likely to report depressive symptoms. Individuals who reported that their parents engaged in more socialization activities (e.g., attending cultural events) were also more likely to feel positively about their race and, in turn, report fewer depressive symptoms. These results suggest that positive feelings about one's race are important considerations in our understanding of the relation between ethnic-racial socialization and youth psychological adjustment.

870 WHAT HELPS AND WHY? PREDICTING PATIENT OUTCOMES IN INTERSTITIAL CYSTITIS/BLADDER PAIN SYNDROME (IC/BPS) WITH PAIN APPRAISALS AND BEHAVIOURAL COPING STRATEGIES

You have accessJournal of UrologyInfections/Inflammation of the Genitourinary Tract: Interstitial Cystitis1 Apr 2013870 WHAT HELPS AND WHY? PREDICTING PATIENT OUTCOMES IN INTERSTITIAL CYSTITIS/BLADDER PAIN SYNDROME (IC/BPS) WITH PAIN APPRAISALS AND BEHAVIOURAL COPING STRATEGIES Dean A. Tripp, J. Curtis Nickel, Jillian Mulroy, Laura Katz, Michel Pontari, Robert Moldwin, Mayer Robert, Lesley Carr, Ragi Doggweiler, Claire Yang, Nagendra Mishra, and Jorgen Nordling Dean A. TrippDean A. Tripp Kingston, Canada More articles by this author , J. Curtis NickelJ. Curtis Nickel Kingston, Canada More articles by this author , Jillian MulroyJillian Mulroy Kingston, Canada More articles by this author , Laura KatzLaura Katz Kingston, Canada More articles by this author , Michel PontariMichel Pontari Philadelphia, PA More articles by this author , Robert MoldwinRobert Moldwin New York, NY More articles by this author , Mayer RobertMayer Robert Rochester, NY More articles by this author , Lesley CarrLesley Carr Toronto, Canada More articles by this author , Ragi DoggweilerRagi Doggweiler Knoxville, TN More articles by this author , Claire YangClaire Yang Seattle, WA More articles by this author , Nagendra MishraNagendra Mishra Ahmedabad, India More articles by this author , and Jorgen NordlingJorgen Nordling Herlev, Denmark More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.439AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES IC/BPS is a chronic pelvic pain syndrome. Our previous IC/BPS analysis correlated pain, quality of life (QoL), and psychosocial adjustments with other associated conditions[1], and catastrophizing and behavioural coping strategies (sedentary resting in reaction to pain) have been found to predict pelvic pain outcomes for men and women.[2-5] However, no study has examined a comprehensive list of pain appraisal and behavioural coping strategies as mechanisms in the relationship between pain and QoL in these patients. From a self-regulation perspective, appraisals and coping responses of patients suffering from IC/BPS are important in advancing patient management. METHODS Female patients with IC/BPS (n=190) were recruited from tertiary care urology clinics and completed questionnaires (demographics, O'Leary Sant, McGill Pain Questionnaire, SF12, Chronic Pain Coping Inventory, Pain Catastrophizing Scale). The data was examined for univariate and multivariate normality, and a missing values analysis was conducted. Associations of validated pain appraisals (e.g., catastrophizing) and behavioural coping strategies (e.g., illness focused coping) with outcomes of pain and QoL in IC/BPS were examined. Factor reduction was conducted and resulting variables were input into multivariable mediation models. RESULTS Patients ranged in age from 21-89 years (M=49.8, SD=14.83), were predominantly White (93.7%), with the majority (73%) in a relationship (married or living with partner). Factor analytic analyses revealed a 4-factor solution for these variables (catastrophizing, illness-focused behavioural coping, cognitive coping, and depression), which were used for subsequent mediation analyses. Multivariable mediation analyses for mental QoL showed catastrophizing (P<.0001) was a full and unique mediator of the effect of pain on mental QoL. For physical QoL, illness-focused behavioural coping (i.e., rest/avoidance, seeking assistance)(P<.0001) was a partial and unique mediator between patient pain and physical QoL. CONCLUSIONS These results suggest that catastrophic appraisals and illness-focused behavioural coping act as mechanisms driving the negative association between pain and QoL indices. In fact, the catastrophizing mediation effect supports the hypothesis that symptoms may become mentally disabling through the cognitive mechanisms. These results further support an expanding science emphasizing the importance of biopsychosocial pain/QoL models in Urology. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e359 Peer Review Report Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Dean A. Tripp Kingston, Canada More articles by this author J. Curtis Nickel Kingston, Canada More articles by this author Jillian Mulroy Kingston, Canada More articles by this author Laura Katz Kingston, Canada More articles by this author Michel Pontari Philadelphia, PA More articles by this author Robert Moldwin New York, NY More articles by this author Mayer Robert Rochester, NY More articles by this author Lesley Carr Toronto, Canada More articles by this author Ragi Doggweiler Knoxville, TN More articles by this author Claire Yang Seattle, WA More articles by this author Nagendra Mishra Ahmedabad, India More articles by this author Jorgen Nordling Herlev, Denmark More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

1170 UNDERSTANDING THE MECHANISTIC ROLE OF PAIN APPRAISALS AND BEHAVIOURAL COPING STRATEGIES BETWEEN PAIN AND QUALITY OF LIFE IN CHRONIC PROSTATITIS/CHRONIC PELVIC PAIN SYNDROME (CP/CPPS)

You have accessJournal of UrologyInfections/Inflammation of the Genitourinary Tract: Prostate & Genitalia1 Apr 20131170 UNDERSTANDING THE MECHANISTIC ROLE OF PAIN APPRAISALS AND BEHAVIOURAL COPING STRATEGIES BETWEEN PAIN AND QUALITY OF LIFE IN CHRONIC PROSTATITIS/CHRONIC PELVIC PAIN SYNDROME (CP/CPPS) Dean A. Tripp, J. Curtis Nickel, Adrijana Koljuskov, Daniel Shoskes, Michel Pontari, Mark S. Litwin, and Mary F. McNaughton-Collins Dean A. TrippDean A. Tripp Kingston, Canada More articles by this author , J. Curtis NickelJ. Curtis Nickel Kingston, Canada More articles by this author , Adrijana KoljuskovAdrijana Koljuskov Kingston, Canada More articles by this author , Daniel ShoskesDaniel Shoskes Cleveland, OH More articles by this author , Michel PontariMichel Pontari Philadelphia, PA More articles by this author , Mark S. LitwinMark S. Litwin Los Angeles, CA More articles by this author , and Mary F. McNaughton-CollinsMary F. McNaughton-Collins Boston, MA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.807AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS) is characterized by pelvic pain and is largely refractory. Studies have correlated pain, depression, catastrophizing and sedentary behavior on quality of life (QoL) or pain, showing the saliency of psychosocial factors. However, no study has examined a comprehensive list of pain appraisal and behavioural coping strategies as mechanisms in the relationship between pain and QoL. From a self-regulation model, understanding how appraisals and coping interact with outcomes like pain and QoL are important in advancing patient management. METHODS Men (n=168) previously enrolled in the NIH Chronic Prostatitis Cohort study in North American tertiary care centers (6-U.S., 1-Canada) completed a one-time survey of validated self-report measures (QoL:SF-12; demographics; pain: McGill; behavioural pain coping:CPCI; catastrophizing:PCS; Social Support:MSPSS). Data were examined for normality and missing values. Associations of validated pain appraisals (Catastrophizing) and behavioural coping (Illness-focused coping) with outcomes of pain and QoL were examined. Multivariable mediation models tested mediation roles between pain and QoL. RESULTS Multivariable mediation analyses for the relationship between pain and physical QoL was run with mediators of Illness-Focused Coping (IF-coping), Wellness-Focused Coping (WF-coping), Social Support and Catastrophizing showing that only IF-coping was a significant mediator of this relationship (<.001). Follow-up analyses of subscales for IF-coping (Guarding, Resting, Asking for Assistance, Medication Use) showed Guarding was a unique mediator. Mediation analyses between pain and mental QoL was run with mediators of IF-coping, Social Support and Catastrophizing showing support and catastrophizing were significant mediators (<.001). Subscale follow-ups for support (Family, Friends, Significant Other) and Catastrophizing (Rumination, Magnification, Helplessness) showed Friends and Helplessness were unique mediators. CONCLUSIONS These results suggest that IF-coping, Helpless Catastrophic pain appraisals and Friends act as mechanisms that drive and buffer the negative association between pain and QoL indices. Due to the nature of these associations, the hypothesis that symptoms may be physically and mentally disabling through behavioural, cognitive and environmental mechanisms is supported. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e478 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Dean A. Tripp Kingston, Canada More articles by this author J. Curtis Nickel Kingston, Canada More articles by this author Adrijana Koljuskov Kingston, Canada More articles by this author Daniel Shoskes Cleveland, OH More articles by this author Michel Pontari Philadelphia, PA More articles by this author Mark S. Litwin Los Angeles, CA More articles by this author Mary F. McNaughton-Collins Boston, MA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Depressive symptoms and interpersonal needs as mediators of forgiveness and suicidal behavior among rural primary care patients

BackgroundSuicide is the 10th leading cause of death in the US, and rates of suicide are higher in rural than urban areas. As proposed by the Interpersonal-Psychological Theory of Suicide, thwarted belongingness and perceived burdensomeness are risk factors for suicidal behavior, although protective individual-level characteristics such as forgiveness, may indirectly affect suicidal behavior by decreasing the deleterious effect of thwarted interpersonal needs. MethodA sample of uninsured adults recruited from a rural primary clinic (N=101) completed the Brief Multidimensional Measure of Religiousness and Spirituality; Suicidal Behaviors Questionnaire-Revised; Interpersonal Needs Questionnaire; and Center for Epidemiologic Studies Depression Scale. Parallel and serial multivariable mediation analyses were conducted to test for direct and indirect effects of forgiveness on suicidal behavior. ResultsIn parallel mediation, covarying depressive symptoms, forgiveness of self had an indirect effect on suicidal behavior, through perceived burdensomeness. Inclusion of depressive symptoms as a mediator revealed an indirect effect of forgiveness of self and others on suicidal behavior via depression, thwarted belongingness, and perceived burdensomeness in a serial mediation model. LimitationA longitudinal study, with an equal representation of males and diverse populations is needed to replicate our findings. DiscussionOur findings have implications for the role health providers can play in addressing suicide with rural patients. Promoting forgiveness, may, in turn affect interpersonal functioning and decrease risk for suicidal behavior.

College Graduation Reduces Vulnerability to STIs/HIV among African-American Young Adult Women

African-American women are disproportionately affected by sexually transmitted infections (STIs), including HIV. The Theory of Gender and Power (TGP) posits that socioeconomic exposures, including educational attainment, place women at increased risk for STIs/HIV. This study examined the association between educational attainment and vulnerability to STIs/HIV, as well as potential TGP-driven mediators of this association, among African-American women. Baseline data were assessed from an STI/HIV prevention intervention for African-American women (n = 848) aged 18 to 29 recruited from three Kaiser Permanente Centers in Atlanta, Georgia. Data collection included a survey of demographic, psychosocial, and behavioral measures and self-collected, laboratory-confirmed vaginal swabs for STIs (trichomoniasis, chlamydia, gonorrhea, and human papillomavirus). Multiple regression analyses and multivariate mediation analyses were used to examine the association between educational attainment with a laboratory-confirmed STI and potential TGP mediators. Controlling for age and receipt of public assistance, the odds of an STI diagnosis were 73% lower among participants with a college degree or greater compared with participants who had not completed high school. There were also significant associations between educational attainment and multiple TGP mediators from the sexual division of power and the structure of cathexis. TGP constructs did not mediate the association between educational attainment and laboratory-confirmed STI. The current study suggests that graduating from college may lead to a beneficial reduction in vulnerability to STIs/HIV among African-American women. Findings from this study support expanding structural-level interventions, emphasizing both high school and college graduation, as a means of reducing vulnerability to STIs/HIV among African-American women.