Negative Psychological Responses Research Articles

Psychological responses of elite young riders to the injury of their horses

Sport is considered a high-risk environment for athletes sustaining injury. Athletes are known to experience negative psychological responses to injury, which can destabilise identity. For athletes, identity is typically constructed around participation in sport, and after injury this identity can be threatened. Within equestrian sport, the addition of a partner athlete also at risk of injury presented a unique circumstance for investigation. The purpose of the present study was to investigate the psychological responses of elite young riders (YR) to the injury of their horses. Five riders competing internationally at YR level for dressage, show jumping and eventing were interviewed about their experiences when their horse suffered serious or career-ending injuries. Interview questions explored athletes’ careers, initial reactions to injury, coping mechanisms and return to elite competition. Thematic analysis revealed that riders re-evaluated their identity as elite athletes and experienced a significant sense of loss when their horses became injured. This appraisal of loss led to YR’s experiencing denial and guilt at the onset of injury akin to personal injury in athletes. As riders perceive the horse as part of the ‘athlete’ package, they are at heightened risk of injury-related psychological stress when compared to other individual athletes. Riders reported mixed views on common sources of social support, suggesting a need for pre-emptive coping education in addition to intervention resources within equestrian sport to minimise the psychological impact of injury, particularly at YR level.

Misophonia: a disorder for social world

Dear Editor, Chewing, coughing, breathing, typing are activities that produce low level sounds and these audible activities are frequently encountered in the society. These background sounds are usually ignored in public places or at home. Some people may not ignore and perceive these sounds and become disgusted. Reasons of disgust are distraction and anger. Tension might be followed by anger which may then generate urge to leave the environment or intercept the background noise. Sensitivity to the group of background noise is called misophonia. 1-3 The term consists of two words: misos (strong hate or disgust) and phonia (sound) and was introduced by Margaret and Pavel Jastreboff in 2001. 4 It was aimed to present and discuss two cases of misophonia in this letter to the editor. The first case was a young man with generalized anxiety disorder. He was also suffering from misophonia and misophonia triggered anger. He reported that particularly his family life was devastated because of his anger. The second patient was suffering from obsessive compulsive disorder and misophonia. She reported that she was counting to ten, breathing slowly or leaving the environment as soon as possible, if she cannot relax. She was frequently listening music with headphones in public places to avoid from disgusting sounds. Both patients reported that they could not express themselves during their disgust, because of inhibiting themselves due to the fear of being called crazy. Misophonia is defined as immediate negative psychological responses to certain sounds that most people do not notice. 1-3 This novel psychopathology is proposed to be involved with dysregulation of emotional processing with a neurobiological basis. 5 Current classification systems have not defined misophonia yet and it is not clear whether it is a distinct entity or a dimension or symptom domain which accompany other disorders. 3 Post-traumatic stress disorder was the most frequently accompanying disorder in a recent large-scale study. 6 Accordingly, other psychopathologies may trigger or enhance the responses and therefore misophonia might be a dimensional concept. Misophonia may deteriorate quality of life and social functioning and thus should be further investigated. 1-3,5 A Google search with the key words “misophonia treatment” retrieved 217 results in the date of January 12th. 8 of the web pages’ name was including the term “misophonia”. Increased awareness of this problem would be useful in order to develop better treatments. 7,8

Hypoxia Worsens Affective Responses and Feeling of Fatigue During Prolonged Bed Rest.

Previous research, although limited, suggests that both hypoxia and bed rest influence psychological responses by exaggerating negative psychological responses and attenuating positive emotions. The present study investigated the effect of a 21-day prolonged exposure to normobaric hypoxia and bed rest on affective responses and fatigue. Eleven healthy participants underwent three 21-day interventions using a cross-over design: (1) normobaric hypoxic ambulatory confinement (HAMB), (2) normobaric hypoxic bed rest (HBR) and (3) normoxic bed rest (NBR). Affective and fatigue responses were investigated using the Activation Deactivation Adjective Check List, and the Multidimensional Fatigue Inventory, which were completed before (Pre), during (Day 7, Day 14, and Day 21) and after (Post) the interventions. The most negative psychological profile appeared during the HBR intervention. Specifically, tiredness, tension, general and physical fatigue significantly increased on days 7, 14, and 21, as well as at Post. After the HBR intervention, general and physical fatigue remained higher compared to Pre values. Additionally, a deterioration of psychological responses was also noted following HAMB and NBR. In particular, both hypoxia and BR per se induced subjective fatigue and negative affective responses. BR seems to exert a moderate negative effect on the sensation of fatigue, whereas exercise attenuates the negative effects of hypoxia as noted during the HAMB condition. In conclusion, our data suggest that the addition of hypoxia to bed rest-induced inactivity significantly worsens affective responses and feeling of fatigue.

Can self-affirmation exacerbate adverse reactions to stress under certain conditions?

Objective: Self-affirmation has repeatedly been shown to reduce adverse psychological and physiological responses to stress. However, it is plausible that self-affirmation could exacerbate negative reactions to stress under certain conditions. The current research explored whether self-affirmation would increase negative psychological responses to a stressor occurring in a central life domain characterised by low levels of control.Design: Female participants (Study 1 N = 132; Study 2 N = 141) completed baseline measures of anxiety and mood. They were then randomly allocated to complete a self-affirmation or control task, before reading a narrative documenting a stressful birth and imagining themselves in the place of the woman giving birth. After completing this task, participants again reported their levels of anxiety and positive mood.Main outcome measures: Anxiety and positive mood assessed at follow-up.Results: Study 1 demonstrated that self-affirmed women experienced increased anxiety and less positive mood at follow-up, compared both to baseline and to women in the control condition. Study 2 revealed that the effect of self-affirmation on outcomes was moderated by fear of childbirth.Conclusion: These results provide preliminary evidence that self-affirmation may worsen negative responses to stressors under certain conditions and for certain individuals.

Explaining between-race differences in African-American and European-American women's responses to breast density notification

BackgroundPrior research shows between-race differences in women's knowledge and emotions related to having dense breasts, thus suggesting that between-race differences in behavioral decision-making following receipt of breast density (BD) notifications are likely. Guided by the theory of planned behavior, this study examined differences in emotion-related responses (i.e., anxiety, worry, confusion) and behavioral cognition (e.g., intentions, behavioral attitudes) following receipt of BD notifications among African American (AA) and European American (EA) women. This study also examined whether race-related perceptions (i.e., discrimination, group-based medical mistrust), relevant knowledge and socioeconomic status (SES) explained the between race differences. MethodMichigan women (N = 457) who presented for routine screening mammogram and had dense breasts, no prior breast cancer diagnoses, and had screen-negative mammograms were recruited from July, 2015 to March 2016. MANOVA was used to examine between race differences in psychological responses (i.e., emotional responses and behavioral cognition), and a multi-group structural regression model was used to examine whether race-related constructs, knowledge and SES mediated the effect of race on emotional responses and behavioral cognition. Prior awareness of BD was accounted for in all analyses. ResultsAA women generally reported more negative psychological responses to receiving BD notifications regardless of prior BD awareness. AA women had more favorable perceptions related to talking to their physicians about the BD notifications. Generally, race-related perceptions, SES, and related knowledge partially accounted for the effect of race on psychological response. Race-related perceptions and SES partially accounted for the differences in behavioral intentions. Between-race differences in emotional responses to BD notifications did not explain differences in women's intentions to discuss BD notifications with their physicians. ConclusionsFuture examinations are warranted to examine whether there are between-race differences in actual post-BD notification behaviors and whether similar race-related variables account for differences.

Effects of achievement goals on perceptions of competence in conditions of unfavourable social comparisons: The mastery goal advantage effect.

Previous prospective studies have documented that mastery-approach goals are adaptive because they facilitate less negative psychological responses to unfavourable social comparisons than performance-approach goals. This study aimed to confirm this so-called 'mastery goal advantage' effect experimentally. A 2×3 design was adopted where achievement goals (mastery vs. performance) and normative information (favourable vs. no-normative information vs. unfavourable) were manipulated as between participant factors. Participants were 201 undergraduates, 57 males and 144 females, ranging in age from 17 to 55years (Mage =22.53, SD=6.51). Regression analyses pointed out that experimentally induced mastery-approach goals facilitated higher levels of competence and happiness with task performance than experimentally induced performance-approach goals in conditions of unfavourable social comparisons. In contrast, although performance-approach goals yielded the highest levels of happiness with task performance in conditions of favourable social comparisons, this positive effect of performance-approach goals did not extend to perceptions of competence. Current findings broaden understanding of the adaptive nature of mastery-approach goals and suggest that it is possible to modulate aversive responses to unfavourable social comparisons by focusing attention on mastery-approach goals.

Negative psychological responses of injury and rehabilitation adherence effects on return to play in competitive athletes: a systematic review and meta-analysis.

Previous research offers evidence that psychological factors influence an injured athlete during the rehabilitation process. Our first objective was to conduct a systematic review and meta-analysis of the results from all published studies that examined the relationships among negative affective responses after sport injuries, rehabilitation adherence, and return to play (RTP). The second objective was to use a meta-analytic path analysis to investigate whether an indirect effect existed between negative affective responses and RTP through rehabilitation adherence. This literature review resulted in seven studies providing 14 effect sizes. The results from the meta-analysis showed that negative affective responses had a negative effect on successful RTP, whereas rehabilitation adherence had a positive effect on RTP. The results from the meta-analytic path analysis showed a weak and nonsignificant indirect effect of negative affective responses on RTP via rehabilitation adherence. These results underline the importance of providing supportive environments for injured athletes to increase the chances of successful RTP via a decrease in negative affective responses and increase in rehabilitation adherence.

Correlates of the positive psychological byproducts of cancer: Role of family caregivers and informational support.

Experiencing a life-threatening illness such as cancer can elicit both negative (e.g., distress) and positive (e.g., growth) psychological responses. The present study sought to determine the correlates of four positive psychological byproducts in cancer survivors: becoming a stronger person, coping better with life's challenges, making positive changes in life, and adopting healthier habits. Data for this cross-sectional study were taken from the Medical Expenditures Panel Survey (MEPS) Experiences with Cancer Survivorship Supplement (Yabroff et al., 2012). Cancer survivors (N = 785) reported their sociodemographic and cancer-related characteristics. Descriptive statistics were utilized to summarize cancer survivor characteristics, including demographic factors, cancer factors, and stressors and resources related to cancer. Multivariable logistic regressions were employed to assess the independent association of the stressors and resources with each psychological response, controlling for covariates. All analyses were weighted to account for the complex sampling design of the MEPS. In multivariable analyses, those with a family caregiver were 50% more likely to report better coping with challenges, and around 70% were more likely to report making positive changes in life or adopting healthier habits because of their cancer. Receiving informational support from healthcare providers was also consistently associated with positive byproducts (odds ratios ranging from 1.6 to 2.0). Few of the stressors were associated with positive byproducts: having insurance problems due to cancer was positively associated with becoming a stronger person, and work limitations were associated with making positive changes in life; those who reported high perceived chances of recurrence were less likely to report becoming a stronger person. Having a family caregiver and receiving detailed informational support from healthcare providers were associated with reporting positive experiences with cancer. The hypotheses and future research stimulated by these findings may improve our understanding of the process by which positive byproducts develop and may ultimately help improve psychological well-being among cancer survivors.

Models Of Informed Consent For Genomic Sequencing

Genome sequencing (GS) is becoming prevalent in medical research and making its way into clinical practice. Although genetic testing is used less frequently in psychiatry than in some related medical specialties, such as neurology, its use is growing, e.g., for the diagnosis of neurodevelopmental syndromes with psychiatric components, such as DiGeorge’s syndrome and Fragile X. Psychiatric researchers are using GS to explore the genetic etiology of disorders such as schizophrenia, bipolar disorder, autism, and intellectual disabilities and its clinical use seems likely to follow. Hence, psychiatric researchers and clinicians need to grapple with how best to obtain informed consent for GS.A number of challenges exist for the consent process, including the large amount of information that needs to be conveyed. Persons facing choices about GS must understand, along with the standard disclosures that accompany any clinical or research consent: the nature of their situation and why the test is being recommended; likely benefits and risks, such as discrimination in insurance; and how secondary findings will be dealt with—a particularly difficult topic because at the time researchers and clinicians will know neither the likely findings nor their potential implications. Moreover, persons affected by psychiatric disorders may have difficulties in attention and information processing that can complicate their assimilation of this information.To explore approaches to consent for GS, we surveyed 254 genetic researchers in the US, almost all of whom had used or anticipated using GS. A majority endorsed discussion of a wide range of risks (e.g., negative psychological responses) and benefits (e.g., early detection of disorders, enhanced life-planning), along with information about possible impact of findings on family members; protections for confidentiality; procedures related to return of data should participants become impaired or deceased; whether findings from subsequent research or advances in interpretation would be offered; and whether and how choices about return of findings could be overridden. When return of secondary findings is possible, these discussions will have to cover both primary and secondary results, and explanations of a number of choices about receipt of results and use of samples.However, it is clear that neither clinicians nor researchers have time for such extended discussions, especially given the limits of popular knowledge of genetics. Thus, innovative models of informed consent will need to be developed. Based on our survey findings, we identified 4 such models: traditional consent, staged consent, mandatory return, and outsourced consent. A follow-up survey of 198 genetic researchers found that, despite their liabilities, traditional approaches to consent are seen as the most viable under current circumstances. However, there is considerable interest in staged consent, assuming the infrastructure to support it can be provided.This presentation will review the challenges to obtaining informed consent for GS; data on researchers’, clinicians’, and patients’ preferences for information; and potential approaches to consent that will allow participants and patients to make meaningful choices about genomic sequencing and return of results.

Psychological responses, coping and supporting needs of healthcare professionals as second victims.

To provide an overview of healthcare professionals' psychological responses, coping strategies and supporting needs in the aftermath of an adverse event, thus informing health policy implications and future research in this aspect. Trauma experienced by healthcare professionals as second victims potentially provokesintenseemotional distress, detrimental professional outcomes and imposes harsh long-term effects. A systematic literature review was performed to synthesize the experiences and needs of second victims who are healthcare professionals being traumatized by an unanticipated adverse event, medical error or patient-related injury. CINAHL, Embase, PsycINFO, PubMed and Scopus databases were searched for relevant articles published in English from January 2000 to October 2015. Data extraction was performed for the 30 studies selected. Second victims experienced enduring intense negative psychological responses. They adopted multiple coping mechanisms and desired emotional and informational support. Second victims experience substantial psychological impact which can be mitigated with supportive environments. It is imperative that subsequent research consider the potential factors affecting second victims' emotional experience, efficacy of coping strategies in facilitating recovery and obtain a comprehensive understanding of second victims' experience. Nursing and health management's role in establishingorganizational support structures is necessary to meet second victims' needs. This existing knowledge is significant to guide policy makers in developing a holistic and effective second victim support programme.

What is traumatic birth? A concept analysis and literature review

Background: A number of women experience childbirth as traumatic. This experience can have enduring and potentially lifelong effects on both mental and physical health, and have implications for the woman's relationship with her baby, partner and family. It can also have implications for future decisions about pregnancy and birth. However, the meaning of the term ‘traumatic birth’ remains poorly defined. Clear understanding of the concept is critical to better underpin understanding and effectively evaluate women's experiences. Objective: To review the literature pertaining to ‘traumatic birth’ and produce a definition of the concept. Methods: The concept analysis framework of Walker and Avant (2011) was used. Electronic bibliographic databases CINAHL, Medline, PsycINFO and Cochrane were searched to find papers written in English and dated 1998–2015. From a narrative literature review, the defining attributes were ascertained, and model, borderline, related, contrary, invented and illegitimate cases were constructed. The antecedents and consequences were then identified and empirical referents determined. Findings: The apparent attributes of ‘traumatic birth’ are that a baby has emerged from the body of its mother at a gestation where survival was possible. This birth has involved events and/or care that have caused deep distress or disturbance to the mother, and the distress has outlived the immediate experience. Conclusions: ‘Traumatic birth’ is a complex concept which is used to describe a series of related experiences of, and negative psychological responses to, childbirth. Physical trauma in the form of injury to the baby or mother may be involved, but is not a necessary condition.

The Effect of Emotional Closeness and Exchanges of Support Among Family Members on Residents’ Positive and Negative Psychological Responses After Hurricane Sandy

Introduction: This study examines how changes in emotional closeness and exchanges of support among family members after Hurricane Sandy affected residents' psychological outcomes both positively and negatively.Methods: The working sample included 130 family ties reported by 85 respondents recruited from community and shelter residents on Staten Island after it was seriously damaged by the 2012 Hurricane Sandy. Regression with robust standard errors was used to examine how changes in emotional closeness and exchanges of support with adult family members affected respondents' posttraumatic psychological distress and posttraumatic growth.Results: Results showed psychological distress was significantly increased with higher levels of instrumental support received from family members; whereas posttraumatic growth was significantly increased with greater improved emotional closeness with family members. In addition, having higher levels of education was associated with lower levels of psychological distress and respondents from shelters showed higher levels of posttraumatic growth than those who were from the community.Discussion: It is suggested that after a significant disaster, although a family may be the best to take care of its members' emotional needs, it should not be expected to satisfy the instrumental needs of its members. In addition, posttraumatic psychological distress and growth are not necessarily opposite to each other; the psychological well- being of residents after a disaster needs to be carefully examined from both perspectives.

A Descriptive Study to Assess the Stress as an Impact of Flood among People Living in Flood Affected Areas in Majuli, Assam

Flooding is the most common of all natural hazards globally. Flood can cause a wide range of negative psychological responses like post traumatic stress disorder. This study was conducted to assess the stress among flood affected people and also to find out the association between stress and selected socio demographic variables. The study followed a quantitative, descriptive survey approach with non-experimental descriptive design. A sample of 200 flood affected people living in Majuli, Assam was selected through purposive sampling techniques. The tools used for the study included Socio-demographic performa and Impact of Event Scale Revised (IES-R) to assess the stress. The result showed that 63% of the flood affected people had high chances of having stress disorder. The chi-squire values of selected demographic variables depicted significant association between stress and numbers of family members and no association was found between stress and other variables. Stress was very common among flood victims. It is a great responsibility of the psychiatric nurses to plan and deliver nursing services to support people who were affected by flooding.

Abstract P4-12-10: Uptake and outcomes of multiplex testing for breast cancer susceptibility

Abstract Background: New counseling models for multiplex genetic testing for breast cancer susceptibility are needed. Further, the risks, benefits and utilities of multiplex genetic panels are unknown. Purpose: To obtain stakeholder feedback on an innovative tiered-binned model for pretest counseling and informed consent for multiplex testing and to evaluate the uptake of, cognitive and affective responses to and perceived utility of panel testing. Methods: Patients previously BRCA1/2- or BRCA1/2 untested completed in-person pre-test (V1) and post-test counseling (V2) and surveys regarding the novel counseling model and evaluating cognitive and affective responses to, and perceived utility of the 26 gene Myriad MyRisk panel for cancer susceptibility. Results: 49 patients (62% of eligible) enrolled and completed V1. 38% of decliners were not interested in panel testing. BRCA1/2- were more likely to proceed with MyRisk (89%) than BRCA1/2 untested (48%, p<0.01). Although not statistically significant, those who declined panel testing after V1 had higher anxiety, depression and cancer worry, but no difference in knowledge. They also had lower perceived utility (p=0.005). Most patients would not change anything about their V1 (86%) or V2 (91%) counseling. Surveys suggest that patients value the engagement, personalization, organization and visual aids of the novel counseling model. Potential refinements include enhancing assessments of informational overload, confusion and psychosocial needs, particularly with uncertain results. As shown in Table 1, event anxiety, depression, uncertainty and cancer worry did not change, while general anxiety decreased. Knowledge increased and perceived utility and satisfaction decreased significantly. Exploratory analyses by results to date (positive = 5; VUS = 9; negative =22), suggest no difference in uncertainty by test result. Patients with a positive result might experience greater event anxiety and have less decline in perceived utility (p=0.02) than those with a negative or VUS result. Table 1 BaselinePost V1Post V2 Mean (SD)Mean (SD)Mean (SD)General Anxiety6.8 (3.9)*6.1 (4.0)* 7.2 (3.5)*6.1 (3.6)*5.8 (4.2)*General Depression2.6 (3.0)2.3 (2.6) 2.6 (2.9)2.3 (2.6)2.9 (3.6)Event Anxiety37.1 (9.6)37.7 (9.5) 37.0 (8.9)37.3 (8.5)37.3 (9.4)Cancer Worry18.3 (15.7)16.9 (14.1) 18.4 (15.4)15.7 (14.1)6.6 (14.7)Knowledge (K) Total61.8 (6.1)**63.9 (6.4)** 62.1 (6.7)**64.1 (6.8)**66.3 (6.9)**K-Inheritance29.5 (3.2)30.0 (3.2) 29.7 (3.5)29.8 (3.3)30.3 (3.7)K-Benefits12.0 (1.4)12.3 (1.8) 12.0 (1.4)12.4 (1.7)12.4 (1.9)K-Limitations20.3 (3.2)**21.6 (2.8)** 20.4 (3.4)**21.9 (3.0)**23.6 (2.6)**Satisfaction 42.8 (3.8) 42.9 (3.6)*41.4 (2.6)*Uncertainty7.5 (4.3)6.9 (4.6) 7.7 (4.0)6.5 (4.5)6.7 (4.6)Perceived Utility 37.2 (7.9) 37.7 (7.0)*33.8 (8.6)**p,0.05, **p<0.001 Conclusion: With a tiered-binned counseling model, patients experience increased knowledge. Uptake of panel testing varies by prior testing and potentially by patient affective factors. Most patients do not experience negative psychological responses, although this may vary by test result. Declines in satisfaction and perceived utility may also vary by test result and may reflect the current unclear utility and uncertainty of multiplex testing. Citation Format: Angela R Bradbury, Linda Patrick-Miller, Brian L Egleston, Amanda Brandt, Jessica Long, Jacquelyn Powers, Jill Stopfer, Laura DiGiovanni, Jamie Brower, Susan M Domchek. Uptake and outcomes of multiplex testing for breast cancer susceptibility [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P4-12-10.

Debriefing interventions for the prevention of psychological trauma in women following childbirth.

Childbirth is a complex life event that can be associated with both positive and negative psychological responses. When giving birth is experienced as particularly traumatic this can have a negative impact on a woman's postnatal emotional well-being. There has been an increasing focus on women's psychological trauma symptoms following childbirth, including the relatively rare phenomenon of post-traumatic stress disorder (PTSD), and the benefit of debriefing interventions to prevent this. In this review we examined the evidence for debriefing as a preventative intervention for psychological trauma following childbirth. To assess the effects of debriefing interventions compared with standard postnatal care for the prevention of psychological trauma in women following childbirth. The trials registers of the Cochrane Depression, Anxiety and Neurosis Group (CCDANCTR-References and CCDANCTR-Studies) and the Cochrane Pregnancy and Childbirth Group were searched up to 4 March 2015. These registers include relevant randomised controlled trials from the following bibliographic databases: the Cochrane Library (all years to date), MEDLINE (1950 to date), EMBASE (1974 to date), and PsycINFO (1967 to date). Additional searches were conducted in CENTRAL, MEDLINE, EMBASE, PsycINFO, and Maternity and Infant Care. The reference lists of all included studies were checked for additional published reports and citations of unpublished research. Experts in the field were contacted. We included randomised controlled trials (RCTs) and quasi-randomised trials comparing postnatal debriefing interventions with standard postnatal care for the prevention of psychological trauma of women following childbirth. The intervention consisted of at least one debriefing intervention session, which had the purpose of allowing women to describe their experience and to normalise their emotional reaction to that experience. Three authors independently assessed trial quality and extracted data. Meta-analysis was conducted where there were more than two trials examining the same outcomes. We included seven trials (eight articles) from three countries (UK, Australia and Sweden) that fulfilled the inclusion criteria. The number of women contributing data to each outcome varied from 102 to 1745. Methodological quality was variable and most of the studies were of low quality. The quality of evidence for the prevalence of psychological trauma (primary outcome) and the prevalence of depression symptoms was rated low or very low, based on few studies (ranging from a single study to three studies) with high risk of bias in main domains such as performance bias, random sequence generation, allocation concealment and incomplete outcome data. The quality of evidence for the remaining outcomes (that is prevalence of anxiety, prevalence of fear of childbirth, prevalence of general psychological morbidity, health service utilization and attrition from treatment) was not assessed as data were not available.Among women who had a high level of obstetric intervention during labour and birth, we found no difference between standard postnatal care with debriefing and standard postnatal care without debriefing on psychological trauma symptoms within three months postpartum (RR 0.61; 95% CI 0.28 to 1.31; n = 425) or at three to six months postpartum (RR 0.62; 95% CI 0.27 to 1.42; n = 246). The results were based on two trials, respectively. Among women who experienced a distressing or traumatic birth, there was no evidence of an effect of psychological debriefing on the prevention of PTSD (measured by the MINI-PTSD) at four to six weeks postpartum (RR 1.15; 95% CI 0.66 to 2.01; n = 102) or at six months (RR 0.35; 95% CI 0.10 to 1.23; n = 103). The results were based on one small trial. One trial involving low-risk women who delivered healthy infants at or near term reported no significant difference between the intervention group and the control group in the proportion of women who met the diagnostic criteria for psychological trauma during the year following childbirth (RR 1.06; 95% CI 0.88 to 1.28; n = 1745). We did not find any information about attrition rates. We did not find any high quality evidence to inform practice, with substantial heterogeneity being found between the studies conducted to date. There is little or no evidence to support either a positive or adverse effect of psychological debriefing for the prevention of psychological trauma in women following childbirth. There is no evidence to support routine debriefing for women who perceive giving birth as psychologically traumatic.Future research should provide greater detail of the outcome measures used, and with scales for measuring psychological trauma validated against clinical diagnostic interviews. High rates of obstetric intervention in some birth settings may mean that women require improved emotional care from health professionals to reduce the risk of childbirth being experienced as traumatic. As all included trials excluded women unable to communicate in the native language of the study setting, there is no information on the response of these women to psychological debriefing. No included studies were conducted in low or middle-income countries.

Patient feedback and early outcome data with a novel tiered-binned model for multiplex breast cancer susceptibility testing.

The risks, benefits, and utilities of multiplex panels for breast cancer susceptibility are unknown, and new counseling and informed consent models are needed. We sought to obtain patient feedback and early outcome data with a novel tiered-binned model for multiplex testing. BRCA1/2-negative and untested patients completed pre- and posttest counseling and surveys evaluating testing experiences and cognitive and affective responses to multiplex testing. Of 73 patients, 49 (67%) completed pretest counseling. BRCA1/2-negative patients were more likely to proceed with multiplex testing (86%) than those untested for BRCA1/2 (43%; P < 0.01). Many patients declining testing reported concern for uncertainty and distress. Most patients would not change anything about their pre- (76%) or posttest (89%) counseling sessions. Thirty-three patients (72%) were classified as making an informed choice, including 81% of those who proceeded with multiplex testing. Knowledge increased significantly. Anxiety, depression, uncertainty, and cancer worry did not significantly increase with multiplex testing. Some patients, particularly those without prior BRCA1/2 testing, decline multiplex testing. Most patients who proceeded with testing did not experience negative psychological responses, but larger studies are needed. The tiered-binned approach is an innovative genetic counseling and informed consent model for further study in the era of multiplex testing.Genet Med 18 1, 25-33.

Sports Participation 2 Years After Anterior Cruciate Ligament Reconstruction in Athletes Who Had Not Returned to Sport at 1 Year

Background: A return to their preinjury level of sport is frequently expected within 1 year after anterior cruciate ligament (ACL) reconstruction, yet up to two-thirds of athletes may not have achieved this milestone. The subsequent sports participation outcomes of athletes who have not returned to their preinjury level sport by 1 year after surgery have not previously been investigated. Purpose: To investigate return-to-sport rates at 2 years after surgery in athletes who had not returned to their preinjury level sport at 1 year after ACL reconstruction. Study Design: Case series; Level of evidence, 4. Methods: A consecutive cohort of competitive- and recreational-level athletes was recruited prospectively before undergoing ACL reconstruction at a private orthopaedic clinic. Participants were followed up at 1 and 2 years after surgery with a sports activity questionnaire that collected information regarding returning to sport, sports participation, and psychological responses. An independent physical therapist evaluated physical function at 1 year using hop tests and the International Knee Documentation Committee knee examination form and subjective knee evaluation. Results: A group of 122 competitive- and recreational-level athletes who had not returned to their preinjury level sport at 1 year after ACL reconstruction participated. Ninety-one percent of the athletes returned to some form of sport after surgery. At 2 years after surgery, 66% were playing sport, with 41% playing their preinjury level of sport and 25% playing a lower level of sport. Having a previous ACL reconstruction to either knee, poorer hop-test symmetry and subjective knee function, and more negative psychological responses were associated with not playing the preinjury level sport at 2 years. Conclusion: Most athletes who were not playing sport at 1 year had returned to some form of sport within 2 years after ACL reconstruction, which may suggest that athletes can take longer than the clinically expected time of 1 year to return to sport. However, only 2 of every 5 athletes were playing their preinjury level of sport at 2 years after surgery. When the results of the current study were combined with the results of athletes who had returned to sport at 1 year, the overall rate of return to the preinjury level sport at 2 years was 60%. Demographics, physical function, and psychological factors were related to playing the preinjury level sport at 2 years after surgery, supporting the notion that returning to sport after surgery is multifactorial.

Seeing Things … Differently, or, Hallucinating the Postmodern

From thermodynamics and rocket technology to the deep web, Thomas Pynchon's novels and stories have often juxtaposed science and technology with unusual, not to say downright implausible happenings. This is perhaps the result of a fascination with contorting scientific knowledge into strange applications, whether as metaphors for social mores or to see how far its logics can be pushed toward the breaking point, but it is assuredly grounded in the relationship between the human and the technological and how American society deals with its contemporary technological environment. For example, Bleeding Edge explores the growth of the internet and the dot-com boom, Vineland focuses on television and film, and Gravity's Rainbow deals with the V2 rocket program. Obviously, such reductive statements omit the complexities of Pynchon's inclusions of and allusions to competing paradigms and conspiracy theories, but in each case what is foregrounded is how individuals understand and relate to the world. As such, it is possible to assert that Pynchon's fictions have always been involved in representing and articulating of mind. Such states might differ across his fictions in terms of their setting and context, but whether concerned with the 1893 Chicago World's Fair (Against the Day), the 9/11 attacks (Bleeding Edge), California at various points (The Crying of Lot 49, Vineland, Inherent Vice), World War Two and its aftermath (V, Gravity's Rainbow), or even colonial America (Mason & Dixon), Pynchon's works are invariably concerned with seeing things differently than established histories might otherwise imply and, moreover, foregrounding the relativism and partiality of any individual perspective or overly simplified way of perceiving the world. His protagonists search for answers to make sense of their experiences as they are cast adrift from meaning; in the case of Slothrop from Gravity's Rainbow, he is literally lost as he disappears from the narrative part way through. Within this framework, a recurrent trope of Pynchon's fictions is negative psychological responses to the environment (paranoia, uncertainty, emotional and epistemological insecurity) as a result of a failure to reconcile individual experiences with something defined as normal or normative. Pynchon's characters neither grow nor find answers, but this is precisely the point: they accumulate data, clues, and/or experiences, but no single answer suffices to define everything, and no individual's answer corresponds to any other's. As a result of this, one of the disciplines/discourses most often referenced in his fictions is psychiatry, for even when not directly connected to the narrative arc, psychological and psychiatric terminology and characters are nonetheless present and serve to lead the reader to the perception that reality is contested, not a given, and that perception is not straightforwardly schematic. More specifically, this article examines the ways in which perceptions of hallucinations--as psychiatric symptoms--have been represented in Pynchon's works and, more importantly, how they have augmented and shifted the territory upon which distinctions between hallucination and reality are founded. Within his work is a suspicion of the modes of psychiatric classifications and an attendant concern with the problems of control in the creation of such classifications, and we see this as broadly emblematic of a particular perspective evident within postmodern literature and theory. In this interpretation, Jean-Francois Lyotard's much-vaunted incredulity toward metanarratives is foreshadowed within Pynchon's oeuvre as a suspicion towards those who would describe and define reality at the expense of other worldviews (xxiv). (1) After a brief examination of how theorists such as Fredric Jameson and Jean Baudrillard have represented postmodern society, this essay moves on to explore the problems of binary-based psychiatric definitions of hallucinations. …

Rumination, psychological distress and post-traumatic growth in women diagnosed with breast cancer

Rumination, the repetitive and recursive rehearsal of cognitive content, has been linked to depression and anxiety in physically well populations, and to post-traumatic growth (PTG) in physical illness populations. Women diagnosed with breast cancer may experience both psychological distress and PTG. As rumination may influence outcomes through distinct pathways, this study investigated the association of intrusion, brooding and instrumental subcomponents of rumination with psychological distress and PTG in the breast cancer context. Women diagnosed with primary breast cancer (n = 185), mean age 55.98 years (SD = 9.26), completed an online survey including the Multi-dimensional Rumination in Illness Scale, Depression Anxiety and Stress Scales, Post-traumatic Growth Inventory, Medical Outcomes Social Support Survey, demographic and health-related questions. As predicted, regression analyses indicated that brooding was positively related to depression, anxiety and stress, but was also negatively related to the PTG dimensions of new possibilities and spiritual growth. Partially supporting the study hypotheses, intrusion was positively associated with stress and the PTG of relating to others and new possibilities. As hypothesised, instrumental rumination was positively associated with all five dimensions of PTG. Rumination is a key consideration in both positive and negative psychological responses of women diagnosed with breast cancer. Associations of specific components of rumination with varying psychological outcomes suggest differential paths by which the specific subcomponents of rumination exert this influence.

Postinjury Anxiety and Social Support Among Collegiate Athletes: A Comparison Between Orthopaedic Injuries and Concussions

When an athlete is injured, the primary focus of the sports medicine team is to treat the physical effects of the injury. However, many injured athletes experience negative psychological responses, including anxiety, regarding their injury. To compare the anxiety and social support of athletes with concussions and a matched group of athletes with orthopaedic injuries. Cross-sectional study. Athletic training room. A total of 525 injuries among athletes from 2 Big Ten universities were observed. Of these, 63 concussion injuries were matched with 63 orthopaedic injuries for the athlete's sex, sport, and time loss due to injury. Clinical measures included the State-Trait Anxiety Inventory (which measures both state and trait anxiety) and the modified 6-item Social Support Questionnaire. The group with concussions relied on their family for social support 89% of the time, followed by friends (78%), teammates (65%), athletic trainers (48%), coaches (47%), and physicians (35%). The group with orthopaedic injuries relied on their family for social support 87% of the time, followed by friends (84%), teammates (65%), athletic trainers (57%), coaches (51%), and physicians (36%). We found no differences for the State-Trait Anxiety Inventory (t = -1.38, P = .193) between the concussed and orthopaedic-injury groups. Social Support Questionnaire scores were significant predictors for postinjury state anxiety. Specifically, increased scores were associated with decreased postinjury state anxiety (β = -4.21, P = .0001). Both the concussed athletes and those with orthopaedic injuries experienced similar state and trait anxiety and relied on similar sources of social support postinjury. However, athletes with orthopaedic injuries reported greater satisfaction with support from all sources compared with concussed athletes. In contrast, concussed athletes showed more significant predictor models of social support on state anxiety at return to play.