Psychosocial Adjustment Process Research Articles

QOL-33. CANCER WORRY AND PSYCHOPATHOLOGICAL SYMPTOMS IN ADOLESCENTS AND YOUNG ADULTS SURVIVORS OF PEDIATRIC BRAIN TUMORS

Abstract BACKGROUND Adolescent and young adult (AYA) survivors of pediatric brain tumors may experience cancer-related worries, defined as concerns about relapse and late effects of treatment. Late psychological effects include psychological distress, depression, immaturity, and poor development of social skills. Furthermore, pediatric brain tumor survivors (PBTS) are more vulnerable to developing long-term neurocognitive and psychosocial consequences compared both to the general population and survivors of other types of childhood cancer. The purpose of the study was to identify the presence of cancer worry and psychopathological symptoms in AYA survivors of pediatric brain tumors. METHODS AYA survivors were assessed using the Cancer Worry Scale and Child Behavior Checklist questionnaires. Neurocognitive evaluation was performed using the age-appropriate Wechsler Scale. RESULTS Among 22 AYA survivors (M =14; F=8), the diagnosed tumor types were: germ cell tumor (10/22), low-grade glioma (4/22), embryonal tumor (3/22), high-grade glioma (2/22), craniopharyngioma (2/22), and mesenchymal tumor of the meninges (1/22). Survivors received the assessment at a median age of 20.2 years (range 13.6-28.7), with a median of 92 months after diagnosis. Cancer worry was reported in 50% of patients. The psychological evaluation showed clinical levels of internalizing problems in 17% and externalizing problems in 8%. Depressive and anxiety problems were reported in 25% of our cohort. Neurocognitive assessment demonstrated an average tIQ of 104. CONCLUSIONS As reported in the literature, cancer worry can influence the psychosocial adjustment process, alter self-image, and influence lifestyle decisions in PBTS. These concerns can affect their life prospects and their ability to successfully complete developmental tasks. Therefore, these issues must be early identified to prevent, through targeted psychosocial interventions, the onset of troubles in having romantic relationships, finishing school, entering the job market, and obtaining a good quality of life.

Parent experience with ankle-foot orthoses for their young children with cerebral palsy: a qualitative study

Purpose This study explored the experiences of parents of young children with cerebral palsy who used Ankle-Foot Orthoses (AFOs). Materials and Methods Parents of children with cerebral palsy (n = 11; age range 2–6 years) who used solid or hinged AFOs participated. Interpretive Description, a qualitative methodological approach focused on the application of findings to clinical practice, was used. Semi-structured interviews were conducted, and themes were developed using thematic analysis. Results Four themes described parent experience with their children’s AFOs: 1) “Hear what I am saying”: Collaborative decision-making with families, 2) “Is my child going to be excluded because of AFOs?”: Parent and child adjustment was a journey, 3) AFOs created financial and practical challenges, 4) The perceived benefits of AFO use. Conclusions Adjusting to AFOs was a challenging and time-consuming process for parents and children, which may have resulted in lower frequency and duration of use than anticipated by clinicians. Clinicians must be aware of the physical and psychosocial adjustment process as children and families adapt over time and work with families to ensure AFO use is optimized and individualized.

Psychosocial Adjustment to Illness among HIV-Positive People from Buenos Aires, Argentina.

Objective.To analyze the process of psychosocial adjustment to illness in a sample of people living with the Human Immunodeficiency Virus from Buenos Aires, Argentina.Methods.Cross-sectional analytical study. The sample consisted of 144 HIV-positive people chosen by simple random sampling. The PAIS-SR questionnaire was used to measure the Psychosocial Adjustment process, which is made up of 46 items organized into 7 domains, whose final score ranges between 0 and 100, interpreted so that the higher the score, the worse the psychosocial adjustment process.Results.The respondents reported were mostly male (82.63%), single (61.80%), with university studies (50.00%), without children (74.30%), and with a steady job (88.19%); the mean age of the participants was 43.8 years. The median global score was 51.4 (IQR: 12). The domains with the worst perception of psychosocial adjustment were: Health care orientation (Me: 56, IQR: 20), extended family relationship (Me: 55, IQR: 20), and Sexual relationship (Me: 54, IQR: 14), while those who had a better perception of adjustment were: Domestic environment (Me: 48, IQR: 8), Psychological distress (Me: 48, IQR: 17), Social environment (Me: 50, IQR: 18) and Vocational environment (Me: 50, IQR: 12). It was found that patients with a poor psychosocial adjustment process had low adherence to treatment, higher frequency of smoking, and sedentary lifestyle (p<0.001), while male sex, older age, and employment were related to a better psychosocial adjustment process (p<0.001).Conclusion.The process of psychosocial adjustment to illness in the study group is medium; adjustment was positively related to self-care habits such as better adherence to pharmacological treatment, physical activity, and not smoking.

A Multi-Site Study of Traumatic Brain Injury in Mexico and Colombia: Longitudinal Mediational and Cross-Lagged Models of Family Dynamics, Coping, and Health-Related Quality of Life

Latin America has high rates of traumatic brain injury (TBI), yet reduced mental and physical health outcomes due to limited rehabilitation services. To understand the psychosocial adjustment process in TBI patients in Latin America, the incorporation of cultural values including family-based variables is imperative. The current study examined relations among healthy family dynamics, coping, and mental and physical health related quality of life (HRQL) among a sample of TBI patients across three sites and two countries over the first 4 months post-injury. A sample of 109 acute TBI patients from Mexico and Colombia were recruited, and a series of longitudinal mediation and cross-lag panel analyses were run. Mental and physical HRQL were positively associated with each other, as well as healthy family dynamics and coping. Coping partially mediated the effects of healthy family dynamics on both mental and physical HRQL. Family dynamics showed the strongest cross-lag relationships with coping going from 2 months to 4 months. Similarly, coping showed the strongest cross-lag relationships with both mental and physical HRQL going from baseline to 2 months. Results provide empirical support for the importance of a rehabilitation workforce that has been trained in and can effectively implement family-based interventions for individuals with TBI in Latin America.

Work-Family Balance and Psychosocial Adjustment of Married International Students

The authors investigated how work-family balance mediated the relationship between personality traits, gender roles, social support, and psychosocial adjustment. Data were collected from 243 married international graduate students (MIGSs) studying in the United States. Results of structural equation modeling indicated that personality traits influence the psychosocial adjustment process. In addition, being extraverted, agreeable, and conscientious contributed to balancing academic and family life, whereas having neurotic tendencies such as experiencing depression and anxiety diminished work-family balance. Work-family balance did not mediate the relationship between personality traits, gender roles, social support, and psychosocial adjustment. The authors discussed the findings by considering clinical implications and making suggestions for future research.

Exploring self-concept, wellbeing and distress in therapeutic songwriting participants following acquired brain injury: A case series analysis

ABSTRACTAcquired brain injury (ABI) presents a significant threat to sense of self and necessitates a complex process of psychosocial adjustment. Self-concept changes remain understudied in the early stages of inpatient rehabilitation. The aim of the current study was to examine changes in self-concept, distress, wellbeing and functional skills for five inpatients undertaking a music therapy intervention within a subacute rehabilitation centre in Victoria, Australia. Participants completed a six-week, 12-session therapeutic songwriting programme to produce past-, current- and future-self-focused songs. A range of self-concept, subjective wellbeing and distress measures were completed pre-, mid- and post-intervention. A descriptive case series approach was applied to determine trends in pre-post scores for five individual cases. Participants showing the greatest gains across self-concept and subjective wellbeing indices also showed the greatest functional gains on the Functional Independence Measure (FIM) from admission to discharge. The current study highlights the importance of examining early changes in self-concept, wellbeing and distress in subacute rehabilitation, and suggests that individualised songwriting programmes warrant further research attention in neurological populations.

Hope, coping and psychosocial adjustment after spinal cord injury.

The study was a prospective, longitudinal design. The purpose was to explore the role of hope in the coping and psychosocial adjustment process following a spinal cord injury. The study was conducted at Spinal cord injury rehabilitation units in Queensland, Australia and Christchurch, New Zealand. This was a longitudinal study conducted in two SCI rehabilitation centres, one in Australia and one in New Zealand. A total of 47 participants with newly acquired traumatic SCI were administered a survey consisting of the Adult Hope Scale; the Moorong Self-Efficacy Scale; the Centre for Epidemiology Studies-Depression Scale (CES-D); Life Satisfaction, Self-Rated Adjustment and Life Problems Subscales of the Life Situation Questionnaire and selected subscales from the Spinal Cord Lesion-related Coping Strategies Questionnaire (SCL-CSQ) and the COPE scales at 6 weeks post injury and 3 months post discharge. Hope levels and coping strategies remained consistent over time. Hope levels significantly and positively correlated with life satisfaction and self-reported adjustment, and negatively correlated with life problems. Hope levels also positively correlated with positive coping styles, including positive reappraisal, planning, acceptance and fighting spirit. Finally, hope levels negatively correlated with the negative coping strategies behavioural disengagement and social reliance. Hope and coping styles are likely to be determined by personality traits. The findings suggest that hope enhancing interventions should be explored as a means of improving outcomes for people with SCI.

Proposal of an integrative model of adjustment to chronic conditions: An understanding of the process of psychosocial adjustment to living with type 2 diabetes.

Psychosocial adjustment to living with a chronic condition was explored in this grounded theory study, focusing on type 2 diabetes. Despite a range of relevant theories, there is limited understanding of the process of adjustment. The study aimed to address this issue. That was achieved through collecting and analysing personal narratives using individual interviews and focus groups. This allowed for the development of a normative integrative model of adjustment to chronic conditions based on biopsychosocial principles. The integrative model of adjustment to chronic condition has the potential to lead to improved understanding of adjustment processes.

"Reconstructing a Sense of Self": Trauma and Coping Among Returned Women Survivors of Human Trafficking in Vietnam.

Survivors of human trafficking who return to their community of origin must cope with the trauma they experienced as victims as well as the conditions that contributed to their trafficking vulnerabilities. In this article, I examine the psychosocial adjustment process among women survivors of trafficking who returned to Vietnam. Supplemented by participation observation, thematic analysis of in-depth interviews with survivors revealed that throughout the trafficking process, the women experienced multiple abuses and changes in relationships and environments. The women coped by navigating a process of "reconstructing a sense of self," seeking congruence between their self-understandings and the changing contextual factors while exhibiting three main coping strategies: regulating emotional expression and thought, creating opportunities within constraints, and relating to cultural schemas. The findings underscore the importance of considering contextual factors such as cultural norms and societal values in efforts to assist trafficked survivors reintegrate into their communities.

The psycho-social adjustment process of adolescent dropouts

The psycho-social adjustment process of adolescent dropouts

The burden of normality: from ‘chronically ill’ to ‘symptom free’. New ethical challenges for deep brain stimulation postoperative treatment

Although an invasive medical intervention, Deep Brain Stimulation (DBS) has been regarded as an efficient and safe treatment of Parkinson's disease for the last 20 years. In terms of clinical...

Psychosocial Well-Being in Persons with Aphasia Participating in a Nursing Intervention after Stroke

The psychosocial adjustment process after stroke is complicated and protracted. The language is the most important tool for making sense of experiences and for human interplay, making persons with aphasia especially prone to psychosocial problems. Persons with aphasia are systematically excluded from research projects due to methodological challenges. This study explored how seven persons with aphasia experienced participating in a complex nursing intervention aimed at supporting the psychosocial adjustment process and promoting psychosocial well-being. The intervention was organized as an individual, dialogue-based collaboration process based upon ideas from “Guided self-determination.” The content addressed psychosocial issues as mood, social relationships, meaningful activities, identity, and body changes. Principles from “Supported conversation for adults with aphasia” were used to facilitate the conversations. The data were obtained by participant observation during the intervention, qualitative interviews 2 weeks, 6 months, and 12 months after the intervention and by standardized clinical instruments prior to the intervention and at 2 weeks and 12 months after the intervention. Assistance in narrating about themselves and their experiences with illness, psychological support and motivation to move on during the difficult adjustment process, and exchange of knowledge and information were experienced as beneficial and important by the participants in this study.

Psychosocial Adjustment of Low-Income Koreans with Cancer

To describe psychosocial adjustment of low-income Koreans who have cancer. Data were collected during 2008 using individual in-depth interviews with 18 Korean people with cancer. The income status of the participants was low, 11 were recipients of the National Basic Livelihood Protection program. Mean age was 58.3 yr and 11 were female. Five participants had stomach cancer, five, colorectal cancer, and four, breast cancer. Data were analyzed using grounded theory methodology. The core category emerged as 'bearing up alone with double suffering'. 'Poverty and cancer: A double suffering' emerged as a causal condition. The adjustment process consisted of three stages: 'forming a treatment will to live' ,'practicing for the cure',and 'restructuring self and repaying favors'. Each stage indicated action-interaction strategies which were employed to bear up alone with double suffering during the illness process. Self-reflection, parental responsibility, and support from the public sector played important roles in overcoming the double suffering. Two types of consequences were identified: Transcended life and strained life suppressed by poverty and cancer. The results provide insights into the psychosocial adjustment process for low income Korean with cancer and can be used in developing and implementing efficient home-care services for these people.

Psychosocial Adjustment Process of Mothers Caring for Young Men With Traumatic Brain Injury

This study focuses on the mother-son relationship of 13 mothers caring for single sons between the ages of 15 and 30 years who have higher brain dysfunction due to a traumatic brain injury. We aimed to elucidate the psychosocial adjustment process of mothers for 5 years following the injury to facilitate the social rehabilitation of both mother and son. Data obtained through a semistructured interview method were analyzed using a modified grounded theory approach. After 56 concepts were identified, 18 categories and then 8 core categories were semantically created. The 8 core categories were (a) avoid contact with son, (b) support son based on mother's own desire, (c) support son alone without external support, (d) realize mother's care limits and seek external support sources, (e) request and utilize external support, (f) support and work toward son's independence while monitoring his interactions with others, (g) mother considers own feelings and reenters society, and (h) strive for continued care of son with mother's acquired energy and efficient management skills. These were grouped into the following five stages: (a) avoidance, (b-c) closed, (d) support seeking, (e-f) withdrawal, and (g-h) reconstruction.

Psychosocial adjustment following relief of chronic narcolepsy

Background and purpose No previous research has examined the psychosocial adjustment of chronic narcolepsy patients following efficacious pharmacotherapy. In contrast, considerable research has examined the process of psychosocial adjustment following surgical relief of chronic epilepsy. This process can manifest as a clinical syndrome, the ‘burden of normality’, comprising psychological, behavioural, affective and sociological features. The aim of the present study was to characterise the process of psychosocial adjustment of patients with successfully treated narcolepsy and to explore the applicability of the burden of normality. Patients and methods Thirty-three narcolepsy patients and 31 epilepsy surgery patients were recruited through routine outpatient follow-up at the Austin Hospital in Melbourne. All patients underwent in-depth, qualitative psychosocial assessment using a well-validated semi-structured interview, the Austin CEP Interview. They were also administered quantitative measures of anxiety ( State Trait Anxiety Inventory) and depression ( Beck Depression Inventory-II). Results Narcolepsy patients spontaneously reported similar themes of post-treatment adjustment to successfully treated epilepsy patients, including symptoms of the burden of normality. Chi-squared analyses revealed that the two groups differed only on disease-specific factors, reflecting the later diagnosis and treatment of narcolepsy ( P < 0.05). Conclusion The results support a general model of adjustment following successful treatment of chronic neurological illness, as the patient discards perceptions of illness and behaviours associated with being ‘sick’ and learns to become ‘well’. Recognition of the burden of normality has important clinical implications for maximising the post-treatment care and outcome of narcolepsy patients.

The psychological impact of a newly diagnosed seizure: Losing and restoring perceived control

This study aimed to characterize the process of psychosocial adjustment following a newly diagnosed seizure. Eighty-five adult patients were assessed 1 and 3 months after a first seizure presentation with a purpose-developed semistructured interview, the NEWQOL, and the COPE. Among a broad range of patient concerns, psychological issues were paramount, representing a process of losing and restoring perceived control. Two psychological adjustment trajectories were identified, which hinged on the experience of a limited ( n = 37) or pervasive ( n = 48) loss of control. These adjustment trajectories were predicted by demographic and clinical factors. The pervasive group described a more extensive process of reevaluation, leading to an improved sense of self at 3 months. Pervasive loss of control, anxiety, and depression predicted subsequent seizure recurrence. Overall, a first seizure can trigger a complex adjustment process, which might require therapeutic management in some patients.

Psychosocial Adjustment Process in Adolescents with Epilepsy

The purpose of this study was to explore the psychosocial adjustment process in adolescents with epilepsy in the context of Korean society and culture. A grounded theory method was used for data collection and analysis. Participants for this study were 9 adolescents who regularly visited an epilepsy clinic in a university hospital. The data was collected through in-depth interviews during the period from November, 2002 to June, 2003. Data collection and analysis were performed simultaneously. Twenty-three categories emerged including 'suffering', 'psychological stigma', and 'social isolation from one's peers'. Categories were divided into paradigms which consisted of conditions, actions/interactions, and consequences. 'Reconstructing life' was the core category in this study. The theoretical scheme was described by organizing categories around the core category. This study provides a framework for the development of individualized nursing interventions to care for adolescents with epilepsy.

The potential unlimited programme: an outdoor experiential education and group work approach that facilitates adjustment to brain injury

Two pilot Potential Unlimited Programmes (PUPs) were examined to determine participant outcomes related to adjustment to acquired brain injury (ABI) and to investigate the contribution of the group work component of the programme. A mixed qualitative and quantitative longitudinal design was employed with 14 participants and a demographically matched comparison group of eight respondents. Results showed significant and sustained improvement in participants’ subjective quality of life. Analysis of interview data provided insights into how the programmes provided opportunities for participants to engage in key tasks of adjustment to injury. Participants who regularly attended the follow-up group stages of the programmes made significantly greater gains than non-attendees. In conclusion, the combination of outdoor experiential education with extensive group work found in the PUPs is likely to represent a unique and powerful approach for addressing many of the issues associated with the process of psychosocial adjustment to injury and restoring quality of life, following ABI.

Outcome of temporal lobectomy: expectations and the prediction of perceived success.

This study examined the independent contributions of medical and psychosocial factors to perceived surgical success. We aimed to develop a multidimensional model predictive of perceived surgical outcome. Fifty anterior temporal lobectomy (ATL) patients were prospectively assessed, using a formally coded, semistructured clinical interview. This has been routinely administered pre- and post-operatively as part of a larger, nationwide study of Australian ATL patients. The interview covers a broad range of epileptological, psychiatric, neuropsychological and psychosocial issues. Variables from these domains were examined in relation to the patient's perception of surgical success at the 6-month post-operative review. Variables that correlated with success were analysed using principal components analysis and multiple regression. A predictive model of perceived surgical success emerged, which highlighted the multidimensionality of outcome. Independent effects were observed for both medical and psychosocial factors. These included the patients' pre-operative expectations of surgery, their post-operative seizure outcome, and affective state. The findings also highlighted the importance of discarding sick role behaviours associated with chronic epilepsy, after surgery. Traditional outcome measures (seizure frequency, post-operative affect) are significant in the patient's evaluation of surgical success. These traditional measures, however, do not account for the process of psychosocial adjustment surrounding seizure surgery. This process involves two major components: (1) positive anticipation of change prior to surgery, and (2) learning to discard roles associated with chronic epilepsy after surgery.

Long-term psychosocial adjustment following pediatric liver transplantation.

This study assessed long-term psychosocial adjustment to pediatric liver transplantation in 146 patients aged 4-25 yr, who had received a transplant 2-12 yr previously. Evaluations of psychosocial adjustment and related variables were based on the Harter Self-Perception Profiles for children, Child Behavior Checklist (CBCL), and children's academic level. Up to the age of 8 yr, transplant children as a group did not perceive themselves as less competent than healthy peers. Gender effects were characterized by older girls perceiving significantly less scholastic cognitive competence than their healthy peers. Adolescent and young adult boys had significantly lower global self-worth and lower perceived athletic competence than their healthy peers. In comparison to normative data of healthy children, CBCL parent-reported scores revealed significant deficits in competences for all age groups. Only for the older boys, however, did these deficits reported by the parents reach a pathological level. The majority of transplant children also had significantly higher problem scores, but they remained within the normal range, except for the older boys whose internalizing problems reached a borderline level. Our results suggest that liver transplantation does not substantially affect schooling. Regardless of statistically significant differences in psychosocial adjustment, the majority of the transplant children functioned at a normal level. For adolescent and young adult boys, however, the presence of problems and the lack of competences observed by parents and by the youngsters themselves reached borderline to pathological levels. Our findings stress the importance of psychological post-transplant follow-up with increased attention of caregivers to child and parental concerns about their long-term psychosocial adjustment process.