Psychosocial Adjustment To Illness Scale Research Articles

Understanding the Traumatic Impact of Serious Chronic Illness

IntroductionThe diagnosis of a severe chronic illness represents a deeply impactful traumatic event, frequently giving rise to initial adverse consequences that can manifest as post-traumatic stress. The duration and characteristics of these effects exhibit considerable variation among individuals.ObjectivesThis study aims to explore the levels of post-traumatic stress, post-traumatic growth, and psychosocial adaptation among individuals coping with chronic diseases.MethodsThis cross-sectional study involved 92 participants with chronic illnesses, recruited through convenience and snowball sampling. Data collection utilized an online questionnaire that included both demographic questions to provide a comprehensive understanding of participants’ experiences, as well as psychometric scales for measuring post-traumatic stress, post-traumatic growth, and psychosocial adaptation.Instruments used :1.PTSD Checklist for DSM-5 (PCL-5)2.Posttraumatic Growth Inventory (PTGI) and Tedeschi and Calhoun Posttraumatic Growth Inventory (TCGI).3.Psychosocial Adjustment to Illness Scale (PAIS).Analysis included descriptive statistics and inductive analysis using SPSS (p < 0.05). Ethical considerations were observed, with informed consent and data confidentiality.Results The study revealed the presence of low to moderate levels of post-traumatic stress (M= 2.45), moderate levels of post-traumatic growth (M= 2.90), and moderate levels of psychosocial adaptation in various aspects of participants’ lives, including work (M= 2.36), sexuality (M= 2.11), sociability (M= 2.28), relationships with partners and family members (M= 1.92), and perception of their health (M= 1.94). Furthermore, the overall psychosocial situation of the participants was found to range from low to moderate (M= 2.48). Notably, individuals with fewer chronic illnesses tended to experience lower levels of post-traumatic stress and exhibited less adaptation in their work. Additionally, higher levels of post-traumatic growth were observed in women and patients with higher educational backgrounds. The analysis revealed a positive and statistically significant correlation (sig.<0.05) between post-traumatic stress, post-traumatic growth, and various dimensions of psychosocial adjustment among the participants.ConclusionsA chronic illness diagnosis can be deeply traumatic, potentially causing post-traumatic stress. However, it’s crucial to understand that this doesn’t diminish the possibility of post-traumatic growth and effective psychosocial adaptation. To foster this positive path, individuals must receive holistic psychological and emotional support, along with essential social assistance as they navigate life with chronic diseases.Disclosure of InterestNone Declared

Evaluating the Relationship Between Emotion Regulation and Pain Self-efficacy with Psychosocial Adjustment in Athletes with Chronic Pain Considering the Mediating Role of Mental Fatigue

Background: Pain is a pervasive and disabling barrier for the injured athlete threatening his/her ability to participate in sporting events and professional goals. However, psychological factors in the treatment process of chronic diseases are an important factor in involving the patient in treatment and making treatment decisions. Objectives: This research aimed to investigate the relationship between emotion regulation and pain self-efficacy with psychosocial adjustment in athletes with chronic pain, considering the mediating role of mental fatigue. Methods: The statistical population of this descriptive correlational study was all athletes with chronic pain referred to the Iranian Sports Medicine Federation. Using the convenience sampling method, a total of 200 injured athletes were selected as the sample size. For data collection, Psychosocial Adjustment to Illness Scale (PAIS), Pain Self-efficacy Questionnaire (PSEQ), Pain Fatigue Scale (PFS), and Cognitive Emotion Regulation Questionnaire (CERQ-short) were used. Descriptive statistics, correlation matrix, and path analysis (structural model) were used to analyze data. Also, SPSS (v21) and AMOS (v23) software were used to analyze the data. Results: According to the results, pain self-efficacy (β = 0.18), adaptive emotion regulation (β = 0.27), and mental fatigue (β = -0.19) had a direct positive and significant impact on psychosocial adjustment. Also, the direct effect of pain self-efficacy (β = -0.19), maladaptive emotion regulation (β = 0.17), and adaptive emotion regulation (β = -0.12) on mental fatigue was significant. In addition, the indirect effect of pain self-efficacy and maladaptive emotions on psychosocial adjustment via mental fatigue was significant. Conclusions: Mental fatigue plays a good mediating role between pain self-efficacy and emotion regulation with psychosocial adjustment of athletes with chronic pain.

Effectiveness of Acceptance and Commitment Therapy on Hypochondriasis and Psychosocial Adjustment in Divorced Women

Background: Divorce is one of the most stressful life events leading to increased susceptibility to diseases and mood disorders such as hypochondriasis. Objectives: The present study aimed to investigate the effectiveness of acceptance and commitment therapy (ACT) on hypochondriasis and psychosocial adjustment in divorced women in Tehran. Methods: The research method was quasi-experimental with a pretest-posttest design and a control group. The statistical population in this study consisted of divorced women suffering from divorce-induced psychological distress who visited counseling centers in Tehran in 2018. The sample consisted of 30 divorced women selected by convenience sampling method. The participants were randomly divided into experimental and control groups (n = 15 per group), and the pretest was performed for the experimental and control groups before the intervention program. The experimental group underwent ten sessions of ACT (90-minute sessions per week), and the control group did not receive any treatment. The research instruments included the Health Anxiety Inventory (HAI) and the Psychosocial Adjustment to Illness Scale (PAIS). The Shapiro-Wilk test, Levene test, Pearson correlation coefficient, and analysis of covariance (ANCOVA) were used to analyze the data. Results: The results indicated that the ACT-based intervention significantly reduced hypochondriasis in divorced women (P = 0.043). In addition, ACT improved the psychosocial adjustment in these women (P = 0.0001). Conclusions: This intervention decreased anxiety under difficult conditions and also improved psychosocial adjustment in divorced women. Therefore, ACT can be used as an effective approach in reducing social and interactional problems and also anxiety in divorced women.

Illness Perception in Adolescent Patients With Anorexia: Does It Play a Role in socio-Emotional and Academic Adjustment?

People’s beliefs about their illness have been shown to affect their adjustment. The aim of this study was to describe illness perception in adolescent patients with anorexia nervosa (AN) and assess its relationship with socio-emotional and academic adjustment following Leventhal’s Self-Regulation Model. Thirty-four female AN patients, with a mean age of 15.76 (SD = 2.00), completed the Revised Illness Perception Questionnaire (IPQ-R), the Psychosocial Adjustment to Illness Scale (PAIS) and the Hospital Anxiety and Depression Scale (HAD). Adolescent anorexia patients perceived that they had control over their illness and treatment would improve their condition. However, they also believed that it was highly distressing, going to last a long time and would have serious consequences. As for the causes of the disorder, they were attributed primarily to a specific eating disorder and psychological factors. The results showed that anorexia patients’ illness perceptions were related to socio-emotional and academic adjustment. In this sense, identity with the illness was associated with a worse academic adjustment, while emotional representation was associated with a worse emotional and social adjustment. These findings highlight how important it is for patients’ beliefs about their disease to be considered in the treatment of anorexia. In this respect, clinicians treating these patients should consider how certain beliefs affect their academic and socio-emotional adjustment. It would be interesting for patients to become aware of how these beliefs influence the strategies they use to cope with their disease as well as their adjustment to it.

Psychosocial Adjustment to Illness and Its Relationship with Spiritual Wellbeing in Iranian Cancer Patients.

Background The aim of this study was to investigate the psychosocial adjustment to illness and its relation with spiritual health in cancer patients. Methods This study was conducted in 2019 in Iran. It was a descriptive study with a sample of 124 cancer patients. Data were collected using two questionnaires of the psychosocial adjustment to illness scale (PAIS) with 46 questions and the Paloutzian and Ellison spiritual health scale with 20 questions. Results The mean age of the participants in this study was 52.4 ± 13.2 (range 18 to 87 years). The mean months of life with cancer were 16.5 months. The mean score of psychosocial adjustment to illness was 30.7 ± 15.5. The mean score of spiritual wellbeing in the studied patients was 71.4 ± 17.1. The results of the Pearson correlation test showed a significant inverse relationship between the mean score of psychosocial adjustment to illness and the mean score of spiritual wellbeing (p > 0.001, rr = −.355). Conclusion Cancer patients in this study had relatively good psychosocial adjustment with their illness. Spiritual wellbeing can increase psychosocial adjustment to illness in this group of patients.

Fatigue predicts impaired social adjustment in survivors of allogeneic hematopoietic cell transplantation (HCT).

The aim of this study is to examine social adjustment to illness and to identify factors related to social adjustment in allogeneic hematopoietic cell transplantation (HCT) survivors. Cross-sectional data were drawn from a longitudinal study of patients ≥ 3years after their first HCT. The five subscales of the Psychosocial Adjustment to Illness Scale (PAIS) that reflect social adjustment, specifically vocational environment (VE); domestic environment (DE); sexual relationships (SEX); extended family relationships (ER); and social environment (SE) were examined in this analysis. Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) measured cancer-related fatigue. Subjects (N = 171) were a median of 5.19years from HCT (range 3-16). The most impaired dimension of social adjustment was ER with 38% of participants reaching clinically relevant (score ≥ 62) levels of social maladjustment. Unmarried and unemployed participants had lower levels of social adjustment in VE (p < .001 and p < .001, respectively) and DE (p = .004 and p = .006, respectively). Survivors with some college had poorer SEX adjustment than those with less or more education (p < .005). Hispanics reported lower adjustment with respect to ER adjustment (p = .002). Participants with higher fatigue had poorer adjustment in all five dimensions (p < .001). Although the majority of survivors are well adjusted, subgroups may experience significant poor social adjustment. Specifically, survivors with fatigue are at risk to experience lower levels of social adjustment. Development of effective rehabilitation strategies to improve affected areas of social health is warranted, and all HCT survivors should be screened periodically for social maladjustment and provided with resources and referrals.

Sexual and Romantic Relationships: Experiences of Adolescent and Young Adult Cancer Survivors.

This study examined the quality and satisfaction of sexual/romantic relationships of adolescents/young adults (AYAs) who recently completed cancer treatment. AYAs between 16 and 26 years old (62.5% female) and less than 24 months post-treatment were interviewed using the Psychosocial Adjustment to Illness Scale (PAIS) interview. Of 43 participants, 16 (37.2%) were in a relationship at time of the interview; eight (50%) reported minor relationship/sexual difficulties. AYAs identified emotional support with their partner as positive aspects of their relationships, and described relational conflict associated with communication difficulties and loss of sexual interest. Better understanding the factors that enable healthy relationships warrants further exploration.

A Controlled Evaluation of Mindfulness-Based Cognitive Therapy for Patients with Coronary Heart Disease and Depression

This study evaluated the effectiveness of an eight-session mindfulness-based cognitive therapy (MBCT) group intervention programme for treating depression in coronary heart disease (CHD) patients. Thirty-two depressed CHD patients were assigned to an MBCT treatment group, and a demographically and clinically similar group of 30 cases were assigned to a waiting list control group. Participants were evaluated at baseline, 8 weeks, and 6-month follow-up with the Hospital Anxiety and Depression Scale (HADS), Brief Symptom Inventory (BSI), Profile of Mood States (POMS), Psychosocial Adjustment to Illness Scale (PAIS) and the Mindful Attention Awareness Scale (MAAS). After each session, MBCT participants completed the post-session Questionnaire on helpful aspects of therapy and after the programme, completed the Client Satisfaction Questionnaire. At follow-up, 71 % of the MBCT group was clinically recovered from depression compared with 50 % of the control group. The MBCT group showed significantly greater improvement than the control group on all measures with effect sizes at follow-up of d = 0.43–1.0. Increases in mindfulness on the MAAS correlated significantly with improvements on the HADS, BSI, POMS and PAIS. Key helpful aspects of therapy identified by MBCT participants included learning meditation, obtaining group support and developing optimism. There was a high level of satisfaction with the MBCT programme. These results indicate that a randomized controlled trial of MBCT for depressed CHD patients is now warranted.

Quality of Life for Hong Kong Chinese Patients with Advanced Gynecological Cancers in the Palliative phase of Care: A Cross-Sectional Study

This study investigated the quality of life (QOL) of Hong Kong Chinese patients with advanced gynecological cancers (AGC). A cross-sectional study was conducted with 53 consecutive patients with AGC who were admitted to a university-based palliative care unit. The assessment tools utilized were: the McGill quality of life questionnaire for Hong Kong Chinese (MQOL-HK); the hospital anxiety and depression scale (HADS); the Palliative Performance Scale (PPS); and the psychosocial adjustment to illness scale (PAIS), sexual relationships subscale. The mean total score of the MQOL-HK was 4.63 +/- 1.94, within which the physical domain scored the worst (mean=3.99, SD=2.15, range: 0-7). Depression symptoms were common (62 percent). The median PPS was 40 percent. Younger age, higher HADS depression scores, and higher HADS anxiety scores were significantly correlated with poorer QOL. Furthermore, younger age and depression were significant predictors for a worse MQOL-HK score. In conclusion, Chinese patients with AGC have a relatively poor QOL, especially in the physical domain and in terms of depression symptoms. Age and depression symptoms are the most important factors affecting QOL. Proper identification of physical symptoms and depression symptoms, along with appropriate treatments, are important for improving QOL for patients.

The Efficacy of Chronic Disease Self Management Programs and Tele-Health on Psychosocial Adjustment by Increasing Self-efficacy in Patients with CABG

Aim: Coronary Artery Disease is a chronic and debilitating condition that seriously affects the lives of patients and their families. Despite advances in medical treatment, CAD is still associated with high morbidity and mortality, high hospitalization rates. It is well known that rehabilitation is an integral component of the care of people with chronic disease. Despite the expense associated with rehabilitation following chronic disease, dissatisfaction with psychosocial outcomes is common. The purpose of this study was to test the efficacy of The Chronic ِ Disease Self Management Rehabilitation Program and Telehealth in cardiac patients undergone Coronary Artery Bypass Surgery (CABGS), in order to improve, enhance and maintain their psychosocial adjustment to illness through increasing self efficacy. Method: A total of 300 patients, were recruited through Tehran Heart Center's cardiac rehabilitation clinic. They were randomly assigned to intervention group which received 6 sessions (each session 150minutes in a week) of psycho-educational intervention (N=150), or to a control group which received no intervention (N=150). The patients in both groups completed pretest measures consisting of Psychosocial Adjustment to Illness Scale (PAIS) and Cardiac Self Efficacy Questionnaire (CSEQ). Participants were reassessed 2-months and 3- months later. Results: Multiple regression analysis of the collected data, revealed that both after 2 and 3 months, by enrolling the CDSMRP and Tele-health in the intervention group, enhanced significantly Psychosocial Adjustment to Illness through enhanced self efficacy. Conclusion: The Chronic Disease Self management Rehabilitation Program and Tele-health improved the self efficacy of cardiac patients which then enhanced and maintained their Psychosocial Adjustment to Illness.

Responsiveness to change to change due to supportive-expressive group therapy, improvement in mood and disease progression in women with metastatic breast cancer

To compare the responsiveness of six questionnaires using three hypotheses of change: (i) change due to supportive-expressive group therapy (SEGT), (ii) improved mood defined as a small effect size (.2) on Profile of Mood States (POMS) Total Mood Disturbance score and (iii) progression of disease. Data from the "Breast Expressive-Supportive Therapy" study, a multicentre randomized controlled trial of change due to SEGT versus standard of care in women with metastatic breast cancer were used. Questionnaires studied were: POMS, Impact of Event Scale, Psychosocial Adjustment to Illness Scale (PAIS), EORTC QLQ-C30, Mental Adjustment to Cancer and a Pain visual analog scale (VAS). Responsiveness to change was evaluated using the standardized response mean. POMS was used as the standard. POMS was the most responsive questionnaire to change due to SEGT. Questionnaires measuring psychosocial attributes were responsive to improvement in mood. EORTC QLQ-C30, PAIS, PAIN VAS and MAC were the most responsive to disease progression. More responsive questionnaires were associated with the smallest sample size required to detect an effect. Responsiveness to change is context specific. The POMS was the most responsive questionnaire to psychosocial therapy.

Illness perception in eating disorders and psychosocial adaptation

The current study is based on the framework of the Self-Regulatory Model of Illness (SRM). The aim of this work was to examine perception of illness in eating disorder (ED) patients and investigate whether illness perception is related to psychosocial adaptation in these patients. A total of 98 female ED patients completed the specific eating disorders Spanish version of the Revised Illness Perception Questionnaire (IPQ-R) and a range of adjustment variables including the Psychosocial Adjustment to Illness Scale (PAIS) and the Hospital Anxiety and Depression Scale (HAD). ED patients reported a moderate number of physical symptoms, and perceived their illness as controllable, treatable, highly distressing, as a chronic condition and with serious consequences. Emotional representation was the most significant dimension related to emotional adjustment. Illness identity and cure dimensions were the most significant dimensions associated with psychosocial adaptation. This study shows that patients' illness perceptions are related to illness adaptation. Illness identity was associated with emotional and psychosocial adjustment, and having faith that treatment may control the illness was related to positive benefits for ED. These results suggest that a psychological intervention, which addresses patients' illness representations, may assist in their adjustment to ED.

Improvement of Psychosocial Adjustment to HIV-1 Infection through a Cognitive-Behavioral Oriented Group Psychotherapy Program: A Pilot Study

The present study evaluated the efficacy of a group therapy program in improving psychosocial adjustment to HIV infection, and tried to identify variables predictive of greater improvement. The outcome of 47 completing patients was analyzed, comparing the measures between T1 (1 month before therapy), and T2 (first session), and between T2 and T3 (last session) using the Wilcoxon matched-pairs signed-ranks test for each dimension of the Psychosocial Adjustment to Illness Scale (PAIS). The therapy consisted of 16 weekly 2-hour sessions following a structured time-limited cognitive-behavioral group psychotherapy program. During the intervention (between T2 and T3) a significant improvement was observed in health care orientation, vocational environment, domestic environment, sexual relation, extended family relationships, social environment, and total PAIS. There were no changes during baseline (between T1 and T2) in any of the PAIS subscales, or in the total PAIS score. Sexual route of transmission was independently associated with an improvement in health care orientation (beta = 2.525). Time since HIV diagnosis (beta = 0.022) and being employed (beta = 2.548) were independently associated with an improvement in adjustment to vocational environment. Men who have sex with men showed a poorer improvement in adjusting to family relations after the intervention (beta = -2.548). Finally, a lower CD4 count (beta = -0.005) and being employed (beta = 3.054) were independently associated with an improvement in adjustment to social environment. Our psychotherapy program improved psychosocial functioning in a heterogeneous sample of HIV-1-infected patients referred to a consultation-liaison psychiatry unit.

Quality of life among patients with Stage II and III breast carcinoma randomized to receive high‐dose chemotherapy with autologous bone marrow support or intermediate‐dose chemotherapy

The objective of this study was to compare the quality of life (QOL) after treatment among patients who had breast carcinoma with multiple positive lymph nodes. The patients were randomized to receive either high-dose chemotherapy with autologous stem cell support (HDC) or intermediate-dose chemotherapy (IDC) in the adjuvant setting. Two hundred forty-six patients with AJCC Stage IIA, IIB, or IIIA breast carcinoma who had > or = 10 positive lymph nodes and who were participants in Cancer and Leukemia Group B (CALGB) 9082 were enrolled in this companion study, CALGB 9066. Patients were randomized to receive either high-dose cyclophosphamide, carmustine, and cisplatin (CPA/cDDP/BCNU) and autologous bone marrow transplantation (the HDC arm) or intermediate-dose CPA/cDDP/BCNU as consolidation to adjuvant chemotherapy (the IDC arm). QOL was assessed at baseline and at 3 months, 12 months, 24 months, and 36 months using the Functional Living Index-Cancer (FLIC), the Psychosocial Adjustment to Illness Scale (PAIS)-Self Report, and the McCorkle Symptom Distress Scale (SDS). At the 3-month assessment, patients in the HDC arm demonstrated significant worsening of QOL compared with the IDC arm in terms of their physical well being (FLIC, P = 0.023), social functioning (FLIC, P = 0.026; PAIS, P < 0.0001), symptom distress (SDS, P = 0.0002), and total QOL scores (FLIC, P = 0.042). At 12 months, the differences in QOL scores between the HDC arm and the IDC arm had resolved. Patients who received more intensive adjuvant therapy experienced transient declines in QOL. By 12 months after therapy, QOL was comparable between the 2 arms, regardless of therapy intensity, and many QOL areas were improved from baseline.

Impact of chemotherapy-induced neutropenia on quality of life: a prospective pilot investigation

In this exploratory, prospective study evaluated quality of life (QoL) changes in patients with diverse cancers during the first cycle of myelosuppressive chemotherapy. Of 80 patients enrolled, 71 were observed during one of five chemotherapy regimens: docetaxel; CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone); carboplatin-paclitaxel; carboplatin-docetaxel; and carboplatin-gemcitabine. Complete blood counts were taken weekly. QoL and symptom burden measures were administered at baseline and throughout the cycle, and included SF-36, Cancer Care Monitor (CCM), Hospital Anxiety and Depression Scale (HADS), and Psychosocial Adjustment to Illness Scale (PAIS). Using generalized estimating equations, we modeled the change in each measure from baseline to the end of each week using the following covariates: baseline QoL measure, baseline SF-36 Physical and Mental Health Summary scores, sex, age, cycle week, grade 4 neutropenia any time in the past 7 days (yes/no), and the interaction of the latter two covariates. Of the 71 patients observed, 33 developed grade 4 neutropenia during the first 2 weeks. Changes from baseline in SF-36 Bodily Pain, HADS Anxiety, and PAIS Social Environment scores were significantly less favorable (P<0.05) when patients experienced grade 4 neutropenia any time in the past 7 days compared to when they did not (grade 0-3). A similar, but non-significant, trend was also observed for 12 other QoL measures. QoL may be adversely affected up to 7 days after patients experience grade 4 (versus grade 0-3) neutropenia. Such findings need to be examined further in studies with adequate statistical power to test a priori hypotheses regarding specific QoL measures.

Association of young age and chemotherapy with psychosocial distress and health-related quality of life (HRQOL) during the first year after breast cancer (BC)

8014 Background: Psychosocial distress and HRQOL after BC diagnosis may be related to a variety of factors, including age and treatment. Methods: We investigated these attributes in 397 women with newly diagnosed T1–3, N0–1, M0 BC. Women completed the Profile of Mood States (POMS), Impact of Event Scale (IES), Psychosocial Adjustment to Illness Scale (PAIS), Mental Adjustment to Cancer Scale (MAC) and EORTC QLQ-C30 questionnaires shortly after diagnosis (9.7±5.2 weeks) and one year post diagnosis (57.4±7.7 weeks). The impact of age and adjuvant chemotherapy was analysed with t-tests and regression analysis. Mean age was 52.0±9.9 years. 47.6% were postmenopausal, 68.0% had ER/PgR positive tumors, 39.8% received CXT, 44.0% tamoxifen. Results: At baseline, young age was significantly associated with greater distress (POMS all scales, total score), greater adverse impact on adjustment (PAIS 4 subscales, total), greater anxious-preoccupied and reduced fatalistic coping (MAC), and reduced emotional and cognitive functioning (EORTC QLQ-C30) (all p≤0.05); most of these effects were attenuated at one year, reflecting improvement over time. At 1 year, anxiety, anger and total mood disturbance (POMS), psychological distress and total score (PAIS), poor emotional functioning (EORTC QLQ-C30), and greater anxious-preoccupied coping and fatalistic coping (MAC) remained significantly associated with young age (p≤0.05). Physical functioning (EORTC QLQ-C30) was worse in older women at both timepoints. Adjusting for age, women who received chemotherapy reported greater adverse impact on vocational and social functioning (PAIS); role, social functioning and QOL (EORTC QLQ-C30) at baseline (p≤0.05). At one year, greater adverse impact of chemotherapy was seen for most PAIS scales and for physical, role and social functioning (EORTC QLQ-C30) (p≤0.05). Conclusions: Age is an important determinant of psychosocial distress and HRQOL in newly diagnosed BC; women who receive CXT report greater adverse impact on adjustment, role, social and vocational functioning which persisted at one year. No significant financial relationships to disclose.

Refining a health-related quality of life assessment strategy for solid organ transplant patients.

The psychometric properties of generic health-related quality of life (HRQOL) assessment instruments were evaluated to identify a reliable, valid, and non-redundant battery to measure longitudinal outcomes in organ transplant patients. Objective functional performance and subjective HRQOL were assessed in 371 solid organ (liver, heart, kidney, lung) transplant patients using the Karnofsky scale, the SF-36 Health Survey (SF-36), and Psychosocial Adjustment to Illness Scale (PAIS). The surveys' internal-consistency reliability, criterion-related validity, and redundancy were tested. The SF-36 mental (MCS) and physical components (PCS), and PAIS summary scales were internally consistent (all alpha > or = 0.83). Four out of seven PAIS scales (vocational, domestic, sexual, social) were collectively associated with the PCS (R = 0.65, P < 0.001), as was functional performance (r = 0.52, P < 0.001). Three PAIS scales (family, social, psychological distress) were associated with the MCS (R = 0.72, P < 0.001). Only the PAIS healthcare orientation (satisfaction) scale was not associated with the SF-36((R)). The relationship between functional performance and the PCS is stronger (r = 0.52, P < 0.001) than with the MCS (r = 0.25, P < 0.001) and the PAIS global score (r = 0.37, P < 0.001). The SF-36 and PAIS are internally consistent and exhibit divergent criterion-related validity but, with the exception of the PAIS healthcare orientation scale, are statistically redundant. The advantages of the SF-36 include wider use, more norms, and a lesser response burden. A transplant-specific patient satisfaction inventory was indicated and was developed.

Psychosocial adjustment to orthotopic liver transplantation in 266 recipients

Although the survival rate of patients undergoing orthotopic liver transplantation (OLT) is highly satisfactory, one of the most important objectives for liver transplantation teams at the present time is to achieve the best possible quality of life and psychosocial functioning for these patients after transplantation. We present the preliminary results of a study designed to determine which domains of psychosocial functioning are most affected in liver transplant recipients, and to examine the factors associated with poorer adjustment after OLT, using a utility-based standardized measure. Patients who had undergone liver transplant more than 12 months previously were eligible. They were administered the Psychosocial Adjustment to Illness Scale (PAIS), and they provided the answers themselves. Multivariate regression models showed that attitudes toward health care were poorer in women (beta = 0.916, P <.001), in patients who were employed at the moment of transplantation (beta = 0.530, P =.032), and in patients of lower social class (beta = 0.722, P =.026) than in men, unemployed patients, and patients of higher social class. Sexual functioning was worse in women (beta = 0.907, P =.001) and older patients (beta = 0.999, P <.001) than in men or younger patients. Psychological distress was higher in women (beta = 0.981, P =.001) than in men, and lower in currently employed patients (beta = -0.937, P =.001) than in the unemployed. Only gender remained significantly associated with the total PAIS score (beta = 0.969, P <.001), with women showing a poorer overall psychosocial adjustment to OLT. In conclusion, there seems to be no doubt that liver transplantation improves quality of life, but special attention should be paid to female recipients, who seem to have more difficulty than their male counterparts in adjusting to the psychosocial consequences of the procedure.

Effects of diabetes and cadaveric organs on functional performance and health-related quality of life after kidney transplantation

Background The current study was undertaken to identify factors specific to kidney transplantation that are associated with posttransplant functional performance (FP) and health-related quality of life (HRQOL). Methods Karnofsky FP status was assessed longitudinally in 86 adult kidney transplant recipients. Patients reported HRQOL using the Short Form-36 (SF-36) health survey and the Psychosocial Adjustment to Illness Scale (PAIS). Results FP improved ( P <0.001) after kidney transplantation (from 75 ± 1 to 77 ± 1, 81 ± 1, and 82 ± 1 at 0, 3, 6, and 12 months, respectively). Patients receiving organs from living donors showed continued improvement through posttransplant year 1 while those receiving cadaveric organs stabilized at month 6 (simple interaction contrast, year 1 versus pretransplant; P <0.05). Patients receiving dialysis therapy for 6 months or more prior to transplantation demonstrated lower SF-36 posttransplant physical component scores in comparison with patients who were transplanted preemptively (38 ± 1 versus 45 ± 2, P <0.05). Path analysis demonstrated the positive direct effect of time on FP with kidney transplantation (β = 0.23, P <0.05), and the negative direct effects on FP of diabetes (β = −0.22) and cadaveric organs (β = −0.22, both P <0.05). In turn, FP had a positive direct effect on HRQOL (β = 0.40, P <0.001). Conclusions Overall improvement in FP is attenuated 1 year after kidney transplantation in recipients of organs from cadaveric donors. The positive effect of time after transplantation, and the negative effects of cadaveric organs and diabetes on posttransplant HRQOL, are indirect and are mediated by the direct effects of these variables on posttransplant FP.

Psychosocial impact of heart transplantation on spouses.

The purpose of this study was to evaluate the psychosocial impact of heart transplantation on spouses and compare the adjustment of spouses and their partners. Data were collected from 51 couples prior to transplant and 12 months posttransplant. The Psychosocial Adjustment to Illness Scale (PAIS) was used to measure adjustment in seven domains. Prior to the transplant, spouses experienced profound psychosocial distress related to their partner's illness. From pretransplant to posttransplant, PAIS total score decreased (lower scores indicate better adjustment) for spouses (M = 42, SD = 16, vs. M = 26, SD = 13). Spouses showed improvement in all domains. Posttransplant, patients' and spouses' PAIS total scores (overall adjustment) were not significantly different. Spouses reported more psychological distress than patients; patients reported more problems than spouses in vocational and domestic function. Study findings highlight the importance of sensitivity in the clinical setting to the distinct psychosocial needs of spouses.