Can Distress Thermometer Predict Mood Disorders? (original) (raw)
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Purpose: Palliative patients and their family caregivers were interviewed at the beginning of home care in personal inter- views at home in regard to their psychological distress as well as their quality of life. Methods: Quality of life was collected with the palliative mod- ule EORTC QLQ-C15-PAL (patients) and the Short Form-8 Health Survey (caregivers). The psychological distress was assessed using the Hospital Anxiety and Depression Scale, the extent of social support with the Oslo 3-items social support scale. Two multiple regression models were employed to examine factors associated with psychological distress. Data from 106 palliative patients (39.6 % female) and their family caregivers (67.9 % female) were included in the analysis. Results: Every fourth patient had clinically relevant anxiety levels and half of the palliative patients had clinically symp- tomatic depression scores. The main symptoms of the patients were: fatigue, loss of appetite, pain, and shortness of breath. Patients’ and caregivers’ anxiety and depression scores were significantly correlated (anxiety r=0.386, depression r= 0.416). Thirty-three percent of caregivers suffered from high anxiety and 28 % from depression. Spousal caregivers had higher psychological distress than other caregivers. Other relevant factors for higher distress were high financial burden and low social support. There was hardly any family member receiving professional psychological support. Conclusions: In palliative patients, depressive symptoms should not be judged as a normal attendant of the terminal illness situation. Instead, patients should be referred to appropriate support services for pharmacological or psychological treatment. Spousal caregivers and caregivers who are socially not well integrated are in particular need of support. Attention to the financial burden of family caregivers is also very important. Due to the existing correlation between the psychological situation of palliative patients and their caring relatives, couples must be considered an emotional system rather than just two individuals.
Describing and understanding depression in spouses of cancer patients in palliative phase
Psycho-oncology, 2015
The cancer patient's relatives and family constitute one of the patient's main sources of support throughout the disease. In recent years, several studies have emphasized the psychological vulnerability of spouses-caregivers with a high proportion suffering from anxiety and depression symptoms. The literature underlines several factors of detrimental outcomes but critical aspects of the spousal relationship as attachment were neglected. This study aims at (1) describing depressive symptoms and depression among spouses who care for palliative cancer patients and (2) highlighting important factors explaining these symptoms. We surveyed 60 spouses 1-6 months before the patient's death, (38 men, mean age: 62 years). We found a high frequency of depression symptoms (25%) in the sample. Higher depression scores were associated to insecure-anxious attachment style, more frequent venting of emotion and disengagement through substance use. Despite limitations, this description of...
BACKGROUND: The purposes of this study were (1) to identify healthy and unhealthy patterns of coping strategies after bereavement among spouses of cancer patients and (2) to explore the characteris-BACKGROUND: Whereas a grief-related disorder tapping prolonged disabling reactions might be included in the DSM 5, the mechanisms underlying it remain poorly described. Some studies highlighted the risk for bereaved spouses after a cancer to develop this disorder, especially when reporting an insecure attachment. However no qualitative study explores associations between attachment styles and adjustment to grief in this population. This study aims at enhancing knowledge about the delineation of this debilitating condition. METHOD: The interview of a male widower (57 years) of a cancer patient, presenting a disorganized attachment and meeting at 6 months post-death the criteria for PGD (Inventory of Complicated Grief, Prigerson et al., 1995) was subjected to an Interpretative Phenomenological Analysis (IPA, Smith, Flowers & Larkin, 2009). This standardized analysis targets the meaning making processes with regards to attachment styles. RESULTS: Three inter-related master themes are presented: (1) Forgetting, and continuing bonds;
The effects of terminal illness on patients and their carers
Journal of Advanced …, 1996
The effects of terminal illness on patients and their carers As part of a larger study, this paper describes the development and design of a project looking at the expenences of the relatives and carers of terminally ill patients m one health authority, as a replication of a similar study undertaken in another area Following a description of the problems associated with studies into the problems of dying people and of the method used here, the results indicate that there are quite important effects on the household and carers, which include the problem of obtaining a diagnosis of terminal illness, and the actual process of dying The study also highlights some of the effects of the terminal illness on the patients and their carers In particular the results indicate that it was usually a spouse or the daughter who bore the brunt of the care, but that most preferred to retain their independence of the services as long as possible Often, carers (and the patients) were not fully appraised that a terminal stage had been reached Some doctors seemed reluctant (or found it difficult) to admit that such a stage had been reached For many, the expenence of dying was a very slow, distressing and often painful period, with senous limitations on their lifestyle imposed by the illness A number of these limitations could have been reduced if earlier diagnosis had been made or if community nursing or sociai services had been called m sooner Correspondence Professor BD Dans Dean of Nursing Studies, School of Increased interest and emphasis on improving care for
Principal caregivers of oncology patients in palliative care and their perspectives on death
Nursing and Palliative Care, 2019
The overall aim of this study was to ascertain how the principal caregivers of oncology patients placed under Palliative Care envision the act of caring and the imminent loss of a family member, evaluating how this affects their levels of emotional stress. Ten caregivers aged between 31 and 73, who were also family members, participated in the study, 80% of the sample being female. Oncology patients, accompanied by their respective caregivers, were cared for at a hospital in upstate São Paulo. For the data collection, a semi-structured interview script and Lipp's Stress Symptoms Inventory (LSSI) for adults were used. Data analysis was both quantitative and qualitative. The results showed that 100% of the respondents suffered from stress, of which 60% were in the near-exhaustion phase and 40% in the resistance phase. It was found that the act of caring is envisioned by caregivers as bringing about change, both in daily routines and in interpersonal family relations, that create difficulties, necessities and growth during the terminal stages of the patient's life. Caregivers' experiences of the imminence of the death of a loved one gave rise to assorted feelings, such as fear, despair, impotence, thinking about one's own finiteness and the avoidance of thoughts of death. It is important to emphasize that, despite the small sample size of the study, the results are consistent with other studies, underscoring the need to devise specific, effective and continuous interventions with the principal caregivers of patients with no hope of a cure, for the good of their own health, improvement in the quality of life and preparation for potential loss and separation.
Predicting bereavement outcome: Marital factors
Family Systems Medicine, 1983
This paper describes system variables in the marital relationship that portend problems in the bereavement period for spouse survivors and that can be assessed prior to the death of the spouse. Marital relationships that are characterized by skewed decision-making processes, control and dominance of one member over the other, non-negotiation of decisions, inflexibility, lack of sensitivity to feelings, and constricted expression of affect place survivors at risk for problems in the bereavement period. Case material collected at a facility for the care of the terminally ill involved predeath marital evaluation and follow-up in the bereavement period. There is general agreement in the literature that the outcome of bereavement for spouse survivors is one of increased mortality as well as morbidity, including poor emotional and physical health (2, 3, 9, 14, 19, 22, 25, 26). Indeed, the problems of the bereavement period are of such significant proportions as to be a major public health concern. Thus, it is important to be able to predict who will be at risk. This paper will describe system variables in the marital relationship that portend problems in the bereavement period for the spouse survivor that can be assessed prior to the death of the spouse (25). Illustrative case material will be drawn from case consultation with spouses of terminally ill patients cared for at a hospice in the pre-death and the bereavement period. OUTCOME OF BEREAVEMENT There are many excellent reviews of bereavement and some are quite current (2,3, 9,14,19,22,26). Almost all the studies of individuals in the bereavement period are undertaken after the death of the loved one and many are of widows. The following description of the outcome of bereavement will be brief. For more detail, the reader is referred to the reviews.
Marital therapy for couples facing advanced cancer: Case review
Palliative and Supportive Care, 2007
Objective: The primary objective of this article is to elucidate the significance of psychosocial distress and risk in a sub-population of end-stage cancer patients and their spouse caregivers who present with an especially challenging attachment style and histories of childhood trauma. The case study presented highlights the need to both identify and offer an empirically validated couple -based intervention, along with a multi-disciplinary team approach over the trajectory of the illness and at end of life.
Patients with cancer and their spouse caregivers. Perceptions of the illness experience
Cancer, 1992
This study focuses on patterns of response between patients with cancer and their spouse caregivers to examine the reliability of spouse informants in research and clinical settings. Thirty dyads (patient with cancerspouse caregiver couples; total n = 60) were interviewed concurrently in their homes concerning patient functioning, psychologic distress, physical symptoms, caregiver perceptions of patient functioning, and marriage quality. Couples had been married an average of 32 years. Patients had either the lung or colon as their primary cancer site, and one third had metastasis. Correlations between 14 variable pairs and cross-tabulation of scale scores suggest that spouse caregivers agree with patients on objective measures with observable referents (e.g., ability to dress independently). Partners disagree on subjective aspects of patient functioning (e.g., depression, fear of future, and confidence in treatment) and marriage quality. Almost without exception, caregivers viewed patients' functioning more negatively than patients described themselves. Patients, however, viewed marital quality more negatively than did caregivers. It was concluded that caregivers can serve as proxies for patients with cancer in research and clinical settings when objective data are sought. Data from both spouses are needed, however, to complete the picture of subjective illness experiences in patients with cancer, including perceptions of pain and disease symptoms. Cancer 1992; 69:1074-1079.
2019
Objective. The issues surrounding a patient's terminal phase of cancer and the imminent death of the individual represent a major family crisis affecting all its members. The goal of this study was to assess the prevalence of psychological morbidity in family caregivers of persons with terminal cancer in terms of psychological distress, depression, anxiety, somati-zation, and complicated anticipatory grief, and to determine which factors may influence these responses. Method. One hundred and twelve family caregivers of individuals with terminal cancer completed an assessment protocol comprising the Brief Symptom Inventory (depression, anxiety, somatization, and a computed score for global distress), the Marwit-Meuser Caregiver Grief Inventory-Short Form (anticipatory grief), the Family Inventory of Needs (importance and satisfaction of needs), and the Systemic Clinical Outcome Routine Evaluation-15 (family functioning). Prevalence of psychological morbidity was determined through descriptive and frequency statistics. Predictors of psychological morbidity were ascertained through structural equation modelling methods. Result. Regarding the prevalence of psychological morbidity in family caregivers, 66.1% reported high levels of distress, 68.8% showed high risk of depression, 72.3% showed high risk of anxiety, 50.9% reported high levels of somatization, and 25.9% showed high risk of complicated anticipatory grief. It was found that the predictors of age, gender, relationship to the family member with terminal cancer, the caregiving role played (i.e., primary vs. non-primary), the satisfaction of needs by healthcare professionals, and family functioning play an important role in terms of one's risk of developing psychological morbidity. Significance of results. This study revealed an alarming prevalence of psychological morbidity in family caregivers of individuals living with terminal cancer, making it crucial to move forward from a patient-centered approach to a family-centrad approach to reduce the risk of family maladjustment when facing the imminent death of a family member and to prevent postdeath unadjusted responses.