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ABSTRACT: BACKGROUND: Implantable cardioverter defibrillator recipients sometimes report "phantom shocks" (PSs), defined as a reported shock lacking objective evidence. The aim of this study was to describe the subjective experience of PSs and their psychosocial correlates using a mixed methods approach. METHODS: PS participants were matched on sex and age with individuals who received objective shocks only (OSO). Participants were interviewed and completed measures of posttraumatic stress disorder (PTSD Checklist-Civilian Version), depression and anxiety (Hospital Anxiety and Depression Scale), disease-specific distress (Cardiac Anxiety Questionnaire-CAQ), and social desirability (Socially Desirable Response Set-SDRS). Interviews were analyzed using interpretative phenomenological analysis (IPA). RESULTS: Seventeen male patients participated (PS: n = 9; OSO: n = 8). Three themes emerged from IPA: (1) PS as a somatic experience, (2) the emotional impact of PSs, and (3) searching for meaning. Quantitative analyses showed that both groups exhibited elevated trauma and anxiety levels. Effect size differences (ESD) suggested a medium ESD on depression (P = 0.176, η(p) (2) = 0.118) and PTSD (avoidance: P = 0.383, η(p) (2) = 0.055, numbing: P = 0.311, η(p) (2) = 0.068), and a large ESD on SDRS (P = 0.081, η(p) (2) = 0.189), where PS participants, comparatively, exhibited elevated levels. A medium ESD was detected on CAQ-fear (P = 0.237, η(p) (2) = 0.092) where OSO participants exhibited greater heart-focused worry. CONCLUSION: The qualitative and quantitative findings of this mixed method study show convergence in terms of the emotional factors associated with the experience of PSs. PSs are often reported to be indistinguishable from objective shocks, evoking alarm, frustration, and confusion, forcing the individual to face the uncertainties of what to them is a novel and confusing experience.
Pacing and Clinical Electrophysiology 02/2013; · 1.35 Impact Factor
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ABSTRACT: Background: Depression is associated with increased cardiac morbidity and mortality in the general population and in patients with coronary heart disease (CHD). Recent evidence suggests that patients with new-onset depression post-CHD diagnosis have worse outcomes than do those who had previous or recurrent depression. This meta-analysis investigated the timing of depression onset in established CHD and CHD-free cohorts to determine what time frame is associated with greater mortality and cardiac morbidity. Methodology/Principal Findings: The MEDLINE, EMBASE, and PsycINFO databases were searched systematically to identify articles examining a depression time frame that specified an end point of all-cause mortality, cardiac mortality, rehospitalization, or major adverse cardiac events. A meta-analysis was conducted to estimate effect sizes by time frame of depression. Twenty-two prospective cohort studies were identified. Nine studies investigated premorbid depression in CHD-free cohorts in relation to cardiac death. Thirteen studies in patient samples with CHD examined new-onset depression in comparison with previous or recurrent depression. The pooled effect size (risk ratio) was 0.76 (95% confidence interval (CI) = 0.48Y1.19) for history of depression only, 1.79 (95% CI = 1.45Y2.21) for premorbid depression onset, 2.11 (95% CI = 1.66Y2.68) for postmorbid or new depression onset, and 1.59 (95% CI = 1.08Y2.34) for recurrent depression. Conclusions/Significance: Both premorbid and postmorbid depression onsets are potentially hazardous, and the question of timing may be irrelevant with respect to adverse cardiac outcomes. However, the combi-nation of premorbid depression with the absence of depression at the time of a cardiac event (i.e., historical depression only) is not associated with such outcomes and deserves further investigation. Key words: coronary heart disease, depression, timing of onset, mortality, morbidity, outcome. CHD = coronary heart disease; MI = myocardial infarction; ES = effect size; RR = risk ratio; HR = hazard ratio; CI = confidence interval; DSM = Diagnostic and Statistical Manual.
Psychosomatic Medicine 10/2012; · 3.97 Impact Factor
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ABSTRACT: This study assessed a Web-based cognitive-behavioral therapy (CBT) for maladaptive perfectionism, investigating perfectionism, anxiety, depression, negative automatic thoughts, and perceived stress.
Participants were undergraduate students defined as maladaptive perfectionists through a screening questionnaire at an urban university. The data were collected from July 2009 to August 2010.
Forty-seven maladaptive perfectionists were randomly assigned to a 12-week CBT or a wait-list control group and assessed via questionnaires at pre- and postintervention. Statistical procedures included t tests, Pearson correlations, and analysis of covariance.
At the postintervention measure, the CBT group demonstrated significant decreases in anxiety sensitivity and negative automatic thoughts compared to the control group. Within the CBT group, changes in perfectionism scores were significantly correlated with positive changes in depression, anxiety, stress, and automatic thoughts.
The treatment group improved on psychological outcomes, demonstrating the effectiveness of a Web-based CBT for perfectionism in a university setting.
Journal of American College Health 07/2012; 60(5):357-66. · 1.45 Impact Factor
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ABSTRACT: The present study assessed the effectiveness of a web-based psycho-educational intervention protocol for decreasing levels
of perfectionism and psychological distress. Different levels of therapeutic intervention (no treatment, general stress management
intervention, general stress management intervention plus cognitive behavioral intervention) were provided to perfectionistic
participants over a 10-week period. It was found via a longitudinal structural equation model that higher levels of therapeutic
intervention predicted greater improvements in perfectionism and psychological distress. Further, amount of improvement in
trait perfectionism and perfectionistic automatic thoughts was highly related to amount of improvement in psychological distress.
The findings attest to the potential usefulness of a web-based intervention that combines a general stress management intervention
with a cognitive behavioral intervention.
Journal of Rational-Emotive and Cognitive-Behavior Therapy 04/2012; 26(3):151-167.
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ABSTRACT: Posttraumatic growth (PTG) is frequently reported after the strike of a serious medical illness. The current study sought to: 1) assess the relationship between degree of cardiac "threat" and PTG one-year post-hospitalization; and 2) to explore the association between PTG and healthcare utilization.
In a cohort study, 2636 cardiac inpatients from 11 Ontario hospitals completed a sociodemographic survey; clinical data were extracted from charts. One year later, 1717 of these outpatients completed a postal survey, which assessed PTG and healthcare utilization. Morbidity data were obtained retrospectively through probabilistic linkage to administrative data. The predicted risk of recurrent events for each participant was calculated using a logistic regression model, based on participants' sociodemographic and clinical characteristics. The relationship among PTG, trauma and health service use was examined with multiple regression models.
Greater PTG was significantly related to greater predicted risk of recurrent events (p<0.001), but not the actual rate of recurrent events (p=0.117). Moreover, greater PTG was significantly related to more physician visits (p=0.006), and cardiac rehabilitation program enrolment (p=0.001) after accounting for predicted risk and sociodemographic variables. PTG was not related to urgent healthcare use.
Greater PTG was related to greater objective risk of morbidity but not actual morbidity, suggesting that contemplation about the risk of future health problems may spur PTG. Moreover, greater PTG was associated with seeking non-urgent healthcare. Whether this translates to improved health outcomes warrants future study.
Journal of psychosomatic research 04/2012; 72(4):293-9. · 2.91 Impact Factor
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ABSTRACT: Objectives: There is an increasing amount of research being conducted regarding the psychosocial challenges associated with living with congenital heart disease (CHD), however little is known about how these challenges influence the type of psychosocial services patients want. This study investigated (1) the type of services patients want; (2) how they want to access these services; and (3) why they want these services. Methods: Three focus groups with adults with CHD (total of 14 participants aged 19-67) were conducted and thematic analysis was used to identify emerging themes. Results: Participants described wanting to access specific psychosocial services in three broad categories (counselling, connecting with other adults with CHD and psycho-education) and in three main formats (individual/group therapy, mentorship programmes and patient conferences). Reasons for wanting these services were grouped under two overarching themes, namely intrapersonal factors and interpersonal challenges. Conclusions: Psychosocial challenges are part of the everyday lives of adults with CHD, yet they are rarely addressed as part of routine medical care. Patients themselves have clear opinions regarding the psychological services most appropriate to target their experiences of living with CHD.
Psychology & Health 03/2012; 27(11):1260-70. · 1.69 Impact Factor
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ABSTRACT: We evaluated the influence of psychological stress and depression on motivation to adhere to recommended guidelines for exercise and diet. This study was conducted within a larger e-counseling trial. Subjects diagnosed with hypertension (n = 387, age = 44-74 years, 59% female) completed assessments at baseline and within 2 weeks after a 4-month intervention period. Outcomes included mean level of readiness to change diet and exercise and symptoms of depression and stress. Per protocol analysis defined e-counseling support as follows: ≥8 e-mails = therapeutic dose, 1-7 e-mails = subtherapeutic dose, and 0 e-mails = Controls. Baseline adjusted symptoms of depression and stress were inversely correlated with improvement in exercise (partial R = -.14, P = .01, and partial R = -.17, P = .01, resp.) but not diet or e-counseling. Subjects who received a therapeutic dose of e-counseling demonstrated greater readiness for diet adherence versus Controls (P = .02). Similarly, subjects receiving a therapeutic level of e-counseling demonstrated significantly greater readiness for exercise adherence versus Controls (P = .04). In sum, e-counseling is associated with improved motivation to adhere to exercise and diet among patients with hypertension, independent of symptoms of psychological stress and depression.
International journal of hypertension. 01/2012; 2012:191789.
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ABSTRACT: This study assessed the effectiveness of a web-based cognitive behavioral intervention (CBT) in reducing perfectionism and psychological distress in post-secondary students. Participants assessed as high in perfectionism (n=77) were randomized to one of three 10-week, web-based, intervention conditions (no treatment [NT], general stress management [GSM], or CBT). Results indicated the CBT condition was effective in reducing perfectionism, and supported a pattern of significantly greater improvement than observed in participants in the GSM or NT conditions. While both CBT and GSM demonstrated capacities to significantly reduce distress, for CBT participants changes in perfectionism were significantly correlated with changes in depression and anxiety. Results offer support for the effectiveness of web-based CBT in positively affecting perfectionist-related problems. Given the considerable proportion of individuals who suffer from perfectionism-related distress, the intervention's apparent effectiveness, cost-effectiveness and ease of dissemination warrant future replication studies.
Psychotherapy Research 11/2011; 22(2):194-207. · 1.75 Impact Factor
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Gary Naglie,
David B Hogan,
Murray Krahn,
B Lynn Beattie,
Sandra E Black,
Chris Macknight,
Morris Freedman,
Christopher Patterson,
Michael Borrie,
Howard Bergman,
Anna Byszewski,
David Streiner, Jane Irvine,
Paul Ritvo,
Janna Comrie,
Matthew Kowgier,
George Tomlinson
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ABSTRACT: To assess whether the core symptoms of Alzheimer disease (AD) consistently predict patient self-rated quality of life (QOL) as assessed by a variety of QOL measures in a large national sample of AD patients.
Cross-sectional.
Fifteen dementia and geriatric clinics across Canada.
Community-living patients with AD (n = 370) with Mini-Mental State Exam (MMSE) scores greater than 10.
Patients rated their QOL by using two utility indexes, the European QOL-5 Dimensions and the Quality of Well-Being Scale, a global QOL Visual Analog Scale, and the disease-specific QOL-AD instrument. Cognition was assessed with the AD Assessment Scale-Cognitive subscale and MMSE, function with the Disability Assessment for Dementia, and behavioral and psychological symptoms with the Neuropsychiatric Inventory and the Geriatric Depression Scale (GDS). One-way analysis of variance and fully adjusted multiple linear regression were used to assess the relationship between core dementia symptoms and QOL ratings.
The QOL measures had only small-to-moderate correlations with each other. For all QOL measures, patient ratings were significantly lower among patients with more depressive symptoms. In multivariable analyses, the GDS score was the only significant independent predictor of patient self-ratings for all four QOL measures.
Self-rated symptoms of depression were a consistent independent predictor of patient-rated QOL across diverse QOL measures, while performance-based measures of cognition and informant-based functional status were not. These findings confirm the importance of identifying and treating depression in patients with AD and endorse the use of measures of self-rated depressive symptoms and QOL as outcomes in AD clinical trials.
The American journal of geriatric psychiatry: official journal of the American Association for Geriatric Psychiatry 10/2011; 19(10):881-90. · 3.35 Impact Factor
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Gary Naglie,
David B Hogan,
Murray Krahn,
Sandra E Black,
B Lynn Beattie,
Christopher Patterson,
Chris Macknight,
Morris Freedman,
Michael Borrie,
Anna Byszewski,
Howard Bergman,
David Streiner, Jane Irvine,
Paul Ritvo,
Janna Comrie,
Matthew Kowgier,
George Tomlinson
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ABSTRACT: To assess whether the core symptoms of Alzheimer disease (AD) and caregiver factors consistently predict family caregiver ratings of patient quality of life (QOL) as assessed by a variety of QOL measures in a large national sample.
: Cross-sectional.
Fifteen dementia and geriatric clinics across Canada.
: Family caregivers (n = 412) of community-living patients with AD of all severities.
Caregiver ratings of patient QOL using three utility indexes, the European Quality of Life-5 Dimensions, Quality of Well-Being Scale and Health Utilities Index; a global QOL visual analogue scale; a disease-specific measure, the Quality of Life-Alzheimer's Disease; and a generic health status measure, the Short Form-36. Patient cognition was assessed with the cognitive subscale of the Alzheimer's Disease Assessment Scale and Mini-Mental State Examination, function with the Disability Assessment for Dementia, and behavioral and psychological symptoms with the Neuropsychiatric Inventory and the Geriatric Depression Scale. Caregiver burden was assessed with the Zarit Burden Interview and caregiver depression with the Center for Epidemiologic Studies Depression scale. One-way analysis of variance and fully adjusted multiple linear regression were used to assess the relationship between patient dementia symptom and caregiver variables with QOL ratings.
In multivariable analyses, caregiver ratings of patient function and depressive symptoms were the only consistent independent predictors of caregiver-rated QOL across the QOL measures.
Caregiver ratings of patient function and depression were consistent independent predictors of caregiver-rated QOL, using a spectrum of QOL measures, while measures of patient cognition and caregiver burden and depression were not. These findings support the continued use of caregiver ratings as an important source of information about patient QOL and endorse the inclusion in AD clinical trials of caregiver-rated measures of patient function, depression, and QOL.
The American journal of geriatric psychiatry: official journal of the American Association for Geriatric Psychiatry 10/2011; 19(10):891-901. · 3.35 Impact Factor
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ABSTRACT: The care of adult patients with congenital heart disease (CHD) is challenging from a mental health perspective, as these patients continue to face a variety of biopsychosocial issues that may impact emotional functioning. Despite these issues, there are limited data on the psychosocial functioning of adults with CHD, and there are no data on the impact of parental overprotection on heart-focused anxiety in this patient population.
The aim of this study was to examine the relationships between patient recollections of parental overprotection and current heart-focused anxiety in adults with CHD.
A cross-sectional sample of 190 adult patients with CHD (51% male; mean age = 32.28, SD = 11.86 years) completed validated measures of perceived parental overprotection (Parental Bonding Instrument) and heart-focused anxiety (Cardiac Anxiety Questionnaire).
The results indicated that perceived parental overprotection (β = 0.19, p = 0.02) and heart defect complexity (β = 0.17, p = 0.03) were significantly related to heart-focused anxiety. Contrary to hypotheses, perceived parental overprotection did not vary as a function of heart defect complexity (F (2, 169) = 0.02, p = 0.98).
Perceived parental overprotection and heart defect complexity are associated with heart-focused anxiety in adults with congenital heart disease. These results can inform the development of clinical interventions aimed at improving the psychosocial adjustment of this patient population.
International Journal of Behavioral Medicine 09/2011; 18(3):260-7. · 2.63 Impact Factor
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Cleveland Clinic Journal of Medicine 08/2011; 78 Suppl 1:S88a. · 3.77 Impact Factor
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Jane Irvine,
Jill Firestone,
Lephuong Ong,
Robert Cribbie,
Paul Dorian,
Louise Harris,
Paul Ritvo,
Joel Katz,
David Newman,
Doug Cameron,
Sabine Johnson,
Ana Bilanovic,
Ann Hill,
Suzan O'Donnell,
Samuel Sears
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ABSTRACT: To evaluate a eight-session cognitive behavior therapy (CBT) intervention tailored to adaptation in implantable cardioverter defibrillator (ICD) patients; and to test for treatment group by gender interaction effects.
Patients receiving their first ICD implant were randomized to CBT or usual cardiac care. Primary outcomes measured at baseline, 6-month, and 12-month follow-ups were symptoms of anxiety and depression (Hospital Anxiety and Depression Scale), posttraumatic stress disorder symptoms (Impact of Events Scale-Revised), and phobic anxiety (Crown-Crisp Experiential Index). Secondary outcomes were quality of life (Short Form-36 Physical Component Summary and Short Form-36 Mental Component Summary) and ICD shocks or antitachycardia pacing therapies.
Of 292 eligible patients, 193 consented and were randomized to CBT (n = 96) or usual cardiac care (n = 97). Eighty percent were male; mean age was 64.4 years (standard deviation = 14.3); and 70% received an ICD for secondary prevention. No baseline differences were observed between the treatment conditions; however, women scored worse than men on all psychological and quality of life variables (p < .05). Eighty-three percent completed follow-up. Repeated-measures analyses of covariance revealed significantly greater improvement with CBT on posttraumatic stress disorder total and avoidance symptoms for men and women combined (p < .05) and significantly greater improvement in depressive symptoms and Short Form-36 Mental Component Summary only in women (p < .01). No differences were observed between treatment conditions on ICD therapies over follow-up.
A CBT intervention to assist adaptation to an ICD enhanced psychological functioning over the first year post implant.
Psychosomatic Medicine 02/2011; 73(3):226-33. · 3.97 Impact Factor
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Jane Irvine,
Jill Stanley,
Lephuong Ong,
Robert Cribbie,
Paul Ritvo,
Joel Katz,
Paul Dorian,
Suzan O'Donnell,
Louise Harris,
Doug Cameron,
Ann Hill,
David Newman,
Sabine N. Johnson,
Ana Bilanovic,
Samuel F. Sears
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ABSTRACT: We aimed to assess cardiac patients, acceptance of cognitive behavior therapy (CBT); determine if gender was associated with treatment engagement (session attendance and utilization of intervention strategies); and relate engagement to outcome. Of 193 patients receiving an implantable cardioverter defibrillator (ICD) who agreed to participate in a randomized controlled trial, 96 were randomized to CBT. Measures of treatment acceptance indicated that most participants rated counseling as "very to extremely helpful." Gender was associated with only one treatment engagement index. Symptoms of depression and post-traumatic stress improved from baseline to 6- and 12-month follow-up. Number of counseling session attendance was not associated with outcome. Reported utilization of two of the six CBT strategies (modifying faulty thinking, correcting cognitive distortions) was associated with a better treatment outcome. In conclusion, a CBT intervention was well received by ICD patients. There was some indication that treatment engagement related to better treatment outcomes.
Journal of Cognitive Psychotherapy 10/2010; 24(of counseling session attendance was not associated with outcome. Reported utilization of two of the six CBT strategies (modifying faulty thinking):246-264.
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ABSTRACT: This study evaluated the sociodemographic, clinical and behavioral correlates of post-traumatic growth (PTG) in coronary artery disease (CAD) patients, and the degree of PTG compared to other patient groups. Using a prospective design, 1497 CAD outpatients completed a survey assessing potential PTG correlates. A total of 1268 responded to a nine-month follow-up survey assessing PTG. Significant PTG correlates were being younger, non-white, having lower income, functional status, and depressive symptoms, greater social support, and positive illness perceptions. The degree of PTG was equivalent to that of cardiac patients in other countries, but was lower than that of breast cancer and multiple sclerosis patients.
Journal of Health Psychology 10/2010; 15(7):1049-63. · 1.22 Impact Factor
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ABSTRACT: Recent research has reported an association between in-hospital depression and poorer long-term prognosis and a greater risk of in-hospital complications.
The purpose of the current study was to examine the relationship between past and incident depressive symptoms and in-hospital complications in acute coronary syndrome (ACS) inpatients.
A group of 906 ACS inpatients from 12 coronary-care units participated in the study. Incident depressive symptoms were assessed through the Beck Depression Inventory, and participants' were asked about past history of prolonged depressed mood. In-hospital complications were noted as present or absent by nurses, and authors conducted logistic-regression analyses.
A subset of 492 patients (58.4%) experienced an in-hospital complication, the most common being ischemia (48.8%) and cardiac arrest (7.2%). After adjusting for prognostic indicators, incident and past-combined-with-incident depressive symptoms were significantly associated with an increased risk of experiencing an in-hospital complication.
Incident symptoms, in particular, seem to be prognostic. This finding suggests that acute emotions may be triggering cardiac complications, and early identification of emotional symptoms is warranted.
Psychosomatics 07/2010; 51(4):283-8. · 2.12 Impact Factor
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ABSTRACT: Preferences (utilities) for health outcomes have an important role in decisions about prostate cancer screening and treatment. The responsiveness of utility instruments has not been evaluated.
Prostate cancer outpatients from the Princess Margaret Hospital, Toronto (n = 248) were allocated into three cohorts: N - newly diagnosed and treated; M - metastatic disease; O - all others.
We measured quality of life at 3 points within 12 months using 3 disease-specific utility instruments (Patient Oriented Prostate Utility Scales), 3 generic utility instruments (Health Utilities Index, EQ-5D, Quality of Well-Being Scale), and 3 profile scales (PORPUS-P profile, Prostate Cancer Index, QLQ-C-30). Responsiveness was assessed using measures of internal responsiveness (standardized effect size, standardized response mean) and external responsiveness (receiver operator curve analysis, mixed model regression).
Cohort N patients showed post-treatment declines followed by improvement in global health and functional status. Disease specific instruments detected moderate (0.4-1.3) decrements followed by small increments (0.1-0.4) in standardized effect size and standardized response mean. Most instruments detected change using external responsiveness measures (all cohorts).
Disease-specific utility instruments appeared to be more responsive than generic instruments. Use of generic instruments should be supplemented with a responsive disease-specific instrument, particularly for applications in early prostate cancer.
Quality of Life Research 05/2007; 16(3):509-22. · 2.30 Impact Factor
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ABSTRACT: In clinical and research practice linked to prostate cancer treatment, frequent monitoring of patient health-related quality of life (HRQOL) is essential. Practical and analytic limitations of paper questionnaire data capture may be overcome with the use of self-administered personal digital assistant (PDA) data collection. The objective of this study was to assess the reliability, validity, and feasibility of using PDA in place of paper versions of the International Prostate Symptom Score (IPSS), the Patient Oriented Prostate Cancer Utility Survey (PORPUS), and the International Index of Erectile Function-5 (IIEF-5) in a prostate cancer clinic setting.
152 participants were randomly assigned to one of three conditions: 1) paper followed by PDA survey; 2) PDA followed by paper survey; or 3) PDA followed by PDA survey. Evaluation included an assessment of data quality (internal consistency, test-retest reliability, response correlation, completeness of data), and feasibility (participation rates, time to completion, preference and difficulty/ease of using PDA).
Internal consistency was similar for both PDA and paper applications. Test-retest reliability was confirmed for PDA repeated administration. Data from paper and PDA questionnaires were strongly correlated. Lower missed item rates were found in PDA administration. 82.8% of participants preferred using the PDA or had no preference. Mean difficulty/ease ratings indicated that participants found the PDA easy to use. Age did not significantly correlate with preference or difficulty.
The results confirm the adaptability of the IPSS, IIEF-5, and the PORPUS to PDA administration. Similarly, the findings of this study support the feasibility of using PDA technology for HRQOL serial data capture in the prostate cancer patient population.
Health and Quality of Life Outcomes 02/2007; 5:38. · 2.11 Impact Factor
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ABSTRACT: This study set out to evaluate whether patients' expectations affected their responses to treatment of a sleep disorder.
Fifty consecutive patients attending a sleep clinic for the first time and who had different diagnoses of sleep disorders were included in this study. The patients completed a set of 6 questionnaires on 7 occasions as they progressed through the process of a sleep clinic referral, assessment and treatment. Self-report questionnaires were used to assess their sleepiness, fatigue and alertness. Predictor measures included mental health and individual items assessing expectation regarding the seriousness of the sleep problem. A battery of questions dealt with mental health issues, patients' expectation and their commitment to the sleep investigation and treatment process. Each patient's responses were examined over a period of 6 months.
Immediately following their interview with the sleep consultant, the patients' concern regarding their sleep problem was higher than the first measures obtained at baseline. Compared to prior to their first consultation with a sleep specialist, while on treatment they directed more attention to their sleep problem when problems associated with fatigue were reduced. Although there was a lessening in fatigue with treatment, subjectively rated sleepiness (Epworth Sleepiness Scale) did not vary over the study. Contact with a sleep center and the diagnosis and treatment of individual sleep problems also resulted in improved satisfaction with life.
Contact with and treatment at a sleep clinic was found to be beneficial. The fatigue levels were reduced and the patients had greater life satisfaction regardless of the diagnosis and treatment of their sleep disorder, although subjective sleepiness did not change. Patient expectations were not critical in determining the outcome of the sleep clinic assessment.
Psychotherapy and Psychosomatics 02/2007; 76(6):395-9. · 6.28 Impact Factor
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ABSTRACT: This study investigated gender differences, depression, and health-related quality of life (QoL) in a cross-sectional sample of patients with atrial fibrillation (AF).
This cross-sectional study involved a convenience sample of AF patients from two tertiary-care clinics in Toronto, Canada. Ninety-three AF patients completed psychometrically validated measures of generic QoL and depression. Mediation analyses evaluated the relationship between gender and QoL using depression as mediating variable.
Relative to male patients, female patients reported lower physical, but not mental, QoL. Gender was associated with both depression and physical QoL, while depression was correlated with poorer physical QoL. Path analyses demonstrated that depression significantly mediated the relationship between gender and physical QoL.
Among AF patients, female patients report lower physical QoL relative to male patients, and this relationship may be mediated by self-reported symptoms of depression. Albeit correlational, the findings underscore the need to develop a better understanding of the role of depression in physical QoL, especially when considering the burden of AF in women.
Journal of Psychosomatic Research 01/2007; 61(6):769-74. · 3.30 Impact Factor
