Emotion Regulation in Dementia Caregiving: The Role of Neuropsychiatric Symptoms and Attachment Orientation.

Family caregivers are usually the main source of support for persons living with dementia, being exposed to a loved one's suffering, which can lead to experiencing strong and negative emotions. This study aimed to identify factors capable of explaining individual differences in the way caregivers regulate their emotions. This cross-sectional study included 78 informal caregivers (M = 64.84 years; SD = 13.32) and 84 controls (non-caregivers) (M = 77 years; SD = 7.59). Neuropsychiatric symptoms (NPS), attachment orientations, and emotion regulation were measured using self-report scales. Caregivers of persons living with dementia used more expressive suppression in comparison to non-caregivers. NPS and attachment avoidance were associated with expressive suppression. Moderation analyses showed that NPS only predicted expressive suppression when attachment avoidance was low or medium. The present study showed that caregivers are more likely to suppress their emotions in the presence of NPS, especially those with lower/middle levels of attachment avoidance. Psychological interventions targeting emotion regulation should be offered especially to caregivers that face NPS of persons living with dementia and present lower/middle levels of attachment avoidance.

Communication concerns in mothers with cancer: Development and psychometric properties of a new measure.

OBJECTIVE: This study aimed to present the development of the Communication Concerns in Parents with Cancer Scale (CCPCS) and to evaluate its psychometric properties in mothers with cancer. METHODS: Two hundred and twenty-nine mothers with cancer participated in this study. Participants reported on parenting concerns, depressive and anxiety symptoms and quality of life. An exploratory factor analysis (EFA) was performed to explore the factor structure of the new scale. Concurrent and convergent validity, internal consistency and test-retest reliability were evaluated/obtained. To measure invariance according to type of cancer and time passed since diagnosis, a multi-group analysis was used. RESULTS: EFA suggested that the scale comprised one factor that explained 75.63% of the total variance. The developed CCPCS had high internal consistency. Communication concerns were positively associated with other parenting concerns, as well as anxiety and depression symptoms. Test of measurement invariance showed scalar invariance for type of cancer, and residual invariance for time passed since diagnosis. CONCLUSION: The CCPCS seems to be a promising scale to measure communication concerns in mothers with cancer for clinical and research purposes. Knowing the impact of communication concerns in the mother's process of adaptation to cancer can provide clues for the psycho-oncological care offered.

BRCA1/2 pathogenetic variant carriers and reproductive decisions: Gender differences and factors associated with the choice of preimplantation genetic diagnosis (PGD) and prenatal diagnosis (PND).

PURPOSE: To investigate the way carriers of a BRCA1/2 pathogenetic variant make their reproductive decisions and to examine the factors associated with the choice of preimplantation genetic diagnosis (PGD) and prenatal diagnosis (PND). METHODS: We conducted a comprehensive literature search in PubMed, Scopus, and Web of Science in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method. RESULTS: A total of 16 articles published from 2000 to 2021 were included in this review. Data were overall collected from 3564 participants (86% females). Three important themes were identified across studies: changes in family planning, factors associated with family plans, and with acceptance or regret of PGD and PND. CONCLUSION: This review may contribute to the knowledge of the experience of those who have a BRCA1/2 mutation and want a child. These results may help genetic counselors and healthcare professionals that support people with a BRCA pathogenetic variant with reproductive issues.

The Emotion Regulation Goals Scale: Advancing its psychometric properties using item response theory analysis.

OBJECTIVE: Emotion goals are considered paramount for influencing the initiation, maintenance, and cessation of emotion regulation. Recently, some authors developed an instrument to assess emotion goals-the Emotion Regulation Goals Scale (ERGS). METHOD: This study included two studies aimed to examine the psychometric properties of the ERGS in two Portuguese samples: 400 adults from the community (76% women; M age = 37.10) (Study 1) and 205 university students (80% women; M age = 21.72) (Study 2). RESULTS: Confirmatory factor analysis (CFA) and item response theory (IRT) analysis were used to examine the psychometric properties of the ERGS in the two samples. The CFA confirmed the five-factor structure of the 18-item ERGS, but the analyses of both studies suggested the elimination of two items given their lower loadings/low discrimination. CONCLUSIONS: A five-factor structure with 16 items was proposed, with good reliability and with evidence of construct validity with relevant constructs.

A systematic review on social constraints in the context of cancer.

This review aims to identify, summarise and critically evaluate studies that examined moderators or mediators of the relationship between social constraints and cancer adjustment. A database search was conducted to identify eligible studies published between inception and November 2019. A narrative synthesis of the included studies was conducted. We identified 18 papers, comprising 6933 participants (Mage = 55.70) with different types of cancer (mainly breast cancer). All of the studies used the Social Constraints Scale. Our synthesis shows that the association between social constraints and cancer adjustment is likely to be moderated or mediated by different cognitive (e.g. avoidant coping, intrusive thoughts) and emotional (e.g. emotionality, negative affect) variables. The importance of the moderators and mediators found in this study should be further examined by employing more sophisticated data analytic strategies to assess mediation and by collecting longitudinal data in order to better disentangle the complex associations among variables. However, some important variables were identified as potential targets of interventions for patients facing cancer.

Perceived Threat of Infertility and Women's Intention to Anticipate Childbearing: The Mediating Role of Personally Perceived Barriers and Facilitators.

To study the role of perceived threat of infertility, barriers, and facilitators in intention to anticipate childbearing, a cross-sectional study was conducted with 240 women desiring to have children and committed in a heterosexual relationship. Participants answered an online survey between July 2016 and February 2018. Results showed that perceiving infertility as a strong barrier and being willing to use fertility treatment as a facilitator fully mediated the effect of perceived threat on intention to anticipate childbearing. In conclusion, women who perceive themselves at risk of being infertile will consider, to a higher degree, infertility as a strong barrier to achieve their reproductive life plan or will report higher willingness to use fertility treatments, which in turn would increase intentions to anticipate childbearing. Since evidence showed lack of fertility awareness, intervention initiatives should target these mediators.

The Parenting Concerns Questionnaire: A validation study with Portuguese parents with cancer.

OBJECTIVES: To examine the psychometric properties of the Parenting Concerns Questionnaire (PCQ) in a sample of Portuguese parents with cancer. METHODS: The PCQ was completed by 209 adults with cancer, who are parents of at least one minor child. Participants reported on parenting concerns, depressive and anxiety symptoms, parental stress as well as quality of life. Confirmatory factor analysis and Item Response Theory (IRT) were used to assess the psychometric properties of the PCQ. Cronbach's alpha was used to examine its reliability. Pearson correlation coefficients provided information regarding convergent validity. Criterion validity was analysed. RESULTS: Confirmatory factor analysis confirmed the original three-factor structure. IRT indicated that most of the items were highly discriminant and better identified as moderate versus low or high levels of parenting concerns in the three dimensions of PCQ. The pattern of associations with depressive and anxiety symptoms, parental stress, and quality of life provided evidence for the convergent validity. The PCQ differentiated between parents with and without depressive symptoms. CONCLUSION: Exploring parenting concerns provides additional relevant information about the experiences and the potential psychological distress experienced by these parents with cancer. The PCQ can be an important tool to identify parents with cancer who might benefit from psychological support regarding parenting.

Attachment, emotion regulation, and well-being in couples: Intrapersonal and interpersonal associations.

OBJECTIVE: There is a well-established link in the literature between secure romantic attachment orientation and psychological well-being. The underlying processes of this link and the couple interplay between attachment and well-being are notably less explored. Using a dyadic framework, this study examines both couple members' emotion regulation strategies as potential mediators of this link. METHOD: One hundred and nineteen heterosexual couples completed self-report measures on attachment style, psychological well-being, tendency to suppress emotions, and emotion expression. Analyses were performed using the actor-partner interdependence mediation model that distinguishes between intrapersonal and interpersonal influences. RESULTS: Results showed that controlling for relationship length, there was an intrapersonal indirect effect of attachment avoidance on psychological well-being through emotion suppression. Moreover, interpersonal indirect effects were found (a) with individual attachment avoidance being associated with partner's psychological well-being through own emotion expression and (b) individual's attachment anxiety being associated with partner's psychological well-being through both own's emotion expression and partner's emotion suppression. CONCLUSIONS: These findings highlight the complex associations among attachment, emotion regulation, and well-being and point out the role of emotion regulation as a potential underlying pathway explaining these associations. The results suggest the importance of considering the relational nature of emotional and attachment dynamics in couples.

Posttraumatic Growth After Childbirth in Women: A Systematic Review.

This systematic review aimed to synthesize and critically appraise research evidence on posttraumatic growth (PTG) and related factors within the perinatal context. PRISMA guidelines were followed. Five databases were searched from inception to February 2019 using relevant search terms. Of 121 abstracts identified, 13 studies were deemed eligible for inclusion. Data were extracted from each study regarding study sample characteristics, design, PTG measure, and main findings. Factors associated with PTG were divided into individual, event-related and contextual factors, as conceptualized by the functional-descriptive model of Tedeschi and Calhoun. Most individual consistent factors included age, personality and coping strategies; most event-related factors included premature birth and threat appraisal; finally, most contextual consistent factors included grandmothers' and spouses' emotional support. These factors highlight targets to the development of psychosocial interventions. Recommendations for future research are discussed.

Dyadic coping, marital adjustment and quality of life in couples during pregnancy: an actor-partner approach.

Objective: This study aimed to examine the impact of dyadic coping on the quality of life of couples during pregnancy and to explore the potential mediating role of marital adjustment on this association.Background: According to the systemic transactional model, pregnancy can be characterised as a situation of dyadic stress because it affects both members of the couple. However, the impact of dyadic coping on couples' quality of life during pregnancy is unexplored. Also, the potential mediating role of marital adjustment on this association remains understudied.Methods: Participants were 320 pregnant women and their partners (N = 640) who completed the Dyadic Coping Inventory, the Dyadic Adjustment Scale and the World Health Organisation Quality of Life instrument. Data were analysed using the actor-partner interdependence mediation model.Results: Results showed that there was an intrapersonal indirect effect of dyadic coping on quality of life through marital adjustment. Moreover, an interpersonal indirect effect was found with fathers' dyadic coping being associated with mothers' quality of life through mothers' marital adjustment.Conclusions: These findings highlight the importance of assessing dyadic coping strategies of couples during pregnancy and targeting them in the psychological support offered to couples as a way of improving their marital adjustment, and consequently, their quality of life.

Brief emotional screening in oncology: Specificity and sensitivity of the emotion thermometers in the Portuguese cancer population.

OBJECTIVE: This study aimed to determine the cutoff and the specificity and sensitivity of the Emotion Thermometers (ET) in a Portuguese sample of cancer patients. METHOD: A total of 147 patients (mean age = 49.2; SD = 12.6) completed the ET, the Brief Symptom Inventory (BSI), and the Subjective Experiences of Illness Suffering Inventory. Data were collected in a cancer support institution and in a major hospital in the North of Portugal. RESULT: The optimal cutoff for the Anxiety Thermometer was 5v6 (until 5 and 6 or more), which identified 74% of the BSI-anxiety cases and 70% of noncases. The Depression Thermometer cutoff was 4v5 (until 4 and 5 or more), which identified 85% of BSI-depression cases and 82% of noncases. Cutoff for the Anger Thermometer was 4v5 (until 4 and 5 or more), which identified 83% of BSI-hostility cases and 73% of noncases; for the Distress Thermometer, the optimal cutoff was 4v5 (until 4 and 5 or more), which identified 84% of the suffering cases and 73% of noncases. Finally, for the Help Thermometer, it was 3v4 (until 3 and 4 or more), which helped to identify 93% of the suffering cases and 64% of noncases. SIGNIFICANCE OF RESULTS: Results supported the Portuguese version of the ET as an important screening tool for identifying the emotional distress in cancer patients.

Classism in Pain Care: The Role of Patient Socioeconomic Status on Nurses' Pain Assessment and Management Practices.

OBJECTIVE: Research on social disparities in pain care has been mainly focused on the role of race/racism and sex/sexism. Classism in pain assessment and management practices has been much less investigated. We aimed to test the effect of patient socioeconomic status (SES; a proxy of social class) on nurses' pain assessment and management practices and whether patient SES modulated the effects of patient distress and evidence of pathology on such practices. DESIGN: Two experimental studies with a two (patient SES: low/high) by two (patient distress or evidence of pathology: absent/present) between-subject design. SUBJECTS: Female nurses participated in two experimental studies (N = 150/N = 158). METHODS: Nurses were presented with a vignette/picture depicting the clinical case of a female with chronic low back pain, followed by a video of the patient performing a pain-inducing movement. Afterwards, nurses reported their pain assessment and management practices. RESULTS: The low-SES patient's pain was assessed as less intense, more attributed to psychological factors, and considered less credible (in the presence of distress cues) than the higher-SES patient's pain. Higher SES buffered the detrimental impact of the presence of distress cues on pain assessment. No effects were found on management practices. CONCLUSIONS: Our findings point to the potential buffering role of SES against the detrimental effect of certain clinical cues on pain assessments. This study contributes to highlighting the need for further investigation of the role of SES/social class on pain care and its underlying meanings and processes.

The impact of informal cancer caregiving: A literature review on psychophysiological studies.

Caregiving can be experienced as a stressful process, which can cause psychological and physical consequences. The combination of prolonged stress and the physical demands of caregiving may impair the physiological functioning of caregivers and increase the risk of health problems creating considerable stress in the life of caregivers regarding emotional, physical, social and financial areas. This literature review explored studies that used measures of the autonomic nervous system in caregivers of oncology patients such as electrodermal and cardiovascular (re)activity. The results revealed that caregivers had elevated stress levels and a serious autonomic imbalance that may, in the long term, trigger negative health consequences such as infectious diseases, cancer progression, cardiovascular disease and even premature death. The results showed the need to carry out preventive strategies in this population, in order to improve the autonomic profile of caregivers of cancer patients.

Experiences of breast cancer patients and helpful aspects of supportive-expressive group therapy: A qualitative study.

OBJECTIVE: This study explored the experiences and perceived changes of breast cancer (BC) patients after participating in 16-weekly sessions of Supportive-Expressive Group Therapy (SEGT). METHODS: A semi-structured interview adapted from Elliott's Client Change Interview was carried out with 12 women (aged 33-60 years) with BC, about 6 months after completing the treatment. RESULTS: Content analysis identified four main themes: expectations and motivations to participate in SEGT, group processes and experiences, perceived changes enhanced by SEGT and perceptions about the therapeutic relationship. The most helpful aspects of SEGT mentioned by participants were as follows: the expression/normalisation of feelings, thoughts and reactions; the improvement of social support; and the learning opportunities obtained through sharing of experiences among participants. Additionally, participants mentioned that SEGT contributed to improve personal and social skills, such as the capacity to express emotions and the ability to establish satisfactory interpersonal relationships. CONCLUSIONS: Based on the participants' experiences, SEGT seems to be an effective intervention to support women facing BC during the initial phase of cancer. The use of SEGT by health care professionals is encouraged, but the specific needs/problems of each group member should be carefully attended.

Mothers with breast cancer: A mixed-method systematic review on the impact on the parent-child relationship.

OBJECTIVE: To systematically review and integrate the findings from quantitative and qualitative studies on parenting and parent-child relationships in families where mothers had breast cancer (BC). METHODS: Ten different databases were searched from inception to January 2016. All authors assessed these data independently. Full-text, peer-reviewed articles exploring parenting and/or mother-child relationships in families where the mother had BC, regardless of cancer stage, were considered for inclusion. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. RESULTS: From 116 studies, 23 were deemed eligible for inclusion. Five of them were quantitative, 15 were qualitative, and 1 study used a mixed-method approach. Most studies analysed the mother's perceptions about the experience of having BC in parenting and in the parent-child relationship. The majority of studies explored experiences and perspectives on the parent-child relationship in mothers with minor children, although a minority of studies included adult children. Additionally, a few studies (17%) addressed perceptions and experiences of women with advanced stage cancer. Three main themes were found: priorities and concerns of patients, decision-making processes about sharing the diagnosis with their children, and mother-child relationship and parenting after mother's diagnosis. CONCLUSIONS: Findings indicated that the diagnosis of BC is accompanied by an array of challenges that affect parental roles and parenting. Further studies are needed to explore these issues more sensitively. For now, however, the evidence suggests that the families of women with BC, and particularly the women themselves, may benefit from informal and formal support aimed at helping them cope effectively with this challenging life event.

Psychological adjustment after breast cancer: a systematic review of longitudinal studies.

OBJECTIVES: Breast cancer (BC) can be a traumatic and stressful experience for women, but there are wide-ranging differences in the ways in which women respond and adapt to BC. This systematic review examines which sociodemographic, disease-related, and psychosocial factors near diagnosis predict later psychological adjustment to BC. METHODS: Database searches were conducted in 9 different health-related databases from 2000 to December 2015 using relevant search terms. Full-text, peer-reviewed articles in English that analyzed potential predictors of psychological adjustment in longitudinal studies were considered for inclusion. RESULTS: Of 1780 abstracts, 41 studies fulfilled inclusion criteria. Consistent sociodemographic and disease-related variable predictors of adjustment were income, fatigue, cancer stage, and physical functioning. Psychosocial factors, particularly optimism and trait anxiety, as well as perceived social support, coping strategies, and initial levels of psychological functioning, were found to be predictive of later depressive and anxiety symptoms, psychological distress, and quality of life for women with BC, in predictable ways. Other psychosocial variables, such as cognitive and body image factors, predicted psychological adjustment but were explored only by a few studies. CONCLUSIONS: The majority of studies showed a significant relationship between psychosocial factors and psychological adjustment. These results point to specific sociodemographic, disease-related, and psychosocial factors that can help to identify women at the time of diagnosis who are at risk for long-term psychological challenges so they can be referred for psychological support that targets their specific needs and can improve their quality of life and mood and decrease indicators of anxiety, depression, and psychological distress.

The emotion regulation questionnaire in women with cancer: A psychometric evaluation and an item response theory analysis.

OBJECTIVE: Emotion regulation is thought to play an important role in adaptation to cancer. However, the emotion regulation questionnaire (ERQ), a widely used instrument to assess emotion regulation, has not yet been validated in this context. This study addresses this gap by examining the psychometric properties of the ERQ in a sample of Portuguese women with cancer. METHODS: The ERQ was administered to 204 women with cancer (mean age = 48.89 years, SD = 7.55). Confirmatory factor analysis and item response theory analysis were used to examine psychometric properties of the ERQ. RESULTS: Confirmatory factor analysis confirmed the 2-factor solution proposed by the original authors (expressive suppression and cognitive reappraisal). This solution was invariant across age and type of cancer. Item response theory analyses showed that all items were moderately to highly discriminant and that items are better suited for identifying moderate levels of expressive suppression and cognitive reappraisal. Support was found for the internal consistency and test-retest reliability of the ERQ. The pattern of relationships with emotional control, alexithymia, emotional self-efficacy, attachment, and quality of life provided evidence of the convergent and concurrent validity for both dimensions of the ERQ. CONCLUSION: Overall, the ERQ is a psychometrically sound approach for assessing emotion regulation strategies in the oncological context. Clinical implications are discussed.

Marital adjustment in the context of female breast cancer: A systematic review.

OBJECTIVE: Breast cancer (BC) diagnosis and subsequent treatments present significant challenges and distress for both patients and their partners. This can lead to difficulties in marital relationships and, consequently, decreases in marital adjustment and psychosocial adaptation to BC for both partners. Our objective was to systematically review studies assessing marital adjustment in the context of female BC to understand which factors are associated with marital adjustment in both patients and partners and characterize the measures used to assess marital adjustment within these studies. METHODS: This systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. English, peer-reviewed articles exploring factors associated with marital adjustment in the context of female BC were considered for inclusion. RESULTS: Fourteen studies were included. Results evidenced that psychosocial variables play an important role on marital adjustment. Specifically, open and constructive communication, more social support, and supportive dyadic coping were found to be associated with higher levels of marital adjustment. Other variables such as self-efficacy, sexual functioning, and psychological adjustment were also positively associated with marital adjustment. CONCLUSIONS: Most studies evidenced an association between psychosocial variables and marital adjustment for both women and their partners. Some important dimensions such as communication patterns, coping strategies, and social support dynamics were identified as potential targets for psychological interventions. Some variables, however, were explored only in a few studies, which limit our conclusions. Future studies should explore the role these variables and other relational and emotional variables play in promoting marital adjustment after BC.

Attachment, emotion regulation, and adaptation to breast cancer: assessment of a mediational hypothesis.

OBJECTIVES: This study examines the links between attachment, adaptation to breast cancer, and the mediating role played by emotional regulation processes. METHODS: Participants were 127 women with breast cancer recruited in two public hospitals of Porto and at the Portuguese Cancer League. Women completed measures of attachment, quality of life, and emotion regulation. Path models were used to examine the associations between the constructs and to test the mediational hypotheses. RESULTS: Significant associations were found between attachment and adaptation. Dimensions of emotion regulation totally or partially mediated the associations between attachment and adaptation outcomes. Attachment security effects on interpersonal relations were totally mediated by communicating emotions. Also, attachment anxiety effect on physical well-being was totally mediated by rumination. Attachment avoidance effects on psychological outcomes were totally mediated by emotional control and partially mediated by communicating emotions for the case of interpersonal relations. CONCLUSIONS: This study highlights the importance of addressing emotional regulation jointly with attachment to deepen the comprehension of the relational processes implicated in adaptation to breast cancer. Results supported a mediational hypothesis, presenting emotional regulation processes as relevant dimensions for the understanding of attachment associations with adaptation to breast cancer.