Improving the quality and quantity of life among patients with cancer: a review of the effectiveness of group psychotherapy.

Cancer patients suffer from a number of psychosocial problems related to the progression of their disease as well as standard medical interventions. Fortunately, there is empirical evidence suggesting that group psychotherapy is effective at ameliorating psychological distress and in some cases improving survival. For this literature review we examined the psychological morbidity, particularly anxiety and depression, among cancer patients. Further, we conducted a critical examination of the current evidence regarding the effectiveness of group psychotherapy for improving the quality as well as the quantity of life in cancer patients. Finally, we explored the specific components of effective group psychotherapy, which has been associated with enhanced survival. We conclude that there is compelling evidence indicating that group psychotherapy improves the quality of life of cancer patients. Furthermore, there is a growing body of evidence suggesting that group psychotherapy improves survival of cancer patients.

Somatic symptoms, social support, and treatment seeking among sexual assault victims.

In an effort to clarify the relationship between the experience of sexual assault and physical health, rape victims and a matched comparison group were repeatedly assessed for somatic symptoms, psychological distress, health care use, and self-rated health perceptions during the year immediately after the assault. Women who experienced sexual assault reported more somatic complaints, poorer perceptions of physical health, greater psychological distress, and increased use of medical services. However, victims did not show a significantly higher use of mental health services and continued to seek medical attention at the end of the year after the assault, when health perceptions and somatic symptoms were no longer significantly elevated. The use of mental health services and social support as moderating variables are examined, and implications for the medical and psychological treatment of sexual assault victims are discussed.

Traumatic stress in HIV-infected women.

This study assesses the prevalence of specific traumatic stressors that meet criterion A for the Diagnostic and Statistical Manual of Mental Disorders' (DSM-IV) diagnosis of posttraumatic stress disorder (PTSD) and symptoms of PTSD in a representative sample of HIV-infected women. The study also assesses the impact of these stressors and symptoms on the clinical progression of HIV infection. The Life Stressor Checklist and the Impact of Events Scale-Revised were administered via interview to 67 Africa-American women beyond the initial stages of HIV infection. The ratio of CD4 t-cells to CD8 t-cells were abstracted from medical records at dates that approximated psychological interviews and were examined at two points in time 12 to 14 months apart. The prevalence of traumatic stressors and PTSD symptoms were high among HIV-infected women. Traumatic stressors were significantly associated with a lower CD4 to CD8 ratio at the 1-year follow-up. Among women who reported a traumatic event, those who also met criteria for PTSD evidenced a lower CD4 to CD8 ratio at the follow-up assessment. The study concludes that prevention and treatment efforts targeted at HIV-infected women must take into account traumatic stressors and PTSD symptoms and their potential impact on the course of the disease.

Victimization experiences and HIV infection in women: associations with serostatus, psychological symptoms, and health status.

The present investigation evaluates the relationship between HIV infection and victimization with regard to the interplay of these two factors as they relate to mental and physical health. Eighty eight inner-city low income African-American women who are HIV-infected and a demographically similar comparison group of women who were not HIV-infected were assessed for victimization experiences (rape, physical assault, robbery/attack) via interview. Additionally, the psychological symptoms and health status correlates of victimization within the HIV-infected group are delineated. Results indicated that women in the HIV-infected sample were significantly more likely to report a victimization experience. Additionally, within the HIV-infected group, victims reported higher levels of global psychological distress, depressive symptomatology, and greater distress regarding physical symptoms than nonvictims. Furthermore, HIV-infected victims were diagnosed with higher rates of AIDS-defining conditions than HIV-infected nonvictims. These results underscore the importance of acknowledging the experience of violent victimization in the prevention and treatment of HIV infection in women.

Relationships among trauma exposure, chronic posttraumatic stress disorder symptoms, and self-reported health in women: replication and extension.

Fifty-two women who served during the Vietnam era were assessed for war-zone exposure, traumatic life events, post-traumatic stress disorder (PTSD), and self-reported health status. Symptoms of PTSD were examined as mediators in the relationship between traumatic exposure and subsequent reports of health problems. Results showed that PTSD symptoms accounted significantly for variance in health problems reported by women with prior traumatic stressor exposure. When the cardinal symptom domains of PTSD (re-experiencing, numbing, avoidance, hyper-arousal) were analyzed separately, the symptom cluster representing hyper-arousal accounted uniquely for the variance associated with health complaints, beyond that contributed by other symptom clusters. Discussion of the results focuses on mechanisms underlying the relationship between specific symptoms of PTSD and self-reported health. Implications for intervention within the medical system are also considered.

Associations among symptoms of depression and posttraumatic stress disorder and self-reported health in sexually assaulted women.

Symptoms of depression and posttraumatic stress disorder (PTSD) were examined for their association with health status in a sample of sexual assault victims. Hypotheses were that symptoms of each disorder would account for unique variance in health status among individuals exposed to traumatic stressors. Fifty-seven sexually assaulted college women were assessed for prior victimization history, assault characteristics, and depressive and PTSD symptoms. When prior history of sexual victimization, assault severity, and physical reactions during the assault were controlled, hierarchical multiple regression models indicated that symptoms of PTSD and depression were significantly associated with global health perceptions and severity of self-reported health symptoms. Only PTSD symptoms were significantly associated with reproductive health symptoms. The results suggest that both symptoms of PTSD and depression account for the relationship between exposure and health impairment among sexual assault victims.

Depression and outpatient medical utilization: a naturalistic 10-year follow-up.

The current investigation described the relationship between depression and outpatient medical utilization in a sample of 424 treatment-seeking individuals diagnosed with a depressive disorder and a demographically matched community sample of 424 men and women. This relationship was assessed longitudinally from baseline (intake for the patient sample) to 1-, 4-, and 10-year follow-ups. Patients and community individuals demonstrated distinct patterns of depressive symptoms and outpatient medical utilization: patients declined in symptoms and medical utilization following treatment, although they continued to have higher levels of depressive symptoms and outpatient utilization than controls at each follow-up period. Community controls demonstrated no change from baseline in symptoms or utilization at any follow-up. Higher levels of depressive symptoms was associated with increased outpatient medical utilization over the 10 years, even when age, sex, marital status, medical comorbidity, and patient status were controlled. Results add further evidence for a relationship between symptoms of depression and outpatient utilization by documenting this relationship in a posttreatment sample. Furthermore, the findings underscore the need for long-term follow-ups in investigations of the association between treatment for depression and the outpatient medical utilization of depressed individuals.