Relationship between mindfulness, meaning in life and post-traumatic growth among Nigerian cancer patients.

Understanding the psychosocial factors that predict recovery and promote growth from trauma is critical to effective management of oncology patients. Although previous studies have shown that mindfulness and meaning in life could be predictors of post-traumatic growth (PTG), no study to date has explored the combined role of mindfulness and meaning in life in the development of PTG among cancer patients. Using a cross-sectional design, data were collected from 957 cancer patients (46.8% male, 53.2% female) who completed relevant self-report measures. Results showed that the presence of meaning in life mediated the relationship between mindfulness and PTG. However, the mediation effect of search for meaning in life was not significant. These findings indicate that the presence of meaning in life is an essential mechanism of mindfulness in facilitating PTG. Therefore, psychosocial interventions geared towards promoting PTG should consider mindfulness as a potential effective component in improving cancer patients' ability to find meaning in life and possibly promote recovery.

Mediating role of emotion regulation in the relationship between mindfulness and mental well-being among formal caregivers of psychiatric patients.

Professional caregivers of psychiatric patients are often exposed to circumstances and environments that threaten their mental well-being in the course of carrying out their professional duties. In this study, we examined the mediating role of emotion regulation in the association between mindfulness and mental well-being among professional caregivers of psychiatric patients. Three hundred and seven professional caregivers of psychiatric patients whose ages ranged between 22 and 63 years (mean age = 39.21 years; SD = 10.09 years) participated in the study. They completed measures of mindfulness, emotion regulation and mental well-being in addition to supplying relevant demographic information. Results of mediation analysis showed that expressive suppression dimension of emotion regulation mediated the relationship between mindfulness and mental well-being. This indicates that mindfulness was associated with increased mental well-being via the pathway of reduced expressive suppression. These findings suggest that expressive suppression may represent an effective way to strengthen the link between mindfulness and mental well-being among professional caregivers and ultimately provide a means to improve their well-being.

Psychological flexibility as a moderator of the relationship between HIV-related stigma and resilience among HIV/AIDS patients.

HIV-related stigmatisation is common in many parts of the world and is experienced by all categories of people living with HIV and AIDS (PLWHA). Although the negative consequences of HIV-related stigmatisation on the resilience of PLWHA is well documented, little is known about the plausible role of certain personal characteristics in moderating the stigma-resilience relationship. In addition to investigating the direct association of HIV-related stigma (personalised stigma, disclosure concern, concern about public attitude and negative self-image) with resilience, the present study examined whether psychological flexibility (PF) moderates the HIV-related stigmaresilience relationship among PLWHA. Participants included 280 PLWHA (M = 39.48; SD = 9.03) selected from Sacred Heart Catholic Hospital (SHCH), Obudu, Cross River State, Nigeria. Participants completed relevant self-report measures. Results showed that patients reported moderately high levels of resilience (M = 59.13; SD = 13.98). Hierarchical multiple regression analysis showed that HIV-related stigma (personalised stigma, disclosure concern and concern about public attitudes) were not significantly associated with resilience (p = 0.230; p = 0.747; p = 0.528). HIV-related negative self-image and PF were independently and significantly associated with resilience (p = 0.024; p = 0.000). Results of moderation hypothesis revealed that PF did not moderate the relationship between HIV-related disclosure concern and resilience (p = 0.903), and between HIV-related concern about public attitudes and resilience (p = 0.905), but PF moderated the relationship of HIV-related personalised stigma and resilience (p = 0.023), and the relationship of HIV-related negative self-image and resilience (p = 0.004). Therefore, interventions to promote resilience abilities in PLWHA should consider facilitating patients' psychological flexibility skills as it is critical in decreasing the hazardous effect of HIV-related stigma on the patients.

Enacted support matters in the relationship between psychological distress and health-related quality of life among type 2 diabetes patients in Nigeria.

We examined whether the association between psychological distress (depression, anxiety and stress) and diabetes-related quality of life (DRQoL) among type 2 diabetes Mellitus (T2DM) patients in Nigeria was moderated by enacted support (ES). Participants were 279 T2DMpatients (Mage = 59.65, SD: 11.57) conveniently sampled from three tertiary health-care institutions in Enugu State, Nigeria. Participants completed measures of diabetes-related Quality of Life, depression, anxiety, and stress. Results showed that ES moderated the relationship between anxiety and DRQoL. Moderation graph revealed that for participants with low and moderate ES, anxiety was positively associated with DRQoL. ES also moderated the association between stress and DRQoL. The moderation graph showed that for participants with low and moderate ES, stress was negatively associated with DRQoL. ES did not, however, moderate the association between depression and DRQoL. Our findings suggest the levels of supports for diabetes management behaviours that may be helpful toT2DM patients. This could guide health managers in developing strategies that might prevent or ameliorate the impact of psychological distress.

Does Posttraumatic Growth Buffer the Association Between Death Anxiety and Quality of Life Among People living with HIV/AIDS?

People living with HIV (PLWH) may experience death anxiety (DA), which can be detrimental to quality of life. Posttraumatic growth (PTG), however, is antithetical to DA, with its positive attributes at odds with negative psychosocial outcomes. Previous research has not examined the buffering effect of PTG on the association between DA and quality of life. Therefore, in addition to the direct effects of DA and PTG on health-related quality of life (HRQoL), we investigated the moderating role of PTG on the relationship between DA and HRQoL among people living with HIV/AIDS (PLWH) in Nigeria. Using cross-sectional design and availability sampling method, we selected 201 outpatients (men, n = 63, 31.3%, women, n = 138, 68.7%, mean age = 40.1, SD = 10.5) managed for HIV/AIDS in a Nigerian tertiary healthcare institution. Death Anxiety Inventory-Revised, Posttraumatic Growth Inventory-Short Form, and Patient-Reported Outcome Quality of Life-HIV were used to access DA, PTG and HRQoL, respectively. Results showed that while adjusting for socio-demographic factors (age, gender, time since diagnosis and educational status), DA was associated with physical health, mental health and social relationships domains of HRQoL as well as overall HRQoL. In contrast, PTG did not evidence significant association with HRQoL dimensions and overall HRQoL. The moderation effect of PTG on the association between DA and HRQoL was not supported. Independent of PTG, alleviating DA may be an important target in terms of therapeutic intervention towards improving quality life of PLWH.

Emotional reactivity and surgical anxiety. The protective nature of perceived social support.

The study examined whether emotional reactivity is associated with surgical anxiety among patients scheduled for elective surgery, and whether any of the dimensions of perceived social support moderates this relationship. Participants consisted of 210 adult patients (females = 117, 55.7%) admitted for surgery at University of Nigerian Teaching Hospital, Ituku-Ozala, Enugu State, Nigeria. Applying cross-sectional design, participants completed the Anxiety Specific to Surgery Questionnaire, Emotion Reactivity Scale, and Multidimensional Scale of Perceived Social Support approximately 24 h before their respective surgery. Results showed that emotional reactivity was positively associated with surgical anxiety at low and moderate but not at high levels of perceived family social support. Emotional reactivity was positively associated with surgical anxiety only at low level of friends and significant others support but not at moderate or high levels of perceived support from friends or significant others. We concluded that anxiety reduction intervention programmes for surgical patients should consider integrating social support for its protective nature in improving surgical outcome.

Roles of Religious Commitment, Emotion Regulation and Social Support in Preoperative Anxiety.

Surgery is a relatively commonplace medical procedure in healthcare settings. The mental health status of the person undergoing surgery is vital, but there is dearth of empirical studies on the mental health status of surgery patients, particularly with regard to the factors associated with anxiety in surgical conditions. This study investigated the roles of religious commitment, emotion regulation (cognitive reappraisal and expressive suppression) and social support in preoperative anxiety in a sample of 210 surgical inpatients from a Nigerian tertiary healthcare institution. A cross-sectional design was adopted. Before the surgery, respondents completed the state anxiety subscale of State-Trait Anxiety Inventory, Religious Commitment Inventory, Emotion Regulation Questionnaire and Multidimensional Scale of Perceived Social Support. After controlling for relevant demographic factors, regression results showed that cognitive reappraisal, social support and interpersonal religious commitment were negatively associated with preoperative anxiety, while expressive suppression was positively associated with preoperative anxiety. The emotion regulation strategies made robust and significant explanation of variance in preoperative anxiety. Appropriate interventions to promote interpersonal religious commitment, encourage cognitive reappraisal and enhance social support quality may improve mental health outcomes in surgery.

Event centrality influences posttraumatic stress disorder symptoms via core beliefs in internally displaced older adults.

OBJECTIVES: There is substantial evidence regarding the role of event centrality (EC) in posttraumatic stress disorder (PTSD) symptoms, but little research has examined the explanatory pathways linking EC with PTSD symptoms severity. The present study examined whether core beliefs (CB) mediates the relationship between EC and PTSD symptoms in internally displaced older adults. METHOD: Internally displaced older adults (N = 279; mean age = 62 years) sheltered in two camps located in north-central Nigeria, completed Tiv language versions of self-report measures, namely, the Harvard Trauma Questionnaire, the Centrality of Event Scale, Core Beliefs Inventory, and provided relevant demographic information. RESULTS: Analysis indicated that EC and CB were linked to greater PTSD symptoms as well as re-experiencing/intrusion, avoidance and hyperarousal symptoms severity. The mediator path was significant which implies that CB was a pathway through which EC influences PTSD symptoms clusters and overall PTSD symptomatology. CONCLUSION: A traumatic event becoming more central in a person's identity and life story distorts entrenched beliefs about oneself, others and the world, thereby resulting in greater PTSD symptoms. Our findings suggest that considerations of disrupted world assumptions may be a salient target for prevention and treatment efforts.

Emotional reactivity and blood pressure elevations: anxiety as a mediator.

There is a strong link between emotional reactivity and hypertension, yet little research to date has examined mediators of this relationship. Ourstudy  investigated the mediating roleof anxiety on the relationship between emotional reactivity and blood pressure elevations. Participants were226 hypertensive patients (93 men and 133 women, Mean age = 53.09, SD = 13.88 years), purposivelydrawn from the General Outpatient Department in University of Calabar Teaching Hospital, Calabar, , Nigeria. .  Measures for data collection were Emotional Reactivity Scale, State Trait Anxiety Inventory, and the Mercury Sphygmomanometer. Hayes PROCESS macro for SPSS which uses a regression-based, path-analytical framework, was employed in analysing the data. Results showed that emotional reactivity was positively associated with blood pressure elevations. Anxiety was positively associated with blood pressure elevations. Anxiety also fully mediated the relationship between emotional reactivity and blood pressure elevations, even after adjusting for the control variables (e.g., age, family history of hypertension, and educational status). The finding suggests that being less emotionally reactive is associated with a decrease in disabling influences of anxiety, thereby contributing to lower levels of mean arterial blood pressure. The findings may be helpful  in improving prevention, control and management of hypertension in healthcare.

Gender and health behaviours of hypertensive patients: mediating role of control beliefs.

Previous studies have reported gender differences in patients' health behaviours but few studied hypertensive patients. The potential underlying factors that may mediate gender influences on health behaviours is also a more critical area worthy of investigation. This study examined health locus of control (HLC) as a pathway of gender effects on health behaviours of hypertensive patients. The Multidimensional HLC Scale (Form C) and Wellness behaviour subscale of Health Behaviour Checklist were completed by 400 hypertensive outpatients in two Nigerian hospitals: Enugu State University Teaching Hospital, Park Lane, Enugu, and Bishop Shanahan Specialist Hospital, Nsukka. Hierarchical multiple regression results showed that gender significantly predicted health behaviours. Gender also significantly predicted internal HLC, chance HLC, and other people HLC, but did not predict doctor HLC. The association between gender and health behaviours was fully mediated by internal HLC, chance HLC and other people HLC. Understanding the explanatory mechanisms linking socio-demographic factors and health behaviours is considered of great importance for future research and healthcare intervention.

Locating event centrality in associations of emotion regulation with posttraumatic stress disorder symptoms and posttraumatic growth in emerging adults.

Previous research suggests that cognitive reappraisal (CR) and expressive suppression (ES) strategies of emotion regulation (ER) are associated with posttraumatic stress disorder (PTSD) and posttraumatic growth (PTG). How the patterns of these associations may vary in the context of event centrality (EC) however requires investigation to help delineate groups for whom the impact of event centrality may be more salient. We examined whether EC would moderate the associations of CR and ES with PTSD symptoms clusters and PTG domains among 388 emerging adults (18-30 year-olds) of Tiv ethnic group who were survivors of armed attack by Fulani herdsmen and were temporarily sheltered in two internally displaced persons' (IDPs') camps in North-central Nigeria. They completed self-report measures of the variables. Results indicated that EC strengthened the negative associations of CR and the positive associations of ES with avoidance, hyper-arousal and total PTSD symptoms, but not intrusion symptoms. For the PTG domains, EC only strengthened the positive association between CR and personal strength and weakened the association of ES with greater appreciation of life. These findings suggest that primary intervention programs that incorporate training of armed attack survivors in cognitive reappraisal strategy centered on the traumatic event could be effective in controlling PTSD but be less critical in engendering PTG. They also show that the psychological processes that underlie PTSD and PTG are related but involve nuances even within PTSD, and do not seamlessly set into the Janoff-Bulman's "strength through suffering" model of PTG. More research is required to test the model.

Social support buffers the impacts of Diabetes distress on health-related quality of life among type 2 diabetic patients.

Diabetes patients experience significant distress. Improving health-related quality of life (HRQoL) is cardinal in the management of all chronic health conditions. We investigated the moderating role of social support (SS) in the relationship between diabetes distress (DD) and HRQoL. Three hundred and ninety-six type 2 diabetes mellitus (T2DM) patients (M age = 57.71 years) completed measures of relevant variables. Results showed that SS moderated DD-HRQoL association. Our findings provided a guide on extent of support for T2DM management behaviors that may be helpful in ameliorating impacts of stress on patients' health.

Somatic symptoms among prison inmates: contributions of emotion regulation, dispositional mindfulness, and duration of stay in prison.

PURPOSE: The modern prison system is not only a necessity to keep the public safe but also a mode of punishment for crimes. The correctional role of prisons is hampered in situations of mental illness, given that mental illness in the prison or correctional setting is a serious security risk. Few studies have given attention to the modifiable factors that may influence the mental health status of prison inmates, especially in developing countries. The purpose of this paper is to investigate emotion regulation (ER), dispositional mindfulness and duration of stay as factors in somatic symptoms among prison inmates. DESIGN/METHODOLOGY/APPROACH: Participants were 209 prison inmates drawn from a prison in Eastern Nigeria, who completed measures of ER (cognitive reappraisal and expressive suppression), mindfulness and somatization. FINDINGS: Results of a hierarchical multiple regression indicated that cognitive reappraisal predicted somatic complaints but it was only among older prison inmates, while expressive suppression was not a significant predictor of somatic complaints. Dispositional mindfulness was a negative predictor of somatic complaints among younger and older prison inmates. Duration of stay in prison positively predicted somatic complaints among prison inmates in emerging adulthood only (younger inmates), but not among older inmates. RESEARCH LIMITATIONS/IMPLICATIONS: Frequent use of cognitive reappraisal strategy of ER by prisoners may not always be productive in reducing somatic complaints, and the length of time in prison may influence somatic symptoms especially for younger prisoners. The possible benefits of incorporating mindfulness-based therapies in psychosocial interventions to reduce somatic complaints in correctional settings deserves further investigation. ORIGINALITY/VALUE: To date, there is limited research on somatic complaints of prisoners in the developing societies, particularly the psychosocial factors that may contribute to mental health problems.

Psychometric properties of the Meaning in Life Questionnaire - Hausa version among internally displaced persons in Nigeria.

Valid measurement of meaning in life (MIL) is crucial for cross-cultural understanding of the construct. The Meaning in Life Questionnaire (MLQ), a widely used measure of MIL, has yet to be translated into any indigenous African language. The current study presents a preliminary report of a Hausa language translation of the MLQ, the MLQ-Hausa version (MLQ-H), and its reliability and validity in a Nigerian sample. Participants were 809 internally displaced persons (IDPs) (50.7% males) in Kabusa IDP Centre in Abuja Municipal Area Council of the Federal Capital Territory of Nigeria. They completed Hausa versions of the MLQ, the Brief Personal Meaning Profile (PMP-B), and scales of the Symptoms Distress Checklist (SCL-90). Results of a confirmatory factor analysis supported the original two-factor model of the MLQ comprising presence of meaning (5 items) and search for meaning (5 items). The two factors had adequate reliability. Responses to the MLQ-H did not differ by sociodemographic factors. Concurrent validity of MLQ-H was suggested by significant correlations between MLQ-H and psychopathology symptom scales. Importantly, we found convergent validity through positive correlations of MLQ-H with the PMP-B. Results indicate that the MLQ-H is a psychometrically sound measure of MIL among Hausa IDPs and may be applied in research on meaning in life among other Hausa-speaking populations.

Role of event centrality and emotion regulation in posttraumatic stress disorder symptoms among internally displaced persons.

BACKGROUND: Event centrality and emotion regulation in relation to posttraumatic stress disorder (PTSD) have been documented in various global samples especially in Western cultures; but internally displaced persons (IDPs) still constitute an underrepresented population in psychotraumatology literature. This study tested the roles of event centrality and emotion regulation strategies (cognitive reappraisal and expressive suppression) in PTSD symptoms among IDPs in Nigeria. DESIGN: The multi-group cross-sectional design was adopted. METHODS: Tiv language versions of the Centrality of Events Scale, Emotion Regulation Questionnaire, and Harvard Trauma Questionnaire were completed by 859 IDPs in two camps located in Benue State, North-central region of Nigeria. RESULTS: Hierarchical multiple linear regression results indicated that event centrality positively predicted PTSD symptoms. Cognitive reappraisal was a negative predictor of PTSD symptoms while expressive suppression was a positive predictor of PTSD symptoms. Bonferroni corrections indicated that expressive suppression was the strongest predictor of total PTSD symptoms, avoidance/numbing symptoms, and hyper-arousal symptoms; but event centrality was the most robust predictor of PTSD intrusion/re-experiencing symptoms. CONCLUSION: The findings underscore recent developments in psychotraumatology indicating that the extent to which individual differences impact the development of PTSD is essential in clinical psychology research and practice.

Effectiveness of group cognitive-behavioral therapy on anxiety and depression in Nigerian breast cancer patients

Breast cancer patients are particularly weighed down by a variety of emotional distresses, including anxiety and depression. While the effects of Cognitive Behavioral Therapy (CBT) have been reported in most Western countries, less is known about the effectiveness of CBT in anxiety and depression among Nigerian women with breast cancer. The study investigated the effectiveness of a 12 weeks group CBT on anxiety and depression among Nigerian breast cancer patients. The study adopted randomized controlled Pre-test Post-test design. Thirty one women with breast cancer were randomly allocated to two groups: CBT Group (n= 16) and a Control Group (CG, n= 15). The CBT group received a 12-week 90-minute CBT session once a week, while the CG received a booklet containing information on cancer and how to cope with cancer. Assessments were carried out for both groups at baseline (pre-test), after the intervention (post-test) and 2-months Follow-Up with measures of Hospital Anxiety Depression Scale (HADS). The results showed that participants in the CBT Group had decreased in anxiety and depression significantly at post-test and 2-month follow-up compared to the participants in the CG. The implications of the study was discussed in line with the inclusion of psychological treatments such as CBT in the management of cancer patients in an oncology setting in Nigeria where such treatments are grossly lacking

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