[COPING WITH DEPRESSION AND ANXIETY AMONG HEART FAILURE PATIENTS].

BACKGROUND: Research shows that high levels of depression and anxiety have a negative effect on the quality of life of people with heart failure. Family and social support are an important source for coping with the emotional distress derived from an illness. It is important to reach a deeper understanding about the relationship between family and social support and levels of depression and anxiety among heart failure patients. OBJECTIVES: To examine the associations between function, social support, depression and anxiety among heart failure patients. METHODS: A total of 50 heart failure patients from the hospital day unit of the Cardiovascular Department in Rambam Healthcare Center answered a structured questionnaire that included measures of depression and anxiety and levels of difficulty in function, family and social support. RESULTS: A total of 15% (n=7) of the participants reported a high level of anxiety and 33% (n=16) reported a high level of depression. The average score for difficulty in functioning was high on a scale of 1-12 (mean=7.16; SD=2.86). The average score on family support was also high on a scale of 1-7 (Mean=6.21;SD=1.14) but social support was very low (mean=3.20; SD=2.06). Positive associations were found between difficulty in functioning, depression (r=.54) and anxiety (r=.39) and a negative association was found between social and family support and anxiety (r=-.30). CONCLUSIONS: Heart failure patients and their families might experience functional and emotional burdens when trying to cope with their illness. Early and inclusive intervention is important and should include combined treatment of both physicians and social workers cooperating in order to identify patients in need and treat the different aspects of the illness in a sensitive and culturally adapted manner.

Translating 'distress' and screening for emotional distress in multicultural cancer patients in Israel.

BACKGROUND: The adaptability of the distress thermometer (DT) to multicultural groups has rarely been assessed. AIMS: To assess DT adaptability to the Israeli population as a multicultural society. METHODS: Participants were 496 cancer patients. They were recruited for 3 days a week in 2009-2010 (97% response rate). Participants completed the DT, a problem list, Hospital Anxiety and Depression Scale (HADS), and the Brief Symptom Inventory (BSI-18). RESULTS: Receiver-operating characteristic (ROC) curve analyses of DT scores yielded area under the curve (AUC) of 0.63 as against HADS and of 0.78 as against BSI-18. ROC analysis revealed that the optimal cutoff score was ≥ 3. It yielded sensitivity and specificity of 0.74 and 0.65, as against the HADS, and 0.64 and 0.64, as against the BSI-18. The Jewish participants reported higher distress than the Arab participants, and the ROC properties were markedly higher for the Jewish subgroup alone. CONCLUSIONS: The adapted DT was moderately efficient for detecting emotional distress in cancer patients in Israel. Cultural aspects related to distress should be taken into account for administration of the DT in multicultural societies.

Is work beneficial to good health?

Unemployment and insecurity at work are a source of stress and may create a threat to individual physical and psychological health. The purpose of this study was to examine the connection between personal, functional, and professional variables and reports of how the health of hospital patients is impacted by financial status in Israel. One hundred and forty three hospitalized patients completed demographic, health-functional, and financial status questionnaires. Of the respondents, 32.9% reported a correlation between financial status and health. Significant connections were found between family status, lack of work, a change in partner's employment status, job insecurity, and financial commitments and reports of a correlation between financial status and health. The multivariate model predicting reports of a correlation between financial status and health was statistically significant. Discussion and implications focus on the need to create special preparation among health care professionals, in the community and in hospitals, to identify and treat people suffering from financial stress.

The suffering is similar--is the treatment equal? An intervention with Arab Terror injured.

In the course of the last Intifada and during the Second Lebanon War, all citizens of Israel were exposed to waves of terrorism that claimed many people wounded and killed, unrelated to religious differences, age, gender, or nationality: Jews and Arabs suffered alike. The acts of terror exposed all inhabitants equally to injury, suffering, and the need to adjust. The professional literature attests that minority groups are at a higher risk of experiencing post-traumatic symptoms as a result of exposure to acts of terror. This article describes the treatment with terror injured, Jews and Arabs, in the frame of the project for terror victims at Rambam Medical Center, in cooperation with Operation Embrace. It also covers the project intervention with casualties of the shooting incident in the Arab town of Shefaram, with the cooperation of Shefaram Social Welfare department. The psycho-social work conducted with the injured, Jews and Arabs, emphasized their similarities, their common fate, and the fact that any of us could be injured in a terror act or a war. The suffering, the loss, and the hurt are common to us all. At the same time, the interventions referred to cultural differences and the diverse ways of coping with the aftermath of the events, based on values, faith, and outlook on life arising from cultural background.

There Is No Place Like Home: A Survey on Satisfaction and Reported Outcomes of a Home-Based Rehabilitation Program Among Orthopedic Surgery Patients.

BACKGROUND: Home-based rehabilitation (HBR) was previously found to be associated with positive outcomes that are equal to inpatient rehabilitation. Few studies have examined the challenges patients are facing during rehabilitation and recovery and their satisfaction from HBR. OBJECTIVE: The purpose of this study was to examine the overall satisfaction and reported outcomes of HBR. METHODS: A telephone survey was conducted among 146 orthopedic surgery patients who participated in an HBR program, at the end of the HBR and 6 months after. The questionnaire included information about level of independence, satisfaction from HBR, and difficulties during HBR. FINDINGS: The overall satisfaction was high (73.1%). Patients reported on improvements in level of independence between the time of hospital discharge, the end of the program (P = .0001), and the 6 months follow-up (P = .004). Long wait for beginning of HBR, being a widower, and residing in a facility or with a nonfamilial caregiver were associated significantly with less general well-being and independence. The repeated measures analysis showed age lower than 71 and private health insurance ownership were associated with a better recovery. The most common difficulties reported were physical difficulties, lack of function, and caregivers' burden. CONCLUSIONS: Patients and families need more emotional, social, and physical support during HBR. The increase in health services delivered in community settings requires a more clear-cut policy and supervision for HBR and the follow-up services.

Perceived parenting style, self-esteem and psychological distress in adolescents with heart disease.

The aim of the study was to assess the relationships between perceived parenting style, depressed mood, anxiety and self-esteem in adolescents with heart disease compared with healthy adolescents. Forty-five adolescents, aged 12-18 with congenital or acquired heart disease and 50 healthy age-matched adolescents answered perceived parental behaviour, self-esteem, depressed mood and anxiety questionnaires. The study group reported higher perceived acceptance and lower perceived parental control than healthy adolescents, but similar levels of depressed mood, anxiety and self-esteem. Fischer's r-to-z transformation and regression analyses showed different associations between perceived parenting style and depressed mood, anxiety and self esteem. In the study group, higher perceived parental acceptance was associated with lower depressed mood and higher self-esteem, whereas these associations were not significant in the control group. In the control, but not the study group, higher perceived parental control was associated with lower depressed mood and lower anxiety. Parenting style proved to exert a differential effect on adolescents with and without heart disease. For the former, perceived parental acceptance had a more substantial effect on psychological well-being than perceived parental control. Professionals caring for these adolescents should be aware of the special importance of parenting style on the well-being of adolescents with heart disease, and address this issue in the clinical setting with the patients and their parents.

Elder abuse: disparities between older people's disclosure of abuse, evident signs of abuse, and high risk of abuse.

OBJECTIVES: To assess and compare three types of assessment tools for identifying elder abuse: direct questions to elicit disclosure of abuse if it exists, identification of evident signs of abuse, and assessment of high risk for abuse. DESIGN: Cross-sectional. SETTING: Rambam and Hadassah medical centers, Israel. PARTICIPANTS: Seven hundred thirty persons aged 70 and older hospitalized in general hospitals in 2004/05 and their principal caregivers. MEASUREMENTS: Expanded indicator of abuse (E-IOA) tool, questionnaires looking for evident signs of abuse, and direct experience of abusive behavior. RESULTS: Although 5.9% of respondents disclosed experiencing abusive behaviors, 21.4% were identified with evident signs of abuse, and 32.6% were classified as being at high risk for abuse. More than 70% of those who disclosed abuse were identified with evident signs and were at high risk for abuse. Those who disclosed being abused suffered particularly from physical and sexual abuse. According to logistic regression, higher caregiver subjective burden was a predictor of disclosure (odds ratio (OR)=1.81, 95% confidence interval (CI)=1.19-2.74), evident signs of abuse (OR=1.86, 95% CI=1.45-2.35), and high risk of abuse (OR=1.55, 95% CI=1.27-1.88); heavier objective caregiver load was a predictor of evident signs of abuse (OR=1.14, 95% CI=1.05-1.24) and of high risk (OR=1.18, 95% CI=1.06-1.38) only; and respondent functional status was a predictor of evident signs of abuse (OR=1.88, 95% CI=1.70-2.37). CONCLUSION: The use of the three assessment tools is needed for optimal identification of abuse, whereas assessment for high risk proved an efficient method in the absence of respondent disclosure or professional detection of signs of abuse. Hospitalization provides an excellent opportunity for identifying elderly persons at risk of abuse.

An ongoing, multi-faceted program for victims of terror attacks and their families.

Victims of terror attacks, whether or not physically injured, sometimes suffer long-term posttraumatic symptoms, although the intensity of symptoms differs among individuals. Often, after discharge from the hospital, additional posttraumatic symptoms and emotional distress are evident, together with difficulty in readjusting to a normal life. This paper describes an ongoing multi-faceted program to empower victims and their families and assist them on the journey to recovery. The program is operated by the social work department in one of the main hospitals in Israel, in alliance with a voluntary non-profit organization in the U.S. One hundred seventeen victims of terror attacks who were previously hospitalized in the hospital for immediate care after attack were enrolled in the program, which is structured to offer comprehensive help in order to meet the psychological, material, and social needs of the participants and their families. Based on needs assessment, the participants are offered individual, family, and group therapies and community activities. Different elements of the project are described, and the need to further develop intervention models and to evaluate them is highlighted.

Development of a screening tool for identifying elderly people at risk of abuse by their caregivers.

OBJECTIVE: This study developed and assessed an instrument to identify older people at high risk of abuse based on Reis and Nahmiash's Indicators of Abuse (IOA) screen. METHOD: A total of 108 people 65 and older, hospitalized in internal medicine departments at two major hospitals in Israel, were screened together with their principal caregivers. The interview was based on the expanded IOA (E-IOA) and a list of evident signs of abuse. RESULTS: Reliability and validity of the E-IOA were tested and confirmed. Indicators proved to be a significant predictor of evident signs of abuse. The E-IOA correctly discerned 92.7% of those at high risk for abuse and 97.9% of those who did not suffer abuse. The main indicators for risk were behavioral problems, emotional problems, and family problems of the caregiver and the elderly person. Fourteen (13%) experienced abuse. DISCUSSION: The proposed assessment tool can be an instrumental guide to identify elderly people who suffer abuse (unidentified) or who are at high risk.

Family support and victim identification in mass casualty terrorist attacks: an integrative approach.

Terrorist bombing attacks in Israel between 2000 and 2004 caused mass casualties. After each attack in the north of Israel, Rambam Medical Center, the largest hospital in the region, absorbs the majority of injured, especially the more severely injured and unidentified victims. Immediately with the media reports of a terrorist attack, tens of relatives come to the hospital, looking for missing family members. This paper describes an assistance unit for families of unidentified victims. It is staffed by the hospital's social work department, and its tasks are to identify the unidentified victims, help relatives find and be united with them, and assist other relatives in the identification of bodies of deceased family members. The process involves gathering information from relatives and cross-checking it with data and pictures from the hospitals' emergency and operating rooms; and providing crisis intervention and psychological first aid to victims' relatives. The family assistance unit works with several other professional units in the hospital and in the community, and always adjusts its operations to the features of each event. Clearer guidelines for dynamic training of social workers and research-based interventions to prevent compassion fatigue among the workers must be further developed.

Psychological functioning and health-related quality of life (HRQoL) in older patients following percutaneous closure of the secundum atrial septal defect (ASD).

To characterize quality of life and psychological well-being in the new growing population of older patients who underwent trans-catheter closure of the secundum ASD. Twenty-seven patients, aged 60 years and older, who underwent trans-catheter ASD closure and 27 age and gender matched controls answered the hospital anxiety and depression scale and the cardiac-specific module of the health-related quality of life (HRQoL) questionnaire. Pre- and post-ASD closure pulmonary artery pressure (Pap), and the New York Heart Association (NYHA) functional capacity class were recorded from medical records. Almost 77% improvement in Pap and 57% improvement in functional status were found. More than 70% reported low/mild depressive symptoms and 59% reported low/mild anxiety in both groups. Almost 78% of ASD patients and 89% of controls reported high/very high levels of HRQoL. Significantly better QoL was reported by the controls. Lower post-ASD closure Pap scores were associated with better QoL, but were not significantly related to levels of depression and anxiety scores. Preoccupation with the ASD closure was related to higher pre-closure Pap scores, worse QoL, and higher depressive and anxiety symptoms. Following ASD closure, depression and anxiety symptoms were in the low range, and HRQoL scores for most patients were in the high range.

Can skill-development training alleviate burnout in hospital social workers?.

Staff development programs, which focus on imparting and improving intervention skills, are acknowledged as an efficient way to reduce burnout, but few studies have examined this effect. The aim of the present study was to detect any difference in the level of social worker's burnout before and after attending two different skill-development groups, namely group-intervention skills for more experienced social workers and general hospital social-work skills for less experienced. Twenty-five hospital social workers participated in the study. The three dimensions of burnout, namely emotional exhaustion, depersonalization, and personal accomplishment, changed between the pre-training and post-training measures: personal accomplishment rose by 12.39% and depersonalization fell by 29.75%. The difference was significant for the two dimensions in both groups. Emotional exhaustion significantly declined in the hospital social-work skills group only, and revealed a group-time effect. The level of peer support rose in the hospital-skills group and was positively related to a lowering of emotional exhaustion. This was an exploratory study, with a rather small sample, and the results are preliminary, but they show a promising possibility of burnout reduction among professional workers. Further research on the effect of skill development training on reducing burnout is needed.

Developing the role of the social worker as coordinator of services at the surrogate parenting center.

A law permitting couples to conceive biological children through surrogacy was legislated in Israel in March 1996. The Rambam Medical Center has established the only nonprofit Surrogate Parenting Center at a public hospital in Israel. The multidisciplinary teamwork at the Center is case managed by a social worker. An important role of the social work intervention is consultation and support for the couple and the surrogate at all stages of the process. The case study presented in the article illustrates the need for sensitive and professional intervention due to the complexity of the surrogacy process and the crisis it involves for both the surrogate and the couple. In light of the growing parenting surrogacy cases in the United States, Europe, and Israel, a structured social work intervention model is described, which may be implemented at public or private surrogate parenting centers.