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OBJECTIVE: We examined positive and negative religious coping as moderators of the relation between physical limitations, depression, and desire for hastened death among male inmates incarcerated primarily for murder. METHODS: Inmates over the age of 45 years who passed a cognitive screening completed face-to-face interviews (N = 94; mean age = 57.7 years; SD = 10.68). Multiple regression analyses included age, race/ethnicity, parole belief, physical health, positive or negative religious coping, and all two-way interactions represented by the product of health and a religious coping variable. RESULTS: Older inmates and those who reported greater levels of positive religious coping endorsed fewer symptoms of depression, whereas those who reported greater levels of negative religious coping endorsed more symptoms of depression. Inmates who reported higher levels of depression endorsed a greater desire for hastened death. The effect of physical functioning on desire for hastened death is moderated by negative religious coping such that those who endorsed higher levels of negative religious coping reported a greater desire for hastened death. CONCLUSIONS: Examinations of religious/spiritual practices and mindfulness-based interventions in prison research have assumed a positive stance with regard to the potential impact of religious/spiritual coping on physical and mental health. The current findings provide cautionary information that may further assist in selection of inmates for participation in such interventions.
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Transtorno Depressivo/psicologia , Nível de Saúde , Prisioneiros/psicologia , Religião , Espiritualidade , Adaptação Psicológica , Idoso , Atitude Frente a Morte , Humanos , Masculino , Pessoa de Meia-Idade , Análise de RegressãoRESUMO
OBJECTIVES: To examine patient preferences for incorporating religion and/or spirituality into therapy for anxiety or depression and examine the relations between patient preferences and religious and spiritual coping styles, beliefs and behaviors. METHOD: Participants (66 adults, 55 years or older, from earlier studies of cognitive-behavioral therapy for late-life anxiety and/or depression in primary care) completed these measures by telephone or in-person: Geriatric Anxiety Inventory, Client Attitudes Toward Spirituality in Therapy, Patient Interview, Brief Religious Coping, Religious Problem Solving Scale, Santa Clara Strength of Religious Faith, and Brief Multidimensional Measure of Religiousness and Spirituality. Spearman's rank-order correlations and ordinal logistic regression examined religious/spiritual variables as predictors of preferences for inclusion of religion or spirituality into counseling. RESULTS: Most participants (77-83%) preferred including religion and/or spirituality in therapy for anxiety and depression. Participants who thought it was important to include religion or spirituality in therapy reported more positive religious-based coping, greater strength of religious faith, and greater collaborative and less self-directed problem-solving styles than participants who did not think it was important. CONCLUSION: For individuals like most participants in this study (Christians), incorporating spirituality/religion into counseling for anxiety and depression was desirable.
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Ansiedade/terapia , Depressão/terapia , Preferência do Paciente/psicologia , Espiritualidade , Adaptação Psicológica , Idoso , Idoso de 80 Anos ou mais , Ansiedade/psicologia , Depressão/psicologia , Feminino , Humanos , Entrevistas como Assunto , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Terapias Mente-Corpo , Assistência Centrada no Paciente/organização & administração , Projetos Piloto , Relações Profissional-Paciente , Escalas de Graduação Psiquiátrica , Telefone , Estados UnidosRESUMO
This study focused on the relative contribution of heart failure (HF) disease severity, depression, and comorbid anxiety to quality of life for 96 ambulatory HF veterans (48 with and 48 without depressive symptoms). Primary analyses sought to predict HF quality of life using constructs including depression symptoms, comorbid anxiety symptoms, HF severity, medical-illness burden, and demographic factors. Multiple regression procedures found 3 significant predictors of better quality of life, including HF severity (beta = -13.33, p < .001), depressive symptoms (beta = -2.34, p = .003), and age (beta = 0.76, p < .01). These results suggest that disease severity and depression, but not necessarily comorbid anxiety, significantly affect quality of life for HF patients. As HF is a progressive, deteriorating condition, mental health interventions, especially those that target depression, might offer opportunities for improved quality of life for HF patients.
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Insuficiência Cardíaca/psicologia , Qualidade de Vida , Veteranos/psicologia , Fatores Etários , Idoso , Ansiedade/epidemiologia , Ansiedade/patologia , Ansiedade/psicologia , Comorbidade , Depressão/epidemiologia , Depressão/patologia , Depressão/psicologia , Feminino , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Análise de Regressão , Índice de Gravidade de DoençaRESUMO
OBJECTIVES: Although sexuality is valued throughout the lifespan, older women's sexual expression can be influenced by physical, mental and social factors, including attitudes and stereotypes held by younger generations. By gaining an understanding of what influences negative attitudes toward sexuality and beliefs about sexual consent capacity, the stigma associated with sexuality in late life may be reduced. METHOD: Using vignette methodology in an online survey, we examined older women's health and young adults' (N = 606; mean age = 18.86, SD = 1.42, range 17-36) general knowledge and attitudes toward aging and sexuality, personal sexual behavior, religious beliefs and perceived closeness with an older adult on attitudes towards sexual behavior and perceptions of consent capacity among older women. RESULTS: The health status of older women proved important in determining young adults' acceptance and perception of sexual consent capacity regarding late-life heterosexual/autoerotic and homosexual behaviors. Specifically, young adults expressed lower acceptance and more doubt regarding capacity to consent to sexual expression when the older woman was described as cognitively impaired. Additionally, young adults' personal attitudes toward late-life sexuality, but not knowledge, predicted acceptance toward sexual expression and belief in sexual consent capacity. CONCLUSION: Attention toward the influence of older women's cognitive health and young adults' attitudes toward late-life sexuality may prove beneficial in designing interventions to decrease the stigma associated with sexual activity in later life.
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Conhecimentos, Atitudes e Prática em Saúde , Sexualidade , Adolescente , Adulto , Fatores Etários , Anedotas como Assunto , Demência , Feminino , Humanos , Masculino , Estereotipagem , Inquéritos e Questionários , Adulto JovemRESUMO
Recent research has suggested that religion/spirituality may be linked to improved physical and emotional health, although the patient's motivation and method of using religious/spiritual beliefs appear to be a key factor in obtaining benefit. Studies have shown that there is a high level of religion/spirituality among older adults in the United States and significant patient-reported desire to include such beliefs in health care settings. This article provides a brief overview of the support for considering religion/spirituality in the health care of older adults and reviews potential drawbacks and methods for providers to assess and use patient beliefs to improve anxiety/depression.
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Ansiedade/terapia , Atitude Frente a Morte , Depressão/terapia , Cuidados Paliativos/organização & administração , Religião e Medicina , Espiritualidade , Idoso , Idoso de 80 Anos ou mais , Atitude Frente a Saúde , Feminino , Humanos , Masculino , Terapias Mente-Corpo , Assistência Centrada no Paciente/organização & administração , Relações Profissional-Paciente , Religião e Psicologia , Estados UnidosRESUMO
PURPOSE: With the rapid growth in the older inmate population and the economic impact of end-of-life treatments within the cash-strapped prison system, consideration should be given to inmate treatment preferences. We examined end-of-life treatment preferences and days of desired life for several health scenarios among male inmates incarcerated primarily for murder. DESIGN AND METHODS: Inmates over the age of 45 who passed a cognitive screening completed face-to-face interviews (N = 94; mean age = 57.7; SD = 10.68). RESULTS: We found a 3-way interaction indicating that the effect of parole expectation on desire for life-sustaining treatment varied by race/ethnicity and treatment. Minority inmates desired cardiopulmonary resuscitation or feeding tubes only if they believed that they would be paroled. The model predicting desire for palliative care was not significant. Future days of desired life were related to prospective health condition, fear of death, negative affect, and trust in prison health care. Caucasian inmates expressed a desire for more days of life out of prison, whereas minority inmates did not differ in days of desired life either in or out of prison. Minorities wanted more days of life than Caucasians but only if they believed that they would be paroled. IMPLICATIONS: End-of-life care for the burgeoning inmate population is costly, and active life-sustaining treatments may not be desired under certain conditions. Specifically, expectation of parole but not current functional ability interacts with future illness condition in explaining inmates' desire for active treatment or days of desired life in the future.
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Envelhecimento , Atenção à Saúde , Cuidados Paliativos/psicologia , Prisioneiros/psicologia , Ordens quanto à Conduta (Ética Médica)/psicologia , Doente Terminal/psicologia , Atitude Frente a Morte/etnologia , Atenção à Saúde/economia , Atenção à Saúde/ética , Atenção à Saúde/normas , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Estatísticos , Relações Médico-Paciente , Prisões/ética , Ordens quanto à Conduta (Ética Médica)/ética , Inquéritos e Questionários , Doente Terminal/estatística & dados numéricos , Estados Unidos/epidemiologiaRESUMO
PURPOSE: To examine whether differences exist between rural and urban veterans in terms of initiation of psychotherapy, delay in time from diagnosis to treatment, and dose of psychotherapy sessions. METHODS: Using a longitudinal cohort of veterans obtained from national Veterans Affairs databases (October 2003 through September 2004), we extracted veterans with a new diagnosis of depression, anxiety, or posttraumatic stress disorder (PTSD) (n = 410,923). Veterans were classified as rural (categories 6-9; n = 65,044) or urban (category 1; n = 149,747), using the US Department of Agriculture Rural-Urban Continuum Codes. Psychotherapy encounters were identified using Current Procedural Terminology codes for the 12 months following patients' initial diagnosis. FINDINGS: Newly diagnosed rural veterans were significantly less likely (P < .0001) to receive psychotherapy (both individual and group). Urban veterans were roughly twice as likely as rural veterans to receive 4 or more (9.46% vs 5.08%) and 8 or more (5.59% vs 2.35%) psychotherapy sessions (P < .001). CONCLUSIONS: Rural veterans are significantly less likely to receive psychotherapy services, and the dose of the psychotherapy services provided for rural veterans is limited relative to their urban counterparts. Focused efforts are needed to increase access to psychotherapy services provided to rural veterans with depression, anxiety, and PTSD.
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Depressão/terapia , Psicoterapia/estatística & dados numéricos , Serviços de Saúde Rural/estatística & dados numéricos , Transtornos de Estresse Pós-Traumáticos/terapia , Serviços Urbanos de Saúde/estatística & dados numéricos , Veteranos/estatística & dados numéricos , Adulto , Idoso , Ansiedade/terapia , Estudos de Coortes , Bases de Dados Factuais , Feminino , Humanos , Modelos Logísticos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Estudos Retrospectivos , Risco , Fatores de Tempo , Estados Unidos , United States Department of Veterans AffairsRESUMO
OBJECTIVE: To examine the effectiveness of tailored cognitive-behavioral therapy (CBT) for veterans with congestive heart failure (CHF) and chronic obstructive pulmonary disease (COPD) with comorbid symptoms of depression and/or anxiety. METHOD: Twenty-three veterans with CHF and/or COPD, identified from electronic medical records at a large Veterans Affairs medical center, with clinically significant symptoms of depression (Beck Depression Inventory-II [BDI-II] score ≥ 14) and/or anxiety (State Trait Anxiety Inventory [STAI] score ≥ 40) were enrolled in an open trial from August 2007 to August 2008. All patients received CBT delivered mostly by advanced psychology trainees that consisted of 6 weekly sessions and 3 telephone booster calls. The intervention expanded traditional CBT techniques in order to address patients' emotional and physical health difficulties using in-person and telephone-based sessions. Outcomes examined depression (BDI-II), anxiety (STAI), and disease-specific quality of life (Chronic Respiratory Questionnaire [CRQ] and Kansas City Cardiomyopathy Questionnaire [KCCQ]) postintervention and at 3-month follow-up. RESULTS: Symptoms of depression (effect size = 0.97) and anxiety (effect size = 0.57) were improved at 8 weeks and maintained at 3-month follow-up. Physical disease outcomes were also improved for COPD (CRQ mastery effect size = 0.65, CRQ fatigue effect size = 0.75) and CHF (KCCQ overall summary score effect size = 1.19). CONCLUSIONS: Modifications to traditional CBT approaches have the potential to address the emotional and physical health challenges associated with complex cardiopulmonary patients. The brief duration and use of telephone-based sessions increase the opportunity for CBT interventions to be integrated within primary care settings, but additional trials are needed. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00727155.
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Using protection motivation theory, we examined racial differences in intent to complete a living will, rational problem solving (e.g., information seeking), and maladaptive coping responses (i.e., wishful thinking) to a health crisis. Sixty healthy, older adults without living wills responded to written vignettes, including information about living wills as an effective coping mechanism to avoid a health crisis. Use of adaptive coping responses predicted intent to execute a living will. A significant race-by-threat interaction predicted use of rational problem solving, with Caucasians more likely to seek information in response to perceived threat in comparison with African Americans. A significant race-by-adaptive-coping interaction predicted maladaptive coping, indicating that Caucasians were more variable in their maladaptive responses. The effectiveness of health care messages regarding living wills for older adults may be enhanced by focusing on racial differences in response to perceived health threat and perceived adaptive coping information.
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The historiography on disability and gender in the West suggests an association between 'masculine' ability and 'feminine' disability. In contrast, Russia's early twentieth-century literature on the treatment of mentally-ill soldiers reveals a broader range of choices in ascriptions of gender and dis/ability. While conceptions of 'masculine' ability and 'feminine' disability existed in Russia, these two permutations of gender and dis/ability were neither strictly opposed in professional medical literature, nor were they the only available options. Physicians and patients most intimately associated with psychiatric casualties in Russia's wars also considered certain individuals to be masculine and disabled, as well as feminine and able. This article discusses and interprets these issues and concludes by exploring some of the possible political and cultural reasons why understandings of gender and disability proved more flexible in Russia than in the West.