Betrayal trauma and somatic symptoms among patients in a medically underserved primary care clinic.

OBJECTIVE: Betrayal Trauma Theory posits that victims of trauma are more prone to developing psychological and physical problems if the traumatic event includes the element of betrayal. We sought to evaluate the impact of betrayal trauma versus nonbetrayal trauma and no trauma exposure on the risk of patients' reporting somatic symptoms in six domains (gastrointestinal, cardiopulmonary, musculoskeletal, pseudoneurological, gynecological, or any symptom). METHOD: Medically underserved patients (N = 1,350) who presented to a primary care clinic in California completed a structured standardized interview that assessed trauma history (Diagnostic Interview Schedule) and somatization symptoms (Composite International Diagnostic Interview). Using Betrayal Trauma Theory as a guide, respondents were classified into "no trauma," "nonbetrayal trauma," and "betrayal trauma" groups. RESULTS: Compared to "no trauma" patients, patients who experienced nonbetrayal trauma were more likely to endorse all symptom domains (ORs = 1.30-1.50) except gastrointestinal and musculoskeletal; compared to "no trauma" patients, patients who experienced betrayal trauma were more likely to endorse all symptom domains (ORs = 1.61-3.12) except gynecological. Compared to patients who experienced nonbetrayal trauma, exposure to betrayal trauma increased the likelihood of reporting any (OR = 2.25), gastrointestinal (OR = 1.56), and pseudoneurological symptoms (OR = 1.71), as well as symptoms spanning multiple physiological systems (incidence rate ratio = 1.27). Each nonbetrayal trauma increased the likelihood of symptom reporting across all domains (ORs = 1.18-1.40); each betrayal trauma increased the likelihood across all domains (ORs = 1.41-2.31) except gynecological. CONCLUSION: Both nonbetrayal and betrayal trauma may predispose victims to somatization. Compared to nonbetrayal trauma, betrayal trauma confers a greater magnitude of risk for having a somatic symptom across each symptom domain except gynecological. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Should Physicians Disclose Their Own Health Challenges? Perspectives of Patients With Chronic Pain.

This study explores how patients with chronic pain view the impact of physician self-disclosure on the patient-physician relationship. We conducted mixed-methods analyses of a cross-sectional survey eliciting experiences and attitudes regarding physician self-disclosure among 934 adults with self-reported chronic pain. Patients with chronic pain commonly recalled experiences of physician self-disclosure, most often "small talk" or physicians' disclosure of their own chronic pain. Patients generally rated these experiences to be beneficial. Patients frequently said they would benefit from seeing a physician who has had chronic pain, or that they would want their physician to self-disclose their own chronic pain. Those who had never experienced self-disclosure were more likely to want their physician to self-disclose their own chronic pain. Nonetheless, patients held varying perspectives toward the advantages and disadvantages of physician self-disclosure, believing that self-disclosure could either positively or negatively impact the patient-physician relationship and care and communication.

Impact of Sarcopenia on Adverse Outcomes After Allogeneic Hematopoietic Cell Transplantation.

BACKGROUND: High intensity treatments such as hematopoietic cell transplantation (HCT) can be curative for patients with hematologic malignancies, but this needs to be balanced by the high risk of nonrelapse mortality (NRM) during the first 2 years after HCT. Sarcopenia (low muscle mass) is associated with physical disability and premature mortality in individuals with nonmalignant diseases and may be a predictor of NRM and poor overall survival in patients undergoing HCT. METHODS: This was a retrospective cohort study of 859 patients with acute leukemia or myelodysplastic syndrome who underwent a first HCT as adults (≥18 years) between 2007 and 2014. Sarcopenia was assessed from pre-HCT abdominal computed tomography scans. Two-year cumulative incidence of NRM was calculated, with relapse/progression considered as a competing risk event. Fine-Gray subdistribution hazard ratio estimates and 95% confidence intervals (CI) were obtained and adjusted for relevant covariates. Kaplan-Meier method was used to examine overall survival. All statistical tests were two-sided. RESULTS: Median age at HCT was 51 years (range = 18-74 years); 52.5% had a high [≥3] HCT-comorbidity index; 33.7% had sarcopenia pre-HCT. Sarcopenia was an independent predictor of higher NRM risk (hazard ratio = 1.58, 95% CI = 1.16 to 2.16) compared with patients who were not. The 2-year incidence of NRM approached 30% in patients with sarcopenia and high (≥3) HCT-comorbidity index. Patients with sarcopenia had on average a longer hospitalization (37.2 days vs 31.5 days, P < .001) and inferior overall survival at 2 years (55.2%, 95% CI = 49.5% to 61.0% vs 66.9%, 95% CI = 63.0% to 70.8%, P < .001). CONCLUSIONS: Sarcopenia is an important and independent predictor of survival after HCT, with potential additional downstream impacts on health-economic outcomes. This information can be used to facilitate treatment decisions prior to HCT and guide interventions to decrease the risk of treatment-related complications after HCT.

Depression predicts longitudinal declines in social support among women with newly diagnosed breast cancer.

OBJECTIVE: Among breast cancer survivors, low social support is associated with adverse clinical and psychosocial outcomes. This study prospectively examined longitudinal trends in perceived social support in women with newly diagnosed breast cancer as a function of depression status prior to initiation of cancer treatment. METHODS: One hundred ten patients with newly diagnosed breast cancer and 59 age-matched noncancer controls completed behavioral measures at four assessments: prior to treatment and at 1 month, 1 year, and 2 years post-treatment. Participants reported their perceived tangible and emotional/informational support using the Medical Outcomes Study Social Support Survey and were categorized as "depressed" or "non-depressed" based on the Brief Symptom Inventory-18 (BSI-18). Analyses first compared longitudinal trends in support between patients and controls and then examined differences in longitudinal trends as a function of depression status in patients only, controlling for key covariates. RESULTS: Both tangible and emotional/informational support decreased among breast cancer patients but increased or remained unchanged among noncancer controls across the assessments. Among patients, depressed individuals experienced a significant decline in both tangible (P = 0.004) and emotional/informational support (P = 0.013) between 1 month and 1 year post-treatment, which remained unchanged between 1 year and 2 years post-treatment. In contrast, nondepressed individuals had stable levels across all assessments. Depressed patients also had lower levels of both support types compared with nondepressed patients across all assessments. CONCLUSIONS: Breast cancer patients with depressive symptomatology have an elevated risk for declines in perceived social support over time.

Secondary Neoplasms of the Female Lower Genital Tract After Hematopoietic Cell Transplantation.

Hematopoietic cell transplantation (HCT) results in long-term survival (≥10 years) in 85% of patients who survive transplant-related complications within the first 2 years posttransplant. Transplant survivors, however, are at an increased risk of chronic health conditions compared with the general population, including the emergence of secondary malignant neoplasms. In particular, female transplant survivors may face a greater risk of lower genital tract (cervical, vulvar, or vaginal) neoplasms due to chronic immune dysregulation in the peritransplant and posttransplant environment. Persistent immune suppression may facilitate the carcinogenesis of human papillomavirus (HPV), the causative agent of nearly all cervical cancers and most vulvar and vaginal cancers. Nevertheless, the risk of these cancers has not been sufficiently quantified in female transplant survivors. Small clinical studies have shown that the rate of cervical cytological abnormalities increases after allogeneic HCT, but large population-based studies have not consistently demonstrated an increased risk of secondary cervical cancer after transplant compared with the general population; the risk of developing secondary vulvar or vaginal cancer after transplant remains unclear. A better understanding of the natural history of HPV-associated lower genital tract neoplasms and their transplant-related risk factors would help delineate optimal long-term follow-up protocols in this population. In this systematic review, we summarize the current literature on this topic and discuss the implications for cervical cancer screening and vaccination in female transplant recipients.