Occupational Performance Issues of Adults Seeking Bariatric Surgery for Obesity.

OBJECTIVE: We sought to describe the occupational performance issues of a sample of bariatric surgery candidates and to explore the relationships among occupational performance, satisfaction with performance, demographic characteristics, and mental health factors. METHOD: We reviewed the health records of 241 bariatric surgery candidates and analyzed their scores on the Canadian Occupational Performance Measure (COPM) and standardized mental health questionnaires. RESULTS: Exercise and eating behavior were the most common occupational performance issues. Cognitive and affective issues were reported more frequently than physical issues. Occupational performance and satisfaction correlated negatively with anxiety and depression and positively with self-esteem. Self-esteem contributed 27% of the variance in occupational performance. CONCLUSION: COPM scores revealed a wide range of occupational performance issues and significant associations with mental health factors, supporting a psychosocial approach to occupational therapy with this population. Routine mental health screening can help ensure that mental health factors are adequately addressed.

Long-term consequences of landmine injury: A survey of civilian survivors in Bosnia-Herzegovina 20 years after the war.

INTRODUCTION: Bosnia-Herzegovina is one of the most landmine-contaminated countries in Europe. Since the beginning of the war in 1992, there have been 7968 recorded landmine victims, with 1665 victims since the end of the war in 1995. While many of these explosions result in death, a high proportion of these injuries result in amputation, leading to a large number of disabled individuals. OBJECTIVE: The purpose of this study is to conduct a survey of civilian landmine victims in Bosnia-Herzegovina in order to assess the effect of landmine injuries on physical, mental, and social well-being. METHODS: Civilian survivors of landmine injuries were contacted while obtaining care through local non-governmental organizations (NGOs) throughout Bosnia-Herzegovina to inquire about their current level of independence, details of their injuries, and access to healthcare and public space. The survey was based upon Physicians for Human Rights handbook, "Measuring Landmine Incidents & Injuries and the Capacity to Provide Care." RESULTS: 42 survivors of landmines completed the survey, with an average follow up period of 22.0 years (±1.7). Of civilians with either upper or lower limb injuries, 83.3% underwent amputations. All respondents had undergone at least one surgery related to their injury: 42.8% had at least three total operations and 23.8% underwent four or more surgeries related to their injury. 26.2% of survivors had been hospitalized four or more times relating to their injury. 57.1% of participants reported they commonly experienced anxiety and 47.6% reported depression within the last year. On average, approximately 3% of household income each year goes towards paying medical bills, even given governmental and non-governmental assistance. Most survivors relied upon others to take care of them: only 41.5% responded they were capable of caring for themselves. 63.4% of respondents reported their injury had limited their ability to gain training, attend school, and go to work. CONCLUSION: The majority of civilian landmine survivors report adverse health effects due to their injuries, including anxiety, depression, multiple surgeries, and hospitalizations. The majority also experience loss of independence, either requiring care of family members for activities of daily living, disability, and inability to be employed. Further research is required to determine effective interventions for landmine survivors worldwide.

[Areas and challenges of oncopsychological rehabilitation]. / Az onkopszichológiai rehabilitáció területei és kihívásai.

Patients with cancer present a number of different difficulties that adversely affect their health care and recovery (e.g. poor communication with physicians, lack of knowledge about their illness and its management, financial problems). Furthermore, mental health problems, such as distress, depression and anxiety, are common amongst patients with cancer. These mental health problems are additional contributors to functional impairment in carrying out family, work, and other social roles, poor adherence to medical treatments, and adverse medical outcomes. Oncopsychosocial rehabilitation aims to optimize the possibilities of medical health care through psychological interventions by helping cancer patients and their families and/or health care workers with the management of the psychological and social aspects of the illness. Oncopsychosocial rehabilitation includes all psychosocial interventions that are designed to positively influence patient psychosocial adaptation and adjustment to diagnosis, treatment, and survivorship. Oncopsychological rehabilitation could also manage cancer related distress and other psychosocial problems with specific types of treatments or interventions including prevention, relaxation techniques, structured psychoeducational interventions including sexual information and/or preparation for surgery, and various methods of psychotherapy.

Comparing depression screening tools in persons with multiple sclerosis (MS).

OBJECTIVE: Depression is more common among persons with multiple sclerosis (MS) than the general population. Depression in MS is associated with reduced quality of life, transition to unemployment, and cognitive impairment. Two proposed screening measures for depression in MS populations are the Hospital Anxiety and Depression Scale (HADS) and the Beck Depression Inventory-Fast Screen (BDI-FS). Our objective was to compared the associations of the BDI-FS and the HADS-D scores with history of depressive symptoms, fatigue, and functional outcomes to determine the differential clinical utility of these screening measures among persons with MS. METHOD: We reviewed charts of 133 persons with MS for demographic information; scores on the HADS, BDI-FS, a fatigue measure, and a processing speed measure; and employment status. RESULTS: Structural equation modeling results indicated the HADS-D predicted employment status, disability status, and processing speed more effectively than did the BDI-FS, whereas both measures predicted fatigue. CONCLUSIONS: This study suggests the HADS-D is more effective than the BDI-FS in predicting functional outcomes known to be associated with depression among persons with MS. (PsycINFO Database Record

[Dance/movement therapy in oncological rehabilitation]. / Tanztherapie in der stationären onkologischen Rehabilitation.

BACKGROUND: Dance/movement therapy may be defined as a psychosocial and body-oriented art therapy, which uses dance for the expression of emotional and cognitive issues. Dance/movement therapy is an important intervention for cancer patients to enhance coping strategies. There are only few studies investigating dance therapy with cancer patients. METHODS: The present study investigates effects of dance/movement therapy (n = 115) in the setting of inpatient rehabilitation based on a pre-post design with a control group as well as a follow-up 3 months later. Standardized questionnaires measuring quality of life, anxiety and depression, and self-concept (EORTC QLQ-C30, HADS, FSKN) were used. In addition, at the end of the inpatient rehabilitation program subjective expectations of the dance/movement therapy and the patients' subjective evaluation of the benefits of the intervention were measured by a new developed questionnaire. RESULTS: As process factors of dance/movement therapy, expression of emotions, enhancement of self-esteem, development of the personality, vitality, getting inner balance, and getting in touch with the body have been identified. In terms of quality of life and psychological well-being, the results showed significant improvements with medium to large effect sizes. CONCLUSIONS: Even though those effects may not be attributed to the intervention alone, the analysis of the data and the patients' subjective statements help to reveal therapeutic factors and process characteristics of dance/movement therapy within inpatient rehabilitation.

Readiness for change predicts VA Mental Healthcare utilization among Iraq and Afghanistan war veterans.

Many veterans present to Veteran Affairs (VA) care intending to seek mental health treatment for symptoms of posttraumatic stress disorder (PTSD), depression, and/or alcohol misuse, yet most subsequently underutilize mental health care. This study examined the association of readiness for change with outpatient VA mental health care utilization in 104 treatment-seeking Iraq and Afghanistan war veterans who screened positive for PTSD, depression, and/or alcohol misuse at intake. Multivariate analyses demonstrated that readiness for change assessed at intake was positively associated (Incident Rate Ratio [IRR] = 1.22) with prospective outpatient mental health care utilization with demographic factors, military characteristics, and mental health burden in the model. Results suggest that interventions that target readiness to change, such as motivational interviewing, may improve treatment utilization in veterans presenting for mental health care.

[Intention to use and use of treatment due to psychological distress of patients in somatic rehabilitation]. / Inanspruchnahmebereitschaft und Inanspruchnahmeverhalten von Behandlungen aufgrund psychischer Belastungen bei Patienten der somatischen Rehabilitation.

BACKGROUND AND OBJECTIVES: Somatically ill patients in somatic rehabilitation often show comorbid psychological distress and mental disorders. In the framework of the implementation of a stepwise psychodiagnostic procedure, the present study investigated the intention to use and the use of treatment due to psychological distress. METHODOLOGY: Cohort study with a 6-months follow-up in 5 orthopedic, cardiologic and oncologic inpatient rehabilitation clinics (n=1 374). Psychological distress, sociodemographic data, intention to use psychotherapeutic or psychiatric treatments and the use of health care offers due to psychological distress were assessed by means of questionnaires. RESULTS: Every third patient (34%) was psychologically distressed at the beginning of rehabilitation. A positive intention to use psychotherapeutic or psychiatric treatment was reported by 79% of the psychologically distressed patients. 6 months after the end of rehabilitation, 26% of the patients who were psychologically distressed at the beginning of rehabilitation, had received treatment for mental health reasons. Reasons for non-utilization of treatment included lack of subjective need (45%) and lack of interest in treatment despite a perceived need (30%). Further 25% were considering treatment or were seeking appropriate treatment. CONCLUSIONS: Psychologically distressed rehabilitation patients show a high intention to undergo treatment. However, they show a clearly diminished use of post-rehabilitative treatments due to mental health problems. Hence, the promotion of motivation as well as the management of treatment barriers for improving post-rehabilitative use in psychologically distressed rehabilitants are of particular importance.

Attachment style is associated with perceived spouse responses and pain-related outcomes.

PURPOSE/OBJECTIVE: Attachment theory can provide a heuristic model for examining factors that may influence the relationship of social context to adjustment in chronic pain. This study examined the associations of attachment style with self-reported pain behavior, pain intensity, disability, depression, and perceived spouse responses to pain behavior. We also examined whether attachment style moderates associations between perceived spouse responses and self-reported pain behavior and depressive symptoms, as well as perceived spouse responses as a mediator of these associations. METHOD: Individuals with chronic pain (N = 182) completed measures of self-reported attachment style, perceived spouse responses, and pain-related criterion variables. RESULTS: Secure attachment was inversely associated with self-reported pain behaviors, pain intensity, disability, depressive symptoms, and perceived negative spouse responses; preoccupied and fearful attachment scores were positively associated with these variables. In multivariable regression models, both attachment style and perceived spouse responses were uniquely associated with self-reported pain behavior and depressive symptoms. Attachment style did not moderate associations between perceived spouse responses to self-reported pain behavior and pain criterion variables, but negative spouse responses partially mediated some relationships between attachment styles and pain outcomes. CONCLUSIONS/IMPLICATIONS: Findings suggest that attachment style is associated with pain-related outcomes and perceptions of spouse responses. The hypothesized moderation effects for attachment were not found; however, mediation analyses showed that perceived spouse responses may partially explain associations between attachment and adjustment to pain. Future research is needed to clarify how attachment style and the social environment affect the pain experience.

[Addictive behaviors in the aged]. / Les conduites addictives de la personne âgée.

This review is devoted to alcoholism but also to other substance-dependences (tobacco, medication, illicit drugs) and behavioral addictions (gambling) in the aged. Compared to younger subjects, addictions in older people are marked by the high frequency of somatic comorbidities, physiological changes related to age, increased severity due to atypical presentations. Moreover, usual screening tests and diagnostic questionnaires are often not suited for the aged. Psychopathology of addictions in the aged points out vulnerabilities not resolved with the advance in age, in connection with separation, narcissism, oral regression, alexithymia and other pathological dimensions of personality. The weight of the environment, dominated by a certain agism, remains a brake to the global care that must be based, as in younger adults, on motivational approach and specific treatments with special pharmacological vigilance.

[Definition, diagnosis and therapy of chronic widespread pain and so-called fibromyalgia syndrome in children and adolescents. Systematic literature review and guideline]. / Definition, Diagnostik und Therapie von chronischen Schmerzen in mehreren Körperregionen und des sogenannten Fibromyalgiesyndroms bei Kindern und Jugendlichen. Systematische Literaturübersicht und Leitlinie.

BACKGROUND: The scheduled update to the German S3 guidelines on fibromyalgia syndrome (FMS) by the Association of the Scientific Medical Societies ("Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften", AWMF; registration number 041/004) was planned starting in March 2011. MATERIALS AND METHODS: The development of the guidelines was coordinated by the German Interdisciplinary Association for Pain Therapy ("Deutsche Interdisziplinären Vereinigung für Schmerztherapie", DIVS), 9 scientific medical societies and 2 patient self-help organizations. Eight working groups with a total of 50 members were evenly balanced in terms of gender, medical field, potential conflicts of interest and hierarchical position in the medical and scientific fields. Literature searches were performed using the Medline, PsycInfo, Scopus and Cochrane Library databases (until December 2010). The grading of the strength of the evidence followed the scheme of the Oxford Centre for Evidence-Based Medicine. The formulation and grading of recommendations was accomplished using a multi-step, formal consensus process. The guidelines were reviewed by the boards of the participating scientific medical societies. RESULTS AND CONCLUSION: The diagnosis FMS in children and adolescents is not established. In so-called juvenile FMS (JFMS) multidimensional diagnostics with validated measures should be performed. Multimodal therapy is warranted. In the case of severe pain-related disability, therapy should be primarily performed on an inpatient basis. The English full-text version of this article is available at SpringerLink (under "Supplemental").

White matter abnormalities correlating with memory and depression in heroin users under methadone maintenance treatment.

Methadone maintenance treatment (MMT) has elevated rates of co-morbid memory deficit and depression that are associated with higher relapse rates for substance abuse. White matter (WM) disruption in MMT patients have been reported but their impact on these co-morbidities is unknown. This study aimed to investigate changes in WM integrity of MMT subjects using diffusion tensor image (DTI), and their relationship with history of heroin and methadone use in treated opiate-dependent individuals. The association between WM integrity changes from direct group comparisons and the severity of memory deficit and depression was also investigated. Differences in WM integrity between 35 MMT patients and 23 healthy controls were evaluated using DTI with tract-based spatial statistical analysis. Differences in DTI indices correlated with diminished memory function, Beck Depression Inventory, duration of heroin use and MMT, and dose of heroin and methadone administration. Changes in WM integrity were found in several WM regions, including the temporal and frontal lobes, pons, cerebellum, and cingulum bundles. The duration of MMT was associated with declining DTI indices in the superior longitudinal fasciculus and para-hippocampus. MMT patients had more memory and emotional deficits than healthy subjects. Worse scores in both depression and memory functions were associated with altered WM integrity in the superior longitudinal fasciculus, para-hippocampus, and middle cerebellar peduncle in MMT. Patients on MMT also had significant WM differences in the reward circuit and in depression- and memory-associated regions. Correlations among decreased DTI indices, disease severity, and accumulation effects of methadone suggest that WM alterations may be involved in the psychopathology and pathophysiology of co-morbidities in MMT.

[Cancer-related fatigue. Psychosocial support]. / Tumorbedingte Fatigue: Psychosoziale hilfen.

Cancer-related fatigue is a subjective sensation of uncontrollable physical, emotional and/or cognitive tiredness and weakness, which occurs in the context of cancer or cancer-treatment. Cancer-related fatigue occurs at all stages of cancer treatment and can persist long after medical treatment. It profoundly affects patients' quality of life and limits their personal, social, and occupational lives. Cancer-related fatigue is also associated with significant levels of distress, and it imposes financial burdens by limiting a patient's ability to work. Current psychosocial interventions with strong or sufficient evidence include physical training, cognitive-behavioral training, relaxation techniques, psychoeducation and patient education. This article gives an overview of currently available psychosocial interventions and information on their implementation.

Screening for depression: integrating training into the professional development programme for low vision rehabilitation staff.

BACKGROUND: To describe the integration of depression screening training into the professional development programme for low vision rehabilitation staff and report on staff evaluation of this training. DESIGN: Pre-post intervention study, in a single population of low vision rehabilitation staff. PARTICIPANTS: Three hundred and thirty-six staff from Australia's largest low vision rehabilitation organization, Vision Australia. METHODS: Staff completed the depression screening and referral training as part of a wider professional development programme. A pre-post-training questionnaire was administered to all staff. MAIN OUTCOME MEASURES: Descriptive and non-parametric statistics were used to determine differences in self-reported knowledge, confidence, barriers to recognition and management of depression between baseline and post training. RESULTS: One hundred and seventy-two participants completed both questionnaires. Following training, participants reported an increased knowledge of depression, were more likely to respond to depression in their clients and reported to be more confident in managing depression (P < 0.05). A range of barriers were identified including issues related to the client (e.g. acceptance of referrals); practitioners (e.g. skill, role); availability and accessibility of psychological services; time and contact constraints; and environmental barriers (e.g. lack of privacy). Additional training incorporating more active and 'hands-on' sessions are likely to be required. CONCLUSIONS: This training is a promising first step in integrating a depression screening tool into low vision rehabilitation practice. Further work is needed to determine the barriers and facilitators to implementation in practice and to assess clients' acceptability and outcomes.

[Benchmarking in psychiatric acute care--a demonstration project in a hospitals network]. / Benchmarking in der psychiatrischen Akutbehandlung - Ein Modellprojekt im Klinikverbund.

The aim of this project was to improve treatment processes and results in acutely ill inpatients within a network of nine psychiatric state hospitals of the Landschaftsverband Rheinland by introducing a benchmarking process. The project was based upon pre-existing measures of quality management. Patient groups were selected that were characterised by a severe clinical development or a high demand for mental health care services (alcohol abuse, depression of the elderly, schizophrenia). Room for improvement concerning specific hospitals and the overall hospital network were identified. The project was conducted with two patient cohorts before and after a quality-related intervention. Interventions were implemented for specific hospitals and the overall hospital network. Overall treatment documentations of 1,696 patients (1(st) cohort n=1,856, 2(nd) cohort n=1,696) were completed. Although there was no constant quantifiable statistically significant improvement of quality within the three patient groups (and certainly not with respect to the overall network), there was successful improvement of essential treatment processes for certain hospitals and the overall network under benchmarking. This was especially relevant where treatment recommendations were concerned. Future projects should focus on the conformance with treatment guidelines by defining both structural and process measures as a starting point and evaluation criterion.

[Permanent disability and death among German workers with depression]. / Invalidität und Tod bei Erwerbsfähigen mit Depressionen.

OBJECTIVE: It was the aim of this study to estimate effects of depression on permanent disability and death in a statutory health insurance population. METHODS: Data from 128,001 clients were used with a mean follow up of 6.4 years. Excess risks were calculated with Cox regression models adjusted for age, gender, education and job classification. RESULTS: Outpatient treatment for depression was associated with an elevated relative risk for permanent disability, but inpatient treatment even more so. Life table analysis suggests higher risks of early retirement for males who get ill early in life. Depression treated solely in an outpatient setting may be associated with lower mortality early in life, but this was only significant for women. CONCLUSIONS: Outpatient treatment should include an emphasis on occupational functioning, but also a gender-specific approach is needed.

Utilization of psychosocial care and oncological follow-up assessments among German long-term survivors of cancer with onset during adolescence.

BACKGROUND: Survivors of pediatric cancer are at increased risk for medical and psychosocial late effects. This study retrospectively investigated the utilization of oncological and psychosocial care by former adolescent cancer patients (≥ 5 years since cancer diagnosis) in Germany. PATIENTS: Based on data of the German Childhood Cancer Registry (N=1 876 survivors of cancer with an age at diagnosis between 15 and 18 years), the study cohort comprised 820 survivors of adolescent cancer (time since diagnosis: M=13.7, SD=6.0, age at follow-up: M=30.4, SD=6.0 years). METHOD: Survivors of adolescent cancer completed standardized questionnaires measuring symptoms of posttraumatic stress, depression and anxiety as well as items on their utilization of medical and psychosocial care. RESULTS: More than a quarter (26.2%) of the survivors was no longer attending regular oncological follow-up assessments. Less than half of the survivors (44.4%) had received psychosocial care, mostly during their in-patient cancer treatment and their post-acute rehabilitation phase. Out of 184 survivors showing clinically relevant symptoms of posttraumatic stress, anxiety and/or depression at time of the study, 12.0% received psychosocial care and 13.6% took psychotropic medication. CONCLUSION: It should be studied further why only a small proportion of the survivors showing clinically relevant symptoms received psychosocial or psychopharmacological treatment. Systematic oncological follow-up assessments should take psychological late effects into greater account.

[Chronic fatigue in cancer patients]. / Chronische Fatigue bei Krebspatienten.

BACKGROUND: Due to improvements in long-term survival in cancer patients, emphasis is increasingly placed on chronic symptoms such as cancer-related fatigue in patients after completion of cancer treatment. Fatigue prevalence in these patients ranges from 17% to 56%. However, there is a lack of complex treatments that take the multifactorial character of fatigue causation into account. PATIENTS AND METHODS: Based on a needs analysis, a patient education program was developed and evaluated. The study aimed at cancer patients after completion of the cancer treatment who suffer from chronic fatigue. The self-management program FIBS consists of six modules. Information about fatigue and behavioural therapy orientated strategies and exercises are included. Patients who attended the program were highly satisfied. They were satisfied with the selected topics at an average of 84.0%, and with the conditions at 84.25%. 95.8% of the patients achieved a subjectively perceived personal benefit, on average 8.14 of 12 possible points. The overall patient education satisfaction scored 78.72%. CONCLUSION: The newly developed self-management program closes a gap in health care of cancer patients with chronic fatigue for whom there are hardly any intervention options to date. The program is characterised by target group-specific contents and methods and a high satisfaction of the patients.