The effect of treatment and coping on the quality of life in breast cancer patients: a moderated mediation model.

PURPOSE: Breast cancer involves complicated emotional processes. One of the factors that impacts the psychological symptoms and decreases QoL is the side effects of treatment. The purpose of this study is to explore the effect of the main medical treatment (chemotherapy or hormone therapy) on the three domains of quality of life. For this, coping strategies were considered as psychological variables that mediate the relationship based on high or low alexithymia as a moderating variable. METHODS: This study had a cross-sectional design. The participant sample comprised 129 women with breast cancer in early stage (I to III) (63 receiving chemotherapy and 66 hormone therapy) and were evaluated from September 2015 to September 2019. Physical, emotional and social functioning were measured by the Quality of Life Questionnaire for cancer patients (EORTC-QLQ-C30), coping strategies were measured by Mental Adjustment to Cancer Questionnaire (MAC) and alexithymia was evaluated by the Alexithymia Toronto Scale (TAS-20). RESULTS: Treatment had a significant negative effect on physical domain in both patients receiving chemotherapy and hormone therapy. Moderated mediation analysis show that this relationship was significant when it was mediated by helplessness. Furthermore, this model is only significant when there are high levels of alexithymia. No significant effect direct was found on emotional and social functioning of quality of life. CONCLUSIONS: Results confirmed that coping based on helplessness and stable emotional variables such as alexithymia can have an effect, mediator or moderator, respectively, in the decrease of the physical functionality of women with breast cancer. Our findings highlight the need to include psychological therapy to help patients alleviate their psychological state because it can affect their physical condition.

Post-Partum Depression, Personality, and Cognitive-Emotional Factors: A Longitudinal Study on Spanish Pregnant Women.

In this study, our purpose was to examine whether personality and cognitive factors could be related to post-partum depression (PPD), mediated by anxiety, in Spanish women. Women were evaluated for personality and cognitive factors after the first trimester, for anxiety in the third trimester, and for PPD 4 months after childbirth. A structural equation model revealed that personality and cognitive factors were associated with anxiety and PPD as predictors. Neuroticism and extroversion proved to be the most relevant factors. Conscientiousness was associated with pregnancy anxiety. Pregnancy anxiety appeared as an independent predictor of PPD. The model presented here includes personality and cognitive and emotional factors as predictors of PPD. Comprehensive care for pregnant women should contemplate assessment and intervention on all these aspects. Special focus should be on cognitive factors and emotional regulation strategies, so as to minimize the risk of later development of emotional disorders during puerperal phases.

Self-efficacy and affect as mediators between pain dimensions and emotional symptoms and functional limitation in women with fibromyalgia.

The aim of this study was to investigate the role of self-efficacy and affect as mediators of the relationship between pain and several fibromyalgia (FM) symptoms (functional limitation, depression, and anxiety). We evaluated 144 women with FM for self-reported pain (numerical pain scale), pressure pain sensitivity (pressure pain thresholds), functional limitation (Fibromyalgia Impact Questionnaire), self-efficacy (Chronic Pain Self-Efficacy Scale), depression-anxiety (Hospital Anxiety and Depression Scale), and positive-negative affect (Positive-Negative Affect Scale). Mediating analyses were conducted with ordinary least squares multiple regression analysis. The results demonstrated that self-reported pain and pressure pain sensitivity exhibited significant relationships with functional limitation, anxiety, depression, self-efficacy, and affect. Affect mediated the relationship between pressure pain sensitivity and anxiety, whereas self-efficacy was the mediating variable between self-reported pain and functional limitation and depression. Our results support a complex nature of pain in women presenting with FM, as cognitive and emotional variables have different mediator relationships between pain dimensions and functional and emotional outcomes in women with FM.

Anxiety, depression and alexithymia in fibromyalgia: are there any differences according to age?

This article analyzes the evolution of alexithymia, anxiety, and depression associated with fibromyalgia (FM) in three age groups in comparison to how they evolve in the same age groups in healthy women. A total of 240 women participated in the study (120 diagnosed with fibromyalgia and 120 healthy women), divided into three age groups (≤35 years,>35 and <65 years, and ≥65 years old). Our analysis revealed that alexithymia, anxiety, and depression in FM patients showed increased levels compared to healthy controls. Also, young women with FM (under 35) show lower alexithymia, anxiety, and depression levels in comparison to older patients (≥65). Alexithymia in FM patients follows a similar pattern as in healthy women (although with significantly higher scores), increasing with age. Our results show that depression, anxiety, and alexithymia develop over age in a different way in FM patients than in healthy individuals, increasing over age.

Intensive care unit professionals during the COVID-19 pandemic in Spain: social and work-related variables, COVID-19 symptoms, worries, and generalized anxiety levels.

BACKGROUND: The severe acute respiratory syndrome coronavirus 2 outbreak has been identified as a pandemic and global health emergency. It presents as a severe acute respiratory disease. The rapid dissemination of the disease created challenges for healthcare systems and forced healthcare workers (HCWs) to deal with many clinical and nonclinical stresses. The aim of our research is to describe work conditions, symptoms experienced by HCWs, worries about contagion, and generalized anxiety symptoms and compare those findings across regions in Spain. METHODS: This cross-sectional study was conducted using an online survey. Critical care units throughout Spain were included. The sample comprised HCWs working in intensive care units from March to May 2020. We assessed work variables, physical symptoms, worries about contagion, and anxiety (generalized anxiety disorder-7 questionnaire). RESULTS: The final sample comprised 448 surveys. Among the respondents, 86.9% (n=389) were nursing professionals, and 84.8% (n=380) were women. All participants cared for coronavirus disease 2019 (COVID-19) patients during the study period. Workload during the pandemic in Madrid was judged to be higher than in other regions (P<0.01). The availability of personal protective equipment was found to be higher in Cataluña. The most frequently experienced symptom was headaches (78.1%). Worries about self-infection and the possibility of infecting others received mean scores of 3.11 and 3.75, respectively. Mean scores for generalized anxiety levels were 11.02, with 58.7% of the professionals presenting with generalized anxiety syndrome during the assessment. CONCLUSIONS: In this study, we found high levels of anxiety among HCWs caring directly for COVID-19 patients, which could produce long-term psychological alterations that still need to be assessed.

The 4 U's Rule of Fibromyalgia: A Proposed Model for Fatigue in a Sample of Women with Fibromyalgia: A Qualitative Study.

Although fatigue usually goes unnoticed, it is a symptom that poses great challenges to patients with fibromyalgia and is a strong limitation. The aim of this study is to identify and describe the variables involved in fatigue in nine different situations of the Goal Pursuit Questionnaire (GPQ) that may occur in the daily lives of women with fibromyalgia, according to an ABC (Antecedents-Behaviors-Consequences) model. This study followed a qualitative descriptive research method and a deductive-inductive hybrid approach based on a phenomenological paradigm. Twenty-six women with fibromyalgia participated in focus group discussions between February and March of 2018. Thematic content analysis was carried out from transcribed verbatim interviews. We identified nine major themes that emerged from the participants' conversations: self-imposed duties, muscle fatigue, overwhelming feeling of tiredness, difficulty thinking, difficulty concentrating, negative emotions, lifestyle changes, affected everyday activities, and lack of motivation for daily activities and social interactions. We conclude that the ABC model allowed certain elements to emerge regarding the fatigue experience, highlighting its importance as a symptom in fibromyalgia. This additional analysis of the ABC model showed that fatigue can be described through the 4 U's Rule, which is integrated by these four adjectives: (1) Unpredictable, (2) Uncontrollable, (3) Unseen, and (4) Unintelligible. Identifying these characteristics can contribute to a better understanding of fibromyalgia in addition to better treatment for these patients.

The Importance of Alexithymia in Post-surgery. Differences on Body Image and Psychological Adjustment in Breast Cancer Patients.

Breast cancer is a disease that is difficult to face and that often hinders body acceptance. Body changes due to surgery can be very emotionally challenging for those who experience them. The aim of this study is to explore the differences on body image and psychological adjustment on women with breast cancer with high and low alexithymia according to the type of surgery. In this cross-sectional study, 119 women diagnosed with breast cancer (stages I, II, and III) were evaluated with different self-report questionnaires. Afterward, patients were divided into two groups (high and low levels of alexithymia) to analyze dependent variables (body image and psychological adjustment) according to the type of surgery (radical mastectomy or breast conserving therapy). The results of the General Linear Model suggest that when patients show high alexithymia combined with having undergone a radical mastectomy, they show higher levels of Hopelessness. Furthermore, in patients with high alexithymia, higher scores of maladaptive coping styles and greater distortion of body image were found. Alexithymia seems to play an important role in the way in which women cope with their disease, especially in those with radical mastectomy.

[Cognitive resources of perceived control, stress-recovery processes and affective discomfort in fibromyalgia]. / Recursos cognitivos de percepción de control, procesos de estrés/recuperación y malestar afectivo en fibromialgia.

This study evaluates a structural equation model (SEM) of linkages among cognitive control resources (illness-specific efficacy beliefs and internal pain control expectancies), stress/recovery state, and affective discomfort in women with fibromyalgia (n=130). Results were consistent with the proposal that stress/recovery balance mediates the relationship between cognitive resources and affective discomfort. In addition, direct effects of cognitive resources on function limitation were observed, and pain intensity and symptoms were direct predictors of the affective discomfort. Based on the results, the possible interpretation of several cognitive-behavioural techniques commonly employed in the treatment of fibromyalgia are indicated as strategies aimed at finding the correct equilibrium between stress and recovery, and the modification of self-efficacy beliefs and pain control expectancies are fundamental.

[Effectiveness of a cognitive-behavioural program to reduce anxiety in medically ill patients]. / Eficacia de un programa cognitivo-conductual para la disminución de la ansiedad en pacientes médicamente enfermos.

The aim of this work is to evaluate four programs to reduce anxiety in medically ill patients: psicoeducative, cognitive, behavioural or control. One hundred and seventy seven patients from the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán were assigned randomly to one of this programs and were evaluated before and after them with the Anxiety Hamilton Scale and the State-Trait Anxiety Inventory (STAI). Program effectiveness was evaluated with descriptive and a Pre-post difference mean analysis. Results show that the program that obtained the best results in reducing anxiety levels was the Psicoeducative Program, reducing significantly the anxiety levels evaluated with both measures. This indicates that in patients that assist to a general hospital, the combination of different psychological techniques such as providing information to the patient, relaxation training and other cognitive strategies are effective in reducing tension, worries, nervousness and levels of anxiety related with their illness.

Nursing Motives for Helping Scale (N-MHS): reliability and validity.

This paper presents the Nursing Motives for Helping Scale (N-MHS), an instrument designed for the evaluation of three of the four motives for helping derived from Batson's helping pathway theory. Dimensionality was analyzed by means of principal component analysis (n = 113), followed by confirmatory factor analysis. A 3-factor structure (corresponding to Batson's differentiation among altruistic motivation, reward-seeking motivation, and punishment-avoidance motivation, respectively), with 9 items distributed in three latent variables, revealed an acceptable fit to the data. Alpha values (.60 - .74) showed that internal consistency was acceptable for a newly developed subscale with a small number of items. Convergence validity was evaluated with correlations between N-MHS subscales scores and scores on the Professional Expectations Scale (Garrosa, Moreno-Jiménez, Rodríguez-Carvajal, and Morante, 2005). The three resulting subscales are a promising instrument for the evaluation of three nursing motives for helping that can contribute to reduce the potential risks and to improve the potential benefits both for the nurse and the patient.