Serving All Who Served: Piloting an Online Tool to Support Cultural Competency with LGBT U.S. Military Veterans in Long-Term Care.

OBJECTIVE: Given health disparities between lesbian, gay, bisexual, and transgender (LGBT) and non-LGBT older adults, ensuring that the care provided in long-term care (LTC) settings is both supportive and sensitive to their unique needs and challenges is essential. This has become a matter of increasing priority in the United States Department of Veterans Affairs (VA), which in recent years has stated its mission to "serve all who served," including LGBT Veterans. With this in mind, we piloted an online training tool designed to enhance the LGBT cultural competence of interdisciplinary staff working in geriatric extended care units. METHOD: Interdisciplinary LTC staff participated in an online training module that contained information on unique factors that affect the lives of older LGBT Veterans, and provided considerations and strategies to assist staff in working with them. RESULTS: Following participation in the training, staff showed a significant increase in knowledge about LGBT Veterans, but not in skills or attitudes. CONCLUSIONS: Online-based LGBT cultural-competency training is useful in providing LTC staff with foundational knowledge that can help them work more competently with LGBT residents. CLINICAL IMPLICATIONS: LTC facilities can develop brief yet effective cultural competency trainings that increase the visibility of LGBT concerns in order to enhance clinical care.

The role of positive and negative interpersonal events on daily fatigue in women with fibromyalgia, rheumatoid arthritis, and osteoarthritis.

OBJECTIVE: The current study tested whether daily interpersonal events predicted fatigue from one day to the next among female chronic pain patients. DESIGN: Self-reported fatigue, daily events, pain, sleep quality, depressive symptoms, and functional health across 30 days were assessed in women with rheumatoid arthritis (RA: n = 89), Osteoarthritis (OA: n = 76), and Fibromyalgia syndrome (FM: n = 90). MAIN OUTCOME MEASURES: Self-report fatigue measured on a 0 to 100 scale and fatigue affect from PANAS-X (Watson & Clark, 1994). RESULTS: Multilevel analyses showed that both higher average levels of and daily increases in negative events predicted more fatigue, whereas daily increases in positive events predicted less fatigue. Across all pain conditions, increases in negative events continued to predict higher fatigue on the following day. Moreover, for participants with FM or RA, increases in positive events also predicted increased fatigue the following day. Daily increases in fatigue, in turn, predicted poorer functional health on both the same day and the next day. CONCLUSION: These results indicate that both on average and on a daily basis, interpersonal events influence levels of fatigue beyond common physical and psychological correlates of chronic pain and highlight differences between chronic pain groups.

Social constraints on disclosure predict daily well-being in couples coping with early-stage breast cancer.

According to the social-cognitive processing model (Lepore, 2001), social constraints on disclosure can limit an individual's ability to communicate openly with others and consequently have negative effects on psychological adjustment, especially in the context of stressful experiences such as the diagnosis and treatment of cancer. The goal of the present study was to examine the influence of social constraints on daily event sharing, individual well-being, and relationship well-being in couples coping with breast cancer. Forty-five patients recently diagnosed and treated for early stage breast cancer and their spouses reported perceptions of spousal constraints on patient disclosure and completed a 7-day electronic diary. Analyses revealed that patient-reported social constraints, independent of the spouse's report, were linked to reduced patient sharing of both cancer-related and other important daily events. Patient and spouse perceptions of social constraints, independent of their shared consensus, predicted reduced daily individual well-being indexed by self-esteem and negative affect, as well as reduced daily relationship well-being indexed by relationship happiness and intimacy. Moreover, many of the aforementioned effects on daily well-being remained after controlling for global marital quality. Overall, these findings reveal that individual perceptions of social constraints have a negative influence on both patient and spouse daily well-being outcomes.

Effects of cognitive therapy for depression on daily stress-related variables.

This study used a daily diary design to evaluate depressed patients' changes on daily stress-related variables during cognitive therapy (CT). Patients completed daily diaries on two week-long occasions: after the intake interview and again after the sixth session of CT. Patients also completed a measure of depressive symptoms before every treatment session. After six sessions of CT, patients reported a significant reduction in: (a) depressive symptoms; (b) daily sad affect (SA); (c) daily negative thoughts associated with the day's most stressful event; and (d) SA reactivity to daily stressors. In addition, patients reported a significant increase in: (e) daily positive affect (PA); and (f) SA reactivity to daily negative thoughts. The results suggest that CT has its intended effects on the daily lives of depressed adults, and highlight the value of a daily diary methodology for research on CT.

Negative affective spillover from daily events predicts early response to cognitive therapy for depression.

This study evaluated the predictive role of depressed outpatients' (N = 62) affective reactivity to daily stressors in their rates of improvement in cognitive therapy (CT). For 1 week before treatment, patients completed nightly electronic diaries that assessed daily stressors and negative affect (NA). The authors used multilevel modeling to compute each patient's within-day relationship between daily stressors and daily NA (within-day reactivity), as well as the relationship between daily stressors and next-day NA (next-day reactivity; affective spillover). In growth model analyses, the authors evaluated the predictive role of patients' NA reactivity in their early (Sessions 1-4) and late (Sessions 5-12) response to CT. Within-day NA reactivity did not predict early or late response to CT. However, next-day reactivity predicted early response to CT, such that patients who had greater NA spillover in response to negative events had a slower rate of symptom change during the first 4 sessions. Affective spillover did not influence later response to CT. The findings suggest that depressed patients who have difficulty bouncing back the next day from their NA reactions to a relative increase in daily negative events will respond less quickly to the early sessions of CT.

Depression history, stress, and pain in rheumatoid arthritis patients.

This study examined the role of past episodes of depression on pain reports for patients with rheumatoid arthritis (RA) before and during stress induction. A history of major depressive episodes was assessed by diagnostic interviews for 138 RA patients, 74 who later participated in a set of laboratory procedures designed to induce interpersonal stress. Patients were evaluated by a rheumatologist and then asked to report joint and bodily pain throughout the laboratory study. We found that RA patients with a history of two or more episodes of major depression had more pain at baseline, and exhibited higher pain in response to the stress induction than did RA patients with either only one episode or no history of depression. Such findings provide new insight in the dynamic relationships between depression, stress, and pain.