Perceptions of caregiver distress, health behaviors, and provider health-promoting communication and their relationship to stress management in MS caregivers.

This study applied the Stress/Health Model to examine a novel approach for promoting stress management among 67 caregivers of persons with multiple sclerosis, who often face unique caregiving challenges. Hierarchical regressions indicated that caregiver distress (i.e., emotional burden) and engagement in other health-promoting activities (i.e., controlling alcohol use) were the best predictors of caregiver stress management. Communication with the MS care recipient's health provider about caregiver engagement in health-promoting activities was associated with caregiver stress management, but not significantly more so than explained by the other factors (i.e., caregiver distress and engagement in health-promoting behaviors). A more controlled study would be indicated to further explain how to encourage, within the medical setting, caregiver engagement in self-care activities.

Depression screening in Black Americans with multiple sclerosis.

Depression is prevalent in Multiple Sclerosis (MS) and impacts treatment adherence. Depression screening may be a useful mechanism to identify Blacks at risk for depression in an MS setting, as they frequently experience more disabling MS disease and also may be less likely than Whites to be accurately diagnosed with depression, which can further impact MS disease and diminish quality of life. The purpose of this study was to compare the clinical presentation (e.g. psychiatric histories, current symptoms, and provider treatment recommendations) of Black and White MS patients identified as at risk for depression using a validated depression screening instrument. Secondary analysis of an archival chart data-set of 279 MS patients (90 Blacks) indicated that Black patients were less likely than Whites to have a past mental health diagnosis (X(2) = 12.794, p < .001), prior experience with psychotropics (X(2) = 11.394, p < .001), or be prescribed psychotropics at the time of screening (X(2) = 10.225, p < .001). No differences in depression scores were observed between Black and White patients. Approximately 44% of patients received provider treatment recommendations following a positive screening with no between group differences in the likelihood of receiving at least one recommendation. Consistent with the literature, our Black patient sample was less likely than Whites to have a history of mental health diagnosis or to have been treated with psychotropics. Although more research is needed, screening programs for depression in MS may facilitate access to services for all MS patients while reducing health disparities in Black American patients and removing barriers to early intervention and ongoing care.

Measuring psychological flexibility in medical students and residents: a psychometric analysis.

PURPOSE: Psychological flexibility involves mindful awareness of our thoughts and feelings without allowing them to prohibit acting consistently with our values and may have important implications for patient-centered clinical care. Although psychological flexibility appears quite relevant to the training and development of health care providers, prior research has not evaluated measures of psychological flexibility in medical learners. Therefore, we investigated the validity of our learners' responses to three measures related to psychological flexibility. METHODS: Fourth-year medical students and residents (n=275) completed three measures of overlapping aspects of psychological flexibility: (1) Acceptance and Action Questionnaire-II (AAQ-II); (2) Cognitive Fusion Questionnaire (CFQ); and (3) Mindful Attention and Awareness Questionnaire (MAAS). We evaluated five aspects of construct validity: content, response process, internal structure, relationship with other variables, and consequences. RESULTS: We found good internal consistency for responses on the AAQ (α=0.93), MAAS (α=0.92), and CFQ (α=0.95). Factor analyses demonstrated a reasonable fit to previously published factor structures. As expected, scores on all three measures were moderately correlated with one another and with a measure of life satisfaction (p<0.01). CONCLUSION: Our findings provide preliminary evidence supporting validity of the psychological flexibility construct in a medical education sample. As psychological flexibility is a central concept underlying self-awareness, this work may have important implications for clinical training and practice.

Predictors of driving in individuals with relapsing-remitting multiple sclerosis.

BACKGROUND: We previously reported that performance on the Stroke Driver Screening Assessment (SDSA), a battery of four cognitive tests that takes less than 30 min to administer, predicted the driving performance of participants with multiple sclerosis (MS) on a road test with 86% accuracy, 80% sensitivity, and 88% specificity. OBJECTIVES: In this study, we further investigated if the addition of driving-related physical and visual tests and other previously identified cognitive predictors, including performance on the Useful Field of View test, will result in a better accuracy of predicting participants' on-road driving performance. METHODS: Forty-four individuals with relapsing-remitting MS (age = 46 ± 11 years, 37 females) and Expanded Disability Status Scale values between 1 and 7 were administered selected physical, visual and cognitive tests including the SDSA. The model that explained the highest variance of participants' performance on a standardized road test was identified using multiple regression analysis. A discriminant equation containing the tests included in the best model was used to predict pass or fail performance on the test. RESULTS: Performance on 12 cognitive and three visual tests were significantly associated with performance on the road test. Five of the tests together explained 59% of the variance and predicted the pass or fail outcome of the road test with 91% accuracy, 70% sensitivity, and 97% specificity. CONCLUSION: Participants' on-road performance was more accurately predicted by the model identified in this study than using only performance on the SDSA test battery. The five psychometric/off-road tests should be used as a screening battery, after which a follow-up road test should be conducted to finally decide the fitness to drive of individuals with relapsing-remitting MS. Future studies are needed to confirm and validate the findings in this study.