The dynamic buffering of social support on depressive symptoms and cancer worries in patients seeking cancer genetic counseling.

PURPOSE: Social support is a crucial protective factor against psychological concerns in patients with cancer. However, there is limited knowledge regarding the differential impacts of social support on cancer worries and depressive symptoms in patients undergoing genetic counseling for hereditary cancer. The current study utilized a high-volume database from a multi-site cancer genetics clinic to assess the impact of perceived social support on depressive symptoms and cancer worries among patients of different age groups (young versus older patients) and diagnosis status (diagnosed survivors versus undiagnosed). METHODS: 6,666 patients completed brief assessments of depressive symptoms, cancer worries, social support, and demographic questionnaires as part of routine clinical care between October 2016 and October 2020. Logistics and moderated regression were used to analyze the relationships between social support, depressive symptoms, and cancer worries. RESULTS: Increased social support was associated with fewer depressive symptoms and fewer cancer worries across all patients. Social support mitigated depressive symptoms most significantly for young adult patients with and without cancer. Social support mitigated cancer worries most significantly for young adults with cancer and older adults without cancer. CONCLUSIONS: While results were mixed, general findings upheld original hypotheses. Social support buffered depressive symptoms and cancer worries differentially for patients of different ages and different disease status. IMPLICATIONS FOR CANCER SURVIVORS: Social support groups are beneficial for all patients and should be emphasized by cancer clinics. However, increasing patient-tailored and age-appropriate support networks will be crucial for managing depression and cancer worries for high-risk survivors: young adults with cancer.

Exploring Depressive Symptoms and Cancer Worries in a High-Volume Cancer Genetics Clinic: What Are the Roles of Age and Cancer Diagnosis?

Limited research has explored depression and cancer worries (CWs) among adolescents and young adults with cancer (AYAs) seeking genetic counseling. This study evaluated depressive symptoms and CWs among five groups: AYAs, adolescents and young adults without cancer (AYAWOCs), older adults with cancer (OAs), older adults without cancer (OAWOCs), and older adults diagnosed with cancer in their adolescent and young adult years (OA/AYAs). A retrospective data analysis was performed on 6524 patients, which found that AYAs reported significantly higher depressive symptoms and CWs compared with all other groups except OA/AYAs. These findings suggest that the intersection between age and cancer diagnosis is related to depressive symptoms and CWs.

Assessing Depressive Symptoms in Patients With Cancer Treated With Interleukin-2: A Comparison of 2 Measures.

BACKGROUND: High-dose interleukin-2 is a therapy available for individuals with renal cell carcinoma; however, it can produce adverse effects, specifically depressive symptoms. There is limited information regarding the trajectory of depressive symptoms and measurement-based care assessment of depressive symptoms. OBJECTIVE: The purpose was to describe the trajectory of depressive symptoms and compare 2 depression measures. METHODS: A descriptive, mixed-method case study approach was used to describe the longitudinal trajectory of depressive symptoms The qualitative assessment included a journal entry and an interview. The quantitative depression symptom severity measures included the 8-item self-report Patient-Reported Outcomes Measurement Information System Depression and the 30-item Inventory of Depressive Symptomatology-Clinician Rated (IDS-C). RESULTS: Ten cases were enrolled. The maximum number of interleukin-2 doses that any patient received within a single hospitalization ranged from 4 to 12. Mean scores on the 8-item Patient-Reported Outcomes Measurement Information System Depression showed no changes in depressive symptoms from pretreatment to posttreatment, nor across hospitalizations. Mean total scores on the IDS-C increased from "normal" to "mild severity" depressive symptom range across all treatment cycles, suggesting transient depressive symptoms within hospitalizations. Qualitative data from the case supported the IDS-C increase, suggesting that the patient developed depressive symptoms pretreatment to posttreatment. CONCLUSIONS: Understanding the trajectory of depressive symptoms allows for the identification of critical time points when depressive symptoms present and change across treatment. It is critical to use measurement-based care using validated measures to assess for the presence and changes in depressive symptoms. IMPLICATIONS FOR PRACTICE: Validated self-report or clinician-rated depression symptom measures should be used to document the presence or absence of depressive symptoms in this population.

Repetitive nonsuicidal self-injury as experiential avoidance among a community sample of adolescents.

OBJECTIVE: This study examined the relationship between experiential avoidance, functionally equivalent behaviors, and repetitive nonsuicidal self-injury (NSSI/RNSSI) among adolescents. METHOD: Self-report questionnaires from adolescents (N = 211) from 3 school-based samples were employed to assess three forms of experiential avoidance (thought suppression, alexithymia, and avoidance/cognitive fusion), various aspects of self-mutilating behaviors, and the existence of functionally equivalent behaviors (disordered eating, substance abuse, suicidal ideation/behaviors). RESULTS: Results indicated one third of participants reported a history of NSSI and 16% reported engaging in RNSSI in the past 6 months. Female adolescents were twice as likely as males to report a history of RNSSI. Unwanted inner experiences, thought suppression, and alexithymia differentiated adolescents with a history of NSSI from their counterparts. Functionally equivalent behaviors occurred more frequently among those with a history of NSSI and increased in severity as NSSI increased, particularly suicidal ideation and behaviors. However, results for patterns of avoidance were not as consistent for males as females, which questions the broad application of this model. CONCLUSIONS: NSSI continues to be surprisingly common among adolescents in the community. NSSI, particularly repetitive forms, appears to be strongly related to common forms of experiential avoidance, moreso for female adolescents. Results also illustrate the importance of conceptualizing and treating self-injury as a form of experiential avoidance.

Development of ETStig, a measure for stigma in essential tremor.

INTRODUCTION: People with essential tremor commonly experience psychological difficulties that are not addressed. The effect of stigma, i.e., negative judgement by others because of a perceived difference in this case shaky movement, is a heretofore unstudied element. This project was undertaken to develop and field test a new measure for stigma associated with essential tremor. METHODS: Under guidance from a patient panel and an expert panel of neurologists and psychologists, the essential tremor stigma construct was delineated, and survey items were written to quantify three dimensions of interest: cumulative experience of stigma; related psychological distress; and resulting behavioral dysfunction. After pilot testing and revision, the essential tremor stigma measure underwent field testing by 198 essential tremor patients at two academic neurology clinics. RESULTS: The experience, distress and dysfunction scales were shown to have good internal consistency and test-retest reliability. Retained items demonstrated acceptable correlations and response properties. The validity of the distress scale was supported by concurrence with an existing stigma scale for neurologic disease, while a patient's openness to psychologic referral was predicted by higher scores on the dysfunction scale. CONCLUSION: This new measure is introduced to study the phenomenon of stigma associated with essential tremor. It may prove useful in assessing potential treatments for the psychological distress and maladaptive behavior that result from this stigma.

Suicidal Ideation and Depression Among Adolescent and Young Adult Cancer Patients.

Purpose: Adolescent and young adult (AYA) cancer patients (aged 18-39 years) represent a unique population within oncology. The developmental and mental health challenges that can co-occur with a diagnosis of cancer during this age range make AYAs a high-risk group for mental health problems, including depression and suicidal ideation. Therefore, the objective of this study was to assess the differences in rates of suicidal ideation and depression between AYAs and older adults (OAs; aged 40+ years) within an outpatient cancer support clinic. Methods: Depression screening data from routine clinical care were gathered and analyzed for adult patients receiving support services at an outpatient academic cancer clinic. The general mental health screening protocol included the Patient Health Questionnaire (PHQ)-9, which was used as a measure of depression symptoms, including suicidal ideation. Results: Five hundred cancer survivors were included in the initial data analysis, with 21 (40.38%) of the AYAs and 143 (31.92%) of the OAs scoring ≥5 on the PHQ-9. Statistical analysis of groups at this cutoff score reflected no significant difference in depression between AYA and OA groups. However, a chi-square analysis revealed significantly higher suicidal ideation endorsement by AYAs versus OAs in this sample (χ2 [1, N = 500] = 3.98, p = 0.046). Conclusion: Results from routinely collected clinical data reveal a higher rate of suicidal ideation in AYAs compared with OA cancer patients, which supports the need for additional research on AYA cancer patient suicidal ideation in different settings and the implementation of mental health programs specifically for AYA patients.

A Cognitive Behavioral Therapy Group for Adolescent and Young Adult Cancer Patients: A Review of a Pilot Program.

Adolescent and young adult (AYA-between ages 15 and 39) cancer patients face unique psychosocial challenges due to their developmental stage and complex health problems. Research indicates psychotherapy and group support can be beneficial to AYAs. Group therapy offers an opportunity for connection among peers who are enduring similar struggles while also utilizing effective therapeutic intervention. The current project describes a model for an AYA cognitive behavioral therapy (CBT) group. The model was informed by existing CBT literature and was successfully implemented. Future research may evaluate the efficacy of the proposed group structure and content for reducing distress in AYA cancer patients.

The Role of Social Support in Adolescent/Young Adults Coping with Cancer Treatment.

Adolescents/young-adult (AYA) cancer patients are a psychosocially at-risk group as they are often less well-studied than other age cancer cohorts. Therefore, they experience disparities in access to developmentally informed treatment. Social support has been determined as an important aspect of AYAs' cancer experience, but additional research was needed to describe specific behaviors AYAs found helpful and to explore how AYAs seek opportunities for additional support. As part of a larger qualitative study, study aims were to determine how AYAs (ages 15-26) cope during cancer treatment and examine how social support interacts with individual AYA coping. Participants included 10 AYA cancer patients undergoing treatment (mean age = 18.9 years) and 10 parents (mean age = 45.6 years). Descriptively, participants scored within the normal to high range on measures of hope, depression/anxiety/stress, quality of life, and social support. Participants completed semi-structured, audio-recorded interviews that were transcribed and coded as generated. Qualitative analysis was guided by principles of grounded theory and utilized the constant comparative approach. Themes within social support groups included presence, distraction, positive attitude, and maintaining AYA autonomy, communication, and advocacy. Results suggest social supports provide additional coping resources for AYAs with cancer through supplementing individual coping strategies. Future directions/implications for intervention/treatment are discussed.