Improving Recruitment for Mental Health Research in Muslim American Women : Research Recruitment in Muslim American Women.

This study determines the methods for improving recruitment of Muslim American women in mental health research. Studying this minority population in more depth will reduce their suffering from mental illness. A 40-item survey, along with cover letter, was hosted on the Stanford University website and sent via email to organizations known to have large Muslim American women populations. Although approximately 200-300 responses were hoped for, an unexpected total of 1279 women completed the survey within days. The effectiveness of this survey was attributed to multiple factors: ease of an online survey, privacy afforded through an anonymous survey, trust in the PI, the survey being hosted by a reputable university and understanding the importance of mental health research. It is important to continue improving methods to recruit the minority Muslim American women population for studies.

Management of side effects during and post-treatment in breast cancer survivors.

Cancer-related fatigue, insomnia, and cancer-related cognitive impairment are commonly experienced symptoms that share psychological and physical manifestations. One or more of these symptoms will affect nearly all patients at some point during their course of treatment or survivorship. These side effects are burdensome and reduce patients' quality of life well beyond their cancer diagnosis and associated care treatments. Cancer-related fatigue, insomnia, and cancer-related cognitive impairment are likely to have multiple etiologies that make it difficult to identify the most effective method to manage them. In this review, we summarized the information on cancer-related fatigue, insomnia, and cancer-related cognitive impairment incidence and prevalence among breast cancer patients and survivors as well as recent research findings on pharmaceutical, psychological, and exercise interventions that have shown effectiveness in the treatment of these side effects. Our review revealed that most current pharmaceutical interventions tend to ameliorate symptoms only temporarily without addressing the underlying causes. Exercise and behavioral interventions are consistently more effective at managing chronic symptoms and possibly address an underlying etiology. Future research is needed to investigate effective interventions that can be delivered directly in clinic to a large portion of patients and survivors.

A review of amnestic MCI screening in east/southeast Asian older adults with low education: implications for early informant-clinician collaboration.

OBJECTIVE: The aim of this study is to review the recent literature on established cognitive tests and appropriate screening methods for amnestic mild cognitive impairment (MCI) in East/Southeast Asian older adults with a focus on those with low education. DESIGN: Peer-reviewed empirical studies conducted in Asia (China, Hong Kong, Japan, Korea, Singapore, and Taiwan) were identified using databases in psychology and medicine with combinations of the search terms "mild cognitive impairment," "dementia," "screening," "literacy," "illiteracy," "low education," "informant," "family," "cognitive test," "memory complaints," "activities of daily living," and "clinical dementia rating," limiting articles to those published in English since 1 January 2002. Of note, is that the term "amnestic mild cognitive impairment" was not used for searching the articles because the related cognitive impairment were often categorized non-specifically as MCI, but participants included those with amnestic cognitive challenges. Hence, the general term "MCI" has been used often throughout the text. RESULTS: Twelve studies that examined MCI screens were identified. An integrative approach using a combination of cognitive test and informant-based measure may be more sensitive or accurate than using any single screening method alone. CONCLUSION: MCI misdiagnosis may be prevalent, highlighting the need for early collaborative work between informants and clinicians to improve the accuracy of this diagnosis in older Asian adults with low education. Findings were suggestive, although restricted in generalizability even within similar cultural groups or neighboring regions. Clinical application is limited, but some findings provide guidance for future research.

Worried together: a qualitative study of shared anxiety in patients with metastatic non-small cell lung cancer and their family caregivers.

PURPOSE: Anxiety is prevalent, distressing, and understudied among patients with advanced lung cancer and their family caregivers. Preliminary evidence suggests that anxiety is not only present in both patients and caregivers but shared by the dyad. Few studies have examined the nature of shared anxiety and its impact on patient-caregiver dyads. METHODS: This study was developed to identify shared causes and manifestations of anxiety experienced by patients with stage IV non-small cell lung cancer (NSCLC) and their primary caregivers. Data were collected through in-depth semi-structured interviews with ten matched patient-caregiver dyads and one unmatched patient (N = 21) recruited from two comprehensive cancer care centers. RESULTS: Using grounded theory, eight themes emerged characterizing shared causes and manifestations of anxiety: (1) uncertainty, (2) loss and impending loss, (3) changing roles, (4) conflict outside the dyad, (5) finances, (6) physical symptoms, (7) fears of decline and dying, and (8) life after the patient's passing. All themes were shared by patients and caregivers. CONCLUSIONS: Implications for future research include the development and evaluation of interventions to reduce anxiety in cancer patient-caregiver dyads.

HIV-related stigma: implications for symptoms of anxiety and depression among Malawian women.

An estimated 11% of the adult population in Malawi, Africa, is living with HIV/AIDS. The disease has taken a toll on communities, resulting in high morbidity and mortality. Malawian women carry the burden of being caretakers for individuals infected with HIV while also worrying about their own health. However, little is known about how HIV/ AIDS affects psychological functioning among Malawian women in areas hit hardest by the epidemic. To that end, this paper examined the influence of HIV-related stigma on symptoms of anxiety and depression among 59 women 17-46 years old who were recruited from the Namitete area of Malawi. Women who reported greater worry about being infected with HIV and greater HIV-related stigma were significantly more likely to report greater symptoms of anxiety and depression. These findings suggest that interventions that reduce HIV-related stigma are likely to enhance psychological functioning among Malawian women, which in turn will improve the women's quality of life and well-being.

Experiences of Mothers Who Are Child Sexual Abuse Survivors: A Qualitative Exploration.

Child sexual abuse has been associated with a number of problems affecting women over their lifespan, including difficulties with parenting. However, there is a modest number of qualitative studies examining the impact of child sexual abuse on survivors who are mothers. There is a particular need for qualitative investigations that ask survivors who are mothers general questions about the impact of child sexual abuse on their lives rather than those that specifically ask about the impact of child sexual abuse on parenting. The former approach would allow survivors to describe effects that may impact parenting but that survivors do not consciously link to affecting their parenting. Such information may inform interventions to assist this population of survivors. This secondary data analysis examined themes revealed in interviews with 44 survivors of child sexual abuse who were mothers. Participants were seeking treatment for their child sexual abuse and completed an in-person interview in which they were asked open-ended questions about the sexual abuse they experienced as a child and how their abuse affects them now as adults. The interviews were recorded, transcribed, and coded using thematic analysis. The following six themes emerged from the narratives: (a) being a parent, (b) family of origin dysfunction, (c) the impact of abuse, (d) the abuse history and response to abuse, (e) coping, and (f) hopes and desires for the future. This study highlights several ways in which child sexual abuse impacts survivors who are mothers, areas for further study, and the need for interventions to assist this population in meeting the challenges they face as mothers.

A qualitative investigation of the effects of psycho-spiritual integrative therapy on breast cancer survivors' experience of paradox.

This study is an exploratory, qualitative investigation of breast cancer survivors' experiences of paradox, following psycho-spiritual integrative therapy (PSIT). Previous studies examined the role of paradox in spiritual development among women diagnosed with cancer; this study investigated a psycho-spiritual intervention for multicultural cancer survivors. Twelve multicultural breast cancer survivors, from a sample of 30 women participants in an 8-week PSIT group intervention, were recruited from oncologists, hospitals, support groups, outpatient oncology centers, surgeons, radiation therapy centers, cancer events, and websites. We conducted semi-structured, open-ended interviews lasting 1-2 h regarding participants' experiences coping with cancer and their experience of PSIT. We transcribed interviews and conducted blind searches for both new and previously identified paradoxes and themes. Two previously identified themes emerged: (1) attempting to maintain coherence in new and old ways and (2) letting go of ultimate control in life. Additionally, three novel themes emerged: (1) interconnection between helpers and hinderers, (2) spiritual edges and tensions, and (3) new paths to empowerment. Results of this qualitative analysis indicate participants experienced previously identified themes and experienced an expanded range of paradoxes. After learning compassionate acceptance through PSIT, breast cancer survivors develop greater access to the multidimensionality of paradoxes, which can go beyond a binary (either/or) construction to a more interdependent (both/and) relationship. Devoting greater attention to investigating and understanding how diverse participants engage with and move through paradoxical change processes could enhance the effectiveness of existential and spiritual interventions.

The relationship between sexual trauma, peritraumatic dissociation, posttraumatic stress disorder, and HIV-related health in HIV-positive men.

This study tested a novel extension of P. P. Schnurr and B. L. Green's (2004) model of the relationships between trauma symptoms and health outcomes with specific application to HIV-positive men. A diverse sample of 167 HIV-positive men recruited from San Francisco Bay Area HIV clinics completed demographic, medical, trauma history, and symptom questionnaires. Mediation analyses were conducted using the method proposed by R. Baron and D. Kenny (1986). Regression analyses found that sexual revictimization (SR) significantly mediated the relationship between child sexual abuse and peritraumatic dissociation (PD), and PD mediated the relationship between SR and current posttraumatic stress (PTS) symptom severity. PTS symptoms partially mediated the relationship between SR and current HIV symptom severity. The findings indicate that among HIV-positive men, sexually revictimized men constitute a vulnerable group that is prone to PD, which places them at risk for posttraumatic stress disorder (PTSD) and worsened HIV-related health. Furthermore, traumatic stress symptoms were associated with worse HIV-related symptoms, suggesting that PTS symptoms mediate the link between trauma and health outcomes. This study highlights the need for future research to identify the biobehavioral mediators of the PTSD-health relationship in HIV-positive individuals.

Personalized normative feedback for depression symptoms: a qualitative pilot study of female undergraduates.

OBJECTIVE: This pilot study explored students' responses to feedback about their own and their peers' depression symptoms. The study also examined how experiences with the normative feedback might vary according to academic exposure to depression-related topics. METHODS: For 9 weeks, female undergraduates (N=73) completed a weekly web-based version of the 8-item Patient Health Questionnaire, which gauges depression symptom levels. Next, they participated in semi-structured face-to-face interviews where they responded to the personalized normative feedback. The interviews were transcribed, coded, and analyzed. RESULTS: Students responded favorably to the feedback and without notable distress. The feedback increased students' awareness of their own depression symptoms and those of their peers. Those with higher academic exposure to depression-related topics were more likely to have accurate perceptions of their peers' depression symptoms and were less likely to be surprised by information in the feedback than students with less exposure. CONCLUSIONS: Personalized normative feedback for depression symptoms has potential as an effective tool for promoting more accurate views of personal and peer depression symptoms and reducing barriers to help-seeking. Students with less academic exposure to depression-related topics may benefit from increased knowledge of how to gauge their own depression symptoms and increased awareness of their peers' symptoms. Further research is needed to more fully evaluate the effects of this feedback and to directly assess the effects of this feedback on help-seeking behaviors.

Attachment style and coping in relation to posttraumatic stress disorder symptoms among adults living with HIV/AIDS.

Research indicates that a significant proportion of people living with HIV/AIDS report symptoms of posttraumatic stress disorder (PTSD). Moreover, attachment style has been associated with psychological and behavioral outcomes among persons living with HIV/AIDS. Attachment style may influence the ability to cope with traumatic stress and affect PTSD symptoms. To examine the association between attachment style and coping with PTSD symptoms, we assessed 94 HIV-positive adults on self-report measures of posttraumatic stress, coping, and attachment style. In multiple regression analysis, avoidant attachment and emotion-focused coping were positively and significantly associated with greater PTSD symptomatology. Support was also found for the moderating effects of avoidant and insecure attachment styles on emotion-focused coping in relation to greater PTSD symptoms. Taken altogether, these results suggest that interventions that develop adaptive coping skills and focus on the underlying construct of attachment may be particularly effective in reducing trauma-related symptoms in adults living with HIV/AIDS.

Surrender as a form of active acceptance among breast cancer survivors receiving Psycho-Spiritual Integrative Therapy.

PURPOSE: The purpose of this study was to describe a domain of spiritual coping known as "surrender," as experienced among women diagnosed with breast cancer who participated in Psycho-Spiritual Integrative Therapy (PSIT). Surrender is a concept similar to active acceptance, which has been studied extensively, but surrender in the context of spiritual supportive care has received little attention. METHODS: After participating in PSIT, which includes exercises in surrender, 23 participants completed an open-ended questionnaire about their experiences of surrender. Twelve women whose responses were most complete and expressive were selected to be analyzed for this study. A thematic analysis was conducted to better understand how surrender experiences may contribute to supportive care. RESULTS: Four distinct themes were identified: experience of surrender, facilitation of surrender, inhibition of surrender, and ease and completeness of surrender. Although the manifestations of surrender varied, women were consistent in describing these experiences positively. CONCLUSIONS: These findings build upon previous evidence that spirituality, optimism, and active acceptance have a positive impact on well-being in cancer patients. The findings provide insight into the usefulness of PSIT for women with breast cancer and inform future research on the intervention.

The impact of denial on health-related quality of life in patients with HIV.

BACKGROUND/PURPOSE: The purpose of this study was to examine the influence of denial coping on quality of life (QOL) over time among individuals living with HIV, as denial has been understudied as a coping strategy within the literature on HIV/AIDS. METHODS: In a sample of 65 adult men and women, we used multilevel linear modeling to test trajectories of change in physical and mental health-related QOL across baseline, 3, 6, and 12 months, including denial as a predictor and gender as a moderator. RESULTS: The use of denial coping was associated with lower physical and mental health-related QOL at baseline. Denial coping predicted an increase in QOL over time, though QOL remained low in those who practiced denial coping. Men's baseline mental health-related QOL was more negatively affected by denial coping than women's. Women tended to increase in QOL more slowly over time compared to men. CONCLUSION: Reliance on denial as a coping strategy is associated with poorer physical and mental health-related QOL in an HIV-positive population, though participants who engaged in denial also displayed more rapid improvement in their QOL over time. Men and women displayed different rates of improvement in QOL, indicating a need for gender-based treatment approaches. Future research should examine the complex role of denial on change in QOL.

Sexual minority status and trauma symptom severity in men living with HIV/AIDS.

Traumatic experiences are common among populations living with HIV; furthermore, the minority stress model indicates that sexual minority group members, such as men who have sex with men (MSM), are more likely to experience negative psychological outcomes after exposure to trauma, given the stress of minority stigma. The current study examined the prevalence of traumatic events and the impact of these events on trauma symptoms in a sample of 113 MSM and 51 men who have sex with women (MSW) who are living with HIV/AIDS. Rates of experiencing trauma were similar for both MSM and MSW. However, MSM, as sexual minority group members, were more likely to report symptoms of trauma and dissociation than MSW. The current study indicates that MSM may experience additional negative psychological outcomes after exposure to trauma. Findings are discussed in the context of implications for HIV prevention with sexual minority group members.

Stressors and barriers to using mental health services among diverse groups of first-generation immigrants to the United States.

This study examined stressors and barriers to using mental health services among first-generation immigrants in San Jose, California. Focus groups for 30 immigrants from Cambodia, Eastern Europe, Iran, Iraq, Africa, and Vietnam were audio-recorded, translated and transcribed. Two researchers coded the data and identified themes pertaining to mental health stressors and barriers. Six primary stressors were identified: economic, discrimination, acculturation due to language differences, enculturation, parenting differences, and finding suitable employment. Primary barriers included: stigma, lack of a perceived norm in country of origin for using mental health services, competing cultural practices, lack of information, language barriers, and cost. A conceptual model is presented that may be used to inform the design and implementation of mental health services for this population.

Relationships among childhood trauma, posttraumatic stress disorder, and dissociation in men living with HIV/AIDS.

This study examined the relationships among dissociation, childhood trauma and sexual abuse, and posttraumatic stress disorder (PTSD) symptoms in HIV-positive men. Data were collected from 167 men enrolled in a randomized clinical trial that examined a group therapy intervention to decrease HIV-related risk behavior and trauma-related stress symptoms. Participants completed the Trauma History Questionnaire, the Impact of Events Scale-Revised, and the Stanford Acute Stress Reaction Questionnaire. Overall, 35.3% of the participants reported having experienced childhood sexual abuse. A total of 55.7% of the sample met diagnostic criteria for PTSD. The intensity of dissociative symptoms that participants endorsed was positively associated with experience of childhood sexual abuse (r = .20, p < .01). Dissociative symptoms were also positively associated with specific PTSD symptoms, notably hyperarousal (r = .69, p < .001). Hierarchical regression indicated that hyperarousal symptoms accounted for more of the variance in dissociation than childhood sexual abuse. These results suggest that childhood sexual abuse may be involved in the development of dissociative symptoms in the context of adulthood stress reactions. Furthermore, the pattern of the association between dissociation and PTSD is consistent with the possibility of a dissociative PTSD subtype among HIV-positive men.

Utilization of psychiatric services among low-income HIV-infected patients with psychiatric comorbidity.

INTRODUCTION: HIV-infected individuals face a tremendous burden of psychiatric comorbidity. This study evaluates a community health care system's effort to screen for psychiatric disorders among patients at an HIV clinic and evaluate adherence to psychiatric service utilization. METHODS: Standardized screening measures were used to identify participants who met diagnostic symptom criteria for post-traumatic stress disorder (PTSD), acute stress disorder (ASD) and depression. All participants who screened positive were referred for psychiatric follow-up. Rates of utilization were measured and barriers to adherence were investigated. RESULTS: Of the 210 participants, 118 patients met screening criteria for PTSD, ASD, and/or depression, and 116 of these had medical records available for review. Of the 116 patients with psychiatric comorbidity, 46.6% saw a psychiatrist and/or were prescribed a psychiatric medication. Thirty-two percent of Latinos, 40.5% of African Americans, and 38.5% of heterosexuals utilized referred psychiatric services, and these rates were significantly less than their counterparts. One hundred patients were seen by a social worker. DISCUSSION: While a large burden of psychiatric comorbidity exists among this population of HIV-positive patients, only half adhered to recommended psychiatric services referrals. Further research is warranted to examine cost-effective interventions to maximize psychiatric screening, referral, and follow-up with mental health services in this vulnerable population.

Brief cognitive-behavioral intervention for maternal depression and trauma in the neonatal intensive care unit: a pilot study.

Parents of hospitalized premature infants are at risk for developing psychological symptoms. This randomized controlled pilot study examined the effectiveness of a brief cognitive-behavioral intervention in reducing traumatic and depressive symptoms in mothers 1 month after their infant's discharge from the hospital. Fifty-six mothers were randomly assigned to the intervention or control group. Results showed that mothers experienced high levels of symptoms initially and at follow-up. At follow-up, there was a trend for mothers in the intervention group to report lower levels of depression (p = .06; Cohen's f = .318), but levels of traumatic symptoms were similar for both groups. Brief psychological interventions may reduce depressive symptoms in this population. Estimates of the effect sizes can be used to inform future intervention studies.

Psycho-spiritual integrative therapy for women with primary breast cancer.

Breast cancer presents physical and psychological challenges, but can also result in posttraumatic growth (PTG). Twenty-four women completed Psycho-Spiritual Integrative Therapy (PSIT) treatment and completed assessments for PTG and QOL before, immediately following, and 1 month after treatment. Women showed improvement (p < .01) on the FACT-B (Functional Assessment of Cancer Therapy-Breast) Physical Well-being, Emotional Well-being, and Functional Well-being subscales, on the Profile of Mood States (POMS) Depression, Anger, and Fatigue subscales (p < .05), and on their POMS Tension, Vigor and Total Mood Disturbance (TMD) scores (p < .01). Also, women showed improvement on the FACIT-Sp-Ex (Functional Assessment of Chronic Illness Therapy-Spiritual) Meaning/Peace subscale, the Spiritual Well-being total scale (p < .01), and on the New Possibilities (p < .01) and Personal Strength (p < .05) subscales of the Posttraumatic Growth Inventory (PTGI). This preliminary study suggests that PSIT may improve well being and stimulate PTG in breast cancer patients.

An evaluation of a computer-imaging program to prepare women for chemotherapy-related alopecia.

OBJECTIVE: This study was conducted to evaluate a computer program named Help with Adjustment to Alopecia by Image Recovery (HAAIR) that was developed to provide educational support and reduce distress in women with hair loss following chemotherapy. METHODS: Forty-five women who had been diagnosed with cancer and anticipated alopecia following treatment were randomly assigned to either the Imagining group (IG) or Standardized Care group (SCG). Patients in the IG used a computer-imaging program that created the patient's image on a screen to simulate baldness and use of wigs whereas patients in the SCG were directed to a resource room at the Cancer Center established for women with chemotherapy-related alopecia. Assessment data using the Brief Symptom Inventory, Importance of Hair Questionnaire, and the Brief Cope were completed at baseline (T1), before chemotherapy and hair loss, following hair loss (T2), and 3 months follow-up (T3). RESULTS: All women were able to successfully use the touch screen computerized-imaging program and reported that using the computer was a positive, helpful experience, thus establishing acceptability and usability. Women in both the IG and the SCG group showed significantly lower hair loss distress scores at T2 after hair loss than at T1 with T3 distress scores increasing in the SCG and decreasing in the IG. Those with avoidance coping reported more distress. CONCLUSIONS: This evaluation demonstrates that the HAAIR program is a patient-endorsed educational and supportive complement to care for women facing chemotherapy-related alopecia.

A pilot study investigating the effects of trauma, experiential avoidance, and disease management in HIV-positive MSM using methamphetamine.

With high rates of trauma among HIV-positive men who have sex with men (MSM) who use methamphetamine, this preliminary pilot study examined the associations between experiential avoidance, trauma symptoms, and management of a chronic illness. Among a small sample of HIV-positive, methamphetamine-using MSM in a California Bay Area County, greater reported experiential avoidance was significantly related to greater reported trauma and symptoms of traumatic stress. Furthermore, greater reported experiential avoidance was significantly related to reduced self-efficacy of illness management and more frequent methamphetamine use. Although further research is needed, these data suggest that addressing issues of experiential avoidance and trauma could affect behavioral choices and treatment outcomes in this high-risk population.