Clinical judgment of the need for professional mental health care in patients with cancer: a qualitative study among oncologists and nurses.

PURPOSE: In daily practice, oncologists and nurses frequently need to decide whether or not to refer a patient for professional mental health care. We explored the indicators oncologists and nurses use to judge the need for professional mental health care in patients with cancer. METHODS: In a qualitative study, oncologists (n = 8) and nurses (n = 6) were each asked to select patients who were or were not referred for professional mental health care (total n = 75). During a semi-structured interview, they reflected on their decision concerning the possible referral of the patient. Thematic analysis was used to analyze the data. RESULTS: Respondents reported using a strategy when judging whether professional mental health care was needed. They allowed patients time to adjust, while monitoring patients' psychological well-being, especially if patients exhibited specific risk factors. Risk and protective factors for emotional problems included personal, social, and disease- and treatment-related factors. Respondents considered referral for professional mental health care when they noted specific indicators of emotional problems. These indicators included lingering or increasing emotions, a disproportionate intensity of emotions, and emotions with a negative impact on a patient's daily life or treatment. CONCLUSIONS: This study identified the strategy, risk and protective factors, and the indicators of emotional problems used by oncologists and nurses when judging the need for professional mental health care in patients with cancer. IMPLICATIONS FOR CANCER SURVIVORS: Oncologists and nurses can play an important role in the identification of patients in need of professional mental health care.

Sex-differential PTSD symptom trajectories across one year following suspected serious injury.

Background: Recent years have shown an increased application of prospective trajectory-oriented approaches to posttraumatic stress disorder (PTSD). Although women are generally considered at increased PTSD risk, sex and gender differences in PTSD symptom trajectories have not yet been extensively studied. Objective: To perform an in-depth investigation of differences in PTSD symptom trajectories across one-year post-trauma between men and women, by interpreting the general trends of trajectories observed in sex-disaggregated samples, and comparing within-trajectory symptom course and prevalence rates. Method: We included N = 554 participants (62.5% men, 37.5% women) from a multi-centre prospective cohort of emergency department patients with suspected severe injury. PTSD symptom severity was assessed at 1, 3, 6, and 12 months post-trauma, using the Clinician-Administered PTSD Scale for DSM-IV. Latent growth mixture modelling on longitudinal PTSD symptoms was performed within the sex-disaggregated whole samples. Bayesian modelling with informative priors was applied for reliable model estimation, considering the imbalanced prevalence of the expected latent trajectories. Results: In terms of general trends, the same trajectories were observed for men and women, i.e. resilient, recovery, chronic symptoms and delayed onset. Within-trajectory symptom courses were largely comparable, but resilient women had higher symptoms than resilient men. Sex differences in prevalence rates were observed for the recovery (higher in women) and delayed onset (higher in men) trajectories. Model fit for the sex-disaggregated samples was better than for the whole sample, indicating preferred application of sex-disaggregation. Analyses within the whole sample led to biased estimates of overall and sex-specific trajectory prevalence rates. Conclusions: Sex-disaggregated trajectory analyses revealed limited sex differences in PTSD symptom trajectories within one-year post-trauma in terms of general trends, courses and prevalence rates. The observed biased trajectory prevalence rates in the whole sample emphasize the necessity to apply appropriate statistical techniques when conducting sex-sensitive research.

Antecedentes: Los últimos años han demostrado una mayor aplicación de enfoques prospectivos orientados a la trayectoria para el trastorno de estrés postraumático (TEPT). Aunque generalmente se considera que las mujeres tienen un mayor riesgo de TEPT, las diferencias de sexo y género en las trayectorias de los síntomas del TEPT aún no se han estudiado ampliamente.Objetivo: Realizar una investigación en profundidad de las diferencias en las trayectorias de los síntomas del TEPT a lo largo de un año después de un trauma entre hombres y mujeres, interpretando las tendencias generales de las trayectorias observadas en muestras desagregadas por sexo, así como comparar el curso y la evolución de los síntomas dentro de la trayectoria y las tasas de prevalencia.Método: Incluimos N = 554 participantes (62.5% hombres, 37.5% mujeres) de una cohorte prospectiva multicéntrica de pacientes del servicio de urgencias con sospecha de lesión grave. La gravedad de los síntomas del TEPT se evaluó 1, 3, 6 y 12 meses después del trauma, utilizando la Escala de TEPT administrada por un médico para el DSM-IV. Se realizó un modelo de mezcla de crecimiento latente sobre los síntomas longitudinales de TEPT en las muestras desagregadas por sexo y en la muestra completa. Se aplicó un modelo bayesiano con antecedentes informativos para una estimación confiable del modelo, considerando la prevalencia desequilibrada de las trayectorias latentes esperadas.Resultados: En términos de tendencias generales, se observaron las mismas trayectorias para hombres y mujeres, es decir, resiliente, recuperación, síntomas crónicos y aparición tardía. Los cursos de síntomas dentro de la trayectoria fueron en gran medida comparables, pero las mujeres resilientes tenían más síntomas másque los hombres resilientes. Se observaron diferencias por sexo en las tasas de prevalencia para las trayectorias de recuperación (mayor en mujeres) y de inicio tardío (mayor en hombres). El ajuste del modelo para las muestras desagregadas por sexo fue mejor que para la muestra completa, lo que indica la aplicación preferida de la desagregación por sexo. Los análisis de la muestra completa llevaron a estimaciones sesgadas de las tasas de prevalencia de trayectorias generales y específicas por sexo.Conclusiones: Los análisis de trayectoria desagregados por sexo revelaron diferencias limitadas entre los sexos en las trayectorias de los síntomas del TEPT durante el año posterior al trauma en términos de tendencias generales, cursos y tasas de prevalencia. Las tasas de prevalencia de trayectoria sesgada observadas en el conjunto de la muestra enfatizan la necesidad de aplicar técnicas estadísticas apropiadas al realizar investigaciones que tengan en cuenta el sexo.