Sexual communication, sexual satisfaction, and relationship quality in people with multiple sclerosis.

OBJECTIVE: This study sought to explore relationships between sexual satisfaction, sexual communication and relationship satisfaction in people living with multiple sclerosis (MS). Specifically, sexual satisfaction was evaluated as a moderator between sexual communication and relationship satisfaction. DESIGN: Individuals diagnosed with MS and being treated in a hospital-based MS clinic in the southeastern United States (n = 58) completed measures of sexual satisfaction, sexual communication, sexual dysfunction, relationship quality, depression, level of disability, and frequency of sex-related communication and behaviors in a cross-sectional survey design. RESULTS: Sexual satisfaction moderated the relationship between quality of sexual communication and relationship quality, controlling for depression and frequency of sexual behavior and sexual communication. Directionality was examined in a 2nd regression analysis, in which the predictor and outcome variables were switched, which was also significant. Additionally, depression most strongly predicted relationship dissatisfaction. CONCLUSIONS: Findings help to establish sexual satisfaction as a moderator between sexual communication and relationship satisfaction, although directionality cannot be supported. Results also highlight the role of depression in overall relationship functioning and support the biopsychosocial model of care for treatment of sexual dysfunction in people living with MS. (PsycINFO Database Record

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.

Family-school connections and internalizing problems among children living with asthma in urban, low-income neighborhoods.

Children with asthma living in urban environments are at risk for experiencing internalizing problems and difficulties at school due to social context and health-related stressors. Parent confidence and participation in the school and children's attitudes about school were explored in association with children's depressed mood and school anxiety. Forty-five parent-child dyads were recruited from urban community health centers. Most participants were members of ethnic minority groups. Hierarchical multiple regression analyses revealed that higher levels of parent confidence in the school were associated with fewer symptoms of school anxiety in children. Children's attitudes toward school moderated the relation between parent participation in the school and children's depressed mood. Specifically, lower levels of parent participation were associated with higher levels of depressed mood only for children with the least positive school attitudes. Although preliminary, these results suggest the importance of attending to family-school connections to optimize the school-related psychological functioning of children living with asthma in urban environments.