The Role of Metacognition in the Prediction of Depressive and Anxiety Symptoms in Chronically Ill Patients.

INTRODUCTION: Cancer, diabetes, and heart diseases are frequent causes of depression and anxiety. The study explored the metacognitive beliefs manifested by chronically ill patients and the presence of depressive or anxiety symptoms and the predictive role of metacognition in both. METHODS: A total of 254 chronically ill patients participated in the study. The Metacognitive Questionnaire was used to measure the patients' metacognitive beliefs, whereas the Hospital Anxiety and Depression Scale was applied to evaluate their psychopathological symptoms. A correlation analysis was performed to explore the relationships between metacognition and psychopathological symptoms. Regression analyses were conducted to examine the predictive role of metacognition in anxiety and depression. RESULTS: The Negative Beliefs about Uncontrollability and Danger scale correlated with both anxiety and depression scales, and the Cognitive Confidence scale correlated with the depression scale. Linear regression analyses indicated that metacognitive beliefs were responsible for 32.2% of the variance of anxiety symptoms among all the chronically ill. Metacognitive beliefs accounted for 48.8% of the variance in anxiety symptoms and 36.6% in depressive symptoms among diabetes patients. CONCLUSIONS: There are specific correlations between psychopathological symptoms and metacognition among chronically ill patients. Metacognitions have a moderate role in developing and sustaining anxiety and depressive symptoms.

Coping with cancer and a history of health-related events.

Background: Cancer is a source of stress related to the resulting change in lifestyle. The processes which take place when a patient is coping with a disease may be explained in terms of the transactional concept of psychological stress (Lazarus, Folkman) and the critical life events model (Filipp). These two complementary theoretical approaches set the direction and aim of the study which was to determine the role played by earlier events responsible for health loss due to a chronic, serious disease in the course of a stress transaction in cancer patients. Materials and methods: The study involved 121 patients with either breast or colorectal cancer undergoing chemotherapy as part of their treatment. They were asked to complete a purpose-designed set of questionnaires which included Revised Illness Perception Questionnaire (IPQ-R), the Mini-Mental Adjustment to Cancer (Mini-MAC) questionnaire, the Hospital Anxiety and Depression Scale (HADS), Acceptance of Illness Scale (AIS). The interdependencies between variables were determined using difference significance tests (Mann-Whitney, Kruskal-Wallis) and the Dunn's correction test. The significance level (alpha) of 0.05 was assumed appropriate for the study. Results: Patients with previous health-related events were found to expect the struggle with cancer to be a greater and more serious challenge. Those patients had suffered loss of health prior to getting cancer and their emotional reactions were heightened. This finding allowed the identification of patients more prone to creating a negative view of their disease. Conclusions: When planning a psychological treatment of patients with cancer, an account must be taken of their past life events and earlier experiences of being ill, in order to implement appropriate psychological intervention aimed at reducing their emotional stress.

Psychological Consequences of Experiencing Violence in Childhood-The Role of Dissociation in the Formation of Early Maladaptive Schemas.

Childhood experiences of violence can lead to severe psychological consequences. One of them is an increased risk of abnormal personality development. It can manifest as rigid negativistic beliefs about the self, others, and the surrounding world, which some specialists term early maladaptive schemas. The conducted study aims to provide a possible explanation of the role dissociation plays in the process of forming early maladaptive schemas. The study was conducted on 342 adult women whose biographies contained one or more episodes of potentially traumatic experiences of violence in childhood. Three questionnaires were used: Childhood Trauma Questionnaire, Dissociative Experiences Scale, Young Schema Questionnaire. The results show that experiences of violence are linked with dissociative disorders and the intensity of early maladaptive schemas. Mediation analysis confirmed that the relationship between experiencing violence and early maladaptive schemas is exacerbated by the presence of dissociative symptoms resulting from the violence experienced. The mediation analysis results suggest that if an experience of violence is followed by the emergence of dissociative symptoms, its impact on personality is more severe. This confirms earlier notions regarding the role that dissociative symptoms play in personality changes stemming from traumatic events.

Mental Health Outcomes Associated with COVID-19 Pandemic in a Group of Health Care Professionals.

Analysis of health care workers' stress levels during the COVID-19 virus pandemic, and whether there is a relationship between health care workers' stress levels and mental health in the context of coping with stress. One hundred and seventy professionally active health care workers took part in the study: doctors (n=41), nurses (n=114) and paramedics (n = 15). On average, study subjects were 37 years old and had 14 years of work experience. The following were used in this questionnaire-based study: General Health Questionnaire (GHQ-28), Perceived Stress Scale (PSS-10), Mini-COPE - Coping Inventory. The research group experienced high levels of stress. Nurses experienced the most acute stress. Increasing stress levels are accompanied by an intensification of psychopathological symptoms (insomnia and depression). Older individuals and those with more years worked at work experienced less psychopathological symptoms. Non-adaptive stress coping methods (e.g. use of psychoactive substances) resulted in deteriorating mental health within the research group. Habitual use of non-adaptive strategies may bring relief in the short term in the form of reduced negative consequences of stress transactions and facilitate mobilisation or just sufficient performance at work. However, in the longer term, it may lead to deteriorating health. The obtained data shows that positive reinterpretation, age and length of work track record constitute protective factors against deteriorating health.

Relationship between stress and alexithymia, emotional processing and negative/positive affect in medical staff working amid the COVID-19 pandemic.

The psychological burden of the COVID-19 pandemic may have a lasting effect on emotional well-being of healthcare workers. Medical personnel working at the time of the pandemic may experience elevated occupational stress due to the uncontrollability of the virus, high perceived risk of infection, poor understanding of the novel virus transmission routes and unavailability of effective antiviral agents. This study used path analysis to analyze the relationship between stress and alexithymia, emotional processing and negative/positive affect in healthcare workers. The sample included 167 nurses, 65 physicians and 53 paramedics. Sixty-two (21.75 %) respondents worked in COVID-19-designated hospitals. Respondents were administered the Toronto Alexithymia Scale-20, Cohen's Perceived Stress Scale, Emotional Processing Scale, and the Positive and Negative Affect Schedule. The model showed excellent fit indices (χ2 (2)=2.642, p=0.267; CFI=0.999, RMSEA=0.034, SRMR=0.015). Multiple group path analysis demonstrated physicians differed from nurses and paramedics at the model level (X2diff (7)=14.155, p<0.05 and X2diff (7)=18.642, p<0.01, respectively). The relationship between alexithymia and emotional processing was stronger in nurses than in physicians (difference in beta=0.27; p<0.05). Individual path χ2 tests also revealed significantly different paths across these groups. The results of the study may be used to develop evidence-based intervention programs promoting healthcare workers' mental health and well-being.

Mediating Role of Stress at Work in the Relationship of Alexithymia and PTSD among Emergency Call Operators.

AIM: The main purpose of this research was to investigate the relationship between alexithymia, stress at work, and post-traumatic stress disorder (PTSD) in impact emergency call center operators working in Poland (province of Greater Poland). The risk of exposure to critical life events was also considered. METHODS: Data were collected using self-report questionnaires administered after dispatchers' shifts. The emergency call center operators (N = 66) completed the Impact of Event Scale-Revised, 20-item Toronto Alexithymia Scale, Workplace Perceived Stress Questionnaire, and a questionnaire measuring the frequency and intensity of potentially traumatic events faced by emergency operators (a questionnaire developed by the authors). RESULTS: Twenty of the most frequent events (e.g., child sexual harassment, rape, etc.) were identified. Results indicated that post-traumatic stress positively correlated with (a) work-related stress and (b) one aspect of alexithymia: difficulty expressing feelings. Additionally, work-related stress was identified as a mediator for the relation between alexithymia and the intensity of post-traumatic stress. CONCLUSIONS: The results of this study confirm that emergency operators are a high-risk group for the development of PTSD. The study results suggest that performing the work of an emergency dispatcher is not only demanding but also inherently involves participation in potentially traumatic events (as encountered through emergency calls).

Dysfunctional Coping Mediates the Relationship between Stress and Mental Health in Health-Care Staff Working amid the COVID-19 Pandemic.

OBJECTIVE: This cross-sectional study aimed to assess the stress outcomes in health-care staff working during the COVID-19 pandemic and to explore the role of coping in the relationship between stress outcomes and mental health dimensions with Preacher & Hayes's mediation analysis. SUBJECTS AND METHODS: One hundred seventy participants including physicians (n = 41; 24.1%), nurses (n = 114, 67.1%), and paramedics (n = 15, 8.8%) with a mean age of 37.69 ± 12.23 years and an average seniority of 14.40 ± 12.32 years were administered the Toronto Alexithymia Scale-20, Cohen's Perceived Stress Scale (PSS-10), the Emotional Processing Scale, and Positive and Negative Affect Schedule. The data were analyzed by estimation of simple correlation coefficients and a Preacher and Hayes's mediation procedure. RESULTS: Participants reported elevated levels of stress (7-8 sten on the sten scale developed for the PSS-10 questionnaire). Statistically significant differences in the stress levels between nurses, paramedics, and physicians could not be determined. In contrast, significant association between mental health outcomes and the occupational category could not be found. CONCLUSION: Our observations support the assumption about a controlling role of coping in the relationship between work-related stress, alexithymia, emotional processing loneliness and positive/negative affect in medical staff working amid pandemic.

Coping and Life Satisfaction: Mediating Role of Ego-Resiliency in Patients with Rheumatoid Arthritis.

OBJECTIVE: Ego-resiliency is attributed the status of a "meta resource" that is responsible for a flexible selection of coping strategies depending on the requirements of a specific difficult situation. A considerably burdensome critical life event is the development of a chronic illness such as rheumatoid arthritis (RA). Apart from coping with the symptoms, a fundamental task confronting patients is maintaining their quality of life. This raises the question of whether ego-resiliency serves as a mediator between coping strategies and quality of life. MATERIALS AND METHODS: 210 RA patients were invited to participate in this study. They were requested to complete a questionnaire that included the Satisfaction with Life scale, the stress coping inventory Mini-COPE, and the Ego-Resiliency scale. The collected data were analyzed by a simple mediation procedure and estimation of simple correlation coefficients. RESULTS: The analysis demonstrated that ego-resiliency (r = 0.46; p < 0.001) and emotion-focused coping (r = 0.39; p < 0.001) determined life satisfaction. Additionally, ego-resiliency mediated the relation between emotion-oriented coping strategies and life satisfaction. Partial mediation was observed (a = 0.45**; b = 0.36**; c = 0.39**; c' =0.22**; R2 = 0.24; F = 35.65; p < 0.001). CONCLUSION: Our observations partly support the assumption about a controlling role of ego-resiliency in the process of selecting coping strategies according to demands of situations.

Psychosocial Predictors of Bruxism.

OBJECTIVES: The study aimed to investigate the psychosocial predictors of bruxism. The association of various psychosocial factors such as alexithymia, emotional processing, state and trait anxiety, and stress with awake bruxism was analysed. METHODS: The study involved 52 volunteers diagnosed with awake bruxism. The toolkit that was used included the Toronto Alexithymia Scale (TAS-20), the Emotional Processing Scale (EPS), the Cohen Perceived Stress Scale (PSS-10), and the State- and Trait-Anxiety Inventory (STAI), with independent individual psychological diagnoses being made for every patient. The results were statistically analysed using IBM SPSS Statistics 24. RESULTS: The obtained data clearly show that psychological traits-both permanent dispositions (e.g., state anxiety and alexithymia) and temporary states (e.g., trait anxiety, emotional processing deficits, and psychological stress)-are significant determinants of awake bruxism. The percentage of explained variance indicates the presence of other factors as well. CONCLUSIONS: Psychosocial factors such as state anxiety and trait anxiety, alexithymia, and perceived stress are as important as somatic causes in the occurrence and maintenance of awake bruxism. The profile of the obtained data suggests the possibility of preventing or minimizing the symptoms of awake bruxism through properly constructed psychoprophylactic interactions.

Mental Health and Rheumatoid Arthritis: Toward Understanding the Emotional Status of People with Chronic Disease.

INTRODUCTION: Rheumatoid arthritis (RA) is a long-term disorder significantly impairing the somatic, emotional, and psychological functioning of its sufferers. Previous research has shown that affected individuals are characterized by an increased level of anxiety and depression. Currently, there are two main treatment schemes for RA; the first uses anti-inflammatory drugs, and the second utilizes biologic agents. This begs the question whether sufferers differ in intensities of pain, anxiety, and depression depending on the type of treatment and what the determinants of these affective states in patients treated using different methods are. METHODS: The study comprised 85 patients affected by RA (including 57 receiving biologically inactive medication). Research participants filled out a set of questionnaires measuring levels of anxiety and depression, intensity of experienced pain, strategies of coping with pain, and ego resiliency. RESULTS: The collected data was analyzed through intergroup comparisons, calculating simple correlation coefficients, developing and solving regression equations. The results imply that the choice of treatment differentiates the intensity of pain experienced by patients. Those receiving biologic agents reported lower levels of pain compared to those taking anti-inflammatory medication. It has also been noted that there are distinct configurations of conditions conducive to anxiety and depression in both anti-inflammatory and biologic agent groups. DISCUSSION: The observed constellation of dependencies between variables indicates that the choice of treatment scheme differentiates pain levels. This confirms the assumption that pain intensity, coping strategies, and ego resiliency depend on the severity of anxiety and depression.

[General and specific individual post-traumatic stress disorder-related mechanisms among paramedics]. / Specyficzne korelaty i ogólny mechanizm psychologiczny zespolu stresu pourazowego u ratowników medycznych.

BACKGROUND: Due to the nature of their work, paramedics face an increased risk of developing a post-traumatic stress disorder. The main goal of this research project was to point out specific correlates of post-traumatic stress. The authors decided to approach that issue from the perspective of emotional-cognitive deficits and resources, such as alexithymia, rumination and coping with stress. MATERIAL AND METHODS: The authors conducted 3 independent research projects in the first half of the year 2017 in the Wielkopolskie voivodship, that included paramedics. In each one of them, they estimated post-traumatic stress disorder (PTSD) symptoms using The Impact of Event Scale-Revised (IES-R). Additionally, in the first study the authors used alexthymia scale, Polish verion of Toronto Alexithymia Scale-20 (TAS-20), in the second - rumination questionnaire, in the third - coping with stress measured with Inventory for Measuring Coping with Stress Mini-COPE. RESULTS: The analyses demonstrate a relationship between PTSD symptoms and both alexithymia and rumination. There was not any significant relationship between coping strategies and PTSD. The mediation analysis results prove the role of intrusion as a mediator in a relationship between hyperarousal and avoidance. Individuals with PTSD demonstrate high avoidance for situations similar to the original traumatic event because high hyperarousal increases the risk of intrusion. CONCLUSIONS: More than a half of paramedics demonstrated post-traumatic stress symptoms, which most likely is a prognosis factor for future development of PTSD among them. The emotional-cognitive deficits correlated with traumatic stress symptoms. Resources such as coping strategies were not sufficient enough mechanisms for coping with traumatic stress. Post-traumatic stress disorder may be seen as a dynamic sequence. The nature of paramedics work entails the risk for experiencing complex and/or secondary trauma, which represent the phenomena that should be further examined. Med Pr. 2019;70(1):53-66.

[Psychometric properties of the Polish version of the brief version of Kutcher Adolescent Depression Scale - assessment of depression among students]. / Wlasciwosci psychometryczne polskiej wersji skróconej Skali Depresji Kutchera dla Mlodziezy (Kutcher Adolescent Depression Scale) - pomiar depresji w grupie studentów.

AIM: Depressive disorders, which remain one of the most common and recurrent mood disorders worldwide, presently affect up to 15% of the population under age 25. Adolescent depression is related to a number of adverse phenomena such as scholastic/academic failure, juvenile delinquency, illicit substance abuse or suicide. Studies show that students are at a high risk of developing this disorder but depression in this population is often misdiagnosed and undertreated. Consequently, it is important to develop reliable diagnostic tools to evaluate symptoms of depression in students. Kutcher Adolescent Depression Scale (brief version) is a commonly used screening test used to identify young people at risk for depression, which consists of six items related to its main symptoms. The aim of the study was to adapt and test reliability and content validity of the Polish version of six - item Kutcher's KADS based on analysis of students using confirmatory factor analysis. MATERIAL AND METHODS: A total of 1,589 student aged 18-24 anonymously answered a questionnaire on the risk of depression (KADS) and a demographics survey. RESULTS: Confirmatory factor analysis showed the good fit of model to empirical data: SB χ² (15) = 968.688, p < .001, RMSEA = .053, CFI = .958, SRMR = .029. Factor loading ranged from .40 to .80. CONCLUSIONS: Validation of Polish version of KADS in a group of students aged 18-24 years has shown its high reliability and content validity. Further studies should be focused on the assessment of the questionnaire criterion validity.

The mediating role of dysfunctional coping in the relationship between beliefs about the disease and the level of depression in patients with rheumatoid arthritis.

AIM: Rheumatoid arthritis is one of the most severe chronic diseases. In many cases it leads to disability and results in a decreased quality of life and increased levels of anxiety and depression. The problem that needs to be addressed is the following: which mental processes lead to increased levels of depression in patients with rheumatoid arthritis? METHODS: 210 patients with rheumatoid arthritis hospitalized in rheumatology wards took part in the research. They filled in illness perception questionnaires (IPQ-R) and questionnaires for testing strategies of handling stress (Mini-COPE) and the level of depression (CES-D). RESULTS: The observed correlation coefficients indicate that several elements of the perception of one's disease moderately contribute to a high level of depression. Moreover, frequent use of dysfunctional coping strategies contributed to high levels of depression. Dysfunctional coping was moderately linked to depression. CONCLUSION: The conducted analyses confirmed the links between the beliefs about the disease and levels of depression and showed that the use of dysfunctional coping strategies mediates the relationship between the following elements of the representation of the disease: illness coherence, emotional representation, psychological attribution, risk factors, and the level of depression.

Mechanisms of psychological resiliency in women after mastectomy.

AIM OF THE STUDY: To investigate into the mechanisms of resiliency in women after mastectomy. We hypothesized that the mechanism of resiliency in women with breast cancer would involve facilitation of adaptive coping strategies and inhibition of maladaptive strategies. We tested a mediational model in which resiliency was related to satisfaction with life through coping strategies. MATERIAL AND METHODS: Thirty women after mastectomy aged 28-69 years (M = 53.23, SD = 9.00) completed the Ego Resiliency Scale, Mental Adjustment to Cancer Scale, and Satisfaction with Life Scale. RESULTS: The bootstrapping technique revealed that there were significant indirect effects for positive reframing (95% CI: 0.01-0.36), hopelessness/helplessness (95% CI: 0.18-0.83) and anxious preoccupation (95% CI: 0.001-0.55) but not for fighting spirit. The models explained up to 33% of the variance in satisfaction with life. CONCLUSIONS: Coping strategies fully explain the effect of resiliency on satisfaction with life in women after mastectomy. This finding provides additional evidence of the fundamental role of coping strategies in the mechanisms of resiliency. We obtained similar results in patients with type II diabetes and rheumatoid arthritis. The lack of significant associations of fighting spirit with resiliency suggests that this coping strategy may be beneficial for somatic health but its contribution to the mechanisms of psychological resiliency is complex.

[Anxiety level and its determinants in rheumatoid arthritis patients]. / Poziom leku i jego wyznaczniki u pacjentów z reumatoidalnym zapaleniem stawów.

Rheumatoid arthritis (RA) is a chronic disease with many somatic, psychological and social consequences. Somatic consequences are connected mainly with increasing levels of negative emotions such as depression, anxiety and a tendency to react with anger to many daily life situations. Additionally, loss of hope has been reported as another effect of rheumatoid arthritis. The goal of the study was to describe anxiety levels and its determinants in RA patients. The study was carried out on 31 RA patients, 22 (71%) of whom were females and 9 (29%) of whom were males. The respondents were assessed with a set of questionnaires such as Spielberger's State-Trait Anxiety Inventory (STAI), Multidimensional Health Locus of Control Scale (MHLC), The Coping Inventory for Stressful Situations (CISS) and Eysenck's Personality Questionnaire - Revised (EPQ-R). We have found the relationship between anxiety as (1) a state and external locus of control - powerful others (tau-b = 0.23, p = 0.09), task - oriented style of coping (tau-b = -0.34, p = 0.01), emotion-oriented style of coping (tau-b = 0.33, p = 0.02) and neuroticism levels (tau-b = 0.29, p = 0.03) and (2) anxiety as a trait and external locus of control - powerful others (tau-b = 0.40, p = 0.01), task - oriented style of coping (tau-b = 0.36, p = 0.01), emotion-oriented style of coping (tau-b = 0.33, p = 0.02) and neuroticism levels (tau-b = 0.47, p = 0,01).

Depression, perceived control, and life satisfaction in university students from Central-Eastern and Western Europe.

The poor health and psychological well-being of people in the former socialist states of Centeral-Eastern Europe are of serious concern and may be related to low perceived control. We compared depressive symptoms, life satisfaction, and self-rated health in 3,571 male and female university students from 5 Western European countries and 4,793 students from 5 Central-Eastern European countries. Depression scores (short Beck Depression Inventory; Beck & Beck, 1972) were higher in Central-Eastern than Western European samples. The prevalence of low life satisfaction was also greater in Central-Eastern Europeans, but ratings of self-rated health did not differ. Ratings of perceived control were diminished, but sense of mastery and internal health locus of control were higher in Central-Eastern Europe. Depression and low life satisfaction were associated with low perceived control and mastery and with strong beliefs in the influence of chance over health. However, taking these factors into account did not explain the East-West difference in depressive symptoms and low life satisfaction.