The impact of parental death versus separation from parents on the mental health of Israeli adolescents.

Early research suggested that the loss of a parent during childhood can lead to depression and other psychopathology in children and adults. More recent research has differentiated between loss due to death and separation from parents and has questioned the link between early parental death and psychopathology. We examined the hypothesis that separation from parents has a more detrimental effect than the death of a parent on the mental health of adolescents in the community. Israeli adolescents (N = 844) with a mean age of 16.7 +/- 1.0 years (mean +/- SD) participated in this study. Seventy reported that a parent did not live at home during one of three 5-year periods until they reached the age of 15; 37 reported the death of a parent and 777 were from intact families. All participants completed the Brief Symptom Inventory (BSI), General Well Being Schedule (GWB), Parental Bonding Instrument (PBI), and Perceived Social Support Family/ Friends Scales (PSS-Fam and PSS-Fr). Adolescents who had experienced separation from parents had more psychiatric symptoms (BSI), expressed a lower sense of well-being (GWB), experienced less support from their family (PSS-Fam), and felt less cared for and more controlled by their parents (PBI) compared with those belonging to intact families. The death of a parent was not associated with significantly different scores on these variables. When we controlled for parental bonding (PBI) and perceived social support from family (PSS-Fam), the differences between the separation group and the intact family group were no longer significant. The psychological impact of separation from parents involves a greater risk for psychopathology than the death of a parent. The quality of the relationship with the parents moderates the negative impact of separation from them.

Psychological distress in healthy women with familial breast cancer: like mother, like daughter?

OBJECTIVE: In 1977, the Israel Cancer Association held a one-day conference, on the subject of familial breast cancer, for healthy women with at least one first-degree relative diagnosed with breast cancer. The objective of this study was to assess the psychological distress of a sample of the women who attended. METHOD: Of the 333 healthy women present at the conference, 230 completed three questionnaires: one on sociodemographic data and the medical history of the first-degree relative(s) (mother and/or sister), and two that measure psychological distress: the Brief Symptom Inventory and the Impact of Events Scale. SAMPLE: The subjects were divided into three categorical groups: those whose mother had breast cancer (group A, N = 176), those whose sister had breast cancer (group B, N = 34), and those whose mother and sister both had the disease (group C, N = 20). In addition, subjects were divided into two groups according to the psychological distress level. RESULTS: Analysis of results (using ANOVA and a Chi square test for categorical variables and both univariate and multivariate procedures for psychological distress assessment) showed elevated levels of distress and persistent intrusive thoughts in all groups, and particularly in group C. CONCLUSION: There is a need to promote genetic diagnostic and appropriate counseling, notwithstanding the potential risks that genetic counseling poses for such women.

Cancer in married couples: higher or lower distress?

This study focuses on the question of what occurs when both spouses become seriously ill. Our hypothesis was that psychological distress in married couples involving two ill partners is far higher than when only one partner is ill. The study group comprised 20 married couples, in which both spouses were diagnosed with cancer. Two comparison groups were also studied: 20 married couples with the husband diagnosed with cancer, and 20 couples with the wife diagnosed with cancer. All patients in the three groups completed four self-report scales: the Brief Symptom Inventory (BSI); the Perceived Family Support (PFS); the Impact of Events Scale (IES); and the Mental Adjustment to Cancer (MAC). The healthy spouses completed only the first three scales. Our findings supported the null hypothesis--that is, that the psychological distress in married couples with both partners diagnosed with cancer was not significantly different than when only one partner had cancer. Our findings also showed that neither sociodemographic background, medical condition, nor family support affect patient distress. Gender differences were found with Intrusiveness contributing to the distress of male, but not female, patients. This study confirms and augments earlier work, and shows that partners of cancer patients report a high degree of distress, with this level of distress not being much different from that of the patients.

The effect of behavioral intervention on the psychological distress of Holocaust survivors with cancer.

METHODS: This study describes a particular psychological intervention offered to a unique self-selected population of cancer patients who, 50 years earlier, had experienced the extreme trauma of the Holocaust. A total of 45 patients in follow-up at the Outpatient Clinic of the Oncology Department at the Hadassah University Hospital were approached. Two self-reports were administered: the Brief Symptom Inventory to assess psychological distress, and the Impact of Events Scale to assess intrusion and avoidance. RESULTS: There was a significant decrease in distress by the specific short-term psychological intervention used in this traumatized population. However, 3 months later the improvement virtually disappeared. CONCLUSION: This study failed to demonstrate a long-lasting effect of behavioral intervention upon Holocaust survivors with cancer.

Coping with additional stresses: comparative study of healthy and cancer patient new immigrants.

The adjustment and psychological distress of 166 cancer patients, who are new immigrants from the former Soviet Union, was assessed and compared to that of 288 healthy new immigrants from the the former Soviet Union. The healthy new immigrants had many adjustment problems and their psychological distress was fairly high. The cancer patients reported extremely severe psychological distress. In the healthy immigrants, age contributed to distress while family support had significant protective effects especially in the male immigrants. In the patients, these differences were even more extreme with family support being protective in the male group but not in the female group. Intrusiveness (IES) seems to be maladaptive adding to distress. The results clearly indicate that additional stresses, such as immigration, make cancer patients more vulnerable. The results also suggest possible interventions, especially those that will help to decrease intrusiveness.

Effect of the Holocaust on coping with cancer.

The aim of the study was to investigate whether surviving stressful life threatening situations influences coping with new stressful life threatening situations. The study group, therefore, was composed of 53 cancer patients (present life threatening situation) who had survived the Holocaust (past life threatening situation). They were compared to 53 cancer patients who had not gone through the Holocaust, matched for sociodemographic and medical background. The Holocaust survivors were unable to mobilize partial denial (had significantly higher scores on the Impact of Events Scale) and their psychological distress was much higher (significantly higher scores on the Brief Symptom Inventory). Their functioning however (as reported along the Psychosocial Adjustment to Physical Illness Scale) did not significantly differ from that of the comparison group. The possible mechanisms for these long term effects of past trauma are discussed as well as the need to regard traumatized persons as 'high risk' psychologically when they have to cope with new life threatening situations.

Clinical, psychological and thallium stress studies in patients with chest pain and normal coronary arteries.

The clinical and psychological profiles of 36 consecutive patients with chest pain and normal coronary arteries (study group) were compared to those of 34 patients with chest pain and significant coronary arterial disease (control group). All 70 patients were hospitalized for chest pain at least once prior to coronary angiography. The features of a typical episode of chest pain were similar in the normal coronary arteries and coronary arterial disease groups, but the female patients with normal coronary arteries had a shorter duration of a typical episode of chest pain, and the male patients with normal coronary arteries had a lower frequency of positive effort tests. Psychological testing showed the women with normal coronary arteries to have a tendency to increased somatization, anxiety, and a lower ability to identify origin of difficulties. The patients in the normal coronary and coronary arterial disease groups had psychological profiles typical of patients with chronic somatic disease. A psychiatric interview demonstrated an increased frequency of depressive trait (score 0-2) in the normal women (0.6 +/- 0.8 vs 0, P less than 0.05), and a tendency to increased somatization, anxiety, and sleeping disorders. Increased somatization was found in the normal coronary men (1.1 +/- 0.7 vs 0.5 +/- 0.7, P less than 0.05). Twenty-five patients of the normal coronary group underwent quantitative thallium stress studies, and 13 patients (52%) had evidence of stress-induced myocardial perfusion defect. There were no differences in the clinical and psychological profiles of the patients with normal and those with pathological thallium stress tests.(ABSTRACT TRUNCATED AT 250 WORDS)

Coping within couples: adjustment two years after forced geographic relocation.

Is our understanding of how individuals adjust to stressful life events increased when we analyze their adjustment in ways that recognize that these individuals are also married couples? The data used to answer this question came from a unique "natural experiment" occasioned by the forced evacuation of the Israeli settlement of Ophira under the terms of the Camp David Accords. We found that the adjustment of individuals within couples became more similar across the relocation, that is, couples adapted as a "family system." This occurred because the coping skills of one member of the couple "drove" the adjustment of both partners.

Comparison of psychosocial adjustment of male nondiabetic kidney transplant and hospital hemodialysis patients.

Psychosocial adjustment and psychological distress was compared in 31 male nondiabetic successful renal transplant and 31 hospital hemodialysis patients, matched for duration of treatment, age, education, and family status. The only significant difference between the two groups was that the transplant patients were more satisfied with the medical staff. Vocational rehabilitation was similar in both groups. Sexual interrelationships, as reported by the patients, were slightly, but insignificantly, better in the transplanted group. Thus, the psychological adjustment of transplant and hemodialysis patients is similar when demographic differences are accounted for.

Psychosocial adjustment before and after coronary artery bypass surgery.

Twenty-eight consecutive male patients were examined a few days before, and again twelve months after, coronary artery bypass surgery. The evaluation included the patients' psychological distress, psychosocial adjustment, cardiac state, personality and family relations. Before surgery the patients were relatively well adjusted, despite being severely disabled physically. On the follow-up evaluation the cardiac state improved significantly on every index examined. On the other hand no change occurred in the psychological distress, personality and family relations. Significant post-operative improvement was found in some of the domains of the psychosocial adjustment, but not in others.

The psychosocial adjustment of patients and spouses to dialysis treatment.

Sixty-eight patients on hospital dialysis and their spouses were studied to compare their levels of adjustment and to examine gender differences. Two measures were used: BSI for psychological distress and PAIS for psychosocial adjustment to dialysis. High scores of psychological distress and adjustment problems were found both for patients and their spouses, with high correlations between the partners. Female patients and their husbands had higher scores than male patients and their wives respectively, and in some areas the husbands of female patients reported even more problems than the male patients. Clinical and theoretical conclusions are discussed.

Adjustment to cancer: who is the patient--the husband or the wife?

The adjustment of 117 cancer patients and their spouses was studied from self-reports. The patients were all in remission and at the time of assessment were not receiving any treatment. The adjustment of the patients was generally good, with no great differences between the types of cancer (breast, colon and testicular). The spouses reported as many adjustment problems as the patients, with high intracouple agreement. The findings of the present study suggest that adjustment is influenced by the gender of the patient, especially of the spouse.

Psychiatric work with the medical staff of dialysis units.

The issue of psychiatric work with the medical staff has been reviewed from two points of view: a) There is some evidence that the medical staff is in psychological distress. Psychological help for the staff per se, however, is not recommended. b) There is quite a lot of evidence that staff attitudes/reactions influence the condition and adjustment of patients. It is very highly recommended to establish group work aimed at changing some staff attitudes, and by that improve patients' adjustment.

Psychosocial adjustment To Illness Scale (PAIS): a study of chronic hemodialysis patients.

One hundred and two patients on chronic hemodialysis were studied by the self-report version of the Psychosocial Adjustment to Illness Scale (PAIS). High agreement was found between patients' total scores (global adjustment) and physicians' assessment of the patients' adjustment. High agreement was also found between patients' reports on specific aspects of adjustment, e.g. vocational rehabilitation, psychological distress and social environment, and the physicians' assessments of the same aspects of adjustment. It is suggested that the PAIS is adequate for measuring some aspects of adjustment/maladjustment and therefore large scale studies can be undertaken, aiming at filling gaps in knowledge, clarifying contradictory information, comparing adjustment in different modalities of treatment, as well as measuring the effectiveness of different psychotherapeutic interventions.

Psychiatric treatment in severe brain injury: a case report.

A patient with severe, penetrating brain injury is presented. The patient was in psychiatric treatment for four years, starting two months after the injury; psychological tests were administered four times. By most criteria, the patient recovered completely. The case confirmed earlier observations that intelligence measured by verbal subtests, recovers faster than that measured by performance subtests. The latter continued to improve during the two to four year period after injury. The case clearly indicates the emotional and psychological problems that arise in the presence of severe brain damage. These reactions may hamper rehabilitation, although the gross psychological disabilities caused by the brain injury have improved. It is suggested, therefore, that brain damaged patients should receive psychiatric treatment. Some of the problems of such psychotherapeutic treatment are briefly discussed.

Nurses' rejection and acceptance of patients. A study of a chronic hemodialysis unit.

A questionnaire used to study the phenomenon of rejection of psychiatric patients by the staff was applied to the nurses of a chronic hemodialysis unit. The main findings of the present study are: (a) High emotional involvment of staff in patients. (b) The tendency to reject was much stronger when compared to the staff of the psychiatric unit. (c) The nurses' tendency to reject patients did not correlate to personality measures used in the study (ATDP and Rotter). (d) Although the amount of rejection varied between the nurses, there was a very definite team opinion about which patients are accepted and rejected. (3) Two factors seem to influence the acceptance/rejection of patients by the staff: patient's adjustment and patients' actual behaviour in the unit. It was suggested that the high involvement as well as high rejection found in the staff is one of the main sources of stress for the nurses. It was further suggested that some of the hostility is caused by frustration of nurses' expectations about patients' adjustment and behaviour.