Self-esteem of children and adolescents with chronic illness: a meta-analysis.

Chronic illness may be a risk factor for low self-esteem; however, previous meta-analyses are inconclusive whether children with a chronic illness have lower self-esteem than their healthy peers. The goal of the present study was to summarize available research in order to compare the self-esteem of children and adolescents with a chronic illness with that of healthy children. Random-effects meta-analysis was used to integrate the results of 621 empirical studies that compare levels of self-esteem of children with a chronic physical illness with healthy peers or general test norms. Studies were identified via the electronic databases Adolesc, Embase, Google Scholar, MEDLINE, PSNYDEX, PSYCINFO, and cross-referencing. Children with chronic illnesses have lower self-esteem than healthy peers or test norms (g = -0.18 standard deviation units). The lowest levels of self-esteem were observed in children with chronic fatigue syndrome and chronic headaches. Lower levels of self-esteem in children with a chronic illness were found in girls than in boys, in adolescents than in children, in children from developing or threshold countries, when results were collected from observer ratings rather than child reports, in studies published in the 1990s, and when children with chronic illnesses were directly compared with healthy children instead of test norms. Paediatricians, parents, and teachers should promote experiences of success and positive peer-relations, which are important sources of self-esteem. In addition, psychosocial interventions for children with chronic illnesses should be offered for children with reduced self-esteem.

Body image of children and adolescents with chronic illness: a meta-analytic comparison with healthy peers.

This meta-analysis integrates results from 330 studies on differences between body image of children and adolescents with and without chronic physical illness. Young people with a chronic illness had a less positive body image than their healthy peers although the average size of differences was small (g=-.30 standard deviation units). A comparison of diseases showed that young people with obesity (g=-.79), cystic fibrosis (g=-.50), scoliosis (g=-.41), asthma (g=-.37), growth hormone deficits (g=-.35), spina bifida (g=-.23), cancer (g=-.20), and diabetes (g=-.17) evaluated their body less positively than their healthy peers. Furthermore, levels of body dissatisfaction varied by age at onset of the disease, method for assessing body image, ethnicity, year of publication, and comparison group. Recommendations are stated for reducing effects of chronic illness on the body image of people with chronic illness.

Do clown visits improve psychological and sense of physical well-being of hospitalized pediatric patients? A randomized-controlled trial.

The study tested whether clown visits would be associated with an increase in psychological and perceived physical well-being of pediatric patients. Patients (6-14 years old) were randomized to a clown visit (n=50) or no-visit control (n=50). Patients and parents were administered a modified version of the KINDL-R questionnaire at pretest, immediately after the clown visit (posttest), and at a 4-h follow-up. The experimental group showed an increase in self-reported and parent-reported psychological well-being at posttest. However, these effects were not maintained at follow-up. There was no effect of the clown visit on perceived physical well-being. It is concluded that clown visits appear to improve psychological well-being of pediatric patients, but the effects may only be short lived.

Depression and cancer mortality: a meta-analysis.

BACKGROUND: The goal of the present study was to analyze associations between depression and mortality of cancer patients and to test whether these associations would vary by study characteristics. METHOD: Meta-analysis was used for integrating the results of 105 samples derived from 76 prospective studies. RESULTS: Depression diagnosis and higher levels of depressive symptoms predicted elevated mortality. This was true in studies that assessed depression before cancer diagnosis as well as in studies that assessed depression following cancer diagnosis. Associations between depression and mortality persisted after controlling for confounding medical variables. The depression-mortality association was weaker in studies that had longer intervals between assessments of depression and mortality, in younger samples and in studies that used the Beck Depression Inventory as compared with other depression scales. CONCLUSIONS: Screening for depression should be routinely conducted in the cancer treatment setting. Referrals to mental health specialists should be considered. Research is needed on whether the treatment of depression could, beyond enhancing quality of life, extend survival of depressed cancer patients.

Effects of psychotherapy and other behavioral interventions on clinically depressed older adults: a meta-analysis.

OBJECTIVES: The goal of the present study was to assess the effects of psychotherapy and other behavioral interventions on depressive symptoms in clinically depressed older patients. METHODS: We used meta-analysis to examine the effects of 57 controlled intervention studies. RESULTS: On average, self-rated depression improved by d=0.84 standard deviation units and clinician-rated depression improved by d=0.93. Effect sizes were large for cognitive and behavioral therapy (CBT) and reminiscence; and medium for psychodynamic therapy, psychoeducation, physical exercise and supportive interventions. Age differences in treatment effects were not observed. Weaker effects were found in studies that used an active control group and in studies of physically ill or cognitively impaired patients. Studies of samples comprised exclusively of patients suffering from major depression (versus other mood disorders) also yielded weaker intervention effects. On average, 18.9% of participants did not complete the intervention, with higher dropout rates reported in group (versus individual) interventions and in longer interventions. CONCLUSIONS: We conclude that cognitive-behavioral therapy and reminiscence are particularly well-established and acceptable forms of depression treatment. Interventions with 7-12 sessions may optimize effectiveness while minimizing dropout rates. For physically and cognitively impaired patients, modifications in treatment format and/or content might be useful, such as combining psychotherapy with social work interventions and pharmacotherapy.

[Age differences in psychosocial resources and psychological well-being of cancer patients at the start of chemotherapy]. / Altersunterschiede in psychosozialen ressourcen und im befinden von krebspatienten am beginn einer chemotherapie.

It has been suggested that older patients would have fewer resources than younger patients. We assessed psychosocial resources in 361 recently diagnosed cancer patients. Older patients had a stronger internal health-related locus of control but also less hope than younger patients. No age differences were found for self-esteem and perceived social support. In addition, older patients reported lower levels of negative and positive affect. Curative-intended therapy and social support were associated with a more positive affect only in younger patients, whereas hope was only related to older patients' psychological well-being. It is concluded that older cancer patients have similar levels of psychosocial resources compared to younger patients, but that lack of hope is a vulnerability factor for older patients in particular.

Associations of functional status and depressive symptoms with health-related quality of life in cancer patients.

Associations of functional status (as measured with the Karnofsky Index), depressive symptoms (as assessed with the Beck Depression Inventory), and sociodemographic characteristics with health-related quality of life (HrQoL; measured with the EORTC Quality of Life Questionnaire QLQ-C30) were assessed in 170 recently diagnosed cancer patients. A better functional status (p<0.001) and a lower level of depressive symptoms (p<0.001) were associated with better HrQoL. In addition, an interaction effect of functional status with HrQoL was found (p<0.001), indicating that stronger functional impairments were related to lower HrQoL in patients with low and average levels of depressive symptoms, but not in those with high levels of depressive symptoms. Associations of HrQoL with sociodemographic variables were not significant. It is concluded that functional decline does not additionally impair HrQoL when patients already have elevated levels of depressive symptoms.

Associations of caregiver stressors and uplifts with subjective well-being and depressive mood: a meta-analytic comparison.

The present meta-analytic study gives a systematic review of research on depression and the subjective well-being of caregivers. We integrate results from 60 studies on informal caregivers' subjective well-being (e.g., positive affect, life-satisfaction) and contrast them with the result of studies on caregiver depression. Analyses were based on a two-factor model of subjective well-being that distinguishes between positive and negative dimensions of well-being (e.g., happiness and depression). The strongest effects were domain-specific: uplifts of caregiving were associated with subjective well-being and caregiving stressors were associated with depression. In addition, weaker effects that crossed domains were present: uplifts were weakly associated with depressive symptoms. In addition, lower levels of caregivers' subjective well-being were weakly related to care receivers' physical and cognitive impairments, as well as behaviour problems, but not to the amount of caregiving. Type of care recipients' illness and the measure of well-being moderated, in part, the association between stressors/uplifts and subjective well-being.

Correlates of subjective health in older adults: a meta-analysis.

Age-associated changes of subjective health and associations of subjective health with physical health, functional health, and mental health were meta-analyzed in older adults (M age > 60 years). An age-associated decline of subjective health, which was stronger in old-old samples than in young-old samples, was found. Subjective health was correlated with the indicators of objective health, but the association with physical health was stronger than with functional health. Correlations of subjective health with physical health and functional health were lower in the old-old than in the young-old samples, whereas associations of subjective health with mental health were stronger in older samples. Furthermore, the size of the association between subjective and objective health varied by the method of assessment of objective health, showing highest associations with symptom checklists and results of medical examinations due to strict protocols.

Gender differences in self-concept and psychological well-being in old age: a meta-analysis.

Because of women's higher risk of being widowed, having health problems, and needing care, one might expect them to have a more negative self-concept and lower subjective well-being (SWB). However, women may also have greater access to sources of SWB (e.g., relations to adult children) and may engage in processes to protect the self (e.g., lowered aspirations). Meta-analysis was used to synthesize findings from 300 empirical studies on gender differences in life satisfaction, happiness, self-esteem, loneliness, subjective health, and subjective age in late adulthood. Older women reported significantly lower SWB and less positive self-concept than men on all measures, except subjective age, although gender accounted for less than 1% of the variance in well-being and self-concept. Smaller gender differences in SWB were found in younger than in older groups. Statistically controlling for gender differences in widowhood, health, and socioeconomic status decreased gender differences in SWB. Cohort differences in SWB are reported as well.

Developing a measure of older adults' preparation for future care needs.

We developed a measure of preparation for future care needs (PFCN) which consists of three parts: a) attitudes regarding the usefulness of planning for future care needs and toward the risk of needing help or care in the future; b) processes of preparation (becoming aware of future care needs, avoidance of preparation, gathering information, developing preferences, concrete planning); and c) contents of planning for short- and long-term care needs. Validity data of the questionnaire are reported based on 590 older adults (65-92 years). Engaging in preparation processes was associated with habitual decision styles, higher satisfaction with preparation, and greater knowledge of services. Greater vulnerability to needing future care was associated with higher expectations of needing care and more preparation. Internal consistency and stability of the measure based on 96 seniors was acceptable for almost all scales.

Preparation for future care needs by West and East German older adults.

OBJECTIVES: We evaluated a model of the process of preparation for future care needs. This model predicted that less concrete preparation activities (e.g., becoming aware and gathering information) would predict more concrete ones (e.g., deciding on preferences and making concrete plans), and that attitudes (expectations of needing care and negative beliefs about the usefulness of planning) would mediate the effect of vulnerability (age, ADL/IADL deficits) and resources (socioeconomic status. social network) on preparation activities. METHODS: The Preparation for Future Care Needs Measure was used to assess two attitudes toward preparation (Cronbach's a range: .66-.86),. four planning processes (Cronbach's a range: .75-.86), and the content of planning for future care needs. In addition, demographic variables, social network, and ADL/IADL limitations were assessed. Using path analysis, the model was first developed on a West German sample (n = 280), and then validated on an East German sample (n = 294). RESULTS: The best-fitting path models suggested that more concrete preparation activities were predicted by less concrete ones, but not always in the expected sequence. Gathering information, deciding on preferences, and age predicted concrete planning. Indicators of vulnerability were mediated by expectations of needing care in the future and several preparation activities, especially becoming aware and gathering information. Negative beliefs about the usefulness of planning inhibited gathering information and concrete planning. DISCUSSION: The results suggest that preparation for future care needs may be conceptualized as a successive process. Some individuals, however, may skip steps in the preparation process. For example, relatives may offer to provide care before the older adult has to decide among her or his options.

Influences of socioeconomic status, social network, and competence on subjective well-being in later life: a meta-analysis.

Meta-analysis is used to synthesize findings from 286 empirical studies on the association of socioeconomic status (SES), social network, and competence with subjective well-being (SWB) in the elderly. All three aspects of life circumstances are positively associated with SWB. Income is correlated more strongly with well-being than is education. The quality of social contacts shows stronger associations with SWB than does the quantity of social contacts. Whereas having contact with friends is more strongly related to SWB than having contact with adult children, there are higher associations between life satisfaction and quality of contact with adult children when compared with quality of friendships. Moderating influences of gender and age on the effects of SES, social network, and competence on SWB are also investigated.

Preparation for future care needs: styles of preparation used by older Eastern German, United States, and Canadian women.

Many older persons have chronic conditions and limitations in their everyday functioning. While some individuals prepare for their future care needs, many others do not. Using semi-structured, qualitative interviews, discourse about dealing with the risk for needing help or care in the future was investigated in 23 East German, 10 U.S., and 12 Canadian elderly community-dwelling women (> or =65 years). Eighty percent had thought about future care needs; 64% had made general plans for their future care. Four preparation styles were identified in the three social-structural contexts: Avoidance of preparation, thinking without planning, short-term planning, and long-term planning. Individuals using these styles differed in their subjective assessment of preparation as well as in objective personal conditions. More similarities than differences were found between German, U.S. and Canadian women in the use of these styles. Results suggest that limited resources, system instability, and personal characteristics contribute to the choice of planning style.

[Effects of psychosocial and psychotherapy interventions on well-being and self concept in advanced age--results of meta-analyses]. / Wirkungen psychosozialer und psychotherapeutischer Interventionen auf das Befinden und das Selbstkonzept im höheren Erwachsenenalter--Ergebnisse von Metaanalysen.

Effects of 94 different psychosocial and psychotherapeutic interventions on well-being in the elderly were meta-analyzed. Psychological well-being was improved and self-rated depression decreased for about half a standard deviation. The mean effect size for other-rated depression reached d = 1.15. Whereas age of participants did not correlate with change in self-rated well-being or depression, other-rated depression improved less in older samples. High effect sizes derived from control-enhancing interventions and behavior therapy. Sub-analyses showed that individual setting produced higher improvement than group setting. Higher "therapeutic" qualifications and interventions in nursing homes were associated with higher effect-sizes too. Implications for planning interventions in old age are discussed.

[Analysis of the self concept of independently living senior citizens]. / Analyse des Selbstkonzepts von im Privathaushalt lebenden Senioren.

The analysis of research on self-concept of the elderly shows a need for more complex methods that measure not only self-esteem and subjective age identity, but also those that reflect the specificity of life in the elderly. The self-concept of 140 elderly living in one community (65-93 years) was analyzed by an age-specific, self-concept interview. Factor-analysis resulted in a 10-factor assessment with the main factor being "bodily competency and purpose of life". Other factors were subjective age identity, composure, social integration, resignation, etc.. The subjects were cluster-analyzed. The first cluster contained almost 50% of the elderly who had a positive self-concept of competency, social integration, mood, and self-esteem; they were younger, often married, and in good health. Some clusters identified elderly with a moderate self-concept and some problems regarding health and activities of daily life. A very negative self-concept was shown by two groups of socially isolated (7.14%) and strongly physically and/or psychologically handicapped (5.71%) elderly, who had a generally negative self-concept and needed psychosocial therapy. Implications for further research are discussed.