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1.
J Cancer Surviv ; 2021 Apr 27.
Artigo em Inglês | MEDLINE | ID: mdl-33907994

RESUMO

PURPOSE: Considering that breast cancer survivors (BCSs) have been dealing with unwanted job changes after diagnosis, this study aimed to investigate involuntary job changes (unwanted modifications in employment since diagnosis) and explore the association between job changes, involuntariness, and occupational development satisfaction in BCSs 5-6 years after diagnosis. METHODS: Data were drawn from the mixed-methods breast cancer patients' return to work (B-CARE) study. We surveyed 184 female BCSs who were working at the time of study enrollment during hospitalization (T1), 10 weeks after discharge (T2), 40 weeks after discharge (T3), and 5-6 years after diagnosis (T4) and used descriptive measures and stepwise linear regression models for data analysis. RESULTS: The mean age of BCSs was 57 years. A total of 105 participants reported 410 job changes, of which 16.1% were reportedly (rather) involuntary. The most commonly reported involuntary changes were increased workload (15.2%) and increased scope of work (15.2%). In the final model, significant predictors of satisfaction with occupational development 5-6 years after diagnosis were age, state of health ΔT2-T3, state of health ΔT3-T4, and involuntariness of job changes. CONCLUSIONS: Although the number of job changes alone is not substantially associated with BCSs' satisfaction with occupational development, experiencing involuntary job changes is. Sociodemographic, disease-related, and work(place)-related factors may influence occupational satisfaction among BCSs. IMPLICATIONS FOR CANCER SURVIVORS: The findings indicate the importance of strengthening one's ability to work as desired to prevent involuntary job changes and enable desired work participation in long-term support. The significance of workplace characteristics highlights the need for employers to encourage satisfying work participation. TRIAL REGISTRATION NUMBER: German Clinical Trials Register (DRKS00016982), 12 April 2019.

2.
Artigo em Inglês | MEDLINE | ID: mdl-33917493

RESUMO

BACKGROUND: The COVID-19 pandemic is impacting mental health worldwide, particularly among healthcare workers (HCWs). Risk and protective factors for depression and generalized anxiety in healthcare workers need to be identified to protect their health and ability to work. Social support and optimism are known protective psychosocial resources, but have not been adequately studied in the context of the COVID-19 pandemic among healthcare workers in Germany. METHODS: Within the first wave of the VOICE study (n = 7765), a longitudinal web-based survey study among healthcare workers in Germany, we assessed symptoms of depression (PHQ-2) and generalized anxiety (GAD-2), social support (ENRICHD Social Support Inventory; ESSI), and generalized optimism as well as sociodemographic, occupational, and COVID-19 related variables. Multiple linear regression analyses were conducted to examine associations between the constructs. RESULTS: The analyses revealed that higher levels of social support and optimism were associated with lower levels of depression and generalized anxiety. They showed a higher association with depression and generalized anxiety than demographic or occupational risk factors such as female gender and direct contact with infected individuals. CONCLUSION: Psychosocial resources such as social support and optimism appear to contribute to successful coping with the COVID-19 pandemic and should be considered in future studies.

3.
J Psychosom Res ; 144: 110415, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33743398

RESUMO

OBJECTIVE: The aim of this cross-sectional web-based study was to examine self-reported mental distress, psychosocial burdens, working conditions and potential risk and protective factors for depressive and anxiety symptoms during the COVID-19 pandemic in health care workers (HCW). METHODS: In the largest survey on mental health of HCW conducted during the first wave of COVID-19 in Europe (N = 8071 HCW), we investigated depressive (Patient Health Questionnaire-2, PHQ-2), and anxiety symptoms (Generalized Anxiety Disorder-2, GAD-2), working conditions, and psychosocial burden of 3678 HCW of three health care professions in hospitals: physicians (n = 1061), nurses (n = 1275), and medical technical assistants (MTA, n = 1342). RESULTS: The prevalence of clinically significant levels of depressive and anxiety symptoms was 17.4% and 17.8% for physicians, 21.6% and 19.0% for nurses, and 23.0% and 20.1% for MTA, respectively. All three professions demonstrated significantly elevated PHQ-2 and GAD-2 scores, when compared with general German population before the pandemic, but lower scores in relation to that during the pandemic. Multiple linear regression analyses revealed that higher levels of depressive symptoms were associated with insufficient recovery during leisure time, increased alcohol consumption, and less trust in colleagues in difficult situations at work. In addition, elevated anxiety scores were related to increased fear of becoming infected with COVID-19. CONCLUSION: During the pandemic HCW demonstrated a lower burden of mental distress compared to the general population. Nevertheless, a high percentage of HCW demonstrates psychosocial distress, so that the establishment of regular mental health screening and prevention programmes for HCW is indicated.


Assuntos
Ansiedade/epidemiologia , Depressão/epidemiologia , Pessoal de Saúde/psicologia , Hospitais , Saúde Mental , Local de Trabalho , Adulto , Idoso , Estudos Transversais , Feminino , Alemanha/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Questionário de Saúde do Paciente , Fatores de Proteção , Fatores de Risco
4.
BMC Psychiatry ; 21(1): 116, 2021 02 22.
Artigo em Inglês | MEDLINE | ID: mdl-33618700

RESUMO

BACKGROUND: There is evidence for the relevance of attachment style and anger expression for the manifestation of social anxiety disorder (SAD). METHOD: In a cross-sectional study 321 individuals with social anxiety disorder (41% men, age 38.8 ± 13.9) were compared with 94 healthy controls (37% men, age 35.8 ± 15.1) on several questionnaires (Attachment Styles Questionnaire, State Trait Anger Inventory, Social Phobia Inventory, Beck Depression Inventory). RESULTS: Individuals with SAD showed moderate-sized reduced levels of secure and large-sized increased levels of fearful and preoccupied attachment style compared to healthy controls (all p < 0.001) as well as small-sized increased levels of trait anger (p = 0.03) and moderate-sized increased levels of anger-in (p < 0.001). Attachment style and anger regulation could predict 21% (R2 = 0.21, p < 0.001) of the extent of social anxiety (SPIN) in SAD; secure (ß = - 0.196, p < 0.01) and preoccupied attachment style (ß = 0.117, p < 0.05), as well as anger-in (ß = 0.199, p < 0.01) were significant cross-sectional predictors. Further analysis revealed that the relationship between preoccupied attachment and social anxiety is partially mediated by anger-in. CONCLUSION: Study findings confirm the relevance of preoccupied attachment style and anger suppression for social anxiety. Disentangling the role of anger regulation in early attachment patterns has significant therapeutic implications in SAD.


Assuntos
Fobia Social , Adulto , Ira , Ansiedade , Estudos Transversais , Medo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Apego ao Objeto , Escalas de Graduação Psiquiátrica , Inquéritos e Questionários , Adulto Jovem
5.
BMC Cardiovasc Disord ; 20(1): 520, 2020 Dec 10.
Artigo em Inglês | MEDLINE | ID: mdl-33302871

RESUMO

BACKGROUND: Coronary heart disease (CHD) is the leading cause of death and years of life lost worldwide. While effective treatments are available for both acute and chronic disease stages there are unmet needs for effective interventions to support patients in health behaviors required for secondary prevention. Psychosocial distress is a common comorbidity in patients with CHD and associated with substantially reduced health-related quality of life (HRQoL), poor health behavior, and low treatment adherence. METHODS: In a confirmatory, randomized, controlled, two-arm parallel group, multicenter behavioral intervention trial we will randomize 440 distressed CHD patients with at least one insufficiently controlled cardiac risk factor to either their physicians' usual care (UC) or UC plus 12-months of blended collaborative care (TeamCare = TC). Trained nurse care managers (NCM) will proactively support patients to identify individual sources of distress and risk behaviors, establish a stepwise treatment plan to improve self-help and healthy behavior, and actively monitor adherence and progress. Additional e-health resources are available to patients and their families. Intervention fidelity is ensured by a treatment manual, an electronic patient registry, and a specialist team regularly supervising NCM via videoconferences and recommending protocol and guideline-compliant treatment adjustments as indicated. Recommendations will be shared with patients and their physicians who remain in charge of patients' care. Since HRQoL is a recommended outcome by both, several guidelines and patient preference we chose a ≥ 50% improvement over baseline on the HeartQoL questionnaire at 12 months as primary outcome. Our primary hypothesis is that significantly more patients receiving TC will meet the primary outcome criterion compared to the UC group. Secondary hypotheses will evaluate improvements in risk factors, psychosocial variables, health care utilization, and durability of intervention effects over 18-30 months of follow-up. DISCUSSION: TEACH is the first study of a blended collaborative care intervention simultaneously addressing distress and medical CHD risk factors conducted in cardiac patients in a European health care setting. If proven effective, its results can improve long-term chronic care of this vulnerable patient group and may be adapted for patients with other chronic conditions. TRIAL REGISTRATION: German Clinical Trials Register, DRKS00020824, registered on 4 June, 2020; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00020824.

6.
Psychiatr Prax ; 2020 Nov 24.
Artigo em Alemão | MEDLINE | ID: mdl-33232980

RESUMO

AIM: The aim is to investigate the association between sociodemographic characteristics and the interactive health literacy and the time to treatment of social anxiety disorder. METHODS: An online survey of N = 311 patients was carried out (response rate 54.1 %). Descriptive statistical analysis and a logistic regression analysis were carried out. RESULTS: The respondents are on average 46 years old (20-81), 59 % are women. Older age (OR 2,579), not living in partnership (OR 1,963), fear of personal contact (OR 5,716) and low (OR 3,585) or moderate (OR 3,144) interactive health literacy were significantly associated with the time to treatment. CONCLUSION: The data suggest that social inequalities exist regarding the use of psychotherapeutic or pharmacological interventions in people with social anxiety disorder.

7.
Psychol Health Med ; : 1-14, 2020 Jun 02.
Artigo em Inglês | MEDLINE | ID: mdl-32484756

RESUMO

This studyinvestigates the need for psycho-oncological care over the course of a breast cancer treatment and possible associated factors to develop such a need. The PIAT-Study was a longitudinal postal survey study conducted in Germany (2013 to 2014) with breast cancer patients (BCPs). Patients received a questionnaire at three-time points (T1: few days after surgery, T2: after 10 weeks; T3: after 40 weeks). This study considers information about patients' needs for psycho-oncological care, their breast cancer disease, social support, anxiety, health literacy (HL) and sociodemographic information. Data were analysed with descriptive statistics and logistic regression modelling to estimate the association between a need for psycho-oncological treatment and patient characteristics. N = 927 breast cancer patients reported their psycho-oncological need. 35.2% of patients report at least at one measuring point to be in need for psycho-oncological care. In a multiple logistic regression, noticeable determinants for developing such a need are an inadequateHL(OR = 1.97), fear of progression (FoP) (OR = 2.08) and psychological comorbidities (OR = 8.15) as well as certain age groups. BCPs with a low HL, suffering from a dysfunctional level of FoP or mental disorders are more likely to develop a need for psycho-oncological care.

8.
Patient Educ Couns ; 103(1): 120-126, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31474389

RESUMO

OBJECTIVE: As satisfaction with information received is an important precondition of adherence to treatment in cancer patients, we aimed to examine the level of perceived information, information satisfaction and information needs, and examine the prospective association between information satisfaction and anxiety. METHODS: In a multicenter study in Germany, 1398 cancer patients were evaluated in terms of this at baseline, after 6 and 12 months. RESULTS: At baseline, the majority of patients reported to feel well-informed. Nevertheless, a considerable proportion reported to wish more information. The proportion of patients reporting unmet information needs declined over time (p < 0.001). Anxiety at baseline is negatively associated with information satisfaction after 6 months (ß = -0.10, p < 0.01). Conversely, information satisfaction at baseline is negatively associated with anxiety after 6 months (ß = -0.10, p < 0.01). At 12 months, only the negative path leading from anxiety to information satisfaction was significant (ß = -0.12, p < 0.01). CONCLUSION: We found high levels of information received and high information satisfaction. Nevertheless, there was a considerable quantity of unmet information needs. A bidirectional relationship between information satisfaction and anxiety symptoms emerged after 6 months. PRACTICE IMPLICATIONS: These results underline the priority of providing information and emotional support to cancer patients to improve satisfaction with information.

9.
BMJ Support Palliat Care ; 10(4): e36, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30981992

RESUMO

OBJECTIVE: To describe psycho-oncological care structures and processes in German breast cancer centres from the perspective of the centre administration. METHODS: The findings are based on a postal survey of a representative random sample of surgical sites of certified breast cancer centres in Germany. Data were collected in 2013 and 2014. The questionnaire included questions about infrastructure, patient information standards, psycho-oncological services and aspects of organisational culture. Data analyses included frequencies, means and bivariate relationships. RESULTS: The return rate was 88.3% (53 hospital sites). Psycho-oncological care is provided by permanent employees in 87%. The average number of full-time-equivalent employees (FTE) is 1.23. Most breast cancer centres engage the occupational group of psycho-oncologists for psycho-oncological care (90%), followed by the medical service (80%) and breast care nurses (78%) (multiple answers were possible). The correlation coefficient between FTEs and surgical treatments per year is not significant (r=0.292, p=0.051). Hospitals are screening every inpatient for the need of psycho-oncological support in 76% of all sites. Frequently used screening instruments are distress thermometer (19%), clinical interview (13%) and basic psycho-oncological documentation (11%). CONCLUSION: Our data provide insights into the self-reported structural and procedural quality of psycho-oncological care in German breast cancer centres. Further research should examine patient and caregiver perspective on the psycho-oncological services provided by breast cancer centres.

10.
Mol Psychiatry ; 2019 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-31712720

RESUMO

Panic disorder (PD) has a lifetime prevalence of 2-4% and heritability estimates of 40%. The contributory genetic variants remain largely unknown, with few and inconsistent loci having been reported. The present report describes the largest genome-wide association study (GWAS) of PD to date comprising genome-wide genotype data of 2248 clinically well-characterized PD patients and 7992 ethnically matched controls. The samples originated from four European countries (Denmark, Estonia, Germany, and Sweden). Standard GWAS quality control procedures were conducted on each individual dataset, and imputation was performed using the 1000 Genomes Project reference panel. A meta-analysis was then performed using the Ricopili pipeline. No genome-wide significant locus was identified. Leave-one-out analyses generated highly significant polygenic risk scores (PRS) (explained variance of up to 2.6%). Linkage disequilibrium (LD) score regression analysis of the GWAS data showed that the estimated heritability for PD was 28.0-34.2%. After correction for multiple testing, a significant genetic correlation was found between PD and major depressive disorder, depressive symptoms, and neuroticism. A total of 255 single-nucleotide polymorphisms (SNPs) with p < 1 × 10-4 were followed up in an independent sample of 2408 PD patients and 228,470 controls from Denmark, Iceland and the Netherlands. In the combined analysis, SNP rs144783209 showed the strongest association with PD (pcomb = 3.10 × 10-7). Sign tests revealed a significant enrichment of SNPs with a discovery p-value of <0.0001 in the combined follow up cohort (p = 0.048). The present integrative analysis represents a major step towards the elucidation of the genetic susceptibility to PD.

11.
BMC Cancer ; 19(1): 1024, 2019 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-31666035

RESUMO

BACKGROUND: Research shows disparities in cancer outcomes by ethnicity or socio-economic status. Therefore, it is the aim of our study to perform a matched-pair analysis which compares the outcome of German and non-German (in the following described as 'foreign') cancer patients being treated at the Center for Integrated Oncology (CIO) Köln Bonn at the University Hospital of Bonn between January 2010 and June 2016. METHODS: During this time, 6314 well-documented patients received a diagnosis of cancer. Out of these patients, 219 patients with foreign nationality could be matched to German patients based on diagnostic and demographic criteria and were included in the study. All of these 438 patients were well characterized concerning survival data (Overall survival, Progression-free survival and Time to progression) and response to treatment. RESULTS: No significant differences regarding the patients' survival and response rates were seen when all German and foreign patients were compared. A subgroup analysis of German and foreign patients with head and neck cancer revealed a significantly longer progression-free survival for the German patients. Differences in response to treatment could not be found in this subgroup analysis. CONCLUSIONS: In summary, no major differences in survival and response rates of German and foreign cancer patients were revealed in this study. Nevertheless, the differences in progression-free survival, which could be found in the subgroup analysis of patients with head and neck cancer, should lead to further research, especially evaluating the role of infectious diseases like human papillomavirus (HPV) and Epstein-Barr virus (EBV) on carcinogenesis and disease progression.


Assuntos
Neoplasias dos Genitais Femininos/etnologia , Neoplasias dos Genitais Femininos/mortalidade , Neoplasias de Cabeça e Pescoço/etnologia , Neoplasias de Cabeça e Pescoço/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Grupo com Ancestrais do Continente Europeu , Feminino , Seguimentos , Neoplasias dos Genitais Femininos/terapia , Alemanha/etnologia , Neoplasias de Cabeça e Pescoço/terapia , Humanos , Estimativa de Kaplan-Meier , Masculino , Análise por Pareamento , Pessoa de Meia-Idade , Intervalo Livre de Progressão , Estudos Retrospectivos , Adulto Jovem
12.
Acta Oncol ; 58(9): 1298-1306, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31284793

RESUMO

Background: This prospective multicenter study aimed to investigate the courses of positive support (PS) and detrimental interaction (DI), two different aspects of social support, and the relation between social support and psychosocial distress and/or health-related quality of life (HRQOL) in a large sample of patients with different cancers. Methods: For this observational study, we enrolled adult patients with cancer from 13 comprehensive cancer centers (CCCs) in Germany. We included a total of 1087 patients in our analysis. We assessed the outcomes via standardized self-report questionnaires at three measurement points: at admission for acute care (T1), 6 (T2) and 12 months (T3) thereafter. Our outcome variables included PS and DI, depression and anxiety symptoms, distress, mental quality of life (MQoL) and physical QoL (PQoL). Data were analyzed using three-level hierarchical linear modeling (HLM) and group-based trajectory modeling. Results: During the first year after the cancer diagnosis, both PS and DI decreased in our sample. Baseline depression symptom severity was a significant predictor of PS and DI. Further analyses revealed significant associations between PS, DI and the course of depression and anxiety symptoms, and MQoL. PS buffered the negative effects of DI with regards to these variables. Low DI was associated with better PQoL, whereas PS was not. In general, the impact of social support on psychosocial outcomes was weak to moderate. Conclusions: Our findings provide evidence for the influence of PS and DI on psychosocial symptoms and HRQOL, and emphasize the importance of psycho-oncological interventions that strengthen PS and prevent or reduce DI for patients with cancer and their relatives.


Assuntos
Neoplasias/psicologia , Angústia Psicológica , Qualidade de Vida/psicologia , Apoio Social , Adulto , Ansiedade/diagnóstico , Depressão/diagnóstico , Feminino , Alemanha , Humanos , Modelos Lineares , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Autorrelato , Inquéritos e Questionários , Fatores de Tempo
13.
Sleep Med ; 58: 107-113, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31146122

RESUMO

OBJECTIVE: The study aimed to examine the 12-month course of cancer-related insomnia (CRI) and to identify possible predictors for the prevalence and persistence of CRI. METHODS: This longitudinal multicenter study included N = 405 patients with cancer (56% females, mean age: 58.6 years). CRI was measured by the Insomnia Severity Index (ISI). Socio-demographic and clinical data, as well as psychological parameters (Distress Thermometer, PHQ-9, GAD-7, and EORTC-Fatigue), were assessed at baseline (T1) and 12 months later (T2). RESULTS: In our sample, a high prevalence of relevant insomnia symptoms (49.4%, ISI > 7) was found, while a clinical insomnia diagnosis was verified in 12.8% (ISI > 14). When insomnia was present at T1, this problem was persistent after one year in 64%. At T2, however, significantly more women suffered from insomnia symptoms (53.3% women vs. 39.3% men; p = 0.003). Insomnia was associated with many clinical and psychological parameters, especially with fatigue (r = 0.5). Multiple regression analysis revealed that, in women, only insomnia at T1 was a significant predictor for insomnia at T2 (R2 = 0.40; F(5) = 12.5; p < 0.001), whereas in men insomnia, depressive symptoms and the use of psychotropic drugs at T1 predicted the extent of insomnia at T2 (R2 = 0.28; F(7) = 9.5; p < 0.001). In all participants, levels of distress, depression, and anxiety decreased from T1 to T2 (p's < 0.016). CONCLUSION: Insomnia is a common disorder in cancer patients. Although medical and psychological parameters improved during the 12-month course of cancer treatment, our results show that insomnia is highly persistent, especially in women. This indicates that adequate support for those affected is needed. CLINICAL TRIAL REGISTRATION NUMBER: DRKS00004860.


Assuntos
Neoplasias/complicações , Distúrbios do Início e da Manutenção do Sono/etiologia , Distúrbios do Início e da Manutenção do Sono/psicologia , Idoso , Transtornos de Ansiedade/epidemiologia , Transtornos de Ansiedade/psicologia , Estudos de Casos e Controles , Depressão/epidemiologia , Depressão/psicologia , Fadiga/epidemiologia , Fadiga/psicologia , Feminino , Alemanha/epidemiologia , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Neoplasias/psicologia , Prevalência , Psicotrópicos/efeitos adversos , Psicotrópicos/uso terapêutico , Índice de Gravidade de Doença , Fatores Sexuais , Distúrbios do Início e da Manutenção do Sono/epidemiologia , Distúrbios do Início e da Manutenção do Sono/terapia , Estresse Psicológico/epidemiologia , Estresse Psicológico/psicologia
14.
PLoS One ; 14(2): e0211223, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30726284

RESUMO

BACKGROUND: Studies from general practitioner (GP) populations from various European countries show a high prevalence of burnout, yet data from Germany are scarce and there are no data comparing GPs from solo versus group practices. METHODS: This cross-sectional survey addressed all GPs from a German network of family medicine practices comprising 185 practices. Participants were asked to fill in a self-administered questionnaire addressing socio-demographic and job-related characteristics. The German version of the Maslach Burnout Inventory was used to measure the dimensions emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA). Each participant was categorized as having high EE, high DP and low PA following pre-defined cut-offs. RESULTS: A total of 214 GPs from 129 practices participated: 65.9% male, 24.8% solo practice. Of all GPs, 34.1% (n = 73) scored high for EE, 29.0% (n = 62) high for DP, 21.5% (n = 46) low for PA and 7.5% (n = 16) for all three dimensions. A higher risk for EE was found among female physicians, those unsatisfied with their job, those using few stress-regulating measures regularly and those reporting bad work-life balance. Burnout prevalence was higher in GPs in group than in solo practices (37.9% vs. 28.8% had high EE, 33.1% vs. 18.9% had high DP and 22.8% vs. 18.9% had low PA). A significantly higher prevalence of burnout symptoms was found in group practice employees compared to group practice owners. CONCLUSION: Burnout prevalence was higher among physicians in group practices compared to solo practices. In group practices, employed, young, female and part-time working physicians showed a higher burnout risk.


Assuntos
Esgotamento Profissional/epidemiologia , Despersonalização/epidemiologia , Clínicos Gerais/psicologia , Estudos Transversais , Feminino , Alemanha/epidemiologia , Prática de Grupo/estatística & dados numéricos , Humanos , Satisfação no Emprego , Masculino , Pessoa de Meia-Idade , Prevalência , Prática Privada/estatística & dados numéricos , Autorrelato
15.
Breast ; 44: 66-72, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30669033

RESUMO

OBJECTIVES: Aim of this study was to investigate the experiences of breast cancer patients who participated in multidisciplinary tumor conferences (MTCs). STUDY DESIGN: Data from two consecutive years of an annual postal survey of patients with primary breast cancer were combined. Data was collected between February and July 2015 (response rate 72%) and 2016 (response rate 73%) from N = 8893 patients (ICD-10 C50) after hospital discharge from 86 breast cancer center hospitals in North Rhine-Westphalia, Germany. The study used a mixed-methods design. Standardized quantitative survey questions were analyzed descriptively and an open-ended question was analyzed using qualitative content analysis. RESULTS: Around 9% of the patients were invited to participate in a multidisciplinary tumor conference (MTC) and 49% of the invited patients reported actual participation in a MTC. Approximately 87% of those patients did not regret their participation in the MTC. The qualitative analysis from the open-ended question indicated that MTC participation was perceived by patients as being both supportive and informative (n = 109 expressions). However, some patients reported difficult experiences and emotional reactions during and after participation (n = 37 expressions). Altogether, the patients' perception was divided into positive and negative, cognitive and emotional experiences following participation in a MTC. CONCLUSION: The perception of the MTCs varies between the participating patients. Further research on advantages and disadvantages for patients and particularly on the feasibility from the provider's perspective is necessary.


Assuntos
Neoplasias da Mama/psicologia , Congressos como Assunto , Participação do Paciente/psicologia , Satisfação do Paciente/estatística & dados numéricos , Adulto , Idoso , Atitude Frente a Saúde , Neoplasias da Mama/terapia , Feminino , Alemanha , Humanos , Pessoa de Meia-Idade , Participação do Paciente/estatística & dados numéricos
16.
Psychooncology ; 27(12): 2847-2854, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30276915

RESUMO

OBJECTIVE: The study aimed to assess cancer patients' use of psychological care and its correlates in a large sample of cancer patients in Comprehensive Cancer Centers (CCCs) in Germany. METHODS: In a multicenter study in Germany, cancer patients with various diagnoses were evaluated for self-reported use of psychological support. We measured psychological distress, depression and anxiety, quality of life, and social support with standardized questionnaires and analyzed its association with the utilization of psychological care using multivariable logistic regression. This paper focuses on a cross-sectional analysis of the data assessed during inpatient care. RESULTS: Three thousand fifty-four (50%) of hospitalized patients were asked for participation, and n = 1632 (53.6%) participated. We were able to analyze n = 1,398 (45.9%) patients. Three hundred ninety-seven (28.4%) of the sample utilized psychological support. Users of psychological care were significantly younger than nonusers (odds ratio [OR]: 0.967, P < 0.001) and were more often female (OR: 1.878, P < 0.001), whereas educational level was not associated with the use of psychological care. In the multivariable analysis, effects on the use of psychological care were observed for Hospital Anxiety and Depression Scale (HADS) anxiety (OR: 1.106, P = 0.001) and both subscales of the 12-item Short Form Health Survey (SF-12) quality of life measure (mental, OR: 0.97, P = 0.002; physical, OR: 0.97, P = 0.002). CONCLUSION: Psychological distress and anxiety are higher, and quality of life is lower in users of psychological care in comparison with nonusers during inpatient cancer treatment. Although psychooncological services should be provided to all patients who need them, special efforts should be made to reach populations that report low utilization.


Assuntos
Determinação de Necessidades de Cuidados de Saúde , Neoplasias/psicologia , Qualidade de Vida/psicologia , Apoio Social , Estresse Psicológico/etiologia , Adulto , Idoso , Ansiedade/epidemiologia , Estudos Transversais , Depressão/epidemiologia , Feminino , Alemanha/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/terapia , Inquéritos e Questionários , Adulto Jovem
17.
PLoS One ; 13(6): e0198244, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29864139

RESUMO

Functional imaging studies of affective disorders have demonstrated abnormal activity in the amygdala in response to emotionally salient stimuli. Since in other studies this response has been shown to habituate during the scanning session, it is not clear if it may be of use in monitoring disease progression or remission, or in monitoring the effects of therapy, as habituation may confound normalisation of response. We investigated here amygdala activation in healthy participants exposed to displays of emotional facial expressions in a sample of N = 31 individuals assessed twice in an interval of three weeks. At this interval no habituation could be detected, suggesting the validity of this imaging assay in repeated assessments of amygdalar reactivity. However, the fusiform gyrus and the inferior frontal lobes showed decreases in activations that may be related to the role of these areas in encoding visual and emotional aspects of the stimuli.


Assuntos
Tonsila do Cerebelo , Emoções/fisiologia , Face , Imagem por Ressonância Magnética , Percepção Visual/fisiologia , Adulto , Tonsila do Cerebelo/diagnóstico por imagem , Tonsila do Cerebelo/fisiologia , Feminino , Humanos , Masculino
18.
Psychiatry Res ; 262: 295-302, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29477673

RESUMO

Social anxiety disorder (SAD) is frequently associated with alcohol use disorders (abuse/dependence). However, there has been little research on the characteristics of this subgroup so far. In the current study we investigated individuals with SAD and comorbid alcohol use disorder (AUD) with regard to socialization experiences and personality. The sample comprised 410 individuals diagnosed with SAD by the Structured Clinical Interview of DSM-IV. 108 participants with comorbid AUD were compared to 302 participants without comorbid AUD concerning traumatic experiences during childhood and adolescence (Adverse Childhood Experiences Questionnaire; ACE), parental bonding (Parental Bonding Instrument; PBI), and personality (Temperament and Character Inventory; TCI). MANCOVA with covariates sex and depression displayed that individuals with SAD plus AUD reported significantly more traumatic events during childhood and adolescence, lower levels of maternal care, as well as lower cooperativeness. Our results highlight that adverse childhood experiences and unfavourable maternal bonding characterize individuals suffering from SAD plus AUD. These experiences might be reflected in a personality-based tendency to distance themselves from others, which corresponds to low scores on the character dimension cooperativeness. A deeper understanding of personality and specific socialization experiences is necessary to develop new treatment options in this clinically challenging subgroup.


Assuntos
Alcoolismo/psicologia , Acontecimentos que Mudam a Vida , Apego ao Objeto , Fobia Social/psicologia , Adolescente , Adulto , Alcoolismo/diagnóstico , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fobia Social/diagnóstico , Ajustamento Social , Inquéritos e Questionários , Temperamento
19.
Z Psychosom Med Psychother ; 64(4): 365-379, 2018 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-30829171

RESUMO

Pain and fatigue - a systematic review Introduction: Chronic pain and fatigue are symptoms that often occur together and characterize the symptom picture of various diseases. Nevertheless, integrative explanatory approaches have so far received little attention in medical practice. METHODS: Based on a systematic literature search in the Embase, Medline, PsychInfo, and CENTRAL databases, we searched for high-quality intervention studies for the simultaneous treatment of pain and fatigue. RESULTS: From 1,496 total hits, 158 studies were included in the evaluation. The most commonly studied clinical pictures of the symptomcomplex were tumor catabolism, fibromyalgia, chronic fatigue, rheumatoid arthritis, and osteoarthritis.Current explanations of the symptom complex focus on the activation of proinflammatory microglia in centralized pain syndrome with multiple effects on neurotransmission, neuroendocrinology, neuroplasticity, and the autonomic nervous system. In this model, fatigue can be understood as an evolutionary, meaningful symptom protective of the organism. CONCLUSIONS: A deeper understanding of the relationship between centralized pain syndrome and fatigue allows for new explanatory and treatment approaches.


Assuntos
Dor Crônica , Fadiga , Fibromialgia , Dor Crônica/complicações , Fadiga/complicações , Fibromialgia/complicações , Humanos
20.
J Psychosom Res ; 99: 162-168, 2017 08.
Artigo em Inglês | MEDLINE | ID: mdl-28712423

RESUMO

OBJECTIVE: Anxiety and depression are associated with an activation of coagulation and an impairment of fibrinolysis, which may contribute to the increased cardiovascular risk associated with the two disorders. However, very few studies have examined the impact of psychological distress on coagulation factors in coronary artery disease patients. The aim of this study was to assess the correlation between anxiety/depression and factors of coagulation and fibrinolysis in patients who had suffered an acute MI three months prior. METHODS: In 148 patients, anxiety and depression were assessed by the Hospital Anxiety and Depression Scale (HADS) shortly after MI and three months later. At the second time of assessment, plasma levels of fibrinogen, factor VII, factor VIII, von Willebrand factor, prothrombin-fragment 1 and 2, tissue-plasminogen-activator, plasminogen activator inhibitor-1, D-dimer, and homocysteine were measured. RESULTS: In 32% of the patients, elevated levels of anxiety and depression were found three months after a MI. Multiple regression analyses showed that coagulation and fibrinolysis markers were not significantly associated with HADS anxiety and depression scores. We found that age, gender, BMI, and smoking status were significant predictors for haemostasis factors. A higher age was associated with a higher coagulability but lower anxiety levels. CONCLUSION: We measured parameters of coagulation and fibrinolysis in patients three months after MI and found no predictive value of HADS anxiety and depression scores shortly after MI or at the time of blood sampling. The effects of age on the relationship between anxiety and haemostasis should be further investigated.


Assuntos
Ansiedade/etiologia , Fatores de Coagulação Sanguínea/metabolismo , Transtorno Depressivo/etiologia , Infarto do Miocárdio/complicações , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Envelhecimento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/psicologia , Fatores de Risco , Adulto Jovem
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