Religious practice and psychological distress: the importance of gender, ethnicity and immigrant status.

The present study examined the relationship between religious practice and psychological distress in a culturally diverse urban population to explore how religious affiliation, gender, ethnicity, and immigrant status affect this relationship. Data were drawn from a study of health care utilization in Montreal. A stratified community sample of 1485 yielded four religious groups: Protestant (n = 205), Catholic (813), Jewish (201), and Buddhist (150), and a group with no declared religion (116). The sample was composed of five ethnocultural groups: Anglophone Canadian-born, Francophone Canadian-born, Afro-Caribbean, Vietnamese, and Filipino immigrants. Psychological distress was assessed with the 12-item version of the General Health Questionnaire (GHQ). Religious involvement was measured with three items: 1) declared religion; 2) frequency of attendance at religious meetings; and 3) frequency of religious rituals performed at home. Multiple regression models examined the relationship of religious practice to distress, controlling for sociodemographic variables including ethnicity. Overall, attendance at religious services was associated with a lower GHQ score. Attendance at religious services also was inversely related to psychological distress for females, Protestants, Catholics, Filipinos, and Afro-Caribbeans; but not for males, Buddhists or Jews. Religious practice at home was not associated with level of distress for any group. The 'no declared religion' group had the highest mean GHQ score of all the groups. Results confirm the association between attendance at religious services and lower levels of distress, but reveal ethnospecific and gender effects indicating the need to understand the impact of religious practice on mental health in social and cultural context.

[Phenomenology: a scientific approach to lived experiences]. / La phénoménologie: une approche scientifique des expériences vécues.

Phenomenology is a philosophical current which intends to observe and describe the meaning attributed to an experience from the consciousness of the person who is living it. While it can be applied to different domains, especially to human care it describes subjective phenomenon such as suffering or quality of life. It constitutes as a real discipline, with its epistemology, its specific data (the individual's narration), its method of analysis to find the speech units of significance, and collaboration between researcher and participant (who becomes a co-researcher). Validity of the method is defined by the fact that the phenomenon becomes intelligible. In the representation of the disease and of the patient, the method is close to ethical principles like respect of autonomy and optimization of quality of life.

Psychological correlates of functional status in chronic fatigue syndrome.

BACKGROUND: The present study was designed to test a cognitive model of impairment in chronic fatigue syndrome (CFS) in which disability is a function of severity of fatigue and depressive symptoms, generalized somatic symptom attributions and generalized illness worry. METHODS: We compared 45 CFS and 40 multiple sclerosis (MS) outpatients on measures of functional ability, fatigue severity, depressive symptoms, somatic symptom attribution and illness worry. RESULTS: The results confirmed previous findings of lower levels of functional status and greater fatigue among CFS patients compared to a group of patients with MS. Fatigue severity was found to be a significant predictor of physical functioning but not of psychosocial functioning in both groups. In CFS, when level of fatigue was controlled, making more somatic attributions was associated with worse physical functioning, and both illness worry and depressive symptoms were associated with worse psychosocial functioning. CONCLUSIONS: Our findings support the role of depression and illness cognitions in disability in CFS sufferers. Different cognitive factors account for physical and psychosocial disability in CFS and MS. The SF-36 may be sensitive to symptom attributions, suggesting caution in its interpretation when used with patients with ill-defined medical conditions.

Correlates of illness worry in chronic fatigue syndrome.

BACKGROUND: Anxiety about illness leading to restriction of activity and physical deconditioning has been hypothesized to contribute to the chronicity of fatigue. Pathological symptom attributions, personality traits, and depression have all been hypothesized to contribute to illness worry. METHODS: We compared 45 chronic fatigue syndrome (CFS) and 40 multiple sclerosis (MS) outpatients using a battery of psychometric instruments comprising the 12-item Illness Worry scale, the Symptom Interpretation Questionnaire (SIQ), the NEO Five-Factor Inventory (NEO-FFI), and a modified version of the SCL-90R Depression scale. RESULTS: There was no difference between the two diagnostic groups on neuroticism, depressive symptoms, as well as the three scales of the SIQ. On the illness worry index, the CFS group had significantly higher scores than the MS group. This difference was due to items tapping vulnerability to illness and the perception that others are not taking their illness seriously. Somatic attributional style, neuroticism, depressive symptoms, and age were all significant predictors of illness worry in both CFS and MS patients. CONCLUSIONS: Somatic attributions, neuroticism, and depression all contribute to illness worry in chronic illness. However, these factors do not account for the higher levels of illness worry in CFS as opposed to MS, which may be due to other specific cognitive and social interactional processes.

[Marital communication and depressive symptoms in couples in which the woman has cancer of the breast]. / Communication conjugale et symptômes dépressifs dans des couples dont la femme est atteinte de cancer du sein.

If doctor-patient communication is a frequent subject of research, couples communication where one partner has cancer is quite recent. Some studies deal with couples communication, but from an anecdotic perspective, without any operational measure. The aim of this paper is to study couples' communication frequency and link it to depressive symptomatology. Marital communication was assessed with three scales: frequency of general communication, frequency of communication about cancer and satisfaction with communication. About one month following surgery, 120 breast cancer patients were interviewed; only 11 partners (9%) refused to be interviewed. Results show less communication is associated with higher depressive level. Patients and partners with a passable level of communication, particularly about cancer, are clinically at risk for depression. Communicating frequently about cancer in the couple seems thus associated with a positive effect, i.e. a depressive level found in the general population. Direction of causality between frequency of marital communication and depressive symptomatology cannot be established from this study.

Use of health care services for psychological distress by immigrants in an urban multicultural milieu.

OBJECTIVE: Research in the United States tends to attribute low rates of use of mental health services by immigrants to economic barriers. The purpose of our study was to examine this issue in the context of Canada's universal health care system. METHODS: A survey of the catchment area of a comprehensive clinic in Montreal interviewed random samples of 924 Canadian-born individuals and 776 immigrants born in the Caribbean (n = 264), Vietnam (n = 234), or the Philippines (n = 278) to assess their health care use for somatic symptoms, psychological distress, and recent life events. RESULTS: Overall rates of use of medical services in the past year were similar in immigrant (78.5%) and nonimmigrant (76.5%) groups. Rates of use of health care services for psychological distress were significantly lower among immigrants (5.5% compared with 14.7%, P < 0.001). This difference was attributable both to a lower rate of use of specialty mental health services by immigrants (2.5% compared with 11.7%, P < 0.001) and to differential use of medical services for psychological distress (3.5% compared with 5.8%, P = 0.02). When level of psychological distress was controlled, Vietnamese and Filipino immigrants were one-third as likely as Canadian-born residents to make use of mental health services. The lower rate of use by immigrants could not be explained by differences in sociodemographics, somatic or psychological symptoms, length of stay in Canada, or use of alternative sources of help. CONCLUSION: Immigrant status is associated with lower rates of use of mental health services, even with universal health insurance. This lower rate of use likely reflects cultural and linguistic barriers to care.