Journal of Psychosomatic Research - Articles in Press

The way forward: A case for longitudinal population-based studies in the field of functional somatic syndromes - Corrected Proof

Judith G.M. Rosmalen — 2010-02-01

This special issue is focused on functional somatic syndromes or disorders (FSDs): syndromes that do not have a known underlying pathophysiology. Among the most important examples are irritable bowel syndrome (IBS), chronic fatigue syndrome (CFS), and fibromyalgia (FM). Although there is an ongoing debate between the lumpers (who argue that all FSDs are in fact manifestations of one single disorder) and splitters (who argue that despite communalities, the differences should not be ignored) , most researchers currently agree that FSDs share at least a common core. It is increasingly recognized that FSDs are not discrete diseases but heterogeneous clusters of fluctuating common functional symptoms with no clear boundaries between healthy and disordered. Remarkably, we have not yet translated this increasing knowledge into our research designs. Despite the fact that we do not know how many symptoms a person needs of which types for how long to become a case of what exactly, the field of FSDs is filled with cross-sectional case-control studies. In this editorial, I will identify some of the problems associated with the current approach, after which I will make a case for longitudinal population-based studies as the way forward to further increase our knowledge on the etiology of FSDs.

The future of neuroscientific research in functional gastrointestinal disorders: Integration towards multidimensional (visceral) pain endophenotypes? - Corrected Proof

Adam D. Farmer, Qasim Aziz, Jan Tack, Lukas Van Oudenhove — 2010-02-01

Abstract: The growing evidence for a key role of psychophysiological processes in the etiopathogenesis of functional gastrointestinal disorders (FGID) originates from various sources, including epidemiological, psychometric, physiological, and behavioural studies. Functional neuroimaging has improved our knowledge about central processing of visceral pain, a defining feature of FGID. However, results have been disappointingly inconsistent, often due to psychosocial factors not being controlled for. In this paper, we aim to show that using integrated research strategies, encompassing a number of scientific disciplines, is critical to advancing our understanding of FGID. We will illustrate this by describing recent integrative studies that may serve as good examples. More specifically, future FGID neuroimaging studies should control for psychosocial factors and incorporate methods from other branches of neuroscience outside this field, especially cognitive, affective and autonomic neuroscience. We therefore propose a framework for the development of an integrative cross-disciplinary research strategy based on advancing our understanding of visceral nociceptive physiology in health as well as vulnerability and susceptibility factors for FGID. This approach will allow the identification of factors responsible for the inter-individual differences in visceral pain perception and susceptibility to chronic visceral pain, leading to the description of multidimensional (visceral) pain “endophenotypes.” These may represent the critical steps needed towards a pathophysiological, rather than symptom-based, classification of FGID, which may be more suitable for genetic association studies. This approach may ultimately culminate in individual tailoring of treatment, in addition to disease prevention, thereby improving outcomes for the patient and researcher alike.

Validity of the Ghent Multidimensional Somatic Complaints Scale in a clinical sample - Corrected Proof

Koen Beirens, Johnny R.J. Fontaine — 2010-01-22

Abstract: Objective: To evaluate the validity of the Ghent Multidimensional Somatic Complaints Scale (GMSCS) in a Clinical Sample.Method: Three hundred fifty-four non-clinical subjects and 151 clinical patients completed the GMSCS, an 18-item five-factorial scale for the assessment of somatic complaints.Results: The five-factorial structure was reliable and valid in the non-clinical as well as the clinical sample. Furthermore, group differences after controlling for the other factors were only significant for pain and fatigue.Conclusion: The GMSCS is a suitable multidimensional scale for assessing five clusters of somatic complaints in a clinical (primary care and pain patients) and non-clinical population.

Negative association of concomitant physical symptoms with the course of major depressive disorder: A systematic review - Corrected Proof

2010-01-22

Abstract: Objective: The prognosis of depression greatly varies among patients, and the physical symptoms that often accompany depression may predict treatment resistance and a worse outcome. If so, this may have important clinical implications. The aim of this systematic review was to explore the association of concomitant physical symptoms with the outcome of major depressive disorder (MDD).Methods: Systematic review: Medline, Psychinfo, and the Cochrane Library were searched for prospective, cross-sectional, and retrospective studies, and also for open-label trials and randomized controlled trials. The risk of bias assessment and data extraction were performed in duplicate. A qualitative best-evidence synthesis was performed, based on the number of studies reporting on the association between physical symptoms and the course of MDD, the consistency of the results, and the methodological quality. The findings were reported according to the PRISMA guidelines.Results: Nine studies met the inclusion criteria. Although the design, outcome measures, and data presentation varied too much to make statistical pooling possible, the best evidence synthesis resulted in strong, consistent evidence for a negative association between physical symptoms and the course of MDD.Conclusion: This systematic review shows a negative association of concomitant physical symptoms with the course of MDD. The effect might be considerable, but the number of studies addressing this topic is small and there was a wide variation in the study designs and outcome measures. More research is needed.

Illusory touch and tactile perception in somatoform dissociators - Corrected Proof

Richard J. Brown, Natalie Brunt, Ellen Poliakoff, Donna M. Lloyd — 2010-01-22

Abstract: Objective: The psychological mechanisms of somatoform dissociation (i.e., pseudoneurological symptoms) are poorly understood. This study evaluated recent theoretical predictions regarding the role of tactile perception in the development of somatoform dissociative symptoms.Methods: Eighty nonclinical participants scoring either high or low on the Somatoform Dissociation Questionnaire (SDQ-20) completed the Somatic Signal Detection Task (SSDT), a novel perceptual paradigm designed to simulate the occurrence of somatoform symptoms in the laboratory. Prior to the SSDT, participants completed a memory task designed to produce either minimal or maximal activation of tactile representations in memory.Results: The high SDQ-20 group exhibited a more liberal response criterion (c) on the SSDT than the low SDQ-20 group after controlling for negative affectivity, somatosensory amplification and depression. This effect was mainly attributable to an increased number of false alarms (i.e., illusory experiences of touch) in the high SDQ-20 group rather than an increased hit rate. General perceptual ability (i.e., tactile sensitivity) was comparable between the two groups. The memory manipulation had no effect on SSDT performance.Conclusions: Somatoform dissociators appear more likely to experience illusory perceptual events under conditions of sensory ambiguity than nondissociators, despite comparable perceptual abilities more generally. These findings support theories that identify distorted perceptual processing as a feature of somatoform dissociation. The SSDT has potential as a tool for further research in this area.

The contribution of disease severity, depression and negative affectivity to fatigue in multiple sclerosis: A comparison with ulcerative colitis - Corrected Proof

2010-01-22

Abstract: Background: Fatigue is one of the most common and troubling symptoms of multiple sclerosis (MS) and more severe and disabling than fatigue in other somatic populations. Although fatigue seems MS specific, its pathogenesis is still poorly understood.Objective: To study the disease specificity of fatigue in MS by comparing its level, its physical and psychological correlates to those of patients with ulcerative colitis (UC), a peripheral chronic auto-immune disease. We focused on the relative contribution of disease severity, depression and negative affectivity to fatigue in both patient samples.Methods: A total of 88 MS and 76 UC patients were included in this cross-sectional study. Fatigue, depression and negative affectivity were assessed respectively with the physical and mental fatigue subscales of the Multidimensional Fatigue Inventory, the depression subscale of the Hospital Anxiety and Depression Scale, and the neuroticism subscale of the Dutch NEO Five-Factor Inventory. The Expanded Disability Status Scale and the Colitis Activity Index were used to measure disease severity in MS and UC patients respectively.Results: While levels of both physical and mental fatigue were significantly higher in MS patients than in UC patients, there were no group differences in the contribution of disease severity, depression and negative affectivity to both physical and mental fatigue.Conclusion: Although levels of fatigue are higher for MS patients when compared with UC patients, the correlates of fatigue do not indicate MS specificity. As such our results support a transdiagnostic approach to fatigue in MS.

Factors associated with prospective development of environmental annoyance - Corrected Proof

Frida Eek, Björn Karlson, Kai Österberg, Per-Olof Östergren — 2010-01-22

Abstract: Objectives: Idiopathic environmental intolerance (IEI) has in cross-sectional studies been associated with emotional problems and psychiatric disorders. However, in the absence of prospective studies it has not been possible to determine whether emotional problems precede the onset of IEI, or are a consequence of IEI. The purpose of this study was to address this issue in a prospective panel study design.Methods: The study sample (n=10 275) responded to a postal survey that included five questions regarding annoyance from environmental factors, at baseline and at follow-up five years later. Associations between a number of self-rating scales of stress, subjective health, and working conditions at baseline on one hand, and development of environmental annoyance from baseline to follow-up on the other, were examined.Results: Participants having developed environmental annoyance between baseline and follow-up had at baseline reported more subjective health complaints, higher levels of stress, strain, and lack of recovery, more dissatisfaction with their work situation, and lower personal social support, compared to participants not developing environmental annoyance.Conclusion: Elevated subjective health complaints, high stress in daily life and a strained work situation, all possible signs of sustained arousal, increase the risk of developing annoyance to environmental factors. The results fit the hypothesis that reduced subjective health, over the course of time, may be attributed to environmental factors.

Measurement in psychosomatic research - Corrected Proof

Colin Shapiro — 2010-01-22

With this issue, we commence a monthly series on the use of health measurement scales. The editors of this series, Marta Novak and David Streiner, bring different skills to this project and a breadth of experience that will allow the individual articles to be honed in a way that makes them both clinically pertinent and academically precise.

Effect of psychiatric consultation models in primary care. A systematic review and meta-analysis of randomized clinical trials - Corrected Proof

2010-01-18

Abstract: Objective: Psychiatric consultation in primary care is meant to enhance and improve treatment for mental disorder in that setting. An estimate of the effect for different conditions as well as identification of particularly effective elements is needed.Methods: Database search for randomized controlled trials (RCTs) on psychiatric consultation in primary care. Validity assessment and data extraction according to Cochrane criteria were performed by independent assessors in duplicate. Meta-analysis was performed.Results: Data were collected from 10 RCTs with a total of 3408 included patients with somatoform disorder or depressive disorder, which compared psychiatric consultation to care as usual (CAU). Meta-analysis irrespective of condition showed a weighted mean indicating a combined assessment of illness burden as outcome of psychiatric consultation, compared to CAU, of 0.313 (95% CI 0.190–0.437). The effect was especially large in somatoform disorder (0.614; 95% CI 0.206–1.022). RCTs in which after the consult, consultation advice was given by means of a consultation letter, showed a combined weighted mean effect size of 0.561 (95% CI 0.337–0.786), while studies not using such a letter showed a small effect of 0.210 (95% CI 0.102–0.319). Effects are highest on utilization of health care services with 0.507 (95% CI 0.305–0.708).Conclusion: Psychiatric consultation in the primary care setting is effective in patients with somatoform and depressive disorder. Largest effects are seen in reduction of utilization of health care services.

Depression and increased risk of death in adults with stroke - Corrected Proof

Charles Ellis, Yumin Zhao, Leonard E. Egede — 2010-01-15

Abstract: Objective: Depression is a common condition among individuals with stroke and believed to influence post-stroke mortality. The objective of this study was to evaluate the effect of depression on all-cause mortality among adults with and without a history of stroke.Methods: We studied 10,025 participants in the population-based National Health and Nutrition Examination Survey I Epidemiologic Follow-up Study who were alive and interviewed in 1982 and had complete data for the Center for Epidemiologic Studies Depression Scale. Four groups were created based on history of stroke and depression status in 1982: (1) no stroke, no depression (reference group); (2) no stroke, depression present; (3) history of stroke, no depression; and (4) history of stroke present, depression present. Cox proportional hazards regression models were used to calculate multivariate-adjusted hazard ratios (HRs) of death for each group compared with the reference group.Results: Over 8 years (83,624 person-years of follow-up), 1,925 deaths were documented. Mortality rate per 1,000 person-years of follow-up was highest in the group with both a history of stroke and depression. Compared with the reference group, HRs for all-cause mortality were: no stroke, depression present, 1.23 (95% CI 1.08–1.40); stroke present, no depression 1.74 (1.06–2.85); and stroke present, depression present, 1.88 (1.27–2.79).Conclusions: The coexistence of stroke and depression increases the risk of death; however, the combined effect is less than additive.

Delirium in children and adolescents: A systematic review of the literature - Corrected Proof

Sean Hatherill, Alan J. Flisher — 2010-01-11

Abstract: Objectives: The purpose of this study was to collate all works relating to delirium and probable delirium in children and adolescents published since 1980.Methods: A systematic review of the literature in all languages published between 1980 and March 2009 was conducted.Results: The literature is limited to small case series and case reports including a total of 217 children or adolescents with definite delirium and a further 136 children and adolescents with “probable delirium.” These articles, in addition to unsystematic reviews, overviews, editorials, journal commentaries, and pertinent book chapters, are discussed in relation to prevalence, predisposing and precipitating factors, phenomenology, residual psychopathology, mortality, management, and prevention of delirium in childhood and adolescence.Conclusions: Delirium is an important but neglected disorder of childhood associated with significant morbidity and high mortality. Current clinical practice for management is based on slim empirical evidence.

Expectations in rheumatoid arthritis - Corrected Proof

Robert Ferrari, Anthony S. Russell — 2010-01-11

We read with interest the findings of Graves et al. , that rheumatoid arthritis patients' beliefs about their illness are associated with disability and quality of life irrespective of disease status. Graves et al. underpin the importance of illness beliefs and expectations in a variety of illnesses, even when the pathology is significant and demonstrable, and would normally be expected to be the chief determinant of disability and quality of life. Chronic pain and disability should perhaps always be approached from the biopsychosocial model, something we have proposed for more controversial disorders such as whiplash and spinal pain , but which should not be overlooked in our arthritis patients.

Effect of menopause and use of contraceptives/hormone therapy on association of C-reactive protein and depression: A population-based study - Corrected Proof

2009-12-21

Abstract: Objective: Unipolar depression has been found to associate with elevated C-reactive protein (CRP) levels in men, but findings among women have been conflicting. It has been hypothesized that this would be explained by a different hormonal environment (compared with men) and its changes throughout the lifecycle in women, but until now, the corresponding evidence has been lacking. We investigated the association between CRP levels and depressive symptoms in a population-based study in pre-, peri-, and postmenopausal women and, also, whether this association is affected by the use of exogenous hormones (contraceptives and postmenopausal hormone therapy).Methods: The entire age classes of those born in 1942, 1947, 1952, 1957, and 1962 and living in Pieksämäki, Finland, were invited (n=1294), and out of 730 women, 512 (70.1%) participated in this cross-sectional study in 1997 to 1998. Depressive symptoms were assessed by Beck's Depression Inventory-21 (BDI-21), and CRP was measured with a high-sensitivity CRP (hs-CRP) assay.Results: We found a positive correlation between hs-CRP levels and depressive symptoms in peri- and postmenopausal women not using exogenous hormones (Pearson correlation coefficient, r=.248, P<.001; and r=.343, P=.059, respectively). After multivariate adjustment, a statistically significant interaction was noted between hs-CRP levels and the exogenous hormone use on total score of BDI-21 (P=.022) among “peri- and postmenopausal women.”Conclusions: Our novel findings suggest that female hormones may have moderating effect at peri- and postmenopausal women on the association between elevated CRP levels and depressive symptoms. Further studies are, however, needed to confirm our findings.

The influence of long-term awareness of hyperlipidemia and of 3 years of dietary counseling on depression, anxiety, and quality of life - Corrected Proof

2009-12-16

Abstract: Objective: The purpose of this study is to investigate the long-term effects of participation in a cardiovascular screening program and of dietary counseling on self-reported psychosocial outcomes and health concerns.Methods: High-risk subjects (n=563) with hyperlipidemia from the Oslo Diet and Antismoking Study (1972–1977) were reexamined after 25 years and randomly assigned to a new 3-year prospective 2×2 factorial placebo-controlled study in 1997 of n-3 polyunsaturated fatty acids and/or dietary counseling.Hospital Anxiety and Depression Scale (HADS), Life Satisfaction Index (LSI), and a new questionnaire on health concerns and behavior in response to risk information were collected at the 25-year follow-up. Hospital Anxiety and Depression Scale and LSI were evaluated at the end of the 3-year Diet and Omega-3 Intervention Trial on atherosclerosis (DOIT) in 505 subjects.Results: Twenty-five years after the screening program, HADS-anxiety was similar to the Norwegian norms (3.3 vs. 3.5), while HADS-depression was significantly lower (3.6 vs. 4.1, P<.01). Patients reported that 25 years of awareness of hyperlipidemia had influenced health concerns through a moderate change in diet habits, some restriction in life conduct, but an improvement of the total life situation.After a novel 3-year intervention in DOIT, there was no difference between the dietary counseling and control group with regard to anxiety, depression, or life satisfaction, but HADS-anxiety increased significantly (4.0 vs. 3.3, P<.001) in both groups.Conclusion: Compared to the general population, screening-positive subjects did not have increased mental distress 25 years after screening, and beneficial health behavior persisted. Dietary counseling did not affect psychosocial outcomes.

Biopsychosocial impact of the voice in relation to the psychological features in female student teachers - Corrected Proof

Leo F.P. Meulenbroek, George Thomas, Piet G.C. Kooijman, Felix I.C.R.S. de Jong — 2009-12-14

Abstract: Objective: The aim of the study was to assess biopsychosocial impact of the voice in relation to the psychological features in female student teachers.Methods: This research was a cross-sectional study in 755 student teachers using general questionnaires, the Voice Handicap Inventory (VHI), Type D Scale-16, Symptom Check List (SCL-90), and Utrecht Coping List (UCL). Student teachers with a relative high score on the VHI (>75th percentile) and students with a relative low score (<25th percentile) were compared.Results: Type D student teachers had a 4× greater risk of a high VHI-score (OR 4.23) than the non-type-D group. The student teachers with relative high VHI scores scored significantly higher (P<.001) on the SCL-90 total and all subscales, compared to the student teachers with relative low VHI scores. Furthermore, the students with a relative high VHI score had significant high scores on the subscales passive attitude (P<.001), palliative reactions (P<.001), avoidance and a waiting attitude (P<.001), and expression of emotions (P=.003) of the UCL.Conclusion: This study showed that a relative high biopsychosocial impact of the voice is related to the personality trait Type D, psychosomatic well-being and coping strategies in female student teachers.These features should be implemented in screening and training programs for students for a voice demanding profession. The students have to be prepared to cope with psychological, physical and vocal demands of the teaching profession. The speech therapist (of the vocational university) has to be aware of an important role in coaching the students into a more active coping attitude.

Measuring fatigue in clinical and community settings - Corrected Proof

Matteo Cella, Trudie Chalder — 2009-12-11

Abstract: Objective: The Chalder Fatigue Scale (CFQ) is a widely used instrument to assess fatigue in both clinical and nonclinical settings. Psychometric properties of the scale and discriminative abilities were examined.Methods: A total of 361 patients with CFS and 1615 individuals in the community were assessed with the CFQ. Principal component analysis (PCA) was used to explore the structure of the scale. Receiver-operating characteristic curve (ROC) was used to investigate the discriminative properties.Results: Two components, physical and mental fatigue, were identified in the CFS patient group and in the general population samples. Area under the curve for ROC was .91. The fatigue scale effectively discriminates, at high scores, between CFS patients and the general population.Conclusion: Physical and mental fatigue are clearly separable components of fatigue. The CFQ can discriminate reliably between clinical and nonclinical conditions.

Patients with medically unexplained symptoms and their significant others: Illness attributions and behaviors as predictors of patient functioning over time - Corrected Proof

Anja Hilbert, Alexandra Martin, Thomas Zech, Elisabeth Rauh, Winfried Rief — 2009-12-10

Abstract: Objective: Previous research suggests that medically unexplained symptoms (MUS) are maintained in an interpersonal context. The current study examined MUS concurrently and prospectively by measuring specific interpersonal predictors of symptom severity and health care use.Methods: A total of 127 patients with MUS and their significant others were recruited through primary care offices and assessed with self-report questionnaires and structured interviews about illness attributions, illness behavior and responses, relationship quality, symptom severity, and health care use at baseline and 6-month follow-up.Results: Illness attributions and interpersonal illness behaviors of patients with MUS were cross-sectionally associated with illness attributions and responses of the patients' significant others. Relationship quality was related to specific illness behaviors and responses. Symptom severity at baseline was predicted by patients' somatic illness attributions. Symptom severity at 6-month follow-up was predicted by somatic illness attributions of patients and withdrawal of patients' significant others at baseline, but these predictors became insignificant when correcting for baseline symptomatology. Health care use at baseline was predicted by a greater amount of coping behavior and higher anxiety scores of patients, and health care use at 6-month follow-up was predicted by more attention-seeking behaviors and health care use of patients at baseline.Conclusion: The results document the interpersonal influences on the maintenance of MUS. The perspective of significant others should be considered for enhancement of psychological approaches to the treatment of patients with MUS.

Evaluation of the structure of Brazilian State-Trait Anxiety Inventory using a Rasch psychometric approach - Corrected Proof

2009-12-10

Abstract: Objective: This study evaluates the State-Trait Anxiety Inventory (STAI) structure using a Rasch psychometric approach, and a refined and shorter STAI version is proposed.Methods: A cross-sectional study was performed with 900 inpatients scheduled for elective surgery. Age varied from 18 to 60 years (American Society of Anesthesiologists physical status I–III). Demographic information was collected using a structured questionnaire. The measuring instrument (the STAI) was applied to all patients in the afternoon before the surgery and prior to the patients receiving preoperative sedatives.Results: Rasch analysis of the state and trait anxiety scales was performed separately. This analysis demonstrated that the original format of state and trait scales fails to show invariance across the trait-state anxiety level, which results in the unstable performance of items. The refined scale was retested in two subsequent random samples of 300 subjects each, and the results were confirmed. The performance was adequate regardless of gender. In the analysis, some items of the state scale (items 3,4,9,10,12,15, and 20) were deleted due to poor fit statistics. The remaining 13 items showed unidimensionality, local independence, and adequate index of internal consistency. Also, the original trait scale displayed several weaknesses. First, the four-point Likert response scale proved to be inadequate, and threshold disorders were found in all 20 items. Also, the original trait scale showed insufficient item-trait interaction and several individual item misfits. Following the rescoring process, and retesting in a second random sample, items were excluded (namely Items 3, 4, 11, 13, 14, 15, 18, and 19). The refined version showed local independence, unidimensionality, and adequate fit statistics.Discussion: The results indicate that the application of the Rasch model led to the refinement of the classic STAI state and trait scales. In addition, they suggest that these shorter versions have a more suitable psychometric performance and are free of threshold disorders and differential item functioning problems.

The Beliefs about Emotions Scale: Validity, reliability and sensitivity to change - Corrected Proof

Katharine A. Rimes, Trudie Chalder — 2009-12-10

Abstract: Objective: Beliefs about the unacceptability of experiencing or expressing negative emotions have been noted in individuals with a range of problems, including chronic fatigue syndrome (CFS), irritable bowel syndrome, somatization disorder, depression, eating disorders, social phobia, posttraumatic stress disorder, and borderline personality disorder. These beliefs are likely to have implications for emotion regulation and processing, and are addressed explicitly or implicitly within many therapies including cognitive behavior therapy (CBT), mindfulness-based cognitive therapy (MBCT), and Acceptance and Commitment Therapy (ACT). This article describes the development, validation, and internal reliability of the Beliefs about Emotions Scale (BES), a self-report questionnaire to assess such beliefs.Methods: The new scale was completed by people with CFS (n=121) and healthy controls (n=73). Twenty-two individuals with CFS completed the scale before and after CBT.Results: People with CFS had significantly higher scores on this new questionnaire than healthy controls. Principal components analysis identified one factor, and the scale had high internal consistency (0.91). Scores on the BES were most highly correlated with a measure of negative perfectionism (r=0.59) and also showed significant correlations with measures of dysfunctional attitudes, self-sacrifice, depression, anxiety, and fatigue. When completed before and after CBT for CFS, the questionnaire was sufficiently sensitive to detect a significant reduction in endorsement of unhelpful beliefs about emotions.Conclusion: The new Beliefs about Emotions Scale showed good internal reliability, validity and sensitivity to change.

The effects of mindfulness-based stress reduction therapy on mental health of adults with a chronic medical disease: A meta-analysis - Corrected Proof

Ernst Bohlmeijer, Rilana Prenger, Erik Taal, Pim Cuijpers — 2009-12-10

Abstract: Objectives: The objective of this study was to examine the effectiveness of mindfulness-based stress reduction (MBSR) on depression, anxiety and psychological distress across populations with different chronic somatic diseases.Methods: A systematic review and meta-analysis were performed to examine the effects of MBSR on depression, anxiety, and psychological distress. The influence of quality of studies on the effects of MBSR was analyzed.Results: Eight published, randomized controlled outcome studies were included. An overall effect size on depression of 0.26 was found, indicating a small effect of MBSR on depression. The effect size for anxiety was 0.47. However, quality of the studies was found to moderate this effect size. When the studies of lower quality were excluded, an effect size of 0.24 on anxiety was found. A small effect size (0.32) was also found for psychological distress.Conclusions: It can be concluded that MBSR has small effects on depression, anxiety and psychological distress in people with chronic somatic diseases. Integrating MBSR in behavioral therapy may enhance the efficacy of mindfulness based interventions.

Adult attachment measures: A 25-year review - Corrected Proof

Paula Ravitz, Robert Maunder, Jon Hunter, Bhadra Sthankiya, William Lancee — 2009-12-07

Abstract: Objective: Over the past 25 years, attachment research has extended beyond infant–parent bonds to examine dyadic relationships in children, adolescents, and adults. Attachment has been shown to influence a wide array of biopsychosocial phenomena, including social functioning, coping, stress response, psychological well-being, health behavior, and morbidity, and has thus emerged as an important focus of psychosomatic research. This article reviews the measurement of adult attachment, highlighting instruments of relevance to—or with potential use in—psychosomatic research.Methods: Following a literature search of articles that were related to the scales and measurement methods of attachment in adult populations, 29 instruments were examined with respect to their utility for psychosomatic researchers.Results: Validity, reliability, and feasibility were tabulated on 29 instruments. Eleven of the instruments with strong psychometric properties, wide use, or use in psychosomatic research are described. These include the following: Adult Attachment Interview (George, Kaplan, and Main); Adult Attachment Projective (George and West); Adult Attachment Questionnaire (Simpson, Rholes, and Phillips); Adult Attachment Scale (and Revised Adult Attachment Scale) (Collins and Read); Attachment Style Questionnaire (Feeney); Current Relationship Interview (Crowell and Owens); Experiences in Close Relationships (Brennan, Clark, and Shaver) and Revised Experiences in Close Relationships (Fraley, Waller, and Brennan); Parental Bonding Instrument (Parker, Tupling, and Brown); Reciprocal Attachment Questionnaire (West and Sheldon-Keller); Relationship Questionnaire (Bartholomew and Horowitz); and Relationship Scales Questionnaire (Grifiin and Bartholomew).Conclusion: In addition to reliability and validity, investigators need to consider relationship focus, attachment constructs, dimensions or categories of interest, and the time required for training, administration, and scoring. Further considerations regarding attachment measurement in the context of psychosomatic research are discussed.

Health-related quality-of-life profiles in nonalexithymic and alexithymic subjects from general population - Corrected Proof

2009-12-07

Abstract: Objective: Earlier studies have shown an association between alexithymia and health-related quality of life (HRQoL). There has been some controversy as to whether this is attributable solely to psycho-social domains of HRQoL or also to physical domains. Furthermore, there are no studies on HRQoL profiles in representative general population samples controlling for sociodemographic variables, mental health and somatic health.Methods: The study forms part of the Health 2000 Study. Altogether 5090 participants from general population, aged 30-97 years, filled in the 20-item Toronto Alexithymia Scale and the 15D HRQoL scale. Depressive and anxiety disorders were assessed in a structured psychiatric interview. Physical health was examined by physicians. The 15-dimension HRQoL profiles of both alexithymic and non-alexithymic subjects were obtained by analysis of covariance, controlling for sociodemographic and health-related variables.Results: The alexithymic group had significantly (P<.001) lower mean scores on every dimension of the 15D even after controlling for confounding demographic variables, somatic diagnoses and depressive and anxiety disorders. The differences were greatest in the psycho-social domains.Conclusions: Alexithymia seems to be a personality trait with a statistically significant association to every dimension of HRQoL, not only to psychosocial domains. However, the associations between alexithymia and some somatic dimensions may be of little clinical significance.

Social support concepts and measures - Corrected Proof

Benjamin H. Gottlieb, Anne E. Bergen — 2009-12-07

Abstract: Distinctions among concepts and approaches to assessing social support are made, and published generic and specialized measures of social support are reviewed. Depending on study aims, investigators may be interested in assessing perceived or received support from the perspective of the provider, the recipient, or both. Whereas some measures inquire about the availability or mobilization of several kinds of supportive resources, others seek supplemental information about the membership and structural properties of the social network as well. Observational and self-reported measures of support are presented, along with brief and extensive measures. A final set of three support measures is highlighted, including their psychometric properties.

A medical record review for functional somatic symptoms in children - Corrected Proof

2009-12-07

Abstract: Objective: The objectives of this study were to develop and test a systematic medical record review for functional somatic symptoms (FSSs) in paediatric patients and to estimate the inter-rater reliability of paediatricians' recognition of FSSs and their associated impairments while using this method.Methods: We developed the Medical Record Review for Functional Somatic Symptoms in Children (MRFC) for retrospective medical record review. Described symptoms were categorised as probably, definitely, or not FSSs. FSS-associated impairment was also determined. Three paediatricians performed the MRFC on the medical records of 54 children with a diagnosed, well-defined physical disease and 59 with ‘symptom’ diagnoses. The inter-rater reliabilities of the recognition and associated impairment of FSSs were tested on 20 of these records.Results: The MRFC allowed identification of subgroups of children with multisymptomatic FSSs, long-term FSSs, and/or impairing FSSs. The FSS inter-rater reliability was good (combined kappa=0.69) but only fair as far as associated impairment was concerned (combined kappa=0.29).Conclusions: In the hands of skilled paediatricians, the MRFC is a reliable method for identifying paediatric patients with diverse types of FSSs for clinical research. However, additional information is needed for reliable judgement of impairment. The method may also prove useful in clinical practice.

Illness beliefs before cardiac surgery predict disability, quality of life, and depression 3 months later - Corrected Proof

2009-12-07

Abstract: Objective: The purpose of this study was to examine the influence of patients' presurgery illness beliefs and cardiac risk factors on health-related outcomes 3 months following cardiac surgery.Methods: In a prospective design, 56 patients undergoing elective cardiac surgery (coronary artery bypass grafting (CABG), heart valve surgery, or a combined procedure) were approached on admission to hospital and reassessed 3 months after surgery. Presurgery assessment included cardiac risk factors and measures of illness severity. Illness beliefs were assessed using the Illness Perception Questionnaire–Revised (IPQ-R). Outcome measures included levels of illness-related disability, physical functioning, psychological well-being, and depressive symptoms.Results: Physical functioning of patients improved 3 months after surgery, while disability and psychological well-being did not change significantly. Cardiac risk factors prior to surgery were unrelated to the outcomes 3 months later. With the use of hierarchical multiple regression analyses, after controlling for demographic variables and baseline scores of outcome variables, patients' beliefs about their illness predicted disability (adjusted R2=.350, P<.01), physical functioning (adjusted R2=.283, P<.01), and depressive symptoms (adjusted R2=.302, P<.01). Illness severity measures did not mediate the association between illness beliefs and outcomes.Conclusion: Patients' beliefs about their illness before surgery strongly influence recovery from cardiac surgery. The results suggest that patients could benefit from presurgery cognitive interventions aimed at changing maladaptive illness beliefs to improve physical functioning and disability following cardiac surgery.

Assessment of depression in Parkinson's disease: the contribution of somatic symptoms to the clinimetric performance of the Hamilton and Montgomery–Åsberg rating scales - Corrected Proof

Jennifer S.A.M. Reijnders, Richel Lousberg, Albert F.G. Leentjens — 2009-12-07

Abstract: Objective: To assess the influence of somatic symptoms of the Hamilton Depression Rating Scale (HAMD) and Montgomery–Åsberg Depression Rating Scale (MADRS) on the clinimetric performance of these scales in patients with Parkinson's disease (PD).Methods: A total of 224 patients underwent a protocolized mental status examination, consisting of the Structured Clinical Interview for DSM-IV depressive disorder (SCID-D), as well as the HAMD and MADRS. Sensitivity, specificity, positive, and negative predictive values for a range of cut-off scores were calculated for both rating scales and for modified versions of these scales in which all somatic items were eliminated. In addition, receiver operating characteristic (ROC) curves were obtained for both the modified and unmodified scales.Results: Elimination of the somatic items of depression from the HAMD and MADRS resulted in a reduced specificity of both the HAMD and the MADRS, and an increased sensitivity of the MADRS.Conclusion: The authors recommend the full version of the HAMD and MADRS if used for diagnostic purposes; for screening purposes, the abbreviated version without somatic items can be used. Additional advantages of using full rating scales, with somatic items included, are that these provide more information on the severity of depression and allow for easier comparison across studies.

The HSCL-20: One questionnaire, two versions - Corrected Proof

Jane Walker, Michael Sharpe, Kurt Kroenke, Gordon Murray — 2009-12-07

The Hopkins Symptom Checklist Depression Scale (HSCL-20) is a widely used 20-item self-rated measure of depression severity, often assumed to be a subscale of the HSCL-90 . Patients complete the HSCL-20 by reporting how distressed they have been by each of the listed symptoms over the preceding 2 weeks, using a five-point scale that ranges from “not at all” to “extremely.” Its ease of administration and face validity have made the HSCL-20 a popular choice for researchers, and it has been used as a measure of depression severity in a number of major clinical trials of depression management, particularly those carried out in primary care and in nonpsychiatric settings .

Measures of stress in epidemiological research - Corrected Proof

2009-11-26

Abstract: A comprehensive assessment of psychosocial stress often poses significant challenges due to diversity in conceptualization of stress. Consequently, a number of instruments that measure psychosocial stress, its stressors, and its impact at the individual, organizational, and societal levels have been developed. This article aims to provide a brief review of such instruments, focusing on established questionnaire and interview measures in line with the environmentalist and psychological conceptualizations of stress. This includes measures of major life events; work, marital, and social stress; the individual's coping abilities; and psychological and somatic outcomes of stress. We provide a general description of selected instruments and discuss their administration, scoring, and psychometric properties. Appropriate application of these instruments in epidemiological and clinical research, as well as in inpatient care, can aid the detection of psychosocial stress, support thorough assessment and management of the individual's illness, and ensure accurate identification of individuals who would benefit from specific behavioral (psychotherapeutic) interventions.

Can we increase adherence to treatment recommendations of the consultation psychiatrist working in a general hospital? A systematic review - Corrected Proof

Albert F.G. Leentjens, Annette D. Boenink, Christina M. van der Feltz-Cornelis — 2009-11-20

Abstract: Background: Adherence to advice given by the consultation–liaison (CL) psychiatrist is a prerequisite for the effectiveness and success of psychiatric consultation. It is unknown which factors are associated with better adherence to advice.Aim: To review the adherence of consultees with advice given by the psychiatrist during inpatient consultation.Method: Systematic literature review.Results: Eighteen studies reported on the level of adherence with recommendations given by the consultation psychiatrist in a hospital setting. All were retrospective cohort studies conducted before 1998. Thirteen of these reported on the association between clinical variables and the level of adherence.The median level of adherence with diagnostic advice was 56% (range 29–75%), with medication advice 79% (range 68–98%), and with discharge advice 91% (range 85–95%). Patient-related variables were not associated with adherence, nor were consultee-related variables. Consultant-related variables associated with adherence were level of professional expertise, organizing liaison activities, following up on patients after initial consultation, and prescription of medication by the consultant during the consultation.Conclusion: This review provides evidence for a role of consultant characteristics and an active approach of the consultant in terms of CL activities as well as consultation procedures, in attaining adherence to advice. Prospective qualitative research is needed to identify consultation methods that may further enhance adherence.

Commentary on the paper “Is alexithymia a risk factor for major depression, personality disorder, or alcohol use disorders? A prospective population-based study” - Corrected Proof

Olivier Luminet — 2009-11-18

The main aim of the study conducted by Honkalampi et al . was to examine whether alexithymia (and depression) scores at three different times predict major depression, personality disorder, and alcohol use disorders 7 years after the first data collection in a population-based sample. The key issue was thus to assess the ability of the two constructs to predict new cases of psychiatric disorders in the future. This data set tested whether, in a large group of healthy people, alexithymia is a predisposing or vulnerability factor that influences the onset or course of psychiatric disorders.

The effectiveness of bibliotherapy in alleviating tinnitus-related distress - Corrected Proof

John M. Malouff, William Noble, Nicola S. Schutte, Navjot Bhullar — 2009-11-04

Abstract: Objective: The present study examined the efficacy of bibliotherapy in assisting individuals experiencing distress related to tinnitus.Methods: One hundred sixty-two tinnitus sufferers from Australia participated in a study designed to examine the effectiveness of a cognitive–behaviorally based self-help book in reducing distress.To maximize the ecological validity of the findings, we excluded no individuals interested in treatment for tinnitus-related distress.Results: The experimental condition lost 35% of participants at postassessment, compared to 10% in the control group. In an analysis of participants who completed postintervention assessment, those assigned to the intervention condition, who received a tinnitus self-help book, showed significantly less tinnitus-related distress and general distress 2 months later compared to those assigned to the waiting list control condition. The intervention group's reduction in tinnitus-related distress and general distress from preintervention to postintervention 2 months later was significant, and these participants maintained a significant reduction in distress on follow-up 4 months after they received the tinnitus self-help book. A long-term follow-up of all participants, who at that time had received the book at least a year previously, showed a significant reduction in tinnitus distress. Although these group differences and pre–post changes were significant, effect sizes were small. Intention-to-treat analyses showed no significant effect for between-groups analyses, but did show a significant effect for the 1-year follow-up pre–post analysis.Conclusion: Information on the effectiveness of using a self-help book, without therapist assistance, in alleviating distress is important, as bibliotherapy can provide inexpensive treatment that is not bound by time or place.

Structured education program improves the coping with atopic dermatitis in children and their parents—a multicenter, randomized controlled trial - Corrected Proof

2009-10-05

Abstract: Objective: The objective of this study was to prove training-specific effects in children with atopic dermatitis (AD) and their parents concerning coping with the disease after their participation in a training program. In the 1-year follow-up, the changes in the training group were compared to the changes in a waiting control group while controlling the effects of the changes in severity scores.Methods: One hundred eighty-five children aged 8–12 years and their parents participated in the study. Complete data sets at the 1-year follow-up were available for 185 parent-child pairs (102 training group; 83 waiting control group). In addition to the severity of the AD [measured with the Scoring Atopic Dermatitis (SCORAD)], data on children's itching-scratching cognitions and coping behavior and on parents handling their affected children were used in the analysis. To study whether the intervention group experienced an additional psychological benefit, which is not due to the SCORAD values, analyses of covariance with repeated measures with standardized residual change scores of the SCORAD as covariate were calculated.Results: The intervention group showed greater improvement in children's coping behavior and in parents' handling their affected children. Additional effects of the training program not due to somatic improvement could be seen in the scales of itching-scratching cognitions and in three of four scales on parents dealing with their affected children.Conclusion: The training program, which was tested in the German Atopic Dermatitis Intervention Study, had effects on almost all explored psychological variables. Therefore, additional psychological benefit in the training group does not only depend on the greater improvement of SCORAD values in this group.

Managing complex patients on a medical psychiatric unit: An observational study of university hospital costs associated with medical service use, length of stay, and psychiatric intervention - Corrected Proof

2009-10-05

Abstract: Objective: Although there is a suggestion that the medical psychiatric unit (MPU) may reduce length of hospital stay (LOS), little is known about costs in terms of medical service use and psychiatric interventions in MPU care.Method: A record linkage study was conducted, linking cost data of hospital medical service use, LOS, and hospital psychiatric interventions to patients admitted to the MPU of the Maastricht University Medical Centre (MUMC) between 1998 and 2004. The data set was analyzed to enable comparison between cost changes of the same complex patient population following either MPU index admission or index admissions to reference MUMC medical wards.Results: Comparisons revealed lower costs of medical service use in favor of the MPU (−€104; 95% CI −€174 to −€35; P<.01). However, cost of psychiatric intervention and cost of LOS were higher after MPU admission (respectively, +€165; 95% CI +€25 to +€305; P<.05; and +€202; 95% CI +€170 to +€235; P<.001). Total costs were higher after MPU admission compared to medical ward admission (+€263; 95% CI +€68 to +€458; P<.05). These differences were not moderated by somatic diagnosis or previous pattern of admissions.Conclusion: The findings suggest that patients at the interface of psychiatric and somatic morbidity are diagnosed and treated adequately at the MPU, leading to a decrease in medical service use and an appropriate increase in exposure to psychiatric interventions. These results are specifically generalizable to MPUs with a focus on psychosomatic conditions, for instance, somatoform disorders or affective disorders with comorbid somatic diseases. However, failure to show cost savings in terms of LOS compared to medical wards outweighs cost–benefit derived from lower medical service use, suggesting that MPU activities may gain in cost-effectiveness if shifted more to outpatient psychosomatic care solutions.

Measurement of self-reported pain intensity in children and adolescents - Corrected Proof

Anna Huguet, Jennifer N. Stinson, Patrick J. McGrath — 2009-10-05

Abstract: Acute and chronic pain is a common experience in children and youth. A thorough assessment is fundamental to understand this experience and to assess and monitor treatment responses. The intensity of pain is the parameter most commonly assessed. In this article, we describe the different methods employed to assess pediatric pain intensity and review well-validated and commonly used self-report measures of pain. This review is based on the recent systematic reviews conducted for the Pediatric Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials Consensus Group and the Society of Pediatric Psychology. Amongst the several types of pediatric pain measures, self-report, when available, is regarded as the primary source of information about pain intensity, to be complemented by observation and knowledge of the context. There is a large number of self-report measures of pediatric pain intensity; and there is some agreement that professionals in the clinical and research practice should assess pain intensity using the Pieces of Hurt Tool, the Faces Pain Scale, the Oucher, or Visual Analogue Scales because these measures have shown to have sound psychometric properties and clinical utility. Despite the increased number of age-appropriate self-report measures of pediatric pain intensity over the last years, we report several research gaps and priorities of future research.

Cost outcomes on a medical psychiatry unit - Corrected Proof

Roger G. Kathol — 2009-10-05

Nearly 30 years ago, I was privileged to visit a medical psychiatry unit (MPU) similar to the one described by Leue et al. at Duke University. It was one of few MPUs in operation in the United States in the early 1980s and had the charge of assisting patients with psychosomatic illness . Within 2 years of my visit, the unit closed. Personal discussions with Alan Stoudemire, its medical director, suggested that lengths of stay had been considered too long and that the treatments being given could have been provided less expensively in the outpatient setting. Other than improved access to psychiatric care, there were no data showing change in patient outcomes; thus the unit closed.

Measures of self-perceived well-being - Corrected Proof

Ian McDowell — 2009-10-05

Abstract: As people lead longer and generally healthier lives, aspirations and expectations of health care extend to include well-being and enhanced quality of life. Several measurement scales exist to evaluate how well health care reaches these goals. However, the definitions of well-being or quality of life remain open to considerable debate, which complicates the design, validation, and subsequent choice of an appropriate measurement.Objective: This article reviews nine measures of psychological well-being, tracing their origins in alternative conceptual approaches to defining well-being. It compares their psychometric properties and suggests how they may be used.Methods: The review covers the Life Satisfaction Index, the Bradburn Affect Balance Scale, single-item measures, the Philadelphia Morale scale, the General Well-Being Schedule, the Satisfaction With Life scale, the Positive and Negative Affect Scale, the World Health Organization 5-item well-being index, and the Ryff's scales of psychological well-being.Results: Scales range in size from a single item to 22; levels of reliability and validity range from good to excellent, although for some of the newer scales we lack information on some forms of validity.Conclusion: Measures exist to assess several conceptions of psychological well-being. Most instruments perform adequately for survey research, but we know less about their adequacy for use in evaluating health care interventions. There remains active debate over how adequately the questions included portray the theoretical definition of well-being on which they are based.

Is alexithymia a risk factor for major depression, personality disorder, or alcohol use disorders? A prospective population-based study - Corrected Proof

2009-09-24

Abstract: Objective: Disagreements concerning the stability of alexithymia and its ability to predict subsequent psychiatric disorders prevail. The aim of this 7-year follow-up study was to examine whether alexithymia predicts subsequent major depression, personality disorder, or alcohol use disorders in a population-based sample.Methods: The four-phase Kuopio Depression Study (KUDEP) was conducted in the eastern part of Central Finland. The study population (aged 25–64, n=2050) was randomly selected from the National Population Register. Data were collected in 1998, 1999, and 2001. In 2005, a subsample (n=333, 43 were excluded) of the 3-year follow-up population (1998–2001) was gathered and their diagnoses of mental disorders were confirmed by the Structure Clinical Interview for DSM-IV Axis I (SCID-I). Alexithymia was measured using the Toronto Alexithymia Scale (TAS-20) and depressive symptoms using the Beck Depression Inventory (BDI-21). For both of these measures, two groups were formed based on the median of their sum score (summing the 1998, 1999, and 2001 scores). Logistic regression analyses were performed.Results: BDI sum scores, but not those of TAS, were associated with subsequent major depressive disorder, personality disorder, and alcohol use disorders in 2005. The BDI sum scores explained 35.7% of the variation in concurrent TAS sum scores.Conclusion: Alexithymia did not predict diagnoses of major depressive disorder, personality disorder, or alcohol use disorders. Alexithymia was closely linked to concurrent depressive symptoms. Thus, depressive symptoms may act as a mediator between alexithymia and psychiatric morbidity.

Assessment methods for eating disorders and body image disorders - Corrected Proof

Ferenc Túry, Hayriye Güleç, Elisabeth Kohls — 2009-09-24

Abstract: The growing interest in the treatment and research of eating disorders has stimulated the development of assessment methods, and there are now many questionnaires for evaluating behavioral and attitudinal characteristics of eating pathology. The present article sets out to review the assessment tools that are widely used in clinical practice and research. In particular, it covers self-report measures with summaries of their psychometric properties. It also presents diagnostic questionnaires based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, diagnostic criteria. The instruments described include screening questionnaires, measurement tools for specific eating disorder symptoms, measurement of quality of life in eating disorders, and some tools for the measurement of body image disorder, a common feature of eating disorders. There is also a discussion of distorting factors that decrease the authenticity of assessment tools. These problems arise from the definition of some constructs and from the phenomena of denial and concealment, which are frequent among eating-disordered individuals. The frequent co-occurrence of other psychopathological features (e.g., multiimpulsive symptoms) shows that other psychological phenomena should also be evaluated in line with the assessment of eating disorders.

Measurement of psychiatric treatment adherence - Corrected Proof

2009-07-27

Abstract: Objective: Nonadherence to medications for mental disorders substantially limits treatment effectiveness and results in higher rates of relapse, hospitalization, and disability. Accurate measurement of medication adherence is important not only in adherence research but also in clinical trials in which medications are being evaluated and in clinical practice where failure to detect nonadherence results in premature medication changes, unnecessary polypharmacy, and greater likelihoods of functional deteriorations and hospitalizations. This is a review of psychiatric treatment adherence methods and measures arising from a meeting on “Methodological Challenges in Psychiatric Treatment Adherence Research” held on September 27–28, 2007, in Bethesda, MD, and organized by the National Institute of Mental Health (NIMH).Methods: This paper reviews the range of modalities currently available for assessing adherence behavior including pill counts, pharmacy records, technology-assisted monitoring, biological assays, and a range of self-report and interviewer-rated scales. Measures of adherence attitudes are also reviewed.Results: Each of the adherence measures described are imperfect estimates of actual medication ingestion, but each provides informative estimates of adherence or the attitudinal factors associated with adherence. Measure selection depends on a range of factors including the patient sample, the context in which the measure is being used, and the clinical outcomes expected from various levels of nonadherence. The use of multiple measures of adherence is encouraged to balance the limitations of individual measures.Conclusion: While adherence assessment has become increasingly sophisticated in recent years, there remains a need for refinement and expansion on currently available methods and measures.

The psychological impact of accidents on recreational divers: A prospective study - Corrected Proof

Andrew Trevett, David Peck, Robert Forbes — 2009-07-21

Abstract: Objective: The present study aimed to examine the medium and long term psychological impact of diving accidents on the victims (n=52), compared with the impact on two control groups: the victim's diving “buddy” (n=40) who simply witnessed the accident, and a second control from the same boat who did not dive with the victim (n=38).Methods: This was a prospective cohort study of the impact of an accident on the victims who attended the Hyperbaric Unit, in comparison with the two control groups. Pre-accident psychological morbidity was assessed using the General Health Questionnaire. Trauma symptoms were assessed using the Revised Impact of Events Scale at 3, 6 and 12 months post accident.Results: The accident victims endorsed more trauma symptoms and experienced them more intensely and for longer, compared with the two control groups.Conclusion: A significant minority of diving accident victims (between 25% and 50%) continued to suffer from the psychological impact of the accident, some for over a year. This has important implications for their future health care, for their safety on subsequent dives, and for dive training.

Using the Illness Intrusiveness Ratings Scale to understand health-related quality of life in chronic disease - Corrected Proof

Gerald M. Devins — 2009-07-21

Abstract: Objective: Illness intrusiveness is a common, underlying determinant of quality of life in people affected by chronic disease. Illness intrusiveness results from disease- and treatment-induced disruptions to lifestyles, activities, and interests (i.e., interference with psychologically meaningful activity). This paper introduces the Illness Intrusiveness Ratings Scale (IIRS), a 13-item, self-report instrument. The IIRS can be scored to generate a total score or three subscale scores: relationships and personal development, intimacy, and instrumental. In addition to describing the IIRS, the paper presents the theoretical framework in which it is anchored, reviews the evidence, and reports psychometric properties.Methods: Qualitative literature review.Results: Findings support the IIRS's reliability (internal consistency and test–retest), validity (construct, criterion-related, and discriminant), sensitivity to change, and factorial invariance across numerous chronic-disease groups. The paper reports IIRS reliability coefficients and normative statistics for 36 chronic, medical and psychiatric patient populations.Conclusion: The IIRS taps the extent to which disease- and treatment-related factors interfere with psychologically meaningful activity among people affected by chronic disease. It provides a valid, reliable measure that is easy to administer and unequivocally interpretable rendering it suitable for research designed to estimate the psychosocial impact of chronic disease and to document (and compare) the effectiveness of therapeutic interventions.

Assessment of mood: Guides for clinicians - Corrected Proof

Toshi A. Furukawa — 2009-07-13

Abstract: Objective: This article is one of the series of review articles aiming to present a convenient guideline for practicing clinicians in their selection of scales for clinical and research purposes. This article focuses on assessment scales for mood (depression, mania).Methods: After reviewing the basic principles of clinical psychometrics, we present a selective review of representative scales measuring depressed or manic mood.Results: We reviewed and reported on reliability, validity, interpretability, and feasibility of the following rating scales: Patient Health Questionnaire-9 (PHQ-9), K6, Beck Depression Inventory II (BDI-II), and Quick Inventory of Depressive Symptomatology Self-Report (QIDS-SR) as self-report scales for depressed mood; Hamilton Rating Scale for Depression (HAM-D) and Montgomery–Asberg Depression Rating Scale (MADRS) as clinician-administered measure for depression; and Young Mania Rating Scale (YMRS) as a clinician-administered instrument for mania.Conclusion: Although the rating scales for mood represent a well-trodden terrain, this brief review of the most frequently used scales in the literature revealed there is still some room for improvement and for further research, especially with regard to their clinical interpretability.