Spirituality in HIV+ Patient Care

For individuals coping with chronic illnesses such as HIV, spirituality and religion are often centrally important as patients face a unique array of existential challenges as a result of the diagnosis and management of the disease. It is critical for healthcare providers to be cognizant of the spiritual component of HIV/AIDS and to be knowledgeable regarding what the current literature base suggests in terms of addressing spirituality with patients. This Psychiatry Issue Brief provides an overview of the role of spirituality for individuals living with HIV, and offers recommendations for service providers

Pain, Spirituality, and Meaning Making: What Can We Learn from the Literature?

Religion and spirituality are two methods of meaning making that impact a person’s ability to cope, tolerate, and accept disease and pain. The biopsychosocial-spiritual model includes the human spirit’s drive toward meaning-making along with personality, mental health, age, sex, social relationships, and reactions to stress. In this review, studies focusing on religion’s and spirituality’s effect upon pain in relationship to physical and mental health, spiritual practices, and the placebo response are examined. The findings suggest that people who are self efficacious and more religiously and spiritually open to seeking a connection to a meaningful spiritual practice and/or the transcendent are more able to tolerate pain

The relationship between spirituality and burnout among medical students

Medical student burnout has been associated with depression, loss of empathy, and suicidal ideation. Spirituality has been identified in previous studies as a protective factor in coping with the stress but has not been examined as a factor in medical student burnout. An internet link to an anonymous survey was sent via email to medical students at a public northeastern medical school; 259/469 (55.2%) completed it. The survey included measures of spirituality, burnout, psychological distress, coping, and general happiness. A Pearson-r correlation showed significant inverse correlations between measures of spirituality and measures of psychological distress/burnout (r\u27s ranging from -.62 to -.14; p\u27s \u3c .01). In contrast, a positive correlation was found between life satisfaction and spirituality (r\u27s .53 to .12; p \u3c .05). Using hierarchical multiple regression with demographics (Step 1), mental health variables (Step 2), and satisfaction and Adaptive coping (Step 3), burnout remained significantly related to lower scores on both spirituality measures (FACIT-SP p \u3c .00 and DSE p \u3c .05). Students having higher levels of spiritual well being and daily spiritual experiences described themselves as more satisfied with their life in general, while students with low scores on spiritual well being and daily spiritual experiences had higher levels of psychological distress and burnout. Spirituality may therefore be a protective factor against burnout in medical students and future studies should explore potential causal relationships

A Review of the Korean Cultural Syndrome Hwa-Byung: Suggestions for Theory and Intervention

The purpose of this paper is to review Hwa-Byung, a cultural syndrome specific to Koreans and Korean immigrants. Hwa-Byung is a unique diagnosis and differs from other DSM disorders. However, Hwa-Byung has frequent comorbidity with other DSM disorders such as anger disorders, generalized anxiety disorder, and major depressive disorder. There are several risk factors for Hwa-Byung including psychosocial stress caused by marital conflicts and conflicts with their in-laws. Previous interventions of the Hwa-Byung syndrome were based primarily on the medical model. Therefore, based on previous research, we present a new ecological model of Hwa-Byung. We also recommend some areas of future research as well as present some limitations of our ecological model. Finally, we discuss some treatment issues, particularly for Korean women in the United States

Migraine: treatments, comorbidities, and quality of life, in the USA

This study sought to characterize the experience of stress, treatment patterns, and medical and disability profile in the migraineur population to better understand how the experience of migraines impacts the social and psychological functioning of this group. A 30-minute self-report survey was presented via a migraine-specific website with data collection occurring between May 15 and June 15, 2012. Recruitment for the study was done through online advertisements. In total, 2,907 individuals began the survey and 2,735 met the inclusion criteria for the study. The sample was predominantly female (92.8%). Migraine-associated stress was correlated with length of time since first onset of symptoms (P \u3c 0.01) and number of symptoms per month (P \u3c 0.01). Disorders related to stress, such as depression (P \u3c 0.01) and anxiety (P \u3c 0.01), were also positively correlated with the measured stress resulting from migraines. Migraine-associated stress must be understood as a multidimensional experience with broader impacts of stress on an individual correlating much more highly with negative mental and physical health profiles. Stress resulting from frequent migraine headaches may contribute to the development of medical and psychological comorbidities and may be a part of a cyclical relationship wherein stress is both a cause and effect of the social and medical impairments brought about by migraine

Depression Treatment Decreases Healthcare Expenditures Among Working Age Patients With Comorbid Conditions and Type 2 Diabetes Mellitus Along With Newly-Diagnosed Depression

Background: There are many studies in the literature on the association between depression treatment and health expenditures. However, there is a knowledge gap in examining this relationship taking into account coexisting chronic conditions among patients with diabetes. We aim to analyze the association between depression treatment and healthcare expenditures among adults with Type 2 Diabetes Mellitus (T2DM) and newly-diagnosed depression, with consideration of coexisting chronic physical conditions. Methods: We used multi-state Medicaid data (2000–2008) and adopted a retrospective longitudinal cohort design. Medical conditions were identified using diagnosis codes (ICD-9-CM and CPT systems). Healthcare expenditures were aggregated for each month for 12 months. Types of coexisting chronic physical conditions were hierarchically grouped into: dominant, concordant, discordant, and both concordant and discordant. Depression treatment categories were as follows: antidepressants or psychotherapy, both antidepressants and psychotherapy, and no treatment. We used linear mixed-effects models on log-transformed expenditures (total and T2DM-related) to examine the relationship between depression treatment and health expenditures. The analyses were conducted on the overall study population and also on subgroups that had coexisting chronic physical conditions. Results: Total healthcare expenditures were reduced by treatment with antidepressants (16 % reduction), psychotherapy (22 %), and both therapy types in combination (28 %) compared to no depression treatment. Treatment with both antidepressants and psychotherapy was associated with reductions in total healthcare expenditures among all groups that had a coexisting chronic physical condition. Conclusions: Among adults with T2DM and chronic conditions, treatment with both antidepressants and psychotherapy may result in economic benefits

Lifetime Alcohol Abuse Prevalence: Role of Childhood and Adult Religion

Findings presented regarding childhood and adult religiosity/spirituality as protective factors against Lifetime Alcohol Abuse

Distal and Proximal Religiosity as Protective Factors for Adolescent and Emerging Adult Alcohol Use

Data from emerging adults (ages 18-29, N = 900) in the National Comorbidity Survey Replication Study was used to examine the influence of childhood and emerging adult religiosity and religious-based decision-making, and childhood adversity, on alcohol use. Childhood religiosity was protective against early alcohol use and progression to later abuse or dependence, but did not significantly offset the influence of childhood adversity on early patterns of heavy drinking in adjusted logistic regression models. Religiosity in emerging adulthood was negatively associated with alcohol use disorders. Protective associations for religiosity varied by gender, ethnicity and childhood adversity histories. Higher religiosity may be protective against early onset alcohol use and later development of alcohol problems, thus, should be considered in prevention programming for youth, particularly in faith-based settings. Mental health providers should allow for integration of clients\u27 religiosity and spirituality beliefs and practices in treatment settings if clients indicate such interest

Intersection of chronic pain treatment and opioid analgesic misuse: causes, treatments, and policy strategies

Treating chronic pain in the context of opioid misuse can be very challenging. This paper explores the epidemiology and potential treatments for chronic pain and opioid misuse and identifies educational and regulation changes that may reduce diversion of opioid analgesics. We cover the epidemiology of chronic pain and aberrant opioid behaviors, psychosocial influences on pain, pharmacological treatments, psychological treatments, and social treatments, as well as educational and regulatory efforts being made to reduce the diversion of prescription opioids. There are a number of ongoing challenges in treating chronic pain and opioid misuse, and more research is needed to provide strong, integrated, and empirically validated treatments to reduce opioid misuse in the context of chronic pain

Unipolar Depression

Unipolar depression is characterized by a combination of two types of symptoms: neurovegetative and emotional-cognitive. Neurovegetative symptoms are those symptoms that are directly related to the body (e.g., insomnia/hypersomnia, dysregulated eating, fatigue, and decreased energy). Emotional-cognitive symptoms involve those symptoms that are related to how a person processes information (e.g., suicidal ideation, decreased concentration, feeling worthless, anhedonia, and depressed mood). A combination of these depression symptoms must be unremitting for more than 2 weeks in order to be diagnosed with depression. Common treatments for depression include cognitive-behavioral psychotherapy, antidepressant medications, or a combination of these treatments. There are also a number of complementary treatments that are gaining empirical research support for use in combination with traditional approaches to enhance treatment outcome ..