Asociación entre rumiaciones y malestar emocional en pacientes recién diagnosticados de cáncer

Objective: Cancer is a strong psychological stressor, generating emotional distress among patients. Rumination is an information processing mode that increases the vulnerability to such distress. However, rumination has not been appropriately studied in cancer patients. This research examines the relationship between rumination and anxiety/depression symptoms among recently diagnosed cancer patients. Method: A sample of 71 recently diagnosed cancer patients was assessed through the Hospital Anxiety and Depression Scale, the Ruminative Responses Scale, the MOS Social Support Survey and a clinical interview. Correlations between ruminations (and its subscales of brooding and reflection), social support, clinical and socio-demographic variables and emotional distress (both anxiety and depression) were analyzed. Multiple regression models were performed, in order to determine the specific contribution of each variable in the explanatory model. Results: Anxiety symptoms correlated with ruminations, social support, sex and age. Depression symptoms correlated with ruminations and social support. Multivariate models show that anxiety symptoms were associated with both rumination subscales and sex. Depression symptoms were associated with the brooding subscale Discussion: Ruminations are associated with higher levels of anxiety and depression symptoms among recently diagnosed cancer patients. Rumination become an important therapeutic target in prevention of psychological distress associated to both diagnosis and treatment initiation. Longitudinal research should be carry out in order to determine the predictive value of ruminations for psychological distress.Objetivo: El cáncer actúa como un potente estresor psicológico, generando malestar emocional en los pacientes. Los modos de procesamiento de la información basados en rumiaciones constituyen un importante factor de vulnerabilidad para la aparición de dicho malestar. Sin embargo, las rumiaciones no han sido convenientemente estudiadas en pacientes con cáncer. El presente estudio analiza la relación existente entre rumiaciones y los síntomas ansiosos y depresivos en pacientes recién diagnosticados de cáncer. Método: Se evaluó una muestra de 71 pacientes oncológicos recién diagnosticados mediante la Escala de Ansiedad y Depresión Hospitalaria, la Escala de Respuestas Rumiativas, la Escala MOS de Apoyo Social y una entrevista clínica. Se analizaron las correlaciones entre rumiaciones, apoyo social, variables sociodemográficas y clínicas, y malestar emocional (tanto ansiedad como depresión). Se realizó un análisis de regresión múltiple con el fin de determinar las contribuciones específicas de cada variable en el modelo explicativo. Resultados: La sintomatología ansiosa correlacionó con rumiaciones, apoyo social, sexo y edad. La sintomatología depresiva correlacionó con rumiaciones y apoyo social. En el análisis multivariado la sintomatología ansiosa se asoció con las dos subescalas de rumiaciones y con el sexo, mientras que los síntomas depresivos se asociaron con la subescala de reproches. Conclusiones: Las rumiaciones se asocian con una mayor presencia de síntomas ansiosos y depresivos en pacientes con un diagnóstico reciente de cáncer, pudiendo constituir una diana terapéutica clave para la prevención del malestar emocional asociado al diagnóstico e inicio del tratamiento. Estudios longitudinales deben determinar el verdadero valor predictivo de las rumiaciones sobre el malestar emocional

El termómetro del distrés como prueba de cribado de ansiedad y depresión en pacientes oncológicos recién diagnosticados

Objective: The Distress Thermometer (DT) is one of the most used and studied screening tests of psychological distress in cancer patients. However, it includes many false positives. Furthermore, it has not been adequately studied with Spanish populations or with recently diagnosed patients. This research examines the diagnostic performance of the DT with a sample of Spanish recently diagnosed cancer patients. Method: The diagnostic performance of DT was assessed in a sample of 135 recently diagnosed cancer patients using the Hospital Anxiety and Depression Scale (HADS) and a semi-structured diagnostic interview as gold standard. Results: The diagnostic performance of DT was acceptable (AUC=0.79) to detect psychological distress using the HADS as gold standard. The optimal cut-off score was 4 (Sensitivity=0.89; Specificity=0.56). The diagnostic performance of DT using the HADS plus the diagnostic interview as gold standard was good (AUC=0.86).The optimal cut-off score was 6 (sensitivity=0.82; Specificity=0.76). Discussion: The DT is an appropriate screening test to detect anxiety and depressive disorders in recently diagnosed cancer patients. Increasing the cut-off score up to 6 points boosts its specificity, proving to be more useful for the detection of clinically significant distress.Objetivo: El Termómetro del Distrés (TD) es una de las pruebas de cribado de malestar emocional más utilizadas y estudiadas en pacientes oncológicos. Sin embargo, genera numerosos falsos positivos. Además, aún no ha sido convenientemente estudiado con población española, ni en muestras de pacientes recién diagnosticados. El presente estudio analiza el rendimiento diagnóstico del TD en una muestra española de pacientes oncológicos recién diagnosticados. Método: Se evaluó el rendimiento diagnóstico del TD en una muestra de 135 pacientes con diagnóstico oncológico empleando como pruebas de referencia la Escala de Ansiedad y Depresión Hospitalaria (HADS) y una entrevista diagnóstica semiestructurada. Resultados: El TD mostró un rendimiento diagnóstico aceptable (Área Bajo la Curva, ABC=0,79) para detectar malestar emocional usando la HADS como referencia. El punto de corte óptimo fue de 4 puntos (Sensibilidad=0,89; Especificidad=0,56). El rendimiento diagnóstico del TD empleando la combinación de la entrevista clínica y la HADS como referencia fue bueno (ABC=0,86). El punto de corte óptimo fue de 6 puntos (Sensibilidad=0,82; Especificidad=0,76). Conclusiones: El TD constituye una prueba de cribado adecuada para detectar trastornos ansiosos y depresivos en pacientes recién diagnosticados de cáncer. Incrementar el punto de corte a 6 supone un incremento en su especificidad, resultando más útil para la detección del malestar emocional con significación clínica

Asociación entre rumiaciones y malestar emocional en pacientes recién diagnosticados de cáncer

Objetivo: El cáncer actúa como un potente estresor psicológico, generando malestar emocional en los pacientes. Los modos de procesamiento de la información basados en rumiaciones constituyen un importante factor de vulnerabilidad para la aparición de dicho malestar. Sin embargo, las rumiaciones no han sido convenientemente estudiadas en pacientes con cáncer. El presente estudio analiza la relación existente entre rumiaciones y los síntomas ansiosos y depresivos en pacientes recién diagnosticados de cáncer. Método: Se evaluó una muestra de 71 pacientes oncológicos recién diagnosticados mediante la Escala de Ansiedad y Depresión Hospitalaria, la Escala de Respuestas Rumiativas, la Escala MOS de Apoyo Social y una entrevista clínica. Se analizaron las correlaciones entre rumiaciones, apoyo social, variables sociodemográficas y clínicas, y malestar emocional (tanto ansiedad como depresión). Se realizó un análisis de regresión múltiple con el fin de determinar las contribuciones específicas de cada variable en el modelo explicativo. Resultados: La sintomatología ansiosa correlacionó con rumiaciones, apoyo social, sexo y edad. La sintomatología depresiva correlacionó con rumiaciones y apoyo social. En el análisis multivariado la sintomatología ansiosa se asoció con las dos subescalas de rumiaciones y con el sexo, mientras que los síntomas depresivos se asociaron con la subescala de reproches. Conclusiones: Las rumiaciones se asocian con una mayor presencia de síntomas ansiosos y depresivos en pacientes con un diagnóstico reciente de cáncer, pudiendo constituir una diana terapéutica clave para la prevención del malestar emocional asociado al diagnóstico e inicio del tratamiento. Estudios longitudinales deben determinar el verdadero valor predictivo de las rumiaciones sobre el malestar emocional

The role of insight, social rank, mindfulness and self-compassion in depression following first episode psychosis

Gaining awareness of psychosis (i.e., insight) is linked to depression, particularly in the post-acute phase of psychosis. Informed by social rank theory, we examined whether the insight–depression relationship is explained by reduced social rank related to psychosis and whether self-compassion (including uncompassionate self-responding [UCS] and compassionate self-responding [CSR]) and mindfulness buffered the relationship between social rank and depression in individuals with first episode psychosis during the post-acute phase. Participants were 145 young people (Mage = 20.81; female = 66) with first episode psychosis approaching discharge from an early psychosis intervention centre. Questionnaires and interviews assessed insight, depressive symptoms, perceived social rank, self-compassion, mindfulness and illness severity. Results showed that insight was not significantly associated to depression and thus no mediation analysis was conducted. However, lower perceived social rank was related to higher depression, and this relationship was moderated by self-compassion and, more specifically, UCS. Mindfulness was related to depression but had no moderating effect on social rank and depression. Results supported previous findings that depressive symptoms are common during the post-acute phase. The role of insight in depression for this sample is unclear and may be less important during the post-acute phase than previously considered. Supporting social rank theory, the results suggest that low perceived social rank contributes to depression, and reducing UCS may ameliorate this effect. UCS, social rank and possibly mindfulness may be valuable intervention targets for depression intervention and prevention efforts in the recovery of psychosis

The association between different domains of quality of life and symptoms in primary care patients with emotional disorders

Despite the importance of quality of life (QoL) in primary care patients with emotional disorders, the specific influence of the symptoms of these disorders and the sociodemographic characteristics of patients on the various QoL domains has received scant attention. The aim of the present study of primary care patients with emotional disorders was to analyse the associations between four different QoL domains and the most prevalent clinical symptoms (i.e., depression, anxiety and somatization), while controlling for sociodemographic variables. A total of 1241 participants from 28 primary care centres in Spain were assessed with the following instruments: the Patient Health Questionnaire (PHQ)-9 to evaluate depression; the Generalized Anxiety Disorder Scale (GAD)-7 for anxiety; PHQ-15 for somatization; and the World Health Organization Quality of Life Instrument-Short Form (WHOQOL- Bref) to assess four broad QoL domains: physical health, psychological health, social relationships, and environment. The associations between the symptoms and QoL domains were examined using hierarchical regression analyses. Adjusted QoL mean values as a function of the number of overlapping diagnoses were calculated. The contribution of sociodemographic variables to most QoL domains was modest, explaining anywhere from 2% to 11% of the variance. However, adding the clinical variables increased the variance explained by 12% to 40% depending on the specific QoL domain. Depression was the strongest predictor for all domains. The number of overlapping diagnoses adversely affected all QoL domains, with each additional diagnosis reducing the main QoL subscales by 5 to 10 points. In primary care patients with a diagnostic impression of an emotional disorders as identified by their treating GP, clinical symptoms explained more of the variance in QoL than sociodemographic factors such as age, sex, level of education, marital status, work status, and income. Given the strong relationship between depressive symptoms and QoL, treatment of depression may constitute a key therapeutic target to improve QoL in people with emotional disorders in primary care

The distress thermometer as a screening measure of anxiety and depression in recently diagnosed cancer patients

Objective: The Distress Thermometer (DT) is one of the most used and studied screening tests of psychological distress in cancer patients. However, it includes many false positives. Furthermore, it has not been adequately studied with Spanish populations or with recently diagnosed patients. This research examines the diagnostic performance of the DT with a sample of Spanish recently diagnosed cancer patients. Method: The diagnostic performance of DT was assessed in a sample of 135 recently diagnosed cancer patients using the Hospital Anxiety and Depression Scale (HADS) and a semi-structured diagnostic interview as gold standard. Results: The diagnostic performance of DT was acceptable (AUC=0.79) to detect psychological distress using the HADS as gold standard. The optimal cut-off score was 4 (Sensitivity=0.89; Specificity=0.56). The diagnostic performance of DT using the HADS plus the diagnostic interview as gold standard was good (AUC=0.86).The optimal cut-off score was 6 (sensitivity=0.82; Specificity=0.76). Discussion: The DT is an appropriate screening test to detect anxiety and depressive disorders in recently diagnosed cancer patients. Increasing the cut-off score up to 6 points boosts its specificity, proving to be more useful for the detection of clinically significant distress

Mapping bridges between anxiety, depression, and somatic symptoms in primary care patients: a network perspective

In primary care centers, emotional disorders (EDs; depression, anxiety, and somatoform disorders) frequently appear to be associated. However, there is no previous information on the key (bridge) symptoms that maintain comorbidity. The current study aimed to identify symptoms that may play a linking role in bridging comorbidity among EDs from a network analysis perspective. A sample of adult primary care patients (N = 1704) with symptoms of EDs was assessed using the Patient Health Questionnaire (PHQ). Network analysis was applied to examine the network structure, communities, expected influence, and bridge symptoms between depressive, anxiety, and somatic symptoms. Sad mood and low energy were the most central symptoms. Furthermore, low energy, fainting spells, sad mood, and restlessness were detected as prominent bridge symptoms between anxiety, depression, and somatic symptoms. These bridge symptoms could be therapeutic targets for early intervention and prevent the development of comorbidity among EDs. The results of this research highlight the importance of symptom-specific functional properties for the activation of communities within EDs, providing new insights on a complex phenomenon such as comorbidity

Emotion Regulation as a Moderator of Outcomes of Transdiagnostic Group Cognitive-Behavioral Therapy for Emotional Disorders

The aim of this study was to examine the potential moderating effect of baseline emotion regulation skills¿cognitive reappraisal and expressive suppression¿on the relation- ship between treatment allocation and treatment outcomes in primary care patients with emotional symptoms. A total of 631 participants completed scales to evaluate emotion regulation, anxiety, depression, functioning, and quality of life (QOL). The moderation analysis was carried out using the SPSS PROCESS macro, version 3.5. Expressive suppression was a significant moderator in the relationship between treatment allocation and treatment outcomes in terms of symptoms of anxiety (b = 0.530, p = .026), depression (b = 0.812, p = .004), and QOL (b = 0.156, p = .048). Cognitive reappraisal acted as a moderator only in terms of QOL (b = 0.217, p = .028). The findings of this study show that participants with higher scores of expres- sive suppression benefited more from the addition of trans- diagnostic cognitive-behavioral therapy to treatment as usual (TAU) in terms of anxiety and depressive symptoms, and QOL. Individuals with higher levels of cognitive reappraisal obtained a greater benefit in terms of QOL from the addition of psychological treatment to TAU. These results underscore the relevant role that emotion regulation skills play in the outcomes of psychological therapy for emotional symptoms

Transdiagnostic group cognitive behavioural therapy for emotional disorders in primary care: the results of the PsicAP randomized controlled trial

Background. Emotional disorders are highly prevalent in primary care. We aimed to determine whether a transdiagnostic psychological therapy plus treatment-as-usual (TAU) is more efficacious than TAU alone in primary care adult patients. Methods. A randomized, two-arm, single-blind clinical trial was conducted in 22 primary care centres in Spain. A total of 1061 adult patients with emotional disorders were enrolled. The transdiagnostic protocol (n = 527) consisted of seven 90-min sessions (8–10 patients) delivered over a 12–14-week period. TAU (n = 534) consisted of regular consultations with a general practitioner. Primary outcome measures were self-reported symptoms of anxiety, depression, and somatizations. Secondary outcome measures were functioning and quality of life. Patients were assessed at baseline, post-treatment, and at 3, 6, and 12 months. Intention-to-treat and per-protocol analyses were performed. Results. Post-treatment primary outcomes were significantly better in the transdiagnostic group compared to TAU (anxiety: p 0.80) in favour of the transdiagnostic group after treatment and at the 12-month follow-up. Conclusions. Adding a brief transdiagnostic psychological intervention to TAU may significantly improve outcomes in emotional disorders treated in primary care. Trial Registration, isrctn.org identifier: ISRCTN5843708

Cost‐effectiveness and cost‐utility evaluation of individual vs. group transdiagnostic psychological treatment for emotional disorders in primary care (PsicAP‐Costs): a multicentre randomized controlled trial protocol

Background: Emotional disorders are common, and they have become more prevalent since the COVID‐19 pan‐ demic. Due to a high attendance burden at the specialized level, most emotional disorders in Spain are treated in primary care, where they are usually misdiagnosed and treated using psychotropic drugs. This contributes to perpetu‐ ate their illness and increase health care costs. Following the IAPT programme and the transdiagnostic approach, the PsicAP project developed a brief group transdiagnostic cognitive‐behavioural therapy (tCBT) as a cost‐effective alternative. However, it is not suitable for everyone; in some cases, one‐on‐one sessions may be more effective. The objective of the present study is to compare, in cost‐benefit terms, group and individual tCBT with the treatment usu‐ ally administered in Spanish primary care (TAU). Methods: A randomized, controlled, multicentre, and single‐blinded trial will be performed. Adults with mild to moderate emotional disorders will be recruited and placed in one of three arms: group tCBT, individual tCBT, or TAU. Medical data and outcomes regarding emotional symptoms, disability, quality of life, and emotion regulation biases will be collected at baseline, immediately after treatment, and 6 and 12 months later. The data will be used to calcu‐ late incremental cost‐effectiveness and cost‐utility ratios. Discussion: This trial aims to contribute to clinical practice research. The involvement of psychologists in primary care and the implementation of a stepped‐care model for mental disorders are recommended. Group therapy and a transdiagnostic approach may help optimize health system resources and unblock waiting lists so that people can spend less time experiencing mental health problems. Trial registration: ClinicalTrials.gov: NCT04847310; Protocols.io: bx2npqde. (April 19, 2021