Mutual influence of posttraumatic stress disorder symptoms and chronic pain among injured accident survivors: A longitudinal study

The relationship between acute stress disorder (ASD), posttraumatic stress disorder symptoms (PTSD), and chronic pain was investigated in a longitudinal study of injured accident victims (N = 323, 64.7% men). Assessments took place 5 days (T1), 6 (T2) months, and 12 (T3) months postaccident. Relations between pain and posttraumatic stress symptoms were tested by structural equation modeling. Subjects diagnosed with full or subsyndromal PTSD at T2 and at T3 (14 and 19%) reported significantly higher pain intensity. Cross-lagged panel analysis yielded a mutual maintenance of pain intensity and ASD or PTSD symptoms across T2. Across the second half year, PTSD symptoms impacted significantly on pain but not vice versa. Clinicians need to pay careful attention to PTSD symptoms in accident survivors suffering from chronic pain

Dyadic coping, quality of life, and psychological distress among chronic obstructive pulmonary disease patients and their partners

Caroline Meier1, Guy Bodenmann2, Hanspeter Mörgeli1, Josef Jenewein11Department of Psychiatry and Psychotherapy, University Hospital Zurich, Switzerland; 2Institute of Psychology, University of Zurich, SwitzerlandBackground: Successfully coping with a chronic disease depends significantly on social support, particularly that of a significant other. Thus, it depends on the ways of dealing with stress within a couple (dyadic coping). In this study, the relationship between dyadic coping and well-being was investigated among couples in which one partner suffers from chronic obstructive pulmonary disease (COPD).Methods: A total of 43 couples participated. They were mailed questionnaires on anxiety and depression (Hospital Anxiety and Depression Scale), quality of life (World Health Organization Quality of Life Questionnaire-BREF), and dyadic coping (Dyadic Coping Inventory).Results: Low scores of positive and high scores of negative dyadic coping were associated with poorer quality of life and higher psychological distress among couples. Delegated coping (assistance with daily tasks) was higher among partners. When estimated by patients, high delegated partner coping (frequent provision of support by partners) and low delegated personal coping (low provision of support by patients) were associated with poorer quality of life for both patient and partner. COPD patients suffering from depression were supported more often and attributed deficits in dyadic coping primarily to themselves, whereas partners with higher scores of depression provided higher estimates of both their own negative coping and the negative coping of their partner.Conclusion: The higher the patient perceived the imbalance in delegated dyadic coping, the lower the couple's quality of life. More negative and less positive dyadic coping were associated with lower quality of life and higher psychological distress. Psychotherapeutic interventions to improve dyadic coping may lead to better quality of life and less psychological distress among COPD patients and their partners.Keywords: COPD, dyadic coping, partner study, quality of life, anxiety, depressio

Supplementary Material for: Quality of Life after Traumatic Injury: A Latent Trajectory Modeling Approach

<b><i>Background:</i></b> It is largely unknown how quality of life (QoL) changes following accidental injuries. Equally, the mechanisms underlying such changes have not yet been identified in detail. This study of injured accident survivors aimed to: (1) detect a model of change which best explains the observed course of QoL, and (2) identify potential predictor variables. <b><i>Methods:</i></b> 323 injured accident survivors were interviewed within 2 weeks of the trauma, and followed up at 6 and 12 months. Latent trajectory modeling was used to analyze the fit of three potential trajectories regarding the observed course of general QoL as measured by the Questions on Life Satisfaction questionnaire. <b><i>Results:</i></b> The trajectory model adopting a negative square-root change fitted the observed data best, meaning that shortly after the accident, general QoL decreased strongly with diminishing negative changes occurring later on. Early and prolonged QoL impairment was largely attributable to the initial level of posttraumatic stress as measured by the Clinician-Administered PTSD Scale. To a lesser extent, depressive symptoms also predicted change in subjective QoL, while injury severity showed no direct effect; rather, its impact on QoL was mediated by initial posttraumatic stress. By contrast, reduced occupational functioning was attributable to injury severity rather than psychopathology. <b><i>Conclusions:</i></b> When treating injured accident survivors, clinicians should consider symptoms of posttraumatic stress and comorbid depression in order to prevent or mitigate negative changes in QoL

Alexithymia and health-related quality of life in patients with dizziness

Background: Alexithymia is a personality trait characterized by deficits in regulating, experiencing and verbalizing emotions and has been assumed to be associated with a tendency to express emotional arousal through somatization. Although such a tendency is often observed in patients with dizziness, the exact relationship of alexithymia to dizziness is not yet known. The aim of this study was to examine alexithymic characteristics in patients with dizziness and its relation to health-related quality of life (HRQoL). Sampling and Methods: We assessed 208 patients from an interdisciplinary center for vertigo and balance disorders for characteristics of alexithymia (20-item Toronto Alexithymia Scale), HRQoL (Short-Form 12 Health Survey, SF-12), dizziness (Dizziness Handicap Inventory), depression and anxiety (Hospital Anxiety and Depression Scale). Hierarchical regression analyses were used to evaluate the relationship between alexithymia, dizziness and HRQoL. Results: We found that difficulties in identifying and describing feelings, two important factors of alexithymia, were significantly related to more severe symptoms of dizziness. More pronounced alexithymic characteristics were associated with lower HRQoL, especially in the mental dimension of the SF-12. The results remained significant after controlling for possibly confounding variables such as socioeconomic status and depression. Conclusions: These findings contribute to a better understanding of affect regulation in patients with dizziness, which is important for the development of psychotherapeutic interventions suitable for alexithymic patients with dizziness

Post-traumatic stress disorder in serious accidental injury: 3-year follow-up study

BACKGROUND: Long-term data on post-traumatic stress disorder (PTSD) following accidents are scarce. AIMS: To assess and predict PTSD in people 3 years after severe accidental injury. METHOD: Severely injured patients were recruited consecutively from the intensive care unit (n=121) and assessed within 1 month of the trauma. Follow-up interviews were conducted 6 months, 12 months and 36 months later; 90 patients participated in all four interviews. Symptoms were assessed using the Clinician-Administered PTSD Scale. RESULTS: Post-traumatic stress disorder was diagnosed in 6% of patients 2 weeks after the accident, in 2% after 1 year and in 4% after 3 years. Robust predictors of later PTSD symptom level were intrusive symptoms shortly after the accident and biographical risk factors. There were individual changes over time between the categories PTSD, sub-threshold PTSD and no PTSD. Whereas PTSD symptom severity was low or decreased for most of the patients, some of them showed an increase or a delayed onset. Patients with persisting PTSD symptoms at 6 months and patients with delayed onset of symptoms are at risk of long-term PTSD. CONCLUSIONS: The prevalence of PTSD was low over the whole period of 3 years

Return to work following unintentional injury: a prospective follow-up study

OBJECTIVE: The aim of this study was to predict time off work following unintentional injuries due to accidents leading to hospital admission. DESIGN: Prospective 6-month follow-up study. SETTING: Department of Trauma Surgery of a University Hospital. PARTICIPANTS: Consecutively recruited victims of unintentional injuries (n=221) hospitalised for a minimum of 32 h including two consecutive nights. All the participants were aged 18–65 years and were able to participate in an assessment within 30 days of the accident. MAIN OUTCOME MEASURES: Interview-assessed number of days off work during the 6 months immediately following the accident. RESULTS: The patients’ subjective appraisals of (1) accident severity and (2) their ability to cope with the resulting injury and its job-related consequences predicted time off work following the accident beyond the impact of the objective severity of their injury and the type of accident involved. CONCLUSIONS: The patients’ subjective appraisals of the accident severity and of their ability to cope with its consequences are highly relevant for return to work after accidents. Extending the findings from previous studies on severely injured and otherwise preselected accident victims, this seems to apply to the whole spectrum of patients hospitalised with unintentional injuries

Parents' mental health after the birth of an extremely preterm child: a comparison between bereaved and non-bereaved parents

OBJECTIVE: To assess the impact of extremely preterm birth (24-26 weeks of gestation) on the mental health of parents two to six years after delivery, and to examine potential differences in post-traumatic growth between parents whose newborn infant died and those whose child survived. METHOD: A total of 54 parents who had lost their newborn and 38 parents whose preterm child survived were assessed by questionnaires with regard to depression and anxiety (HADS) and post-traumatic growth (PTGI). RESULTS: Neither group of parents had clinically relevant levels of depression and anxiety. Mothers showed higher levels of anxiety than fathers. Bereaved parents with no other, living child reported higher levels of depression than bereaved parents with one or more children. Mothers reported higher post-traumatic growth compared to fathers. In particular, bereaved mothers experienced the value and quality of their close social relationships more positively compared to the non-bereaved parents. CONCLUSION: In the long term, bereaved and non-bereaved parents cope reasonably well with an extremely preterm birth of a child. Post-traumatic growth appears to be positively related to bereavement, particularly in mothers

Resilience in patients and spouses faced with malignant melanoma. A qualitative longitudinal study

Life-threatening diseases like malignant tumours are associated with considerable existential distress. Little is known about the factors that promote resilience within these individuals. This longitudinal qualitative partner study aimed to analyse resilience as per Antonovsky's sense of coherence. Eight patients with malignant melanoma and their partners were interviewed. They were asked about their coping strategies, attitudes towards the meaning of life and their cancer, and comprehension of what is happening to them. The questions were asked shortly after their diagnosis was made and 6 months later. All interviews were audio-taped and later transcribed and analysed according to the method of qualitative content analysis described by P. Mayring. At baseline, the majority of statements made (261; patients = 141/spouses = 120) related to coping/manageability of disease, with only 26 statements (patients = 15/spouses = 11) related to meaning and 127 (patients = 64/spouses = 63) to comprehension. There were no significant differences between the responses of patients and their partners and no significant changes in the number of statements during the 6-month interview. The most significant theme that emerged was manageability of disease, with distraction the most commonly utilised coping skill. The comprehension and meaning themes were far less prevalent. Hence, support should focus on disease and situational manageability

Journal officiel de l'État algérien : ordonnances, décrets, arrêtés, décisions, circulaires, avis, communications et annonces

04 septembre 19621962/09/04 (A1,N11)