Variáveis de saúde, familiares e de psicopatologia em filhos de veteranos da guerra colonial portuguesa

Dissertação de mestrado em Psicologia (área de especialização em Psicologia da Saúde)Este estudo tem como finalidade estudar a Perturbação Secundária de Stress Traumático (STSD) em filhos de Veteranos da Guerra Colonial Portuguesa. A amostra inclui 80 filhos adultos. Trata-se de um estudo correlacional e transversal. Os instrumentos utilizados foram: “Questionário de Vivências Familiares na Infância (QVFI), Versão de Investigação de Pereira e Pedras (2008); “Escala de Avaliação da Resposta ao Acontecimento Traumático Secundário” (EARAT), de McIntyre (1997); “Brief Symptoms Checklist” (BSI), Versão Adaptada Canavarro (1999); “Health Symptoms Checklist” (HSC), Versão de Investigação de Pereira e Pedras (2008); “Family Adaptability Cohesion Evaluation Scale” (FACES III), Versão Portuguesa de Curral e colaboradores (1999); “Questionário de Estilo de Vida” (QEV), Versão de Investigação de Pereira e Pedras (2008). Os resultados revelam que 27.50% da amostra apresenta STSD. A Sintomatologia Traumática relaciona-se de forma positiva com: Psicopatologia (IGS e subescalas), Vivências Familiares Negativas na Infância e Sintomatologia Física e de forma negativa com o Estilo de Vida. O STSD relaciona-se com a psicopatologia, sintomatologia física e de forma negativa com o estilo de vida. Encontramos diferenças entre o grupo de filhos com e sem o diagnóstico de STSD e com e sem Sintomatologia Traumática, ao nível das Vivências Familiares, Psicopatologia, Sintomatologia Física e Funcionamento Familiar. Em ambos os grupos, não se verificaram diferenças ao nível do estilo de vida. Da análise das variáveis preditoras, verificamos que a Sintomatologia Física e as Vivências Familiares na Infância são preditoras da Sintomatologia Traumática, explicando cerca de 44 e 11% da variância respectivamente. A Psicopatologia e a Sintomatologia Traumática são os predictores da Sintomatologia Física, explicando cerca de 66 e 5% da variância respectivamente. O Funcionamento Familiar (adaptabilidade) apresentou-se como variável mediadora da relação entre Sintomatologia Traumática e Estilo de Vida. Relativamente às análises exploratórias, verificamos diferenças nas vivências familiares em função do género, idade e acompanhamento psicológico; na sintomatologia física, em função das habilitações literárias e acompanhamento psicológico e na sintomatologia traumática em função do acompanhamento psicológico. Os resultados revelam a importância da intervenção com esta população ao nível da sintomatologia traumática e da sintomatologia física em particular.This study aims to investigate the Secondary Traumatic Stress Disorder (STSD) in adult children of veterans of the Portuguese Colonial War. The sample comprises 80 adult children. This is a correlational and cross-sectional study. The instruments used were: “Questionário de Vivências Familiares na Infância” (QVFI), Research Version of Pereira and Pedras (2008); “Escala de Avaliação da Resposta ao Acontecimento Traumático Secundário” (EARAT), McIntyre (1997); “Brief Symptoms Checklist” (BSI), Portuguese version of Canavarro (1999); “Health Symptoms Checklist” (HSC), Research Version of Pereira and Pedras (2008); “Family Adaptability Cohesion Evaluation Scale” (FACES III), Portuguese version of Curral et al., (1999); “Questionário de Estilo de Vida” (QEV), Research Version of Pereira and Pedras (2008). The results showed that 27.5% of the sample have STSD. Traumatic Symptomatology is positively associated with: Psychopathology (IGS and subscales), Negative Family Experiences in Childhood and Physical Symptomatology, and negatively with Lifestyle. STSD is positively related to Psychopathology and Physical Symptomatology and negatively with Lifestyle. Differences were found between the group with and without the diagnosis of STSD and with and without Traumatic Symptomatology, on Family Experiences, Psychopathology, Family Functioning and Physical Symptoms. In both groups, there were no differences on lifestyle. In terms of predictors, Physical Symptomatology and Family Experiences in Childhood were e predictors of Traumatic Symptomatology, explaining 44% and 11% of the variance respectively. Psychopathology and Traumatic Symptomatology were the predictors of Physical Symptomatology, explaining about 66% and 5% of the variance respectively. Family Functioning (adaptability) was found to be a mediator in the relationship between Traumatic Symptomatology and Lifestyle. In terms of exploratory analysis, differences were found on family experiences by gender, age and psychological support. We also found differences on Physical Symptomatology according to educational background and psychological support and finally on Traumatic Symptomatology according to psychological support. The results show the importance of designing interventions for this population particularly on traumatic Symptomatology and Traumatology and Physical Symptomatology

A predictive model of anxiety and depression symptoms after a lower limb amputation

Patients with Diabetic Foot Ulcer (DFU) show high levels of depression and anxiety symptoms. The loss of a limb is undoubtedly a devastating experience and several studies have shown that anxiety and depression symptoms are a common reaction after a lower limb amputation (LLA). However, no study has focused on the immediate emotional reactions to LLA as a personal factor based on the ICF Model. Objective: This study focused on the characterization of anxiety and depression levels, before and after surgery, differences in levels of depression and anxiety before and after surgery and the predictors of anxiety and depression one month after surgery, in a sample of patients with DFU. Methods: This was a longitudinal study with 179 patients with Diabetes Mellitus Type 2 and DFU indicated for amputation, screened for the presence of anxiety and depression symptoms during the hospitalization that preceded amputation and one month after surgery, during a follow-up consultation. Results: The results showed a significant effect of anxiety and depression symptoms at pre-surgery in the prediction of anxiety and depression symptoms one month after LLA. Patients showed higher levels of anxiety than depression symptoms at pre-surgery, although anxiety significantly decreased on month after surgery. Both anxiety and depression symptoms contributed to depression after LLA, although anxiety at pre-surgery was the only predictor of anxiety at post-surgery. Conclusions: Tailored multidisciplinary interventions need to be developed providing support before and after an amputation surgery, in order to reduce anxiety and depression symptoms and promote psychological adjustment to limb loss.POCI-01-0145-FEDER-007653. Portuguese Foundation for Science and Technology and the Portuguese Ministry of Science, Technology and Higher Education through national funds and cofinanced by FEDER through COMPETE2020 under the PT2020 Partnership Agreement (POCI-01-0145-FEDER-007653). This work was supported by a grant (SFRH/BD/87704/2012) from the Portuguese Foundation for Science and Technolog

Predictors of quality of life in patients with diabetic foot ulcer: The role of anxiety, depression, and functionality

The goal of this study was to analyze the relationships between anxiety, depression symptoms, and functionality as predictors of quality of life, in patients with diabetic foot ulcer taking in consideration clinical variables. A sample of 202 participants indicated for a lower limb amputation surgery, were assessed before the surgery, on physical and mental quality of life, functionality, a anxiety and depression symptoms. Anxiety and depression symptoms, as well as functionality level were predictors of mental quality of life. Pain, having a first amputation, depression symptoms, and functionality were predictors of physical quality of life. In order to promote quality of life, psychological variables should be targeted, in clinical practice.The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was conducted at Psychology Research Centre (PSI/01662), University of Minho, and supported by the Portuguese Foundation for Science and Technology and the Portuguese Ministry of Science, Technology and Higher Education through national funds and co-financed by FEDER through COMPETE2020 under the PT2020 Partnership Agreement (POCI-01-0145-FEDER-007653). This work was supported by a grant (SFRH/BD/87704/2012) from the Portuguese Foundation for Science and Technology

Self-reported adherence to foot care in type 2 diabetes patients: do illness representations and distress matter?

Aim: This study examined the differences and the predictive role of clinical variables, illness representations, anxiety, and depression symptoms, on self-reported foot care adherence, in patients recently diagnosed with type 2 diabetes mellitus (T2DM) and assessed no longer than a year after the diagnosis (T1) and four months later (T2). Background: The high rate of diabetes worldwide is one of the major public health challenges. Foot care is the behavior least performed by patients although regular foot care could prevent complications such as diabetic foot and amputation. Psychosocial processes such as illness representations and distress symptoms may contribute to explain adherence to foot self-care behaviors. Methods: This is a longitudinal study with two assessment moments. The sample included 271 patients, who answered the Revised Summary of Diabetes Self-Care Activities, Brief-Illness Perception Questionnaire, and Hospital Anxiety and Depression Scale. Findings: Patients reported better foot care adherence at T2. Having a higher duration of T2DM and the perception of more consequences of diabetes were associated with better self-reported foot care adherence, at T1. At T2, the predictors were lower levels of HbA1c, better self-reported foot care adherence at T1, higher comprehension about T2DM, as well as fewer depressive symptoms. Interventions to promote adherence to foot care should have in consideration these variables. The results of the present study may help health professionals in designing interventions that early detect depressive symptoms and address illness beliefs, in order to promote foot self-care behaviors reducing the incidence of future complications.This study is the part of a research project PTDC/SAUESA/67581/2006 supported by the Foundation for Science and Technology of Portugal (FCT)

Psychosocial adjustment to a lower limb amputation ten months after surgery

Objective: This longitudinal multisite study examined the influence of demographic characteristics psychological reactions, functionality coping strategies, and social support on psychosocial adjustment to lower limb amputation 10 months after suigery. Method: Of an initial referral of 206 Portuguese patients, a sample of 86 patients who underwent a lower limb amputation due to Diabetes Mellitus Type II were evaluated during the hospitalization that preceded surgery (t0) and at inpatient follow-up consultations, 1 (tl) 6 (t2), and 10 months (t3) after surgery. Results: Higher levels of anxiety symptoms and functionality at presurgery were associated with lower social adjustment to amputation and with higher adjustment to the limitations (t3) respectively. Traumatic stress symptoms (tl) were negatively associated with general and social adjustment, and with the adjustment to the limitations (t3). Perceived social support (t2) mediated the relationship between traumatic stress symptoms (tl) and adjustment to the limitations (t3). Male gender was associated with a higher anxiety and depression symptoms (t0) and with a higher level of functionality (tl). Male gender was associated with functionality at presurgery and postsurgery, and with anxiety and depression symptoms of presurgery. Implications: Results support the need to improve psychological screening and early treatment of anxiety symptoms before the surgery, as well a.s depression and traumatic stress symptoms after a lower limb amputation, and the promotion of social support over time, in order to promote psychosocial adjustment to amputation. This set of psychosocial variables should be included when planning postamputation rehabilitation and psychosocial intervention programs for this target population.- This study was conducted at the Psychology Research Center (PSI/01662), University of Minho, and supported by the Portuguese Ministry of Science, Technology and Higher Education through national funds and cofinanced by FEDER through COMPETE2020 under the PT2020 Partnership Agreement (POCI-01-0145-FEDER-007653) and by a grant (SFRH/BD/87704/2012) from the Portuguese Foundation for Science and Technology. The authors gratefully acknowledge the contributions of the Multidisciplinary Diabetic Foot Clinics of the following hospitals: CHP, CHSJ, CHVNG/E, CHTS, ULSAM, and the Vascular Surgery Departments in Braga and CHSJ Hospitals. The authors also wish to thank all patients who agreed to participate in this study

Quality of life of women with urinary incontinence in rehabilitation treatment

This article analyzed how sexual satisfaction, suffering, severity and impact of urinary incontinence, and psychological morbidity affected women's quality of life and whether suffering mediated the relationship between psychological morbidity and quality of life. The study included 80 women diagnosed with urinary incontinence receiving rehabilitation treatment. Regression analysis showed that sexual satisfaction, suffering, and urinary incontinence severity and impact predicted quality of life and that suffering mediated the relationship between psychological morbidity and quality of life. The findings suggest that interventions should be tailored according to the suffering reported by women and the impact of the urinary incontinence on the couple's sexual relationship.(undefined

Satisfaction with life in individuals with a lower limb amputation: The importance of active coping and acceptance

The aim of this study was to analyze the relationship between sociodemographic/clinical characteristics, coping strategies and satisfaction with life in individuals with lower limb amputation. Sixty-three individuals with a lower limb amputation due to Diabetes and Peripheral Vascular Disease participated in the study and answered measures of coping strategies and satisfaction with life. Findings revealed high dissatisfaction with life. Acceptance and active coping were the most used coping strategies. Satisfaction with life was positively associated with active and planning coping, religion, acceptance and humour. There were differences in coping strategies according to gender, age, marital status, presence of residual limb pain, prosthesis use and mobility level. Results emphasize the differential role of coping strategies, for each individual. Psychosocial interventions need to take into consideration coping strategies during the process of rehabilitation and be specific regarding individuals` sociodemographic and clinical characteristics. This study may help design interventions that answer individuals with lower limb amputations given that coping strategies are a valuable resource in the promotion of satisfaction with life.- (undefined

Quality of life in elderly Portuguese war veterans with post-traumatic stress symptoms

Studies show that post-traumatic stress symptoms among Portuguese veterans who participated in Colonial War (1961-75) are high, even though 43 years have gone by since the end of the war.Background: Studies show that post-traumatic stress symptoms among Portuguese veterans who participated in Colonial War (1961-75) are high, even though 43 years have gone by since the end of the war.Aims: This study analyzed the role of family type, personality traits, and social support as predictors of post-traumatic stress symptoms and quality of life in war veterans, and whether satisfaction with social support was a mediator between neuroticism/post-traumatic stress symptoms and quality of life.Method: A cross-sectional study was conducted including 230 war veterans with a mean age of 60 years (SD=3.82).Results: Results indicated a high prevalence of post-traumatic stress symptoms as well as high neuroticism, 16.5 (SD=4.41); 81% of veterans presented high psychological distress, suggesting emotional disturbance and 71% belonged to extreme families (families with cohesion and adaptability problems). Results showed that age (beta=-0.166, p<0.05), social support (beta=-0.184, p<0.01), and neuroticism (beta=0.325, p<0.001) predicted post-traumatic stress symptoms. Age, professional status, social support, post-traumatic stress symptoms, family type, neuroticism, and extroversion predicted different dimensions of quality of life. Finally, a path analysis showed that satisfaction with social support was a mediator in the relationship between neuroticism and quality of life (beta=-0.066; p<0.01) and between post-traumatic stress symptoms and quality of life (beta=-0.108; p<0.01).Conclusion: Four decades after the Colonial War have passed, there is still a high prevalence of post-traumatic stress symptoms. Screening elderly veterans who present post-traumatic stress symptoms, for the presence of neuroticism traits, and assessing family type and social support, should be a standard practice in health care services, especially in the oldest and those who are retired. Social support should be promoted in order to enhance quality of life in this population

Translation, adaptation and validation of the amputation experience scales (TAPES-R-PT)

RESUMO: A Trinity Amputation and Prosthetics Experience Scale-revised (TAPES-R) permite uma avaliação multidimensional do ajustamento psicossocial à prótese. Este estudo apresenta a tradução, adaptação, validade e confiabilidade da versão portuguesa do TAPES-R-PT para pacientes amputados sem prótese. Participaram neste estudo 144 pacientes com Diabetes Mellitus Tipo 2 e amputação do membro inferior, na sua maioria do sexo masculino (70,8%) com uma média de idade de 66 anos (DP=10,7). A Análise Fatorial Confirmatória sugeriu um bom ajustamento num modelo com três fatores no Ajustamento Psicossocial (Ajustamento Geral, Ajustamento Social, Ajustamento às Limitações), e um fator unidimensional na Escala de Restrição nas Atividades. Os valores de consistência interna revelaram-se adequados e as correlações significativas com o SF-36 e o HADS demonstraram evidências de validade convergente. A versão portuguesa da TAPES-R-PT revela-se um instrumento prático, compreensível e breve para ser usado na prática clínica, durante as avaliações de rotina e em contexto de investigação no sentido de avaliar e monitorizar o processo de ajustamento à amputação.The Trinity Amputation and Prosthetics Experience Scale-revised (TAPES-R) allows a multidimensional assessment of the psychosocial adjustment to the prosthesis. This study presents the translation, adaptation, validity and reliability of the Portuguese version of TAPES-R-PT for amputees without prosthesis. Participated in this study 144 patients with Type 2 Diabetes Mellitus and lower limb amputation, mostly male gender (70.8%) with a mean age of 66 years old (SD=10.7). Confirmatory Factor Analysis suggested a good fit in a model with three factors in Psychosocial Adjustment (General Adjustment, Social Adjustment, Adjustment to Limitations), and a one-dimensional factor in Activity Restriction Scale. The internal consistency values were adequate and the significant correlations with SF-36 and HADS showed evidence of convergent validity. The Portuguese version of TAPES-R-PT proves to be a useful, understandable and brief instrument to be used in clinical practice, during routine assessments and in the context of research in order to assess and monitor the amputation adjustment process.Fundação para a Ciência e Tecnologia e pelo Ministério da Ciência, Tecnologia e Ensino Superior, através de fundos nacionais e cofinanciado pelo FEDER através do COMPETE2020 no âmbito do Acordo de Parceria PT2020 (POCI-01-0145-FEDER-007653). Este trabalho foi financiado por uma bolsa (SFRH / BD / 87704/2012) da Fundação para a Ciência e Tecnologi

Preditores da Qualidade de Vida e Adaptação à Amputação em Pacientes Diabéticos com Pé Diabético: Um estudo longitudinal

Tese de Doutoramento em Psicologia AplicadaA Diabetes mellitus Tipo 2 é uma doença crónica de elevada prevalência em Portugal, sendo o Pé Diabético uma das suas complicações com maior impacto ao nível físico, psicológico e social para o indivíduo e família, dado que poder culminar numa amputação. O objetivo geral deste trabalho foi obter um maior conhecimento sobre esta população, explorar e identificar os fatores que contribuem para o ajustamento à amputação e qualidade de vida relacionada com a saúde (QdVRS), desde o momento que antecedeu a cirurgia (M0), um mês (M1); seis meses (M2) e 10 meses (M3) após a amputação. Este estudo envolveu 206 doentes com Pé Diabético indicados para cirurgia de amputação avaliados em seis hospitais do Norte do País. Os estudos 1, 2, 3 e 4 realizados revelaram que os doentes com Pé Diabético indicados para amputação (M0), eram maioritariamente do sexo masculino, com baixa escolaridade e com uma média de idade de 66 anos. Ao nível clínico, encontravam-se diagnosticados com diabetes, em média, há 18 anos e com Pé Diabético há 4 anos, sendo o pé Neuroisquémico mais prevalente. Metade dos doentes apresentava dor no membro inferior que interferia significativamente com todas as áreas de funcionamento da vida do doente. Os doentes já amputados não se distinguiam dos não amputados ao nível dos sintomas de ansiedade e depressão, funcionalidade, satisfação com o suporte social e funcionamento familiar (M0). Os sintomas de depressão e ansiedade, e o nível de funcionalidade foram preditores da QdVRS física e mental tendo as varáveis sociodemográficas e clínicas, pouco contribuído para a QdVRS, após a cirurgia (M1). Os estudos 5 e 6 enfatizaram o papel dos sintomas de ansiedade e depressão e da QdVRS (M0), como sendo os melhores preditores deles próprios, no pós-cirurgia (M1). Interessantemente, os resultados dos estudos 7 e 8 revelaram que os sintomas traumáticos (M1) apresentaram um efeito direto na dimensão física e mental da QdVRS bem como no ajustamento geral, social e às limitações, no M3. O suporte social no M2, revelou-se um mediador entre os sintomas de trauma no M1 e o ajustamento às limitações no M3. O estudo 9 revelou os sintomas depressivos (M0) como um fator de risco para a mortalidade após a amputação (M3). Por fim, são propostas sugestões para investigações futuras e implicações para a prática clínica, baseadas nos resultados dos vários estudos realizados que enfatizam a necessidade de avaliação e intervenção psicológica antes e após a cirurgia no sentido de promover a adaptação à amputação e aumentar a QdVRS, nesta população.Diabetes mellitus Type 2 is a chronic disease of high prevalence in Portugal, with Diabetic Foot being one of its complications with greater physical, psychological and social impact for the individual and the family, since it may culminate in an amputation. The main goal of this study was to increase the knowledge regarding this population, to explore and identify the risk factors contributing to the adjustment to amputation and health-related quality of life (HRQoL), from the time before surgery (M0), one month (M1), six months (M2) and 10 months (M3) after amputation. This study involved 206 patients with Diabetic Foot indicated for an amputation surgery assessed at six hospitals in the North of the country. Studies 1, 2, 3, and 4 described that patients with Diabetic Foot indicated for amputation (M0) were mostly male patients, with low education and 66 years old, on average. Regarding clinical data, they were diagnosed with type 2 Diabetes, on average, for 18 years and with Diabetic Foot for 4 years, with the neuroischemic foot being the most prevalent. Half of the patients presented with pain in the lower limb interfering significantly with all areas of the patient’s life functioning. Patients already amputated did not differ from those not amputated in anxiety and depression symptoms, functionality, satisfaction with social support and family functioning (M0). Depression and anxiety symptoms and functionality level were predictors of physical and mental HRQoL, and the socio-demographic and clinical variables little contributed to HRQoL, in post-surgery (M1). Studies 5 and 6 emphasized the role of anxiety and depression symptoms and HRQoL (M0) as their own best predictors, at M1. Interestingly, the results of the study 7 and 8 found that traumatic symptoms (M1) had a direct effect on physical and mental HRQoL as well as in general, social and limitations’ adjustment to amputation, at M3. Social support revealed to be a mediator between traumatic symptoms and adjustment to limitations, at M3. The study 9, revealed depression symptoms (M0) as a risk factor for mortality after amputation (M3). Finally, suggestions for futures studies and implications for clinical practice are presented, based on the studies’ results, which emphasize the need for psychological evaluation and intervention, before and after surgery, in order to promote the adjustment to amputation and increase HRQoL, in this population.Este projeto foi financiado pela Fundação para a Ciência e Tecnologia (FCT), através da atribuição de uma Bolsa de Doutoramento com a referência SFRH/BD/87704/2012