H. Cardoso

I. Silva

José Luís Pais Ribeiro

Repositório Aberto da Universidade do Porto

A - 74Abstract 1183INSECURE ATTACHMENT IS ASSOCIATED WITH PERCEIVEDSTRESS, DEPRESSION AND FATIGUE IN SUBJECTS WITH CHRONICGASTROINTESTINAL DISEASER G. Maunder, J J. Hunter, Psychiatry, Mount Sinai Hospital, Toronto,Ontario, CanadaAdult attachment style may be a useful construct by which to understand howdevelopmental factors contribute to disease course in some illnesses. Althoughinsecure attachment is associated with stress response and depression in non-ill samples, these relationships are not confirmed in the physically ill. In asample of 72 outpatients with chronic gastrointestinal (GI) illnesses (49ulcerative colitis (UC), 17 hepatitis C, 4 Crohn’s disease, 2 other) anxious anddismissing attachment insecurity, depression, chronic perceived stress, stateanxiety, fatigue and illness intrusiveness were measured using self reportinstruments. In UC, disease activity was measured endoscopically. Accordingto Bartholomew’s classification method, subjects were assigned to 4categories of attachment style, based on the presence/absence of high valueson the 2 dimensions of anxious attachment (AA) and dismissing attachment(DA). The prevalence of categorical attachment types was: secure (not AA/notDA) 43 (59.7%), preoccupied (AA/ not DA) 7 (9.7%), dismissing (DA/notAA) 12 (16.7%), and fearful (AA+DA) 10 (13.9%). DA subjects compared tonot DA report higher levels of depression (DA mean=23.2 vs not DAmean=12.6, p = .002), chronic perceived stress (81.4 vs 65.3, P<.001), fatigue(3.5 vs 0.9, P=.004), and state anxiety (46.3 vs. 38.0, p=.01). Similar butsmaller differences are found for AA vs. not AA. Illness intrusiveness did notdiffer between attachment types. In UC, disease activity was higher in DAsubjects (4.6 vs 2.2, p=.05). This study confirms that among GI outpatients,insecure attachment is associated with higher levels of depression, acute andchronic perceived stress, and fatigue. The cross-sectional design cannotdetermine the direction of causality in the relationship of disease activity andinsecure attachment in UC. As has been found in several other studies ofattachment and physical illness, dismissing attachment appears to be morestrongly related to illness that anxious attachment.Abstract 1578DYADIC COPING PATTERNS IN ADOLESCENTS WITH TYPE 1DIABETES AND THEIR MOTHERSRenn Upchurch, Deborah J. Wiebe, Cynthia A. Berg, Carolyn Korbel, NeerajaDivaker, Debra Palmer, Ryan Beveridge, Psychology, University of Utah, SaltLake City, UtahRelatively little attention has focused on the influence of parental copingstyles on adolescent’s adjustment to illness. The effect of parental coping onchildren may be especially important because mothers are typically heavilyinvolved in their child’s illness management. Eighty-one mother-adolescentdyads participated in this study. Adolescents were between 10 and 15 years ofage and diagnosed with type 1 diabetes. Both mothers and adolescentscompleted measures of maternal involvement in diabetes management andpositive affect. They also completed a structured interview in which theydescribed a recent diabetes stressor and listed three strategies they used tocope with the stressor. These strategies were then coded. Adolescents reportedtheir coping styles changing as a function of who was primarily responsiblefor diabetes management. As the child assumed more responsibility, he/sheengaged in more problem focused coping (p<.05) and less emotion focusedcoping (p<.01). The more involved mothers were in the diabetes managementtasks, the more emotion focused coping she employed (p=.01). Overallproblem focused and emotion focused coping were unrelated to psychologicaladjustment and adherence in adolescents. However, regression analysesrevealed that the variables interacted in a complex manner. A three-wayinteraction was found such that the effect of problem-focused coping inadolescents and their mothers interacted with diabetes responsibility (p=.08).Best overall positive mood for the adolescent occurred when both mother andchild used problem focused coping and the mother was highly involved indiabetes management. These results suggest that mother’s coping, as well asher involvement in diabetes management are important in understanding theadjustment of adolescents to diabetes.Abstract 1417LIFE STRESS, GLYCEMIC CONTROL AND CHRONICCOMPLICATIONS IN DIABETIC PATIENTSIsabel Silva, Porto, Portugal, José Ribeiro, Porto University, Porto, Portugal,Helena Cardoso, Santo António General Hospital, Porto, PortugalThe aim of this study was to examine the effects of glycemic control andchronic complications on reported stress of 316 diabetics.A cohort of 316 individuals (44.6% of which were males; 41.8% with Type 1diabetes; 59.8% with disease chronic complications; aged between 16 and 84(M=48.39, SD=16.90))was studied.Participants answered to the Life Experiences Survey in the context of apersonal interview. Medical data about glycemic control and diabetes chroniccomplications were collected from hospital registers after informed consent.Glycemic control was determined through hemoglobin A1c (HbA1c).The results suggest that patients not suffering from chronic complications(t(314)=4.12, p<.0001) and particularly from cataract (t(314)=3.22, p<.01),macroangiopathy (t(314)=2.93, p<.01), autonomic neuropathy (t(314)=3.52,p<.001), sexual dysfunction (t(314)=4.80; p<.0001), coronary heart disease(t(314)=3.96; p<.0001), stroke (t(314)=4.49; p<.0001), hypertension(t(314)=4.84; p<.0001) and peripheral arterial disease (t(314)=2.21; p<.05)present a higher level of positive life events during the last year whencompared with patients who suffer from those sequels. We found that patientswho suffer from glaucoma (t(314)=-.32; p<.01), macroangiopathy (t(314)=-3.83; p<.0001) and diminished libido (t(314)=-2.91; p<.01) present a higherlevel of negative life events during the last year than patients without thosechronic complications. We did not find statistically significant differencesbetween patients with retinopathy or nephropathy and those who do not havethese sequels in what concerns to reported positive and negative life eventsduring the last year. Concerning glycemic control, results suggest that thereare no differences between patients with excellent control (HbA1c = or < 6%),reasonable control (HbA1c= 7 to 8%) and poor control (HbA1c > 8%) in whatrespects to reported positive and negative life events.Abstract 1520PREDICTORS OF FATIGUE IN FIBROMYALGIACatherine C. Schuman, Psychiatry, University of Vermont College ofMedicine, Burlington, VT, Perry M. Nicassio, Psychology, California Schoolof Professional Psychology, San Diego, CAIn a longitudinal design, we evaluated a model that examined predictors offatigue in fibromyalgia (FM) patients. Specifically, in the first phase of thisresearch with aggregated (averaged) data, we examined the contribution ofactive and passive pain coping to pain and depression which, in turn, werehypothesized to lead to increased fatigue. In the second phase of the researchusing disaggregated data, we examined whether depression would mediate theeffects of pain on fatigue. The sample consisted of 52 patients with confirmeddiagnoses of FM. The sample was predominantly female (92%), Caucasian(88%), and of middle to upper-middle class socioeconomic background. Themean age of the sample was 53 years old, and the average duration of illnesswas 11 years. During a psychosocial interview, patients completed the Passiveand Active Coping Scales of the Pain Management Inventory along with othermeasures of their health status. For each of the 5 following months, pain,depression, and fatigue were assessed during a telephone interview. Pain wasmeasured by the AIMS Pain Scale; depression by the CES-D; and fatigue byan adapted version of the Multidimensional Assessment of Fatigue (Tack,1990). Findings from the first phase demonstrated that passive copingcontributed to higher pain (ß=.51, p<001) and depression (ß=.26, p<.05). Pain(ß=.27, p<.05) and depression (ß=.54, P<.001) significantly predicted higherfatigue, as well as mediated the effects of passive coping on fatigue. Theanalysis of disaggregated data revealed that pain contributed to greaterdepression (ß=.27, p<.001) which led to higher fatigue (ß=.38, p<.001). Pain,however, retained a significant, independent relationship with fatigue (ß=.13,p<.05). The findings thus confirm a disruptive cyclical pattern characterizedby the contribution of maladaptive pain coping to both pain and depressionwhich, in turn, contribute to greater fatigue.

Life stress, glycemic control and chronic complications in diabetic patients

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