Aims: To examine the efficacy of CBT for late-life depression in older adults with co-morbid physical illness and to review what has been revealed by meta-analytic studies with regards moderators of treatment in psychological approaches for late-life depression. Method: Systematic literature search and meta-analysis of randomised controlled trials (RCT) evaluating CBT for depression in older adults with co-morbid physical illness and systematic review of meta-analyses examining psychological therapies for late-life depression. Results: Nine papers met inclusion criteria for meta-analysis. CBT was superior to waiting list and treatment as usual control conditions, showing a statistically significant pooled standardised mean difference (SMD) of 0.63 (95 per cent CI, 0.29 to 0.97, p = 0.0003). This was largely maintained at follow up (SMD 0.5, 95 per cent CI, 0.08 to 0.92). Sensitivity analysis showed individual CBT yielded a large, statistically significant summary effect size of 0.80 (95 per cent CI, 0.45 to 1.16), but that group CBT did not show statistical superiority over controls. Clinician-rated measures of depression yielded larger effect sizes, with a SMD of 1.57 (95 per cent CI, 0.56 to 2.59, p = 0.002) as compared with patientrated measures: 1.03 (95 per cent CI, 0.75 to 1.31, p = 0.0001). Fourteen meta-analyses met inclusion criteria for systematic review. More recent publication was significantly correlated with increased reporting quality and reduced analysis of moderating factors. Duration of treatment, treatment setting and gender of participants showed no moderating impact on outcome. Depression severity, participant age, treatment modality, and study quality showed no consistent relationship with outcomes. Active or placebo controls were associated with reduced effect sizes when compared with no treatment or waiting list controls. Patient-rated outcome measures were associated with reduced effect sizes as compared with clinician-rated measures. Conclusions: When compared with treatment as usual and waiting list controls Individual CBT is effective in reducing depressive symptoms for depressed older adults with an underlying physical illness. Meta-analytic studies of late-life depression show variable results regarding moderators of treatment efficacy. More high quality studies examining the effectiveness of psychological therapies are needed with clinically representative older populations, particularly, the older-old and those with co-morbid physical illnesses.

The aim of this essay was to closer understand the experience of loss and sorrow in conjunction with serious physical illness. I have used a phenomenological approach and therefore used the questions: what have the individuals experienced? How have they experience it? And what meaning did they ascribe to the experience? To answer this questions I have examined five different biographies, based on the biographers’ experience of living with a serious physical illness. I have from these biographies deciphered different themes of loss and sorrow: The physical body, identity, loss of everyday life, to live in a social context, loss of control and the future. I have analysed the result with The Dual Process Model (Stroebe & Schut 1999), where the main idea is that people who experience sorrow and grief, are in a need to oscillate, between confronting and avoidance of different emotions and stressors triggered by the loss. I confirm this in my result, where I have found that the individuals experience loss and sorrow in the themes above, but that they express it and experience it in different ways at different times, and therefore are in a need to oscillate between different emotions and stressors triggered by the loss they experience. My conclusion is that loss and sorrow is a complex and fluctuating phenomenon. Nevertheless, it affects a person’s whole existence.

I dag lider ca 25-35 % av skolungdomar av psykisk ohälsa. Tidigare forskning har visat att denna ohälsa beror på att ungdomar sover alltför lite, vilket i sin tur associerats till en ökad användning av sociala media. Orsakssambanden är emellertid oklara och varierar mellan studier. Av den anledningen genomfördes en enkätstudie på gymnasielever, för att ytterligare belysa hur sambanden ser hos svenska ungdomar. I undersökningen användes två frågeformulär bestående av en reducerad version av KASAM, ett sömnformulär, samt frågor angående sociala media. I studien deltog 51 elever (M: 18.0 år, SD 0.35), varav 22 kvinnliga och 28 manliga elever i ÅK 3. Resultatet visade att cirka hälften av eleverna (49 %) ansåg sig sova signifikant kortare tid än vad de önskade (p<0.0001). De som ansåg sig sova för lite hade även signifikant lägre värden på flera sömnvariabler och hade även signifikant lägre värden på KASAM (p<0.003). Inget säkert samband sågs däremot mellan dessa variabler och uppkoppling på sociala media, även om de kvinnliga studenterna spenderade kortare tid än de manliga eleverna. Sammanfattningsvis bekräftar studien tidigare forskning om kortare sömn hos gymnasieelever och ökad skoltrötthet ger ett sämre psykiskt mående, där kvinnliga elever tenderade att må något sämre än de manliga. Kopplingen till utnyttjandet av sociala media visade på ett positivt samband. Ytterligare studier behövs som på ett mer detaljerat sätt undersöker innehållet i kommunikationen på sociala media och dess eventuella inverkan på sömn och psykisk hälsa.

Previous studies have examined how individuals who are diagnosed with mental (McManus, Stubbings, & Martin, 2006) or physical illness (Duggan, Medway & Bunke, 2004) are stigmatized but no study has directly compared how students perceive a person living with a mental versus a physical illness. The present study explored whether participants desired greater social distance from a student who 1) suffered from schizophrenia, 2) was in remission for cancer, relative to a 3) healthy student. The study also investigated whether participants could objectively evaluate the identical written work of these students differently when they are described according to their illnesses. It was hypothesized that college students would desire the greatest social distance from students with mental illness and the least amount of social distance from students described as healthy. In addition, it was hypothesized that college students would evaluate the work of a healthy student more positively than a student who has a chronic mental or physical illness. It was also hypothesized that college students would evaluate the work of a student described as suffering from chronic physical illness more positively than the work of the student described as having a chronic mental illness. For the procedure, participants were given a vignette about a fictional student and were randomly assigned to a vignette that described the student as 1) suffering from schizophrenia which was controlled by medication, 2) in remission for cancer, or 3) healthy. The participants were then asked to evaluate this student's essay using a grading rubric. Participants then completed the Social Distance Scale (Penn, Guynan, Daily, & Spalding, 1994). Finally, students reported demographic information about themselves. A one-way between subjects Multivariate ANOVA was performed on the data, and significant differences were found among conditions for the SDS but not for the scores on the student's essay. The results suggest that the students were able to remain objective while grading the student's assignment, but required greater social distance from a student with a mental or physical illness.

Background Chronic physical illness (CPI) is a prolonged, rarely cured condition, which often causes impairment of activities of a child’s or adolescent’s daily living. This thesis encompasses three cohorts of patients with CPI – diagnosed with diabetes, asthma or epilepsy. Psychological disturbances and difficulties experienced by young patients with CPI are common, and changes in the family environment are inevitable. Hence, from a health care perspective, three cohorts of CPI can give a frame of reference to guide our understanding on the psychological health of adolescents with CPI, and the disease impact on their life; to determine target groups for psychological interventions, and to identify important directions for health care development. Objectives The overall aim of the study was to assess the psychological well-being of adolescents with CPI in Northern Russia, as well as to identify factors of potential risk or protective significance for adolescents’ well-being. Methods The questionnaires covering different aspects of psychological well-being as behavior-emotional problems, depressive symptoms, self-esteem, and health-related quality of life (HRQoL) as well as family functioning were answered by the adolescents with CPI and their mothers, including the Child Behavior Check-List (CBCL) and Youth Self-Report (YSR); Beck Depression Inventory (BDI); The Rosenberg Self-Esteem Scale; I think I am; Quality of Life in Epilepsy Inventory for Adolescents (QOLIE-AD-48); Diabetes Quality of Life Questionnaire for Youths (DQOLY); Pediatric Asthma Quality of Life Questionnaire (PAQLQ); Self-report Family Inventory (SFI); and Socio-Economic Status (SES) questions. Disease related clinical information was withdrawn from the pediatric outpatient clinic. The sample consisted of 148 adolescents with CPI identified from Arkhangelsk pediatric outpatient clinic records and their mothers. Comparative data were obtained from a group of 301 schoolchildren and their mothers. Results Results in Paper I showed certain differences in mental health of adolescents with CPI compared to healthy counterparts indorsed by mother’s reports alone, while self-reports by adolescents with CPI didn’t show any discrepancy in the level of behavior/emotional problems and depression compared to healthy peers. Most pronounced symptoms were found in adolescents with asthma and epilepsy associated with disease severity and gender. In the results of Paper II there were no significant differences found in self/mother reported family functioning of the total group with CPI versus controls. The perception of family functioning differed between the CPI groups and was associated to certain disease-related and non-disease factors. Paper III showed that adolescents with diabetes and asthma maintain positive self-esteem similar to or even higher than that of their healthy counterparts. Adolescents with epilepsy reported lower self-esteem compared to other CPI groups or controls. A diversity of factors contributed to self-esteem variation within the CPI groups. Paper IV provides evidence that adolescents with CPI maintained relatively moderate to high levels of HRQoL. The domains affecting HRQoL were related to both disease-specific (severity) and non-disease factors (gender and SES). Conclusions In the scope of the present thesis we assessed and described psychological well-being and family functioning of adolescents with chronic illnesses. Our results demonstrate generally low levels of behavior-emotional problems, depressive symptoms, and relatively high self-esteem, positive health-related quality of life, and successful family functioning in adolescent with CPI in Northern Russia. However, we conclude that there is a risk of mental health problems, particularly of internalizing nature, in adolescents with asthma and epilepsy. The significant risk factors associated with psychological well-being mediated by family functioning in CPI groups were single-parent household, child age, disease severity, child gender, family SES, and changes in the family life. High family competence and successful family functioning are indisputable protective factors for psychological well-being in adolescents with CPI.

A decisão da cirurgia cardíaca paliativa é um processo crítico para os pais pois envolve risco de vida para o filho. Esta pesquisa investigou aspectos das atitudes maternas na tomada de decisão da cirurgia, com a suposição de que atitudes de recusa podem estar presentes. A partir do referencial teórico da Psicanálise, entende-se que o diagnóstico médico e a indicação cirúrgica podem provocar impactos psíquicos traumáticos. A iminência de perda pela doença de prognóstico ruim, a relação risco-benefício não claramente favorável da cirurgia e o contexto do tratamento, em geral permanente e realizado fora do domicílio de origem, são aspectos que influenciam as decisões da mãe. O processo decisório (tratamento versus não tratamento) foi discutido à luz de noções da Bioética, como autonomia, participação ativa no tratamento, decisões de representação, bem como das implicações jurídicas. A não aceitação da cirurgia pode trazer conflitos de interesse na relação médico-paciente/cuidador, fazendo refletir sobre como se dão, na sociedade atual, as relações entre processos médico-biológicos e processos subjetivos. A partir da abordagem de pesquisa clínico-qualitativa utilizou-se a entrevista semi-dirigida individual. As participantes foram duas mães de crianças cardíacas que passaram por cirurgia paliativa e que estavam hospedadas na Associação de Assistência à Criança Cardíaca e à Transplantada do Coração. Observou-se atitudes de hesitação, questionamento, recusa da cirurgia e atitudes de não pensamento e aceitação imediata do procedimento. Verificou-se a presença de atitudes de recusa da cirurgia, apesar de sua posterior aceitação. Discutiu-se como tais atitudes podem ser entendidas como recusa-reflexão e não apenas como defesas psíquicas ou reações precipitadas. À medida que abre um espaço de pensamento, a recusa-reflexão teria uma função importante para o psiquismo pois auxilia na assimilação dos acontecimentos relativos ao processo decisório. Como conclusão se propõe entender a decisão como um processo e, desta perspectiva, é considerada um momento oportuno de reflexão para a mãe. Sugere-se, então, que na prática psicológica a recusa da cirurgia seja abordada como uma atitude materna possível ao processo decisório, considerando que o encaminhamento na direção do cuidado e do bem-estar global do filho não necessariamente pressupõe a aceitação da cirurgia no momento de sua indicação, da mesma forma que a recusa inicial não significa que seja definitiva. Indica-se o suporte psicológico na decisão da cirurgia que, por legitimar as ambivalências psíquicas, as dúvidas e hesitações desse processo, poderá favorecer um espaço de reflexão e elaboração subjetiva onde se abra a possibilidade de se tomar uma decisão ponderada, consequente, e com a qual a mãe, o pai, a criança, a família, poderão conviver / Decision-making before palliative heart surgery is a critical process for parents because it involves a risk to their childs life. This study investigated aspects of maternal attitudes in deciding about surgery, and takes into account the assumption that attitudes of refusal may be present. Based on Psychoanalysis theoretical framework, we understand that medical diagnosis and indication for surgery may cause psychic trauma. The imminence of loosing ones child due to the poor prognosis associated with the condition, the risk-benefit relationship not clearly favorable to surgical intervention, and the context of treatment, which is in general permanent and carried out outside the patients city of residence, are aspects that influence maternal decision-making. The decision-making process (treatment versus non-treatment) is discussed in the light of notions from the field of Bioethics, such as autonomy, active participation in treatment, proxy decision-making, as well as in the light of the legal implications. Refusing surgery can cause conflicts of interest in the doctor-patient/caregiver relationship, which engenders thinking about how the relationship between medical and biological processes, and subjective processes take place in todays society. The qualitative research design comprised an individual semi-structured questionnaire survey. The two participants were mothers of cardiac children who went through palliative heart surgery and were staying at the Associação de Assistência à Criança Cardíaca e à Transplantada do Coração [Association for Assisting Cardiac and Heart-Transplanted Children]. The attitudes observed were attitudes of hesitation, questioning, refusal of surgery, and attitudes of not thinking, and of immediate acceptance of the surgical procedure. The presence of refusal of surgery was found, despite being followed by acceptance. We discuss how such attitudes can be understood as reflective refusal and not merely as defense mechanisms or unthought reactions. As space is made for thinking, reflective refusal plays a major role in the mental processes because it helps in assimilating events concerning the decision-making process. As a conclusion this study proposes understanding decision-making as a process and, from this perspective, it is considered an opportune moment for maternal reflection. Therefore, it is suggested that during psychological practice, refusal of surgery be approached as a possible maternal attitude during decision-making, taking into account that the caring and global well being of the child do not necessarily presuppose acceptance of surgery at the moment of indication. Likewise, initial refusal does not mean such refusal is final. This study further recommends psychological support for making such decision, which, in bringing about psychological ambivalence, doubt, and hesitation concerning the decision-making process, can promote a place for subjective reflection and elaboration, where there is the possibility of making a wise and pondered decision, with which the mother, the father, the child, and the family, can live with

Made available in DSpace on 2016-03-22T17:27:38Z (GMT). No. of bitstreams: 1 dissert fabio coelho.pdf: 632992 bytes, checksum: f19909ffb25c1ec4f3c3b48862ac3d45 (MD5) Previous issue date: 2006-04-14 / A cross-sectional population-based study was conducted to identify the prevalence of common mental disorders (CMD) and verify its association with chronic illnesses and the declared number of chronic conditions. The Self-Report Questionnaire (SRQ-20) was applied in a multi-stage random sample of 1276 adults aged 40 and older. Socio-demographic, behavioral and health-related variables were also obtained with a structured questionnaire. The CMD prevalence was 30.2%. Lower educational level and social class and the group 46- 55 years old were associated with psychiatric morbidity. Each chronic illness was associated with CMD. However, a stronger association was found between CMD and the declared number of chronic conditions, with a prevalence ratio of 4.67 (IC95%: 3.19 6.83) for five or more declared conditions. The present work emphasizes the importance of CMD in chronically ill patients, particularly when a greater number of chronic conditions is declared. / Estudo transversal de base populacional foi conduzido tendo como objetivos avaliar a prevalência dos transtornos mentais comuns (TMC) e verificar sua associação com determinadas enfermidades crônicas e com o número de doenças crônicas relatadas pelo indivíduo. Para a avaliação de TMC, o Self-Report Questionnaire (SRQ-20) foi aplicado em 1276 adultos com 40 anos ou mais, identificados por meio de amostragem aleatória em múltiplos estágios. O ponto de corte utilizado foi de 6 ou mais pontos para homens e 8 ou mais pontos para as mulheres. Variáveis sócio-demográficas, comportamentais e relacionadas à saúde foram obtidas por meio de um questionário estruturado. Os TMC apresentaram uma prevalência de 30,2%, estando associados à baixa escolaridade e classe social, e à faixa etária de 46 a 65 anos. Todas as doenças crônicas pesquisadas mostraram-se associadas aos TMC, mesmo após ajuste para as demais variáveis. Entretanto, o número de enfermidades apresentadas pelo indivíduo teve maior importância do que cada uma delas individualmente, com uma razão de prevalência (RP) de 4,67 com intervalo de confiança de 95% (IC95%) de 3,19 6,83 para cinco ou mais doenças relatadas. O presente estudo realça a importância de se atentar para os transtornos mentais em indivíduos com enfermidades crônicas, principalmente naqueles que se apresentam com um grande número de doenças.

A decisão da cirurgia cardíaca paliativa é um processo crítico para os pais pois envolve risco de vida para o filho. Esta pesquisa investigou aspectos das atitudes maternas na tomada de decisão da cirurgia, com a suposição de que atitudes de recusa podem estar presentes. A partir do referencial teórico da Psicanálise, entende-se que o diagnóstico médico e a indicação cirúrgica podem provocar impactos psíquicos traumáticos. A iminência de perda pela doença de prognóstico ruim, a relação risco-benefício não claramente favorável da cirurgia e o contexto do tratamento, em geral permanente e realizado fora do domicílio de origem, são aspectos que influenciam as decisões da mãe. O processo decisório (tratamento versus não tratamento) foi discutido à luz de noções da Bioética, como autonomia, participação ativa no tratamento, decisões de representação, bem como das implicações jurídicas. A não aceitação da cirurgia pode trazer conflitos de interesse na relação médico-paciente/cuidador, fazendo refletir sobre como se dão, na sociedade atual, as relações entre processos médico-biológicos e processos subjetivos. A partir da abordagem de pesquisa clínico-qualitativa utilizou-se a entrevista semi-dirigida individual. As participantes foram duas mães de crianças cardíacas que passaram por cirurgia paliativa e que estavam hospedadas na Associação de Assistência à Criança Cardíaca e à Transplantada do Coração. Observou-se atitudes de hesitação, questionamento, recusa da cirurgia e atitudes de não pensamento e aceitação imediata do procedimento. Verificou-se a presença de atitudes de recusa da cirurgia, apesar de sua posterior aceitação. Discutiu-se como tais atitudes podem ser entendidas como recusa-reflexão e não apenas como defesas psíquicas ou reações precipitadas. À medida que abre um espaço de pensamento, a recusa-reflexão teria uma função importante para o psiquismo pois auxilia na assimilação dos acontecimentos relativos ao processo decisório. Como conclusão se propõe entender a decisão como um processo e, desta perspectiva, é considerada um momento oportuno de reflexão para a mãe. Sugere-se, então, que na prática psicológica a recusa da cirurgia seja abordada como uma atitude materna possível ao processo decisório, considerando que o encaminhamento na direção do cuidado e do bem-estar global do filho não necessariamente pressupõe a aceitação da cirurgia no momento de sua indicação, da mesma forma que a recusa inicial não significa que seja definitiva. Indica-se o suporte psicológico na decisão da cirurgia que, por legitimar as ambivalências psíquicas, as dúvidas e hesitações desse processo, poderá favorecer um espaço de reflexão e elaboração subjetiva onde se abra a possibilidade de se tomar uma decisão ponderada, consequente, e com a qual a mãe, o pai, a criança, a família, poderão conviver / Decision-making before palliative heart surgery is a critical process for parents because it involves a risk to their childs life. This study investigated aspects of maternal attitudes in deciding about surgery, and takes into account the assumption that attitudes of refusal may be present. Based on Psychoanalysis theoretical framework, we understand that medical diagnosis and indication for surgery may cause psychic trauma. The imminence of loosing ones child due to the poor prognosis associated with the condition, the risk-benefit relationship not clearly favorable to surgical intervention, and the context of treatment, which is in general permanent and carried out outside the patients city of residence, are aspects that influence maternal decision-making. The decision-making process (treatment versus non-treatment) is discussed in the light of notions from the field of Bioethics, such as autonomy, active participation in treatment, proxy decision-making, as well as in the light of the legal implications. Refusing surgery can cause conflicts of interest in the doctor-patient/caregiver relationship, which engenders thinking about how the relationship between medical and biological processes, and subjective processes take place in todays society. The qualitative research design comprised an individual semi-structured questionnaire survey. The two participants were mothers of cardiac children who went through palliative heart surgery and were staying at the Associação de Assistência à Criança Cardíaca e à Transplantada do Coração [Association for Assisting Cardiac and Heart-Transplanted Children]. The attitudes observed were attitudes of hesitation, questioning, refusal of surgery, and attitudes of not thinking, and of immediate acceptance of the surgical procedure. The presence of refusal of surgery was found, despite being followed by acceptance. We discuss how such attitudes can be understood as reflective refusal and not merely as defense mechanisms or unthought reactions. As space is made for thinking, reflective refusal plays a major role in the mental processes because it helps in assimilating events concerning the decision-making process. As a conclusion this study proposes understanding decision-making as a process and, from this perspective, it is considered an opportune moment for maternal reflection. Therefore, it is suggested that during psychological practice, refusal of surgery be approached as a possible maternal attitude during decision-making, taking into account that the caring and global well being of the child do not necessarily presuppose acceptance of surgery at the moment of indication. Likewise, initial refusal does not mean such refusal is final. This study further recommends psychological support for making such decision, which, in bringing about psychological ambivalence, doubt, and hesitation concerning the decision-making process, can promote a place for subjective reflection and elaboration, where there is the possibility of making a wise and pondered decision, with which the mother, the father, the child, and the family, can live with

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