The Effectiveness of Problem-Solving Therapy Program Intervention in Reducing Depression of Older Cancer Patients

BACKGROUND: Appropriate intervention has not been developed and implemented because depression has been overlooked for older cancer patients. However, because depression is prevalent among this population, the need for the intervention is high. The objective of this study was to verify the effectiveness of the problem-solving therapy program in reducing depression level for older cancer patients. METHODS: The experimental participants were recruited by social workers in five university hospitals in Seoul, Gyeonggi, and Gangwon. Using Patient Health Questionnaire-9 (PHQ-9), older cancer patients who scored between 10–19 points are selected. The subjects were assigned to the experimental group (30 patients) and the control group (30 patients) according to their will, and the experimental group participated in the problem solving therapy program for 6 weeks. The Center for Epidemiological Studies Depression 10 Scale and the Social Problem Solving Ability Scale were used to verify the effectiveness of the problem-solving program. RESULTS: The group homogeneity test indicated that the experimental group and the control group are homogeneous. The results of this study showed that the depression of older cancer patients had a significant positive correlation with the negative attitude toward the problem. The effectiveness of the problem solving program was significantly reduced in the experimental group (Z=−3.534, P < 0.001). And the social problem solving ability of experimental group was significantly improved (Z=−2.908, P=0.003). CONCLUSIONS: The problem-solving therapy program is effective for depression in geriatric cancer patients and this result suggests that it can be implemented as an alternative medical treatment.

The Effectiveness of Problem-Solving Therapy Program Intervention in Reducing Depression of Older Cancer Patients

BACKGROUND@#Appropriate intervention has not been developed and implemented because depression has been overlooked for older cancer patients. However, because depression is prevalent among this population, the need for the intervention is high. The objective of this study was to verify the effectiveness of the problem-solving therapy program in reducing depression level for older cancer patients.@*METHODS@#The experimental participants were recruited by social workers in five university hospitals in Seoul, Gyeonggi, and Gangwon. Using Patient Health Questionnaire-9 (PHQ-9), older cancer patients who scored between 10–19 points are selected. The subjects were assigned to the experimental group (30 patients) and the control group (30 patients) according to their will, and the experimental group participated in the problem solving therapy program for 6 weeks. The Center for Epidemiological Studies Depression 10 Scale and the Social Problem Solving Ability Scale were used to verify the effectiveness of the problem-solving program.@*RESULTS@#The group homogeneity test indicated that the experimental group and the control group are homogeneous. The results of this study showed that the depression of older cancer patients had a significant positive correlation with the negative attitude toward the problem. The effectiveness of the problem solving program was significantly reduced in the experimental group (Z=−3.534, P < 0.001). And the social problem solving ability of experimental group was significantly improved (Z=−2.908, P=0.003).@*CONCLUSIONS@#The problem-solving therapy program is effective for depression in geriatric cancer patients and this result suggests that it can be implemented as an alternative medical treatment.

Doctors' Ageism towards the Elderly Cancer Patients: Focusing on Disclosure of Cancer Diagnosis and Explanation on Treatment

BACKGROUND: This research is an exploratory study that is based on previous studies focusing on relationship between the doctors and the elderly cancer patients; moreover, the research focuses on the doctors' negative attitudes and discriminative behaviors towards the elderly cancer patients so that we may be able to suggest the ways to decrease the ageism. METHODS: Qualitative method and quantitative method were applied sequently. In this research, we practiced in-depth interviews with 8 doctors and then the surveys with 274 doctors. The in-depth interview questions were categorized depending on meaningful testimonies and the survey data were analyzed in the descriptive statistic analysis and paired t-test using PASW statistics 18. RESULTS: Through the in-depth interviews, the following is observed: the doctors rarely notify the elderly cancer patients directly; the family members of patients avoids the doctors to do so; and the doctors even show different attitudes or discriminatory actions to the elderly. Based on the in-depth interview results, the questions on notifying methods of the diagnosis and how to explain for treatment were developed and performed as a survey. Through the survey, only 8.4% of the doctors reported they directly notify the elderly cancer patient; moreover, they also reported they provide less information on treatment, side-effects, prognosis, and medical cost to the elderly than the middle-aged. CONCLUSIONS: This research not only discovered the presence of discrimination towards the elderly cancer patients but also suggested the causes of it. In order to resolve the phenomenon, doctors must consider individualized difference and variability of physiological function and should be aware of the psychological change after the cancer diagnosis to better communicate with them. Additionally, the social family culture which overprotects the elderly must be changed.

The Mediating Role of Optimism and Pessimism on the Relationship between Spirituality and Depression among Elderly Cancer Patients

BACKGROUND: Numerous studies have demonstrated that spirituality has protective effects on depression. However, there are only few studies on the theoretical mechanism showing how spirituality effects on depression. Thus, to find mediating variables explaining the relationship between the spirituality and depression may help to develop appropriate program for reducing depression in elderly cancer patients. In this study, we examined the effect of optimism and pessimism as their mediating effects on depression. METHODS: This study is to verify the relationships between spirituality and depression along with the mediating effects of optimism and pessimism among 600 South Korean elderly cancer patients who participated in a community-based study about their mental health. RESULTS: Optimism and pessimism are linked with spirituality and depression. Higher spirituality levels were associated with increased optimistic thinking, and then optimistic thinking is associated with low possibility of depression, whereas lower spirituality levels were associated with more pessimistic thinking, and in turn pessimistic thinking is associated with high depression scores. CONCLUSIONS: Understanding optimism and pessimism affecting depression level is critical for developing spirituality-based programs to reduce depression in elderly cancer patients.

Moderating Effects of Optimism and Family Support on the Depression of Family Caregivers of Cancer Patients

BACKGROUND: This study examined moderating effects of optimism and family support on the depression of family caregivers of cancer patients aged 55 and over by adopting stress process model. METHODS: 359 family caregivers who accompanied with cancer patients to out-patient clinics were recruited and completed questionnaire at three university hospitals located in Seoul and Gyeonggi province. Exploratory factor analysis was applied to test validity of the construction of the scale. Hierarchical multiple regression analysis was used to determine moderating effects of optimism and family support on depression after making mean centering of each variable. RESULTS: Results showed that spouse caregivers have more depression than do adult children as the nursing period gets longer. Education and income status were significant variables affecting depression of family caregivers. Optimism and family support for family caregivers have moderating effects on the association between stressors (emotional functioning of cancer patients and role overload of family caregivers) and depression of family caregivers. CONCLUSIONS: The findings suggest that more attentions are needed to the depression of spouse caregivers. Interventions are strongly recommended for health professionals to provide cancer patients and their family caregivers with "holding environments" caring for emotions and facilitating adjustment.

A Survey on the Perception for the Disaster Mental Health Services among General Population / 신경정신의학

OBJECTIVES: Disasters exert substantial effects on the mental health of victims and bereaved populations. Thus, a systematic framework for preparing and providing psychosocial and mental health services is necessary. The current attitudes toward and knowledge of disaster mental health-related factors among the general population provides one component for development of the disaster mental health services framework. METHODS: The authors analyzed a web-based survey for disaster mental health-related factors among the general population. Responses for the knowledge and perception for the disaster mental health services were compared between people who experienced and did not experience disaster. RESULTS: One thousand and three people completed the questionnaire. One hundred and seventy (16.9%) people experienced more than one disaster. People who experienced a disaster were more disturbed by disaster broadcasting or reporting than people who had not. People who experienced a disaster gave disaster mental health services an average score 63.5. People who experienced a disaster perceived group psychotherapy and self-help meetings as less important than those who had not. The recognition of both community mental health center and disaster mental health center was higher in the experienced group than non-experienced. CONCLUSION: This study revealed that general satisfaction with the current disaster mental health service is low, particularly among people who have used disaster mental health services. A national mental health system for disaster victims should be established with consideration for efficiency, effectiveness and accessibility.

A Comparative Study on the Assessment of the Quality of Life by Older Cancer Patients and Caregivers and Assessment of Performance Status by Medical Staff

BACKGROUND: The study examined the correlations among the results of the European Organization for Research and Treatment of Cancer (EORTC)-Quality of Life Questionnaire, Core 30 (QLQ-C30) completed by elderly cancer patients and their family caregivers and the Eastern Cooperative Oncology Group (ECOG)-performance status (PS) evaluated by medical doctors. METHODS: The study sample included 269 persons with cancer aged 55 years or older and their family caregivers recruited from hospitals located in Seoul and Gyeonggi-do. The results of the ECOG-PS evaluated by medical doctors were obtained from medical records. Intra-class correlation analysis was used to assess rater reliability between the elderly cancer patients and their family caregivers. Correlations among the EORTC QLQ-C30 and the ECOG-PS were tested using the Kruskal-Wallis test and Spearmen's correlation. RESULTS: The results showed that four subscales of quality of life (physical functioning, emotional functioning, social functioning, and global health status) and three items under symptoms (fatigue, pain, and financial difficulties) in the EORTC QLQ-C30 were highly consistent between patients and their family caregivers. From the EORTC QLQ-C30 results, social functioning, role functioning, health status, fatigue, pain, and appetite loss (patients results) and physical functioning (family caregivers results) were highly consistent with the results of the ECOG-PS by the physicians. CONCLUSIONS: The findings suggest that when the older persons with cancer have difficulty expressing their own thoughts or feelings, the EORTC QLQ-C30 completed by their family caregivers and the results of the ECOG-PS completed by the physicians could be used as substitutes.

Effects of Satisfaction with Social Support on Complicated Grief in Bereaved Dementia Caregivers

BACKGROUND: While complicated grief can lead to adverse health outcomes, social support has been shown to be an important protective factor of its negative effects. The present study investigated the relationship between social support including satisfaction with support, received support, and negative interactions and complicated grief in the transitional context from caregiving to bereavement. METHODS: Bereaved caregivers (n=221) who participated in a multi-site study of dementia caregiving were assessed for complicated grief. Social support measured before and after death were used to examine the longitudinal associations among social support and complicated grief. RESULTS: We found that caregivers reporting greater increase in satisfaction with social support were likely to experience lower levels of complicated grief, while the amount of received social support did not significantly impact complicated grief. Negative social interaction was significantly associated with the level of complicated grief after the death of the care recipient. CONCLUSIONS: The relationship between social support and complicated grief suggests that satisfaction with social support may be associated with lower levels of complicated grief. Study findings point to the importance of the type of social support for reducing the level of complicated grief.

Effects of Satisfaction with Social Support on Complicated Grief in Bereaved Dementia Caregivers

BACKGROUND: While complicated grief can lead to adverse health outcomes, social support has been shown to be an important protective factor of its negative effects. The present study investigated the relationship between social support including satisfaction with support, received support, and negative interactions and complicated grief in the transitional context from caregiving to bereavement. METHODS: Bereaved caregivers (n=221) who participated in a multi-site study of dementia caregiving were assessed for complicated grief. Social support measured before and after death were used to examine the longitudinal associations among social support and complicated grief. RESULTS: We found that caregivers reporting greater increase in satisfaction with social support were likely to experience lower levels of complicated grief, while the amount of received social support did not significantly impact complicated grief. Negative social interaction was significantly associated with the level of complicated grief after the death of the care recipient. CONCLUSIONS: The relationship between social support and complicated grief suggests that satisfaction with social support may be associated with lower levels of complicated grief. Study findings point to the importance of the type of social support for reducing the level of complicated grief.

Effects of Satisfaction with Social Support on Complicated Grief in Bereaved Dementia Caregivers

BACKGROUND: While complicated grief can lead to adverse health outcomes, social support has been shown to be an important protective factor of its negative effects. The present study investigated the relationship between social support including satisfaction with support, received support, and negative interactions and complicated grief in the transitional context from caregiving to bereavement. METHODS: Bereaved caregivers (n=221) who participated in a multi-site study of dementia caregiving were assessed for complicated grief. Social support measured before and after death were used to examine the longitudinal associations among social support and complicated grief. RESULTS: We found that caregivers reporting greater increase in satisfaction with social support were likely to experience lower levels of complicated grief, while the amount of received social support did not significantly impact complicated grief. Negative social interaction was significantly associated with the level of complicated grief after the death of the care recipient. CONCLUSIONS: The relationship between social support and complicated grief suggests that satisfaction with social support may be associated with lower levels of complicated grief. Study findings point to the importance of the type of social support for reducing the level of complicated grief.

Depressive Symptom Trajectories and Associated Risks among Korean Elderly

BACKGROUND: Recent studies conducting changes in depressive symptoms among the elderly reported mixed results. The present study sought to determine if subgroups of elderly Koreans follow distinctive depressive symptom trajectories and the characteristics associated with the depressive symptom trajectories. METHODS: Subjects were those who had participated in a longitudinal study of quality of life in older adults. A latent class mixture model was examined to identify the trajectories of depressive symptom changes with time. RESULTS: We found four depressive symptom trajectories. Poorer health status, poor economic status, and less social support were risk factors in the high depression group. CONCLUSIONS: Early intervention to help elderly individuals manage their health, economic concerns, and social relationships may decrease the risk of high level depression.

Effects of Social Support on Caregiver Burden and Depressive Symptoms in Family Caregivers of Patients with Alzheimer's Disease

BACKGROUND: Alzheimer's disease and other forms of dementia affect an ever-growing number of individuals in the United States, and the family members in charge of caring for relatives with dementia often experience debilitating caregiving burden and depression as a result of this responsibility. METHODS: Using a sample of 612 family caregivers from the Resources for Enhancing Alzheimer's Caregiver Health, this study examined perceived social support (i.e., level of satisfaction with social support received) as a protective factor of caregiving burden and depression. RESULTS: Regression results indicated that there was a significant negative effect of perceived social support on caregiving burden (B=-0.35, P<0.01) and depressive symptoms (B=-0.55, P<0.01). Mediation analysis results indicated a significant indirect effect of perceived social support on depressive symptoms through caregiving burden (B=-0.103, CI=-0.207/-0.035). DISCUSSION: These findings indicate that higher perceived social support may reduce caregiving burden, and in turn, reduce depressive symptoms. These findings provide insight into the mechanisms linking social support with depressive symptoms among caregivers.

Effects of Social Support on Caregiver Burden and Depressive Symptoms in Family Caregivers of Patients with Alzheimer's Disease

BACKGROUND: Alzheimer's disease and other forms of dementia affect an ever-growing number of individuals in the United States, and the family members in charge of caring for relatives with dementia often experience debilitating caregiving burden and depression as a result of this responsibility. METHODS: Using a sample of 612 family caregivers from the Resources for Enhancing Alzheimer's Caregiver Health, this study examined perceived social support (i.e., level of satisfaction with social support received) as a protective factor of caregiving burden and depression. RESULTS: Regression results indicated that there was a significant negative effect of perceived social support on caregiving burden (B=-0.35, P<0.01) and depressive symptoms (B=-0.55, P<0.01). Mediation analysis results indicated a significant indirect effect of perceived social support on depressive symptoms through caregiving burden (B=-0.103, CI=-0.207/-0.035). DISCUSSION: These findings indicate that higher perceived social support may reduce caregiving burden, and in turn, reduce depressive symptoms. These findings provide insight into the mechanisms linking social support with depressive symptoms among caregivers.

Effects of Social Support on Caregiver Burden and Depressive Symptoms in Family Caregivers of Patients with Alzheimer's Disease

BACKGROUND: Alzheimer's disease and other forms of dementia affect an ever-growing number of individuals in the United States, and the family members in charge of caring for relatives with dementia often experience debilitating caregiving burden and depression as a result of this responsibility. METHODS: Using a sample of 612 family caregivers from the Resources for Enhancing Alzheimer's Caregiver Health, this study examined perceived social support (i.e., level of satisfaction with social support received) as a protective factor of caregiving burden and depression. RESULTS: Regression results indicated that there was a significant negative effect of perceived social support on caregiving burden (B=-0.35, P<0.01) and depressive symptoms (B=-0.55, P<0.01). Mediation analysis results indicated a significant indirect effect of perceived social support on depressive symptoms through caregiving burden (B=-0.103, CI=-0.207/-0.035). DISCUSSION: These findings indicate that higher perceived social support may reduce caregiving burden, and in turn, reduce depressive symptoms. These findings provide insight into the mechanisms linking social support with depressive symptoms among caregivers.