Clinical Interviewing: An Essential but Neglected Method of Medicine.

Clinical interviewing is the basic method to understand how a person feels and what are the presenting complaints, obtain medical history, evaluate personal attitudes and behavior related to health and disease, give the patient information about diagnosis, prognosis, and treatment, and establish a bond between patient and physician that is crucial for shared decision making and self-management. However, the value of this basic skill is threatened by time pressures and emphasis on technology. Current health care trends privilege expensive tests and procedures and tag the time devoted to interaction with the patient as lacking cost-effectiveness. Instead, the time spent to inquire about problems and life setting may actually help to avoid further testing, procedures, and referrals. Moreover, the dialogue between patient and physician is an essential instrument to increase patient's motivation to engage in healthy behavior. The aim of this paper was to provide an overview of clinical interviewing and its optimal use in relation to style, flow and hypothesis testing, clinical domains, modifications according to settings and goals, and teaching. This review points to the primacy of interviewing in the clinical process. The quality of interviewing determines the quality of data that are collected and, eventually, of assessment and treatment. Thus, interviewing deserves more attention in educational training and more space in clinical encounters than it is currently receiving.

Incremental validity of acceptance over coping in predicting adjustment to endometriosis.

Psychological acceptance has emerged as an important construct to explain low psychological distress in different clinical samples. However, the incremental validity of psychological acceptance to explain adjustment to medical conditions over other related and well-established constructs, such as coping, is relatively unclear. This study explored whether psychological acceptance significantly contributes to explain adjustment above and beyond coping in females with endometriosis. A total of 169 females (M age = 34.95 years; SD age = 6.07 years) with endometriosis and pain symptoms completed the Acceptance and Action Questionnaire-II, the Brief-COPE, the Hospital Anxiety and Depression Scale, the Psychological Wellbeing Scale, and the Endometriosis Health Profile-5. We conducted Hierarchical Regression Analyses to determine the contribution of psychological acceptance to explaining adjustment. The results showed that the contribution of psychological acceptance ranged from 11 to 20% when controlling for coping, while coping explained from 1 to 8% when the model was reversed. The findings suggest that psychological acceptance is a more useful construct than coping for predicting PD and other psychological outcomes in females with endometriosis.

Cross-cultural validity of the WHO-5 Well-Being Index and Euthymia Scale: A clinimetric analysis.

BACKGROUND: The assessment of psychological well-being and euthymia represents an emerging issue in clinical psychology and psychiatry. Rating scales and indices such as the 5-item version of the World Health Organization Well-Being Index (WHO-5) and the Euthymia Scale (ES) were developed but insufficient attention has been devoted to the evaluation of their cross-cultural validity. This is the first study using Clinimetric Patient-Reported Outcome Measures (CLIPROM) criteria to assess cross-cultural validity and sensitivity of five different versions of the WHO-5 and ES. METHODS: A multicenter cross-sectional study involving a total of 3762 adult participants from different European (i.e., Italy, Poland, Denmark) and non-European (i.e., China, Japan) countries was conducted. Item Response Theory models (Mokken and Rasch analyses) were applied. RESULTS: Mokken coefficients of scalability were found to range from 0.42 to 0.84. The majority of the versions of the WHO-5 fitted the Rasch model expectations. Paired t-tests revealed that the Italian and Danish WHO-5 versions were unidimensional. Person Separation Reliability indices showed that the Polish, Danish, and Japanese ES versions could reliably discriminate between subjects with different levels of euthymia. LIMITATIONS: A convenience sampling was used, thus limiting the generalizability of study findings. In addition, no measures of negative mental health were administered. CONCLUSIONS: WHO-5 can be used in international studies for cross-cultural comparisons since it covers transcultural components of subjective well-being. Findings also suggest that the ES can be used as a cross-cultural screening tool since it entailed the clinimetric property of sensitivity.

Clinimetric Criteria for Patient-Reported Outcome Measures.

Patient-reported outcome measures (PROMs) are self-rated scales and indices developed to improve the detection of the patients' subjective experience. Given that a considerable number of PROMs are available, it is important to evaluate their validity and usefulness in a specific research or clinical setting. Published guidelines, based on psychometric criteria, do not fit in with the complexity of clinical challenges, because of their quest for homogeneity of components and inadequate attention to sensitivity. Psychometric theory has stifled the field and led to the routine use of scales widely accepted yet with a history of poor performance. Clinimetrics, the science of clinical measurements, may provide a more suitable conceptual and methodological framework. The aims of this paper are to outline the major limitations of the psychometric model and to provide criteria for clinimetric patient-reported outcome measures (CLIPROMs). The characteristics related to reliability, sensitivity, validity, and clinical utility of instruments are critically reviewed, with particular reference to the differences between clinimetric and psychometric approaches. Of note is the fact that PROMs, rating scales, and indices developed according to psychometric criteria may display relevant clinimetric properties. The present paper underpins the importance of the clini-metric methodology in choosing the appropriate PROMs. CLIPROM criteria may also guide the development of new indices and the validation of existing PROMs to be employed in clinical settings.

On the contribution of psychological flexibility to predict adjustment to breast cáncer / Contribución de la flexibilidad psicológica en la predicción del distrés psicológico en pacientes con cáncer de mama

BACKGROUND: This study explored the contribution of Psychological Flexibility (PF) to predict adjustment to breast cancer. METHOD: Sixty-four females with breast cancer completed self-report measures of PF and adjustment (anxiety, depression, negative and positive affect) at baseline, and forty-two patients returned for assessment six months later. RESULTS: Higher flexibility at baseline significantly contributed to predict lower anxiety, depression and negative affect at follow-up. The effect sizes ranged from moderate to large. CONCLUSIONS: Results provide evidence for targeting PF to prevent enhanced psychological distress in patients with breast cancer, and add to a growing body of research supporting PF as a common protective factor across different contexts and populations

ANTECEDENTES: este estudio explora el grado de contribución de la Flexibilidad Psicológica (FP) en el pronóstico de diversos indicadores de adaptación al cáncer de mama. MÉTODO: 64 mujeres con cáncer de mama completaron medidas de FP, ansiedad, depresión, afecto negativo y positivo en un primer momento (T1), y 42 de ellas repitieron la evaluación seis meses después (T2). RESULTADOS: los resultados indican que la FP en T1 contribuye significativamente en la predicción de ansiedad, depresión y afecto negativo en T2, con tamaños del efecto que oscilan entre moderado y grande. Elevados niveles de FP se asocian significativamente con niveles más bajos de distrés psicológico. CONCLUSIONES: los resultados apoyan que la FP es un factor protector de niveles excesivos de distrés en pacientes con cáncer de mama. Estos resultados se suman al creciente cuerpo de evidencias que sugiere que la FP es un factor general de protección de la salud mental, transversal a diferentes contextos y poblaciones

On the contribution of psychological flexibility to predict adjustment to breast cancer.

BACKGROUND: This study explored the contribution of Psychological Flexibility (PF) to predict adjustment to breast cancer. METHOD: Sixty-four females with breast cancer completed self-report measures of PF and adjustment (anxiety, depression, negative and positive affect) at baseline, and forty-two patients returned for assessment six months later. RESULTS: Higher flexibility at baseline significantly contributed to predict lower anxiety, depression and negative affect at follow-up. The effect sizes ranged from moderate to large. CONCLUSIONS: Results provide evidence for targeting PF to prevent enhanced psychological distress in patients with breast cancer, and add to a growing body of research supporting PF as a common protective factor across different contexts and populations.

Spanish version of the eating attitudes test 40: dimensionality, reliability, convergent and criterion validity

The Eating Attitudes Test-40 (EAT-40; Garner & Garfinkel, 1979) is one of the most widely used measures in the field of eating disorders (ED). The factor structure of the EAT-40, as well as the optimal cut-off score to identify subjects with ED, are subjects of debate. Both controversial issues are addressed in the present study. Participants were 95 clinical females meeting DSM-IV-R criteria for ED and 89 females without ED. The results supported a unidimensional structure of the EAT-40 items scores. The general factor accounted for a high percentage (50.63%) of the variance in EAT-40 total scores. The questionnaire proved to have good internal consistency and test–retest reliability. Clinical participants displayed higher mean scores than normal subjects in the EAT-40. Further, participants meeting DSM-IV-R criteria for ED differed significantly from «symptomatic» and «asymptomatic» participants. Correlations with the BULIT-R and the EDI-II scores supported the convergent validity of the questionnaire. The EAT-40 also demonstrated good specificity (94.38%) and sensitivity (93.68%) to detect ED when a cut-off score of 27 was used to discriminate between subjects with and without ED. The implications of these findings for the conceptualization and the assessment of ED are discussed (AU)

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Cambios psicológicos tras cirugía bariátrica en personas co obesidad mórbida / Psychological effects of bariatric surgery on subjects with morbid obesity

El estudio analiza los efectos de distintos procedimientos quirúrgicos para tratar la obesidad mórbida, así como el grado de satisfacción de los participantes con las intervenciones y sus resultados. La muestra está formada por veintiséis sujetos con obesidad mórbida que fueron sometidos a gastroplastia vertical anillada o a bandeleta de silicona ajustable. Los resultados indican que ambas técnicas son efectivas para promover la pérdida de peso, así como para producir mejoras en las complicaciones físicas asociadas a la obesidad. Sin embargo, los usuarios están más satisfechos con aquellos procedimientos que producen menos complicaciones post-quirúrgicas, aunque produzcan pérdidas ponderales inferiores. Los beneficios psicosociales asociados a la cirugía bariátrica y la satisfacción del usuario con los resultados del tratamiento, por otra parte, no se relacionan con las pérdidas de peso como con los cambios en otras variables de naturaleza psicológica o comportamental (AU)

This study’s main aim is to analyze the effects on physical and psychological health of different surgical procedures to treat morbid obesity. We also analyze the degree of patient satisfaction regarding intervention and outcome. The sample comprised 26 subjects with morbid obesity (23 women and 4 men) who received surgery to reduce their weight (vertical ring gastroplasty or adjustable silicone gastric banding). The results show that these techniques are effective methods to promote weight loss in morbid obesity and to reduce complications associated with obesity. However, the results show that patients prefer methods with fewer post-surgical complications, even if weight losses are smaller. The psychosocial benefits associated with bariatric surgery and patient satisfaction with outcome are less related to weight loss and more to changes in other psychological and behavioral variables (AU)