The Effects of Osteoarthritis on Depressive Symptomatology Among Older U.S. Military Veterans.

Osteoarthritis (OA) is a leading cause of disability among older adults. By 2050, approximately 60 million will suffer from arthritis adding up to a total societal cost of $65 billion. Chronic illnesses resulting in pain, and functional decline have been associated with depression in previous studies.A causal model was developed and tested using structural equation modeling that examined depression scores of 503 older (age 50-85), male Veterans with moderate to severe symptomatic OA of the knee\hip.The results of the structural equation modeling produced a final model of depressive symptomatology that fit the data well (Chi square = 12.23, DF = 11, p = .346; TLI = .99; CFI = 1.00; RMSEA = .02).The findings indicate the central role that OA severity (pain, stiffness, and functional difficulties) plays in the mental health of older Veterans in terms of the level of reported depressive symptoms.

Writing for publication: perspectives of graduate nursing students and doctorally prepared faculty.

Publication is a common expectation for both faculty and graduate students in schools of nursing. Little is known about the perceptions of students and faculty regarding what supports or interferes with students' success in writing for publication. Perceptions of supports and barriers to writing for publication and the differences in perceptions between graduate nursing students and faculty were examined. A descriptive comparative design was used to sample master's (n = 62), Doctor of Nursing Practice (n = 66), and Doctor of Philosophy (n = 7) students and graduate faculty (n = 35) using two investigator-developed surveys. Students (71.1%) and faculty (57.6%) identified working with faculty and mentors as the greatest support. Students' primary barrier was finding time (64.5%). Faculty identified not knowing how to get started (63.6%) as the students' greatest barrier. Findings support that mentoring and finding sufficient time for writing are priorities for the development of a plan to support students in writing for publication.

Comparison of short scales to measure depressive symptoms in elders with diabetes.

Depression is the most common mental health problem among American elders and it is also prevalent among those with diabetes. The 20-item Center for Epidemiological Studies Depression Scale (CES-D) is commonly used to measure depressive symptoms in elders, but its length is potentially burdensome. Twelve short forms of the CES-D (4 to 16 items) exist, but they have not been tested with elders with diabetes. This study compared reliability and validity estimates across the 12 short forms and investigated similarities in classifying elders with diabetes as clinically depressed using standardized cut scores. Beck's theory provides a framework for identifying the affective, cognitive, behavioral, and somatic symptoms that are measured by the CES-D. Data were merged from two studies, which yielded 80 elders with diabetes who completed the CES-D items during structured interviews. Cronbach's alpha was .87 for the CES-D; it ranged from .60 (5 items) to .84 (16 items) for shorter forms. Correlations of the full CES-D and short forms ranged from .82 (4 items) to .98 (16 items). Using the CES-D cut score, 14% of the elders with diabetes had clinically significant depressive symptoms: 21% men, 11% women, 17% African Americans, and 13% Caucasians. A 5-item scale overestimated 29% as clinically depressed: 33% men, 27% women, 25% African Americans, and 29% Caucasians. The findings suggest that shortened scales to measure depressive symptoms may be potentially useful with elders with diabetes. Further psychometric studies of the CES-D short forms are recommended with elders with chronic conditions.

Cancer communication patterns and the influence of patient characteristics: disparities in information-giving and affective behaviors.

OBJECTIVE: To examine whether patient characteristics are associated with communication patterns between oncologists and breast cancer patients. METHODS: The study was conducted at 14 practices with 58 oncologists with 405 newly diagnosed patients with no prior history of breast cancer. The initial consultation between oncologist and patient was audiotaped and a detailed communication analysis performed. Interviews were conducted with patients and physicians immediately before and after consultations. RESULTS: Disparities were found across all patient demographics. Younger patients asked more questions as did those who were white had more than a high school education and when they reported an income that was high or medium income, compared to low (p<0.01). Patient proactive behavior, such as volunteering information to the physician unasked, was similarly related with all demographic predictors as was physician tendency to ask patients questions. Despite the inherently emotional nature of this encounter, there was surprisingly little overt discussion about how the patient felt about her diagnosis and how she was coping. Both patients and physicians spent time trying to establish an interpersonal relationship with each other, although patients spent more time. Patients differed in the number of relationship building utterances by age, education and income and physicians spent more time engaged in relationship building with white than non-white patients (p<0.01) and more educated and affluent patients (p<0.05). CONCLUSION: This study indicates that patient demographic factors, such as race, income level, education and age seem to influence the amount of time physicians spend in almost all communication categories with patients. One recurring difference across most communication categories was race. Racial differences occurred in almost every one of the communication categories examined. White patients had many more utterances in almost every communication category than their non-white counterparts. These differences may mean a less adequate decision-making process for patients who are members of racial or ethnic minorities, patients who are less affluent, older, and have less education. PRACTICE IMPLICATIONS: This study found that providers communicate differently with patients by age, race, education and income. These differences in communication may lead to disparities in patient outcomes. Communication skills training should explicitly train clinicians to recognize these tendencies. Patients with different demographics characteristics may also required education that is tailored to them.