Neuroticism as a moderator of symptom-related distress and depression in 4 noncancer end-of-life populations.

OBJECTIVES: Neuroticism is a significant predictor of adverse psychological outcomes in patients with cancer. Less is known about how this relationship manifests in those with noncancer illness at the end-of-life (EOL). The objective of this study was to examine the impact of neuroticism as a moderator of physical symptoms and development of depression in patients with amyotrophic lateral sclerosis (ALS), chronic obstructive pulmonary disease (COPD), end-stage renal disease (ESRD), and frailty in the last 6 months of life. METHODS: We met this objective using secondary data collected in the Dignity and Distress across End-of-Life Populations study. The data included N = 404 patients with ALS (N = 101), COPD (N = 100), ESRD (N = 101), and frailty (N = 102) in the estimated last 6 months of life, with a range of illness-related symptoms, assessed longitudinally at 2 time points. We examined neuroticism as a moderator of illness-related symptoms at Time 1 (∼6 months before death) and depression at Time 2 (∼3 months before death) using ordinary least squares regression. RESULTS: Results revealed that neuroticism significantly moderated the relationship between the following symptoms and depression measured 3 months later: drowsiness, fatigue, shortness of breath, wellbeing (ALS); drowsiness, trouble sleeping, will to live, activity (COPD); constipation (ESRD); and weakness and will to live (frailty). SIGNIFICANCE OF RESULTS: These findings suggest that neuroticism represents a vulnerability factor that either attenuates or amplifies the relationship of specific illness and depressive symptoms in these noncancer illness groups at the EOL. Identifying those high in neuroticism may provide insight into patient populations that require special care at the EOL.

A Longitudinal Study of Correlates, Discharge Disposition, and Rate of Re-presentation to Emergency Services of Adults who Engage in Non-suicidal Self-injury.

OBJECTIVE: In DSM-5, non-suicidal self-injury (NSSI) and suicide attempts (SA) are classified as distinct disorders in the section of conditions for further study. However, some have questioned the validity of distinguishing NSSI from SA. The objective of this study was to longitudinally examine the correlates, discharge disposition, and rate of re-presentation to emergency services of adults who engaged in NSSI and compare them to (a) adults who engage in SA and (b) adults with no self-harm or suicidal ideation (SI). METHOD: Data came from 4,772 presentations to adult psychiatric services in the emergency departments of tertiary care hospitals in Winnipeg, Canada between January 2009 and June 2012. Chart reviews were conducted for all presentations with NSSI (n = 158), and a sample of those with SA (n = 172) and no SH or SI (n = 173). RESULTS: Among the adults who returned to emergency services, those who originally presented with SA re-presented significantly sooner than those who presented with NSSI. (χ2(1) = 7.457, p = 0.006). Those who originally presented with NSSI that returned to hospital did not return with repeat NSSI, but instead the majority re-presented with suicidal thoughts and SA. Further, those who re-presented with NSSI and SA were less likely to be hospitalized or to receive a referral to mental health services, and more likely to be discharged to usual care at time of initial presentation. CONCLUSIONS: Overall, these findings indicate a trajectory of escalation of self-harm behavior for certain people who engage in NSSI, especially those who re-present to emergency services.HIGHLIGHTSA quarter of people with self-harm re-present to emergency services within four-and-a-half years.Those with suicide attempts re-presented significantly sooner than non-suicidal self-injury.There is a need for increased interventions in emergency services for those with self-harm.

Longitudinal Mixed Modelling of Emergency Department Use Among a Sample of Homeless Participants in a Housing First Demonstration Trial.

The present Canadian study sought to identify predictors of emergency department (ED) use in a sample of adults who are homeless. Four hundred eighty-three participants were interviewed quarterly for two years, reporting their housing status, income, food security, physical/mental health, and other social determinants of health. Survey data were linked to administrative health and social services data. Predictors of ED visits were analyzed using negative binomial longitudinal mixed modelling. Emergency department visits were positively and reliably predicted by pre-baseline ED use, as well as by concurrent increased social assistance, primary care visits, ratings of physical health, substance use problems, and case management visits. Increased concurrent housing instability and food insecurity, and decreased homelessness history, positively predicted ED visits, but effect reliability was lower. Participant ill health appears to be a primary driver of ED utilization. The findings challenge misconceptions about the appropriateness of ED use among people who are homeless.

A Comparison of Self-Harm Presentations to Emergency Services.

Background: In the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, the distinction between nonsuicidal self-injury (NSSI) and suicide attempts (SA) is highlighted in the section of conditions for further study. Aims: The objective of this study was to examine the correlates of people who presented to emergency departments (ED) with NSSI compared with those who presented with SA and no self-harm or suicidal ideation (no SH or SI). Method: Data came from 4,772 presentations to ED of tertiary care hospitals in Manitoba, Canada, between January 2009 and June 2012. Chart reviews were conducted for presentations with NSSI (n = 158), and a sample of SA (n = 172) and no SH or SI (n = 173). Results: NSSI was associated with borderline personality traits/disorders, previous history of SH, and aggression/impulsivity compared with no SH or SI. SA was associated with a lower likelihood of adjustment disorder (OR = 0.58; 95 % CI [0.34, 0.99]) and previous history of NSSI (OR = 0.30; 95 % CI [0.17, 0.53]) compared with NSSI. Limitations: A limitation of this study is its cross-sectional design. Conclusion: Given the distress associated with NSSI, the findings highlight the need for treatment plans that address all those who present to ED with SH regardless of intent.

Fixed Nodes of Transience: Narratives of Homelessness and Emergency Department Use.

Discourse in popular media, public policy, and academic literature contends that people who are homeless frequently make inappropriate use of hospital emergency department (ED) services. Although researchers have investigated the ED experiences of people who are homeless, no previous studies have examined how this population understands the role of the ED in their health care and in their day-to-day lives. In the present study, 16 individuals participated in semistructured interviews regarding their ED experiences, and narrative analysis was applied to their responses. Within the context of narratives of disempowerment and discrimination, participants viewed the ED in differing ways, but they generally interpreted it as a public, accessible space where they could exert agency. ED narratives were also paradoxical, depicting it as a fixed place for transient care, or a place where they were isolated yet felt a sense of belonging. Implications for policy and practice are discussed.

Negotiating home base: Narratives of psychological well-being among female military members.

The current study aimed to understand how active duty service women with low levels of current psychological distress make sense of their military experiences in ways that might contribute to psychological well-being. Semi-structured interviews were conducted with active duty female members in the Canadian Forces and transcripts were analyzed using narrative analysis. A sense of belonging was found to be of utmost salience to the women, with several participants negotiating and constructing places that felt like home to them, and with different degrees of attachment to the military versus civilian world. The findings of this work are discussed within the context of focusing prevention and intervention efforts on increasing belongingness and a sense of home for female service members.

Information Needs and Preferences of Parents Considering Treatment of Child Anxiety.

OBJECTIVE: To assess the information needs and preferences of parents who were making decisions concerning treatment for their child's anxiety. METHODS: Ninety-three parents were recruited from hospital-based clinics, a parent group, and a public information meeting. They completed a survey about preference for decision-making involvement, information needs, and preferences concerning source and amount of information. RESULTS: Most (69%) parents indicated that they prefer a collaborative decision-making role. They rated very highly the need for general information related to treatment and information related to psychosocial interventions and medication treatment. Fewer parents rated information about logistics of treatment (e.g., scheduling, cost) as highly important although this information was considered important by many parents. Direct discussions with a provider, written information, and information accessed through the internet were the most preferred sources of information. Many parents indicated a preference for substantial amounts of information about psychosocial and medication treatments. CONCLUSION: Much of the information that parents want concerning treatment is not widely available. It would be helpful to develop evidence-based brochures and web information resources that focus on answering parents' questions concerning treatment of children's anxiety.

Men, fire, and burns: Stories of fighting, healing, and emotions.

Burn recovery is a difficult process full of physical and psychological challenges. With increasing survival rates, there has been renewed interest in the psychological aspects of burn recovery. As men represent over 70% of all burn patients, it is particularly important to study how men experience and interpret this process. We interviewed a purposeful sample of ten adult male burn survivors from different age and cultural groups in the first 16 weeks of their recovery and asked them to discuss the problems they faced. Narrative analysis was used to interpret the interviews. In their narratives, the men tended to emphasize gains in their physical recovery; that is, they often used metaphors of "fighting" to demonstrate how committed they were to their healing. Further, they put less emphasis on the emotional aspects of their recovery. In our discussion, we compare these complex storylines to coping strategies identified in the literature and discuss why men may choose these strategies. Based on our findings we argue that it is important for health care providers to be aware of societal pressures which may influence burn survivors to minimize affective elements of burn recovery. Additionally, we encourage exploring and capitalizing on men's "fighting" stories during rehabilitation in order to foster an active role which men can take in their recovery.

Protective factors for mental disorders and psychological distress in female, compared with male, service members in a representative sample.

OBJECTIVE: Although military interest in promoting psychological resilience is growing, resources protective against psychopathology have been understudied in female service members. Using a representative sample of Canadian Forces personnel, we investigated whether religious attendance, spirituality, coping, and social support were related to mental disorders and psychological distress in female service members, and whether sex differences occurred in these associations. METHOD: Religious attendance and spirituality were self-reported. Coping items were taken from 3 scales and produced 3 factors (active, avoidance, and self-medication). Social support was assessed with the Medical Outcomes Study Social Support Survey. Past-year mental disorders were diagnosed with the World Mental Health Composite International Diagnostic Interview. The Kessler Psychological Distress Scale assessed distress. Multivariate regression models investigated links between correlates and psychological outcomes within each sex. For associations that were statistically significant in only one sex, sex by correlate interactions were computed. RESULTS: In female service members, inverse relations were found between social support and MDD, any MDD or anxiety disorder, suicidal ideation, and distress. No associations were found between religious attendance and outcomes, and spirituality was associated with an increased likelihood of some outcomes. Active coping was related to less psychological distress, while avoidance coping and self-medication were linked to a higher likelihood of most outcomes. Although several statistically significant associations were found in only one sex, only one sex by correlate interaction was statistically significant. CONCLUSIONS: Social support was found to be inversely related to several negative mental health outcomes in female service members. Few differences between men and women reached statistical significance. Future research should identify additional helpful resources for female service members.

Objectif : Quoique l'intérêt militaire pour la promotion de la résilience psychologique va en grandissant, les ressources protectrices contre la psychopathologie ont été sous-étudiées chez les membres féminins des forces armées. À l'aide d'un échantillon représentatif du personnel des Forces canadiennes, nous avons recherché si la pratique religieuse, la spiritualité, l'adaptation, et le soutien social étaient liés aux troubles mentaux et à la détresse psychologique chez le personnel féminin des Forces, et si des différences selon le sexe survenaient dans ces associations. Méthode : La pratique religieuse et la spiritualité étaient auto-déclarées. Les items d'adaptation étaient tirés de 3 échelles et produisaient 3 facteurs (actif, évitement, et automédication). Le soutien social était évalué par le Medical Outcomes Study Social Support Survey. Les troubles mentaux de l'année précédente ont été diagnostiqués au moyen du World Mental Health Composite International Diagnostic Interview. L'Échelle de détresse psychologique de Kessler a évalué la détresse. Des modèles de régression multivariée ont servi à rechercher les liens entre les corrélats et les résultats psychologiques de chaque sexe. Pour les associations qui n'étaient statistiquement significatives que pour un sexe, les interactions des sexes par corrélat ont été calculées. Résultats : Chez les membres féminins des forces, des relations inverses ont été constatées entre le soutien social et le trouble dépressif majeur (TDM), tout TDM ou trouble anxieux, l'idéation suicidaire, et la détresse. Aucune association n'a été détectée entre la pratique religieuse et les résultats, et la spiritualité était associée à la probabilité accrue de certains résultats. L'adaptation active était liée à moins de détresse psychologique, tandis que l'adaptation par évitement et l'automédication étaient liées à la probabilité accrue de la plupart des résultats. Bien que plusieurs associations statisquement significatives n'aient été observées que chez un seul sexe, seulement une interaction des sexes par corrélat était statistiquement significative. Conclusions : Le soutien social s'est révélé être inversement lié à plusieurs résultats négatifs de santé mentale chez les membres féminins des forces armées. Peu de différences entre les hommes et les femmes ont atteint la signification statistique. La recherche future devrait identifier des ressources utiles additionnelles pour les membres féminins des forces armées.

"Put on your face to face the world": women's narratives of burn injury.

The survival rate of individuals with burn injury has significantly increased due to medical advances in burn care. This has led to a need to focus on psychological aspects of burn injury recovery, particularly on how people come to terms with their changed bodies. The literature suggests that burn size and severity are not directly associated with the degree of distress but that subjective perceptions and interpretations - of, for instance, body image - are pertinent. Body image appears to be particularly important for women and thus, in this study, we investigated women's experiences of their bodies following mild to moderate burns. We conducted in-depth interviews with 10 female burn survivors in the first year after injury, using methods of narrative analysis for the investigations of the transcripts. Thirteen consecutive women who met inclusion criterion were approached at regional burn care follow-up clinic. In their narratives, the women predominantly emphasized how well they were doing; however, counter-narratives emerged indicating dissatisfaction and distress. The tension between these two different kinds of narratives suggests an ambivalent relationship with the burn injury. We concluded that it is imperative for health care professionals to be cognizant of these conflicting experiences in order to adequately address burn survivors' needs in rehabilitation.

Parental perceptions of family adjustment in childhood developmental disabilities.

Based on the adjustment phase of the double ABC-X model of family stress (McCubbin and Patterson, 1983) this study examined the impact of parenting stress, positive appraisal of the impact of child disability on the family, and parental self-esteem on parental perceptions of family adjustment in families of children with disabilities. For mothers, self-esteem and positive appraisal predicted maternal-perceived family adjustment and mediated the relationship between parenting stress and family adjustment. For fathers, while self-esteem and positive appraisal were not significant in directly predicting perceived family adjustment, self-esteem moderated the relationship between parenting stress and family adjustment. These results suggest that interventions that bolster self-esteem in parents may be useful in enhancing perceptions of family adjustment. Similarly, interventions that enhance mothers' experiences of the positive aspects of parenting a child with disabilities hold potential to strengthen family adjustment.

Listening to parents: the challenges of parenting kindergarten-aged children who are anxious.

The purpose of this study was to increase understanding of the experience of parenting kindergarten-aged children who are anxious. Twenty-three in-depth interviews were conducted with parents of kindergarten-aged children who expressed interest in a parent-focused early intervention program for child anxiety offered in a local elementary school. Key concerns of the parents included their children's separation anxiety, social anxiety, and oppositional behaviour. The child's anxiety was identified as a stressor on the child, the parent, and the family. Parents utilized a range of parenting responses although they tended to be reactive and did not have a consistent strategy for managing the anxiety. A salient parenting struggle was whether or not to push the child to face challenging situations although there were few descriptions of overprotection or overcontrol. The findings suggest greater attention be given to the strengths of parents of children who are anxious and the ways in which parents may be a positive factor in mitigating the effects of child anxiety. Implications for intervention are discussed.

The high risk of IPV against Canadian women with disabilities.

BACKGROUND: Mounting evidence suggests that women with disabilities have a particularly high risk of experiencing violence by an intimate partner. This study examined the elevated risk for male-female intimate partner violence (IPV) against women with disabilities compared to women without disabilities across three large-scale Canadian surveys. An explanatory framework was tested that organized risk markers based on whether they referred to the context of the relationship between the couple (relationship factors), the victim (victim-related characteristics), or the perpetrator (perpetrator-related characteristics). MATERIAL/METHODS: The data employed in this study were from three surveys collected by Statistics Canada: the 1993 Violence Against Women Survey, and the 1999 and 2004 iterations of the General Social Survey. Descriptive analyses consisted of cross-tabulations with Chi-square tests of significance. Logistic regression was used to calculate zero-order odds ratios and to perform multivariate analyses. RESULTS: A pattern was found in which women with disabilities reported a significantly higher prevalence of violence than those without disabilities. The perpetrator-related characteristics were the only variables that reduced the elevated odds of violence against women with disabilities. Partners of women with disabilities were more likely to engage in patriarchal domination as well as possessive and jealous behaviors. CONCLUSIONS: The apparent importance of perpetrator-related characteristics (e.g., jealousy) suggests that future research should include a focus on what it is about the context of disability that makes these men more likely to engage in behaviors that are associated with IPV perpetration. Population-based efforts, professionals working with women who are victims, and professionals working with male perpetrators need to pay attention to the role of disability in IPV.

The elevated risk for non-lethal post-separation violence in Canada: a comparison of separated, divorced, and married women.

The purpose of the study was to shed light on the potentially differing dynamics of violence against separated and divorced women by their ex-husbands and violence against married women by their current husbands. Using a nationally representative sample of 7,369 heterosexual women from Cycle 13 of Statistics Canada's General Social Survey, available risk markers were examined in the context of a nested ecological framework. Separated women reported nine times the prevalence of violence and divorced women reported about four times the prevalence of violence compared with married women. The strongest predictors of violence against married women, namely, patriarchal domination, sexual jealousy, and possessiveness, were not significant predictors of violence against separated and divorced women. This suggested that post-separation violence is a complex phenomenon the dynamics of which can be affected by much more than domination and ownership.

Parental appraisal of the family impact of childhood developmental disability: times of sadness and times of joy.

BACKGROUND: Parental positive and negative appraisals of the family impact of childhood disability are tested as early predictors of parental self-esteem and overall family adjustment in households with young children with intellectual and developmental disabilities. METHOD: Within 103 Canadian families, 103 mothers and 55 fathers independently completed interviews in their home at two time points: 6 months after their child entered childhood disability services (T1), and one year later (T2). RESULTS: Longer-term family adjustment was found to be predicted by level of parental negative appraisal of the family impact of disability, and by level of self-esteem, for both mothers and fathers. For mothers, positive appraisal of childhood disability was also found to predict early family adjustment and was related to enhanced self-esteem. CONCLUSIONS: Gender differences in parental appraisal of the family impact of childhood disability appear to merge over time. Both positive and negative appraisals appear to coexist and are predictive of mothers' and fathers' perceived overall family adjustment in the longer term.

Family adjustment to childhood developmental disability: a measure of parent appraisal of family impacts.

OBJECTIVE: To develop the Family Impact of Childhood Disability Scale (FICD) to assess subjective interpretation or "primary appraisal" of parents regarding the impact of a child with developmental disabilities on the family. METHOD: A random sample of 87 families was assessed while children with developmental disabilities were in the preschool years. After 7 years had elapsed, 64 of these families were interviewed again when the children were in the preteen years. A set of standardized self-report measures provided mother and father views of child, parent, and family functioning. RESULTS: The FICD demonstrated adequate internal consistency, with some evidence of discriminant and predictive validity. The FICD total score, based on the discrepancy between positive and negative subscale scores, was found to be a significant predictor of future parenting stress of mothers and of fathers, even when controlling for other important explanatory variables such as marital adjustment and level of disability in a child. CONCLUSIONS: The 15-item FICD offers a brief assessment of both positive and negative parent appraisals, with a total discrepancy score that predicts long-term parenting stress.