Importance of Coping in the Relationship Between Executive Function and Quality of Life in People with Multiple Sclerosis.

BACKGROUND: Maximizing quality of life (QOL) for people with multiple sclerosis (MS) is a primary focus of health care management professionals. Research has shown a relationship between QOL and a person's coping style and that coping provides an indirect link between cognition and stress, depression, and anxiety in MS. This research assessed whether coping moderates or mediates the relationship between executive function and QOL in people with MS. METHODS: We assessed 107 people with relapsing-remitting (n = 83) or secondary progressive (n = 24) MS using executive function tasks and self-report coping and QOL inventories. RESULTS: Coping strategies that mediated the relationship between executive function and QOL in people with MS included behavioral disengagement, acceptance, growth, and religion, while moderating strategies were denial, active, religion, adaptive, and total coping indices. Less cognitively demanding coping strategies that were related to increased QOL in people with poorer executive function included acceptance, growth, and religion, and maladaptive strategies associated with poorer QOL were behavioral disengagement and denial. CONCLUSIONS: These results suggest that lessening avoidant coping strategies and strengthening use of less cognitively demanding adaptive coping strategies may improve QOL in people with MS who experience deficits in executive function. Consideration should be given to the development of psychoeducation and interventions with this focus.

A qualitative study investigating bipolar patients' expectations of a lifestyle intervention: A self-management program.

BACKGROUND: There is some evidence supporting the efficacy of lifestyle interventions in changing unhealthy habits and reduce the risk of developing comorbid conditions in Bipolar Disorder (BD). AIMS: This qualitative study aimed to identify what an optimal lifestyle intervention would look like for individuals with BD. METHODS: The current findings are based on one focus group and two paired interviews including a total of 10 individuals with BD (44.20 ±â€¯11.11 years; 6 females). Groups' transcripts were analyzed using a narrative approach. Primary themes included facilitating factors and barriers, general content, outcomes, format of the intervention, and background factors. RESULTS: Participants were in favor of a group-based lifestyle intervention as part of their usual treatment. The optimal group format would include 4 to 10 individuals, and comprise of 12 to 18 sessions lasting 1 to 1.5 h each. Accountability, motivation, interaction, and group activities were identified as contributing to the success of a lifestyle intervention. CONCLUSIONS: This qualitative study provides important information regarding aspects of lifestyle intervention format and delivery for individuals with BD. We identified barriers and facilitating factors that should be addressed in health promotion interventions delivered within community mental health settings.

Target Coping Strategies for Interventions Aimed at Maximizing Psychosocial Adjustment in People with Multiple Sclerosis.

BACKGROUND: The experience of psychological distress is prevalent in people with multiple sclerosis (MS), including high levels of stress, anxiety, and depression. It has been shown that people with MS use less adaptive coping compared with healthy individuals. This study examined the ability of coping strategies to predict maladaptive and adaptive psychosocial outcomes across areas of stress, depression, anxiety, and quality of life (QOL) in people with MS. METHODS: 107 people with MS completed measures of depression (Beck Depression Inventory-II), anxiety (State-Trait Anxiety Inventory), QOL (Multiple Sclerosis Quality of Life-54), stress (Daily Hassles Scale), and coping (COPE inventory). RESULTS: Consistent with expectations, depression, frequency of stress, trait anxiety, and mental health QOL were predicted by adaptive and maladaptive coping styles. Severity of stressful events was predicted by maladaptive, but not adaptive, coping styles. Depression and mental health QOL were most prominently connected to coping use. Emotional preoccupation and venting showed the strongest relationship with poorer psychosocial outcomes, whereas positive reinterpretation and growth seemed to be most beneficial. CONCLUSIONS: The results of this study highlight the importance of intervention programs targeting specific coping strategies to enhance psychosocial adjustment for people with MS.

Executive function is an important consideration for coping strategy use in people with multiple sclerosis.

INTRODUCTION: Executive function deficits are prevalent in people with multiple sclerosis (PwMS), and PwMS use less adaptive coping than healthy controls. This cross-sectional study assessed whether there is a relationship between executive function and coping in PwMS. METHOD: One hundred and seven participants with relapsing remitting or secondary progressive MS (n = 83 and 24, respectively; age M = 48.8 ± 11.1 years) completed measures of coping and executive function. RESULTS: A positive relationship was found between verbal fluency and use of active, emotional, and instrumental social support coping, and total executive function and substance abuse coping. There was a negative relationship between coping strategies and core (social support, acceptance, religion, restraint, and total coping), higher order (denial and humor), and total executive function indices (acceptance, religion, behavioral disengagement, denial, and total coping). CONCLUSION: These directional differences provide support for the importance of specific executive functions in coping strategy utilization. Understanding these relationships will assist psychologists and neuropsychologists with patient psychoeducation, adaptive coping strategy intervention and management for PwMS with reduced executive function ability.

Intimate relationship quality, self-concept and illness acceptance in those with multiple sclerosis.

Lower levels of Intimate Relationship Quality (IRQ) have been found in those with Multiple Sclerosis (MS) compared to the general population. This study examined an MS sample to see whether IRQ was positively associated with self-concept, whether IRQ was positively associated with MS illness acceptance and whether IRQ was predicted by self-concept and illness acceptance. In this cross-sectional study, 115 participants with MS who were in an intimate relationship completed an online survey advertised on MS related websites. The survey assessed demographic variables, MS illness variables and levels of IRQ, self-concept and illness acceptance. Results revealed that IRQ was significantly positively associated with self-concept and with illness acceptance. Multiple hierarchical linear regression analysis revealed that, after controlling for illness duration and level of disability, self-concept significantly predicted IRQ but illness acceptance did not significantly predict IRQ. This study addressed several gaps and methodological flaws in the literature and was the first known to assess predictors of IRQ in those with MS. The results suggest that self-concept could be a potential target for individual and couple psychological interventions to improve IRQ and contribute to improved outcomes for those with MS.

A pilot randomized controlled trial of a tailored cognitive behavioural therapy based intervention for depressive symptoms in those newly diagnosed with multiple sclerosis.

BACKGROUND: To examine the effectiveness and acceptability of an 8-week individual tailored cognitive behavioural therapy (CBT) intervention for the treatment of depressive symptoms in those newly diagnosed with multiple sclerosis. METHODS: The current study presents a pilot, parallel group randomized controlled trial (RCT) with an allocation ratio of 1:1 conducted in a large research and teaching hospital in Melbourne, Australia. 30 individuals with a mean age of 36.93 years (SD = 9.63) who were newly diagnosed with multiple sclerosis (MS) (X = 24.87 months, SD = 15.61) were randomized to the CBT intervention (n = 15) or treatment as usual (TAU) (n = 15). The primary outcome was level of depressive symptoms using the Beck Depression Inventory-II (BDI-II). Secondary outcomes were level of anxiety, fatigue and pain impact, sleep quality, coping, acceptance of MS illness, MS related quality of life, social support, and resilience. Tertiary outcomes were acceptability and adherence to the intervention. RESULTS: Large between group treatment effects were found for level of depressive symptoms at post and at 20 weeks follow-up (d = 1.66-1.34). There were also small to large group treatment effects for level of anxiety, fatigue and pain impact, sleep quality, MS related quality of life, resilience, and social support at post and at 20 weeks follow-up (d = 0.17-1.63). There were no drop-outs and participants completed all treatment modules. All participants reported the treatment as 'very useful', and most (73.4%) reported that the intervention had addressed their problems 'completely'. CONCLUSIONS: These data suggest that the tailored early intervention is appropriate and clinically effective for the treatment of depressive symptoms in those newly diagnosed with MS. A larger RCT comparing the CBT intervention with an active comparative treatment with longer term follow-up and cost effectiveness analyses is warranted. The pilot trial has been retrospectively registered on 28/04/2016 with the ISRCTN registry (trial ID ISRCTN10423371).

Coping mediates and moderates the relationship between executive functions and psychological adjustment in multiple sclerosis.

OBJECTIVE: To identify the moderating and mediating relationship of different coping strategies between executive function and stress, depression and anxiety in people with multiple sclerosis (PwMS). METHOD: Participants were 107 people with relapsing remitting or secondary progressive multiple sclerosis who were administered tasks of executive function and completed self-report measures of stress, depression, anxiety, and coping. RESULTS: An indirect relationship was found between executive function and psychosocial adjustment through maladaptive coping strategies: behavioral and mental disengagement, and substance abuse; adaptive coping strategies: acceptance, active, positive reinterpretation, and growth, as well as for an index of adaptive coping. In general, a relationship was found between better performance on tasks of executive function and psychosocial adjustment when adaptive coping strategies were low, as opposed to high, or maladaptive coping strategies were high, as opposed to low. Some unexpected findings are also discussed. CONCLUSION: Executive function and psychosocial adjustment is mediated and moderated by coping strategies used by PwMS. Well-preserved executive function provides relative protection from poorer adjustment in the presence of high maladaptive or low adaptive coping. PwMS who perform poorly on tasks of executive function benefit from using less cognitively demanding adaptive coping strategies to enhance adjustment outcomes and further research in this area would be advantageous to underpin effective intervention strategies.

The effect of executive function on stress, depression, anxiety, and quality of life in multiple sclerosis.

The experience of cognitive deficits and emotional dysfunction are prevalent in people with multiple sclerosis (PwMS), although research examining their interaction has provided inconsistent findings. The current study examined the ability of executive function to predict psychosocial adjustment in PwMS. One hundred and seven PwMS underwent cognitive assessment and completed measures of stress, depression, anxiety, and quality of life (QoL). There was limited support for a relationship. There was no relationship between objective cognitive tasks and state or trait anxiety, mental health QoL, overall QoL, or stress frequency. The only relationship with depression was found when the Beck Depression Inventory Fast-Screen was used, with a task of planning when the timing element was removed. A measure of error rates on a task of cognitive flexibility predicted physical health QoL, and severity, but not frequency, of stress was predicted by a task of working memory. The results of this study highlight the need for further research into the relationship between cognitive deficits and psychosocial adjustment because of the conflicting findings between studies and call for a common measurement framework for future investigation.

Resilience, self-efficacy, coping styles and depressive and anxiety symptoms in those newly diagnosed with multiple sclerosis.

High levels of depressive and anxiety symptoms have been reported by individuals with multiple sclerosis (MS). This study examined the associations between resilience, self-efficacy and coping and depressive and anxiety symptoms and whether resilience, self-efficacy and coping were predictors of depressive and anxiety symptoms in patients newly diagnosed with MS. A sample of 129 individuals newly diagnosed with MS participated in this cross-sectional study and completed an online questionnaire assessing resilience, self-efficacy, coping and depressive and anxiety symptoms. Results revealed that depressive and anxiety symptoms were significantly associated with problem-focused, emotion-focused and avoidance coping strategies, resilience and self-efficacy. Anxiety symptoms were also significantly associated with employment status and level of disability. Results from hierarchical multiple regression revealed that the resilience subscale of personal competence, the avoidance coping style of substance use and emotion-focused coping styles of venting predicted depressive symptoms and uniquely accounted for 63.8% of the variance in the depression score, F (18, 124) = 10.36, p = .000. Level of disability and employment status accounted for 13.2% of the anxiety score and avoidance coping style of denial and emotion-focused coping style of humour accounted for 36.4% of the variance in the anxiety symptom score, F (15, 112) = 6.37, p = .000. Our findings suggest that resilience and avoidance and emotion-focused coping strategies are predictive of depressive symptoms and anxiety symptoms in those newly diagnosed with MS. Resilience and coping styles may be another target for interventions aimed at managing depressive and anxiety symptoms in those newly diagnosed with MS.

Psychometric properties of the cardiac depression scale in patients with coronary heart disease.

BACKGROUND: This study examined the psychometric properties of the Cardiac Depression Scale (CDS) in a sample of coronary heart disease (CHD) patients. METHODS: A total of 152 patients were diagnosed with coronary heart disease and were administered the CDS along with the Beck Depression Inventory- 2 (BDI-2) and the State Trait Anxiety Inventory (STAI) 3.5-months after cardiac hospitalization. RESULTS: The CDS's factorial composition in the current sample was similar to that observed in the original scale. Varimax-rotated principal-components analyses extracted six factors, corresponding to mood, anhedonia, cognition, fear, sleep and suicide. Reliability analyses yielded internal consistency α - coefficients for the six subscales ranging from 0.62 to 0.82. The CDS showed strong concurrent validity with the BDI-II (r = 0.64). More patients were classified as severely depressed using the CDS. Both the CDS and the BDI-2 displayed significantly strong correlations with the STAI (r = 0.61 and r = 0.64), respectively. CONCLUSIONS: These findings encourage the use of the CDS for measuring the range of depressive symptoms in those with CHD 3.5 months after cardiac hospitalization.

Increased psychosocial stress in Greek-born immigrants compared to Anglo-Australians with coronary heart disease: the healthy heart, healthy mind study.

OBJECTIVE: To compare measures of depression and anxiety, physical health status, quality of life, and social support in Greek-born and Anglo-Australian outpatients with coronary heart disease (CHD). METHODS: A cross-sectional study of 61 Greek-born immigrants and 62 Anglo-Australian outpatients with CHD recruited between 2009 and 2011 was undertaken. We administered the Beck Depression Inventory-2 and the Cardiac Depression Scale, the State Trait Anxiety Inventory, the SF-12, the World Health Organisation Quality of Life (brief version), and the Perceived Social Support Scale and Social Enriched Social Support Instrument. RESULTS: Compared to Anglo-Australians, the Greek-born immigrants had higher depression and anxiety scores, lower reported physical health status, lower perceived social support and lower quality of life on the physical, psychological and environmental health subdomains (p values<.05). Birthplace differences remained for level of depression and anxiety when adjustments were made for other CHD risk factors. CONCLUSION: Greek-born immigrants were found to have more psychosocial risk factors for CHD compared to the Anglo-Australians. We suggest that differences in depression and anxiety may help explain differences in CHD risk and morbidity between Greek-born immigrants and other ethnic groups living in Australia.

Effects of a multilingual information website intervention on the levels of depression literacy and depression-related stigma in Greek-born and Italian-born immigrants living in Australia: a randomized controlled trial.

BACKGROUND: Little is known about the efficacy of Internet-based information interventions in increasing depression literacy or reducing depression stigma and depressive symptoms in people from non-English-speaking backgrounds. OBJECTIVE: Our objective was to investigate the effects of Multicultural Information on Depression Online (MIDonline), an Internet-based multilingual depression-specific information resource, on depression literacy, depression stigma, and depressive symptoms in Greek-born and Italian-born immigrants to Australia. METHOD: In all, 202 Greek- and Italian-born immigrants aged 48 to 88 years were randomly allocated to an online depression information intervention (n =110) or a depression interview control group (n = 92). Participants allocated to the information intervention only had access to the website during the 1- to 1.5-hour intervention session. The primary outcome measures were depression literacy (depression knowledge), personal stigma (personal stigma toward people with a mental illness), perceived stigma (participants' views about the probable attitude of the general community toward people with mental illness), and depressive symptoms. Depression literacy, personal and perceived stigma, and depressive symptoms were assessed at preassessment, postassessment, and at a 1-week follow-up assessment. The trial was undertaken at Monash University, Melbourne, Australia. Randomization and allocation to trial group were carried out using a computer-generated table. RESULTS: For depression literacy, there was a significant difference between the MIDonline and the control group with those in the MIDonline intervention displaying higher depression literacy scores postassessment (F(1,178) = 144.99, P < .001) and at the follow-up assessment (F(1,178) = 129.13, P < .001) than those in the control group. In addition, those in the MIDonline intervention showed a significantly greater decrease in mean personal stigma scores postassessment (F(1,178) = 38.75, P < .001) and at the follow-up assessment (F(1,176) = 11.08, P = .001) than those in the control group. For perceived stigma, there was no significant difference between the MIDonline intervention and the control group at postassessment (F(1,178) = 0.60, P = .44) and at the follow-up assessment (F(1,176) = 1.06, P = .30). For level of depression, there was no significant difference between the MIDonline intervention and the control group at preassessment (F(1,201) = 0.56, P = .45), postassessment (F(1,178) = 0.03, P = .86), or at the follow-up assessment, (F(1,175) = 1.71, P = .19). Within group effect sizes for depression literacy were -1.78 (MIDonline) and -0.07 (control); for personal stigma, they were 0.83 (MIDonline) and 0.06 (control); for perceived stigma, they were 0.14 (MIDonline) and 0.16 (control); and for depressive symptoms, they were 0.10 (MIDonline) and 0.10 (control). CONCLUSIONS: Current results suggested that the Internet may be a feasible and effective means for increasing depression knowledge and decreasing personal stigma in non-English-speaking immigrant populations residing in English-speaking countries. The lack of change in perceived stigma in this trial is consistent with results in other trials examining online depression stigma interventions in English-speaking groups. TRIAL REGISTRATION: ISRCTN76460837; http://www.controlled-trials.com/ISRCTN76460837 (Archived by WebCite at http://www.webcitation.org/5xjxva4Uq).

Is internet-based CBT for panic disorder and agoraphobia as effective as face-to-face CBT?

This study compared Panic Online (PO), an internet-based CBT intervention, to best-practice face-to-face CBT for people with panic disorder with or without agoraphobia. Eighty-six people with a primary diagnosis of panic disorder were recruited from Victoria, Australia. Participants were randomly assigned to either PO (n=46) or best practice face-to-face CBT (n=40). Effects of the internet-based CBT program were found to be comparable to those of face-to-face CBT. Both interventions produced significant reductions in panic disorder and agoraphobia clinician severity ratings, self reported panic disorder severity and panic attack frequency, measures of depression, anxiety, stress and panic related cognitions, and displayed improvements in quality of life. Participants rated both treatment conditions as equally credible and satisfying. Participants in the face-to-face CBT treatment group cited higher enjoyment with communicating with their therapist. Consistent with this, therapists' ratings for compliance to treatment and understanding of the CBT material was higher in the face-to-face CBT treatment group. PO required significantly less therapist time than the face-to-face CBT condition.

Managing mental illness in patients from CALD backgrounds.

BACKGROUND: Australian general practitioners are often the first point of call for people seeking mental health care including those from culturally and linguistically diverse (CALD) backgrounds, some of whom may be more at risk of having a mental illness but are failing to access the appropriate mental health care. OBJECTIVE: This article is intended to assist GPs in the recognition, diagnosis and management of mental illness in patients from CALD backgrounds by providing current research evidence and presenting some practical recommendations. More attention is paid to the larger CALD populations such as the southern European and Asian communities, and does not deal with indigenous Australians. DISCUSSION: There is an increasing call for GPs to have a key role in the detection, diagnosis and management of mental illness, including for patients from CALD backgrounds. Effective care requires that GPs are aware of, and understand how culture may influence recognition, diagnosis and management of mental illness in this group of patients.

Depression and anxiety: a comparison of older-aged Greek-born immigrants and Anglo-Australians.

OBJECTIVE: To compare depressive and anxiety illness in an older-aged sample of Greek-born (GB) immigrants who were likely to have been excluded from the National Survey of Mental Health and Wellbeing due to their lack of fluency in the English language and for whom rates of mental disorder are unknown, with a comparably recruited sample of Anglo-Australians (AA). METHOD: One hundred and forty-six GB and 146 AA respondents with a mean age of 68 years living in Melbourne and recruited through social clubs, completed the Beck Depression Inventory-II (BDI-2) and the State-Trait Anxiety Inventory (STAI) in addition to socio-demographic and other background questions. RESULTS: Greek-born respondents exhibited higher depression and anxiety scores and reported more depressive and anxiety symptomatology than the AA respondents. More GB respondents (17.1%) were likely to be included in the moderate to severe BDI-2 depression categories than AA (4.1%). Greek-born respondents (43.1%) were more likely to be included in the higher anxiety categories (i.e. score 41-80) of the STAI than the AA (15.8%). However, when controlling for health, economic and social factors there was no difference in the BDI-2 measures between the two groups. Despite controlling for these factors the GB still scored more highly on STAI measures than AA respondents. CONCLUSIONS: No differences were found between groups on measures of depression once controlling for age, education and occupational level, current financial status, marital status, household composition, current work status, physical health and stress. Such factors were also shown to influence group-differences anxiety but they not entirely explain group differences. Higher anxiety in GB respondents were likely to have been determined through the effects of additional but unmeasured cultural and immigrant status factors. Psychological morbidity in immigrants is best accounted for by considering the influence of social, health and other living conditions in addition to the effects of culture or immigrant status.