Relationship between social support and autonomic function during a stress protocol in ulcerative colitis patients in remission.

BACKGROUND: The relationship of psychological stress to relapse in ulcerative colitis (UC) is inconsistent. This may be due to a failure to identify patient characteristics, such as social support, which moderate the transduction of stress from the central nervous system to the immune system. In this study we tested the hypothesis that social support enhances parasympathetic modulation of heart rate in UC. METHODS: An indirect measure of autonomic function (heart rate variability; HRV) was measured in 108 patients with UC in remission during a standard protocol involving periods of stress, paced breathing, and relaxation. Social support was measured with the Social Support Questionnaire. RESULTS: After controlling for age, which is strongly related to HRV, both satisfaction with social support (F = 5.7, significance = 0.002) and its interaction with age (F = 7.8, significance <0.001) were associated with high-frequency HRV, which measures parasympathetic modulation of heart rate. Social support was associated with higher levels of high-frequency HRV at almost all points in the stress protocol. Neither age nor social support was associated with differences in the LF/HF ratio, which measures sympathetic modulation of heart rate. CONCLUSIONS: Social support is related to parasympathetic activity in UC. Given previous evidence of an antiinflammatory role for the parasympathetic nervous system, this suggests that autonomic function could serve as a mediating link between social support and reduced inflammatory activity.

The impact of ulcerative colitis is greater in unmarried and young patients.

GOALS: To determine whether the perceived impact of ulcerative colitis (UC) on activities of living (illness intrusiveness) is greater for people who are not living in a married or common-law relationship. BACKGROUND: In general, social and occupational achievement is not greatly impaired by UC, yet patients, especially young adults, often have interpersonal concerns. METHODS: One hundred fifty-five outpatients with UC were assessed for disease activity, and completed self-reports of marital status, income, social support and illness intrusiveness. RESULTS: Fifty-one patients (32.9%) were single, separated or divorced, and 104 patients (67.1%) were married or in common-law relationships. Compared with those who were married or in common-law relationships, single or separated patients were younger, had a lower household income, had lived with UC for fewer years and were less satisfied with social support. Among 135 patients in remission, marital status was significantly associated with illness intrusiveness, controlling for age, income and perceived social support (F=5.73; P=0.02). Low social support (F=4.94; P=0.03) and younger age (F=7.24; P=0.008) were independently associated with illness intrusiveness. Single patients in remission reported illness intrusiveness of similar severity to that reported by patients with active disease. CONCLUSIONS: The perceived impact of UC on the lives of patients is greater in those who are not married or living in common-law relationships. Youth, single status and lower social support commonly coexist, and exert additive effects on the functional impact of UC. Resources to improve social support should be directed toward this group of patients.

Insecure attachment in a subgroup with ulcerative colitis defined by ANCA status.

This study is the first test of the novel hypothesis that perinuclear anti-neutrophil cytoplasmic antibody (p-ANCA) marks an etiological division between stress-susceptible and stress-neutral ulcerative colitis. Subjects were 47 UC patients with known p-ANCA status (19 p-ANCA-positive, 28 p-ANCA-absent). Controls were 77 university students. Subjects and controls completed the Reciprocal Attachment Questionnaire. Subjects were categorized as avoidant/nonavoidant and anxious/nonanxious based on scores for compulsive self-reliance and compulsive care seeking, respectively. A higher prevalence of avoidant attachment was present in p-ANCA-absent (58.6%) than p-ANCA-positive subjects (22.2%, chi-square = 5.95, P < 0.02). There was no difference in the prevalence of anxious attachment between p-ANCA-absent and p-ANCA-positive subjects. There was no difference in clinical and psychiatric variables between groups. This finding provides support for a psychobiological contribution to UC in a subgroup identified by the absence of p-ANCA.

The perceived family burden scale: measurement and validation.

Findings in family burden research suggest that, in families with a mentally ill relative, patterns of family interaction develop in response to the onset of major mental illness and result from the burden experienced by family members in coping with illness. The present study focused on instrument development and validation of the Perceived Family Burden Scale (PFBS), a measure of those patient behaviors associated with schizophrenia and the impact of these behaviors on relatives. The PFBS was found to be a valid and reliable instrument which demonstrated greater predictive power for early symptomatic relapse in schizophrenia than another measure of family interaction, expressed emotion.

Seven-year follow-up of speech/language impaired and control children: psychiatric outcome.

This study examined the 7-year psychiatric outcome of 202 speech/language (S/L) impaired and control children selected from a community sample at age 5 years. Children with S/L at age 5 years were more likely to be psychiatric cases at age 12.5 years than were normal controls, even if their S/L improved. Controlling for concurrent psychiatric disorder, S/L impairment at age 5 years was still associated with an increased rate of psychiatric disorder at 12.5 years. Psychiatric disorder at age 12.5 years was more likely to co-occur with language disorder than with speech disorder.

Long-term consistency in speech/language profiles: I. Developmental and academic outcomes.

OBJECTIVE: This study examined the 7-year developmental and academic outcome of speech/language-impaired and control children selected from a community sample. METHOD: Speech/language and psychiatric measures were administered to the children at ages 5 and 12.5 years. Using children's age 5 speech/language test results, a cluster analysis was performed to ascertain whether specific linguistic subgroups would emerge. The long-term consistency of these subgroups was explored. The association between time 1 speech/language clusters and linguistic, cognitive and academic measures at time 2 were examined. RESULTS: Four groups were identified in the cluster analysis: high overall, poor articulation, poor comprehension, and low overall. Children with pervasive language problems continued to perform poorly on linguistic, cognitive, and academic measures, while those with comprehension problems fared slightly better but still had more difficulties than those with normal language. The poor articulation cluster had few articulation errors at follow-up. CONCLUSIONS: Empirically supported speech/language classifications identified as early as age 5 continued to be relevant into late childhood. Pervasive speech/language impairment in early childhood was associated with increased risk of poor linguistic and academic outcome at follow-up, while isolated articulatory problems improved over time. These findings reveal the urgent need for early intervention among children with pervasive speech/language impairment.

Long-term consistency in speech/language profiles: II. Behavioral, emotional, and social outcomes.

OBJECTIVE: This study examined the 7-year behavioral, emotional, and social outcome of speech/language-impaired and control children selected from a community sample. METHOD: Speech/language and psychosocial measures were administered to the children at ages 5 and 12.5 years. Using children's age 5 speech/language test results, a cluster analysis was performed to ascertain whether specific linguistic subgroups would emerge. The association between speech/language cluster at age 5 and psychosocial functioning at age 12.5 was examined. RESULTS: Children with receptive and pervasive speech/language problems at age 5 demonstrated greater behavioral disturbance than children without such impairment. Controlling for initial behavioral status, early childhood language profile was still associated with behavioral and social competence ratings, 7 years later. Children without receptive language problems showed superior social adjustment. CONCLUSIONS: Empirically supported speech/language classifications identified as early as age 5 were associated with behavioral disturbance in late childhood. Receptive and pervasive speech/language impairment in early childhood was associated with the greatest risk at follow-up. Early auditory comprehension problems may be a specific risk factor for later aggressive and hyperactive symptoms. These findings identify the need for effective intervention with speech/language-impaired children.

Factors contributing to nurses' difficulty in treating patients in short-stay psychiatric settings.

Difficulties experienced by nurses in treating a total of 249 patients in four short-stay psychiatric units were examined using a rating scale that assessed such factors as overall extent of treatment difficulty, patients' problem behaviors, adequacy of treatment resources, and staff members' affective responses. Data from each site were analyzed separately using stepwise hierarchical regression. The findings indicated that patient problem behaviors and treatment resources were comparable between settings. Except for patient violence, none of the problems were consistently related to overall treatment difficulty across settings. The results suggest that treatment difficulty is related to the unique combination of patient characteristics, resource deficits, and treatment philosophies in particular treatment settings and that efforts to reduce treatment difficulty should address setting-specific issues.

The impact of childhood sexual abuse on the psychological well-being and practice of nurses.

This study compares the psychological well-being of nurses who were sexually abused as children with those who were not abused and considers the impact of this abuse on aspects of their clinical practice. On the psychological measures, abused nurses differed from the nonabused nurses by having significantly higher distress scores and lower self-esteem scores. For some nurses, the abuse influenced their private and professional relationships including personal sexual relationships and working with other health professionals. These results highlight the need for the educational and health care systems to consider the needs of health care professionals who may have been abused.

Inquiring about childhood sexual abuse as part of the nursing history: opinions of abused and nonabused nurses.

This article explores the opinions of nurses who were sexually abused as children and those who were not, concerning routine inquiry about a history of sexual abuse. Approximately 60% of the participants indicated that routine inquiry should be conducted in pediatric and psychiatric settings. Reasons put forward for not inquiring included concerns about being intrusive, feeling unqualified to deal with content if abuse had occurred, and fear of increasing the distress of clients. Participants believed nurses needed education in this area if they were to be effective. Reasons why this topic involving sexuality and violence may be difficult for nurses are considered.

The relationship between nurses' limit-setting styles and anger in psychiatric inpatients.

OBJECTIVE: Violence by patients in psychiatric settings is frequently associated with the quality of staff-patient interactions. Impulsivity has been identified as a high risk factor for anger and aggression. This study was designed to test the influence of nurses' limit-setting styles on anger among psychiatric inpatients grouped by high or low levels of impulsivity. METHODS: Ninety-seven patients with various diagnoses and either high or low levels of impulsivity participated in role-play scenarios in which nurse actors played out six limit-setting styles, ranging from belittlement to explanations of rules to empathy linked with a presentation of an alternative course of action. Patients' level of anger in response to the acted scenario was assessed using the Spielberger State-Trait Anger Scale. RESULTS: Patients' level of anger was highest in response to unempathic limit-setting styles, moderate for explanations, and lowest for empathic styles. Impulsive subjects were more likely to respond with anger than nonimpulsive patients, regardless of the limit-setting style. CONCLUSIONS: Although many current intervention programs focus on reducing patients' anger after it occurs, the study results suggest that it may be possible to prevent some of patients' anger by improving nurses' limit-setting styles.

The impact of pain and impaired role performance on distress in persons with cancer.

The observed upward trend in the incidence of many cancers is expected to continue for the next 20 years despite monumental basic research efforts. There are interpersonal and intrapsychic complications associated with cancer and its treatment leading to considerable distress which, in extreme cases, becomes clinical depression and anxiety. Pain and impaired role performance have been cited as being important sources of distress in people with cancer. This paper presents data from a community sample of 1,309 people living with cancer in Prince Edward Island, Manitoba and Quebec and examines risk factors for cancer-related distress. In the model tested in this paper, pain and other symptoms and treatment side-effects as well as cancer-related fears were seen to have direct and indirect effects on psychological symptoms of distress. Impaired role performance was a central mediator for the indirect effects. The model explained 34% of the variance in distress scores (General Health Questionnaire) and was equally applicable to all three study sites, both male and female subjects, rural and urban settings, and to all stages of illness. Pain was the single most important explanatory variable. Impaired role performance had a negative effect on distress over and above the effect of pain. The results suggest that interventions directed at reducing distress in cancer should also address interpersonal issues such as the impact of the illness on family, social network a work.

Seven-year follow-up of speech/language-impaired and control children: speech/language stability and outcome.

OBJECTIVE: This study examined the 7-year outcome of speech/language (S/L) impaired and control children selected from a community sample at age 5 years. METHOD: Two hundred fifteen children completed a variety of speech and language tests at age 12 years. Children with S/L impairment were further classified as "speech only," "language only," or "speech and language impaired." RESULTS: More than 72% of children who had S/L impairment at age 5 remained impaired at age 12. Children with both speech and language problems were most likely to remain S/L impaired; 81% had some kind of S/L impairment at follow-up. Similarly, children with both expressive and receptive language impairment were more likely to show expressive or receptive impairment at follow-up than children with expressive impairment alone. One third of time 1 controls had S/L problems at follow-up, and of these 82% had speech impairment only. CONCLUSIONS: S/L impairment identified at age 5 has long-lasting effects. More pervasive problems were associated with poorer outcomes. Screening at age 5 may be useful, as most serious S/L problems that emerged by middle childhood could be identified at age 5. The effects of S/L treatment require further study.

The hostel outreach program: assertive case management for homeless mentally ill persons.

OBJECTIVE: This study measured the impact of an assertive case management program for psychiatrically disabled homeless persons in metropolitan Toronto. It was hypothesized that the program would improve residential stability, reduce psychiatric symptoms, improve social functioning, improve social networks, and increase use of appropriate services. METHOD: For 59 clients admitted to the program, assessments for the nine-month period before program entry were completed and were repeated nine months later. The Brief Psychiatric Rating Scale and a version of the Scale for Level of Functioning were the main measures of outcome. RESULTS: At follow-up significant improvements in residential stability and reductions in psychopathology were demonstrated. Improvements in social functioning and increases in social network size were significant. Although no baseline data about service use were collected, clients used basic support services during their first nine months in the program. CONCLUSIONS: The success of the program demonstrates that a difficult-to-treat patient population can be helped in a humane fashion if trained personnel are available.

Measuring self-perceived role competence among first nations and non native children.

The objective of this research is to develop and test measures of self-perceived academic and social competence among First Nations and non native children. The method used is the analysis of psychometric properties of scales derived from questionnaires administered to First Nations children four culture areas of North America, as well as comparison samples of non native children. The results consist of the reliability coefficients, which fall into a satisfactory range; an internal consistency which increases with age; an agreement between self- and teacher-rated competence which is higher for non native than for native children. In the second grade, the competence scores of the native and non native children were equal. Thereafter, the scores of the native children either declined or remained static, while the non native scores tended to increase. In conclusion, the Flower of Two Soils scales are suitable for children from elementary schools, from First Nations and the majority culture. As children mature, the assessments of competence become an increasingly stable part of their repertoire of self-percepts; asynchronous socialization may adversely affect self-perceived competence.

Residents' and nurses' perceptions of difficult-to-treat short-stay patients.

OBJECTIVE: Characteristics attributed by nurses and by psychiatric residents to difficult-to-treat inpatients in a short-stay setting were compared to determine whether discipline-specific perceptions of such patients existed. METHODS: A total of 117 patients consecutively admitted to a short-stay inpatient unit were assessed by both psychiatric residents and nurses during the third week of hospitalization using subscales of the Hospital Treatment Rating Scales. The degree of management difficulty presented by each patient in 28 areas was rated, and an overall rating was calculated. Two separate regression analyses were used to examine characteristics of patients rated difficult. RESULTS: Self-harm behaviors, violence toward others, and behaviors that sabotage treatment were identified by both nurses and residents as characteristics of difficult patients, although these characteristics contributed less to residents' perceptions of patient difficulty than to nurses'. For nurses, the most important additional characteristics contributing to treatment difficulty were related to patients' inability to form a therapeutic alliance. For residents, by far the most significant contributor to overall treatment difficulty was lack of response to medication. CONCLUSIONS: The discipline-specific differences in perceptions of difficult-to-treat patients were associated with differences in professional roles. Communication problems between physicians and nurses may be due in part to their different perceptions of treatment and management difficulty.

Recurrent themes of concern in groups for health care professionals.

This paper reports of recurrent themes of concern about AIDS expressed by health care professionals participating in small group sessions. Three dominant themes emerged: fear of contagion, homophobia, and attachment and loss. For each of these themes the possible meanings are explored. Fear of contagion was the dominant theme and is discussed as both a possible expression of displaced homophobia and a 'catastrophic' risk factor (extreme negative consequence). The need of health care professionals to see themselves as 'different' from the person with AIDS is also discussed. Professionals also discussed the emotional burden of caring for young patients often similar in age to themselves. It is suggested that hospital policy makers need to accept the reality of staff concerns and provide adequate forums for expression of concerns since without an opportunity for thoughtful discussion, health care professionals may espouse the 'correct' position and attitude, but believe and practise something else.

Gender differences among clients of a case management program for the homeless.

Differences between 24 female and 35 male clients were assessed at entry into an intensive case management program serving homeless shelter residents and again nine months later. Both men and women were socially isolated, with small social networks and severe deficits in social functioning. Histories of homelessness were similar for both genders, and there were no gender differences in psychopathology at baseline or follow-up. At entry into the program women had higher levels of social skills, larger and more supportive networks, and better housing conditions than men, but these differences disappeared after the subjects spent nine months in the program. Inadequate living conditions may have contributed to the more negative initial picture for men. Although there were more similarities than differences between the men and women in this sample, more research on gender differences is needed to design and evaluate programs for homeless mentally ill persons.

Marital support and recovery from depression.

A prospective study of 47 married women who met RDC for major depressive disorder investigated the relationship between the social support provided by the husbands and the post-hospital symptom course of the women. Separate taped semistructured interviews were held with the patient and husband at the time of admission. Six months later, symptom course was rated using the LIFE psychiatric status schedule. Only 51% of the sample recovered in the six months. Few demographic or clinical factors were related to symptom course. Recovery was predicted by the depressed woman's ratings of the current marital relationship and by the husband's rating of the pre-morbid relationship but not by the husband's level of expressed criticism or his ratings of the current relationship.

Fear of contagion and AIDS: nurses' perception of risk.

Nurses' fear of contagion when caring for persons with AIDS remains high despite increased levels of knowledge. This paper examines the multiple factors that contribute to nurses' perception of risk within the workplace. The authors suggests that constructs from theories such as decision making, psychoanalysis and cognitive psychology can provide insight into the assessment of risk. Findings from a recent survey of nurses are used to illustrate the complex nature of fear of contagion. Understanding this complexity may be an essential first step in order to provide opportunities for resolution of fears and modification of behaviors.