Using an Adjunctive Treatment to Address Psychological Distress in a National Weight Management Program: Results of an Integrated Pilot Study.

INTRODUCTION: Obesity is highly comorbid with psychological symptoms in veterans, particularly post-traumatic stress disorder (PTSD), depression, and anxiety. Obese veterans with comorbid psychological symptoms often display suboptimal weight loss and poor physical functioning when participating in weight management programs. The MOVE! program aims to increase healthy eating and physical activity to promote weight loss in obese veterans. Adequately addressing psychological barriers is necessary to maximize outcomes in MOVE! for veterans with PTSD, depression, and anxiety. We examined the preliminary outcomes of administering the Healthy Emotions and Improving Health BehavioR Outcomes (HERO) intervention. HERO is adjunctive cognitive-behavioral therapy to MOVE! that addresses PTSD, depression, and anxiety symptom barriers to engagement in physical activity. MATERIALS AND METHODS: All recruitment and study procedures were approved by the institutional review board and research and development committees of the Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine in Houston, Texas. Participants gave written informed consent before enrollment. Thirty-four obese veterans with a diagnosis of PTSD, depression, and/or anxiety who were attending MOVE! were assigned to the 8-session HERO group or the usual care (UC) group. Veterans completed assessments of PTSD, depression and anxiety symptoms, physical activity, physical functioning, and weight at baseline, 8 and 16 weeks post treatment. Changes from baseline to 8- and 16-week follow-up on the self-report and clinician-rated measures were assessed, using independent samples t-tests and analyses of covariance. RESULTS: At 8 weeks post treatment, participants in the HERO group had significantly higher step counts per day than participants in the UC group. Similarly, at 16 weeks post-treatment, participants in the HERO group continued to experience a significant increase in daily steps taken per day, as well as statistically and clinically significantly lower scores on the depression symptom and PTSD symptom severity. Participants in the HERO group also demonstrated significantly higher scores on the physical functioning inventory than participants in the UC group (44.1 ± 12.1 vs. 35.7 ± 10.7, P = 0.04) at 16 weeks post treatment. CONCLUSIONS: Findings of this small trial have important implications pending replication in a more rigorously designed large-scale study. Providing an adjunctive treatment to MOVE! that addresses psychological distress has potential benefits for psychological symptom reduction, engagement in healthy dietary habits, and greater physical activity for individuals who traditionally experience barriers to making positive weight management changes.

Psychometric Study of the Pain Drawing.

PURPOSE: The objectives of the study were to (1) assess the extent to which interrater reliability of pain drawing location and dispersion scoring methods are similar across pain disciplines in a sample of patients with cancer treatment-induced neuropathic pain (N = 56) and (2) investigate indicators of validity of the pain drawing in this unique sample. METHODS: Patients undergoing cancer therapy completed the Brief Pain Inventory Body Map, the MD Anderson Symptom Inventory, and the McGill Pain Questionnaire. RESULTS: Intraclass correlation coefficients among medical and psychology professionals ranged from .93-.99. Correlations between pain drawing score and symptom burden severity ranged from .29-.39; correlations between pain drawing score and symptom burden interference ranged from .28-.34. Patients who endorsed pain in the hands and feet more often described their pain as electric, numb, and shooting than patients without pain in the hands and feet. They also endorsed significantly more descriptors of neuropathic pain. CONCLUSIONS: Results suggest a similar understanding among members of a multidisciplinary pain team as to the location and dispersion of pain as represented by patients' pain drawings. In addition, pain drawing scores were related to symptom burden severity and interference and descriptors of neuropathic pain in expected ways.

Disease burden and pain in obese cancer patients with chemotherapy-induced peripheral neuropathy.

PURPOSE: Chemotherapy-induced peripheral neuropathy (CIPN) and obesity are prevalent in cancer survivors and decrease quality of life; however, the impact of the co-occurrence of these conditions has garnered little attention. This study investigated differences between obese and non-obese cancer survivors with CIPN and predictors of symptom burden and pain. METHODS: Patients with CIPN were administered the MD Anderson Symptom Inventory and a modified version of pain descriptors from the McGill Pain Inventory. Independent t tests assessed group differences between obese and non-obese survivors, and linear regression analyses explored predictors of patient outcomes. RESULTS: Results indicated a significant difference in symptom severity scores for obese (M = 32.89, SD = 25.53) versus non-obese (M = 19.35, SD = 16.08) patients (t(37.86) = -2.49, p = .02). Significant differences were also found for a total number of pain descriptors endorsed by obese (M = 4.21, SD = 3.45) versus non-obese (M = 2.42, SD = 2.69) participants (t(74) = -2.53, p = .01). Obesity was a significant predictor of symptom severity and total pain descriptors endorsed. Other significant predictors included age and months since treatment. CONCLUSIONS: Cancer survivors with CIPN and co-occurring obesity may be more at risk for decreased quality of life through increased symptom severity and pain compared to non-obese survivors. This paper identified risk factors, including obesity, age, and months since treatment, that can be clinically identified for monitoring distress in CIPN patients. Future research should focus on the longitudinal relationship between obesity and CIPN, and robust interventions to address the multifaceted issues faced by cancer survivors.

Are Child Cognitive Characteristics Strong Predictors of Responses to Intervention? A Meta-Analysis.

We conducted a meta-analysis of 28 studies comprising 39 samples to ask the question, "What is the magnitude of the association between various baseline child cognitive characteristics and response to reading intervention?" Studies were located via literature searches, contact with researchers in the field, and review of references from the National Reading Panel Report. Eligible participant populations included at-risk elementary school children enrolled in the third grade or below. Effects were analyzed using a shifting unit of analysis approach within three statistical models: cognitive characteristics predicting growth curve slope (Model 1, mean r = .31), gain (Model 2, mean r = .21), or postintervention reading controlling for preintervention reading (Model 3, mean r = .15). Effects were homogeneous within each model when effects were aggregated within study. The small size of the effects calls into question the practical significance and utility of using cognitive characteristics for prediction of response when baseline reading is available.

The Relationship between Diabetes Self-efficacy and Diabetes Self-care in American Indians and Alaska Natives.

The objective of the present study was to investigate how American Indian/Alaska Natives' (AI/ANs') attitudes and beliefs might influence how they experience and manage diabetes, with particular attention paid to their attitudes about disease causality. An AI/AN sample of 119 participants completed an anonymous survey that examined the impact of judgments of personal responsibility for disease onset, anger, self-blame, social support, and diabetes self-efficacy on diabetes self-care. Our primary model was tested using structural equation modeling. Results indicated that, while many participants considered themselves almost entirely responsible for their disease onset, this judgment did not predict anger. Anger was strongly related to self-blame and social support, while diabetes self-efficacy was strongly related to diabetes self-care. These psychosocial variables accounted for 70% of the variability in self-reported disease management.

Mental health utilization among older Veterans with coexisting depression and dementia.

OBJECTIVE: We compared mental health service utilization among older, depressed Veterans (60 years or older) with and without coexisting dementia. METHODS: This retrospective study examined data from the 2010 Veterans Health Administration National Patient Care Database outpatient treatment files of Veterans with a newly recognized diagnosis of depression (N = 177,710). RESULTS: Approximately 48.84% with coexisting depression and dementia and 32.00% with depression only received mental health services within 12 months of diagnosis (p < .0001). Veterans with coexisting depression and dementia were more likely to receive medication-management appointments (33.40% vs 20.62%), individual therapy (13.39% vs 10.91%), and family therapy (3.77% vs 1.19%) than depressed Veterans without dementia. CONCLUSION: In general, Veterans with recently diagnosed depression are significantly underusing Veterans Affairs mental health treatment services. Those Veterans who have comorbid dementia are more likely than those with just depression to be enrolled in mental health treatments. Systemic improvements are needed to increase use of mental health services for older, depressed Veterans.

The Flynn effect: a meta-analysis.

The Flynn effect refers to the observed rise in IQ scores over time, which results in norms obsolescence. Although the Flynn effect is widely accepted, most efforts to estimate it have relied upon "scorecard" approaches that make estimates of its magnitude and error of measurement controversial and prevent determination of factors that moderate the Flynn effect across different IQ tests. We conducted a meta-analysis to determine the magnitude of the Flynn effect with a higher degree of precision, to determine the error of measurement, and to assess the impact of several moderator variables on the mean effect size. Across 285 studies (N = 14,031) since 1951 with administrations of 2 intelligence tests with different normative bases, the meta-analytic mean was 2.31, 95% CI [1.99, 2.64], standard score points per decade. The mean effect size for 53 comparisons (N = 3,951, excluding 3 atypical studies that inflate the estimates) involving modern (since 1972) Stanford-Binet and Wechsler IQ tests (2.93, 95% CI [2.3, 3.5], IQ points per decade) was comparable to previous estimates of about 3 points per decade but was not consistent with the hypothesis that the Flynn effect is diminishing. For modern tests, study sample (larger increases for validation research samples vs. test standardization samples) and order of administration explained unique variance in the Flynn effect, but age and ability level were not significant moderators. These results supported previous estimates of the Flynn effect and its robustness across different age groups, measures, samples, and levels of performance.