Correlates of psychological distress among mothers of children and adolescents with hemophilia and HIV infection.

Evaluated the correlates of mood state (psychological distress) in a multisite study of two groups: (a) mothers of HIV-positive children and adolescents with hemophilia (n = 91), and (b) mothers of HIV-negative children and adolescents with hemophilia (n = 92). Socioeconomic status, quality of family relationship support, and frequency of negative life events accounted for significant variance in Total Mood Disturbance (psychological distress) as measured by the Profile of Mood States in the overall sample. Severity of hemophilia was unrelated to distress. A significant interaction between HIV status and frequency of stressful life events indicated that this variable related more strongly to distress among mothers of HIV-infected children and adolescents with hemophilia than among mothers of HIV-negative children with hemophilia. Findings suggest that the presence of HIV infection in their children and adolescents may heighten the impact of negative life events on the psychological distress experienced by these mothers.

Impact of the repressive personality style on the measurement of psychological distress in children and adolescents with chronic illness: an example from hemophilia.

Described the impact of the repressive personality style on the measurement of psychological distress among children and adolescents with hemophilia. Two groups were compared on parent and self-report measures of anxiety and depression: a nondefensive group (n = 34) with low distress; and a highly defensive group (n = 26) who were identified as having a repressive personality style and who also reported low distress. Consistent with hypotheses, highly defensive children reported comparable levels of anxiety and lower levels of depression than nondefensive children. On the other hand, mothers of highly defensive children and adolescents described them as more distressed than mothers of nondefensive (self-assured) children. Findings underscore the importance of including data from other informants, (e.g., parents, teachers, or peers) to avoid misleading findings based on self-reports of anxiety and depression obtained from highly defensive children.

Psychological response to HIV positivity in hemophilia.

OBJECTIVE: To compare the psychological and family adaptation of children and adolescents with hemophilia who were seropositive for human immunodeficiency virus type 1 (HIV-1) with an HIV-negative group of comparable age, demographic characteristics, and disease severity in a multi-site study. DESIGN: Cross-sectional, controlled study. SETTING: Thirty-three hemophilia treatment centers throughout the United States. SAMPLE: Ninety-one children and adolescents with hemophilia who were seropositive for HIV and 92 children and adolescents with hemophilia who were seronegative and of comparable age, demographic characteristics, and disease severity. RESULTS: HIV-seropositive children and adolescents reported less positive affect [(lower well being) (P < .05)], and more frequent hemophilia-related school absences were identified among HIV-infected patients (P < .005). However, the two groups demonstrated surprisingly comparable levels of psychological, social, hemophilia-related adjustment, general family relations, and hemophilia-related family adaptation, as reported by patients and parents. However, mothers of HIV-seropositive children and adolescents reported higher levels of general psychological distress (P < .008) and higher levels of distress related to hemophilia (P < .0002) than parents of HIV-negative children. CONCLUSIONS: Seropositive children and adolescents with hemophilia demonstrate psychological resilience and levels of psychological adjustment that were comparable to seronegative counterparts. However, mothers of seropositive children were more distressed than mothers of HIV-negative children. Practitioners should ensure that stressed mothers obtain necessary psychological support.

Hemophiliac patient's knowledge and educational needs concerning acquired immunodeficiency syndrome.

The Patient Knowledge Assessment Study (PKAS) was conducted among 107 male hemophilic patients, aged 15 to 67 years, at 19 hemophilia treatment centers (HTC). Participants were given a 30-item questionnaire concerning the cause of acquired immunodeficiency syndrome (AIDS), the groups at risk, and modes of transmission. The questionnaire included questions on the participant's status in regard to antibody to human T-lymphotropic retrovirus, type III/lymphadenopathy-associated virus (HTLV-III/LAV), and the meaning of this test result. HTC health-care providers were asked to complete a separate questionnaire containing 17 questions about information given patients concerning their HTLV-III/LAV antibody status and its meaning. Overall, patients had a good base of knowledge about AIDS; however, there were gaps in this knowledge. Twenty-nine percent of patients did not know that spouses of AIDS patients were at risk for AIDS; 47% did not know that sexual partners of persons with hemophilia were at risk; and 32% did not know that hemophilic children were at risk. Further, only 69% understood that antibody-positive individuals had had contact with the AIDS virus. Identifying these and other areas of misunderstanding will provide the information needed to design educational strategies and psychosocial support programs appropriate for the hemophilic population, and which may serve as a model for other populations.

Serum thyroid hormone abnormalities in psychiatric disease.

Psychiatric illness is a cause of "euthyroid sick syndrome" (ESS), defined as abnormal concentrations of circulating iodothyronines in euthyroid subjects with nonthyroidal illness (NTI). We describe a prospective study of 150 consecutive psychiatric admissions studied by endocrine and psychologic techniques. Based on 150 admission blood samples, we found a 7% incidence of ESS and with serial samples (74 patients) the incidence was 27%, demonstrating that ESS can develop after hospital admission. Of the 20 patients with ESS, 11 had elevation of both serum total T4 concentrations (T4) and free thyroxine index (FTI) while their serum total T3 concentrations (T3) remained normal; 5 had elevation of FTI without elevation of T4 or T3; and 4 had low T4 and low FTI and normal TSH. In 2 of the 4 patients in the last category, the T3 was also low. The free T3 index (FT3I) was normal in all but 1 patient who had low FT3I and FTI, low T4 and T3, and normal TSH. The serum thyroid hormone abnormalities were transient in the ESS patients during the 10 day period with 2 exceptions; 1 patient had persistently elevated T4 and FTI with normal T3 and FT3I values while another patient had persistently depressed T4 and FTI without abnormality of FT3I or TSH. Multivariate statistical analysis demonstrated a difference (P less than .06) in the psychologic attributes of somatic and autonomic symptoms in ESS patients compared to controls. We conclude that ESS is as common amongst psychiatric admissions as in general hospital patients previously studied and that blood thyroid function tests should be interpreted cautiously in all hospitalized patients.

Psychological aspects of chronic obstructive pulmonary disease.

This paper describes a number of psychological variables useful in the care of patients with chronic obstructive pulmonary diseases. Attention to these factors does not replace destroyed lung tissue. Yet such efforts can lead to meaningful improvement in performance for many patients. The prolongation of life is not the only goal of comprehensive care. Equally important to the patient and his family are efforts to function as well and as comfortably as possible throughout the remainder of his life.