The relationship of depression and stressors to immunological assays: a meta-analytic review.

This is a broad meta-analysis of the relations of both depression and stressors to immunological assays. The number of study samples (greater than 180) and measures (greater than 40) is much more extensive than any so far. Analyses are done by both fixed and random effects. By a fixed-effects analysis, both major depression and naturally occurring acute stressors are associated with (1) an overall leukocytosis, (2) mild reductions in absolute NK-cell counts and relative T-cell proportions, (3) marginal increases in CD4/CD8 ratios, and (4) moderate decreases in T- and NK-cell function. However, the degree of heterogeneity of the studies' results raises questions about their robustness. Therefore, we also did the first random effects analysis to estimate what is likely to appear in future studies. For depression, the analysis showed the immunological correlates included (1) an overall leukocytosis, manifesting as a relative neutrophilia and lymphoenia; (2) increased CD4/CD8 ratios; (3) increased circulating haptoglobin, PGE(2), and IL-6 levels; (4) reduced NK-cell cytotoxicity; and (5) reduced lymphocyte proliferative response to mitogen. For stressors, the random effects analysis showed that future studies are likely to find the following effects: (1) an overall leukocytosis, manifesting as an absolute lymphocytosis; (2) alterations in cytotoxic lymphocyte levels, CD4/CD8 ratios, and natural killer cell cytotoxicity with the direction of change depending on the chronicity of the stressor; (3) a relative reduction of T-cell levels; (3) increased EBV antibody titers; (4) reduced lymphocyte proliferative response and proportion of IL-2r bearing cells following mitogenic stimulation; and (5) increased leukocyte adhesiveness. The random-effects analysis revealed that for both major depression and naturally occurring stressors the following effects are shared: leukocytosis, increased CD4/CD8 ratios, reduced proliferative response to mitogen, and reduced NK cell cytotoxicity. The implications for these findings for disease susceptibility and the pathophysiology of these conditions is discussed.

Breast cancer in older women: treatment, psychosocial effects, interventions, and outcomes.

It is estimated that 48% of women with breast cancer are age 65 and older; yet, scant research focuses on this cohort. Recent advances in breast cancer management have raised many questions regarding appropriate treatment of older patients with cancer. Despite recent emphasis on medical interventions for older women, there is little focus on the unique clinical presentation and psychological sequelae of breast cancer in this population. While elderly women who survive breast cancer seem to cope better than their younger counterparts, their distress must not be overlooked. Interventions such as use of social support, spirituality, and exercise demonstrate therapeutic benefits for older women with cancer and should be explored. Nurses play a key role in educating and supporting older women with breast cancer and can help dispel many age-related myths and misconceptions.

Psychosocial needs of older cancer patients: a pilot study abstract.

Approximately 50% of all cancers occur in persons aged 65 and over (American Cancer Society, 1994). However, the special psychological problems of these patients have been inadequately addressed (Massie & Holland, 1989). The psychosocial needs of older cancer patients were surveyed in this pilot study. Two-thirds of the older adults surveyed experienced concerns or problems. Almost 50% of the sample did not receive adequate assistance in dealing with their emotional needs and 69% did not receive sufficient spiritual support. Older cancer patients experience psychosocial distress and may benefit from professional assistance in dealing with these concerns.

Self-blame and adjustment to breast cancer.

PURPOSE: To examine the relationship between self-blame and illness adjustment in women with breast cancer. DESIGN: Descriptive, correlational design. SETTING: Outpatient facilities of two metropolitan medical centers. SAMPLE: 234 women diagnosed with stage I or II breast cancer. METHODS: Structured and semistructured interviews using the Psychosocial Adjustment to Illness Scale (PAIS), the Global Adjustment to Illness Scale (GAIS), an attributions and blame interview, and several questions about control over the cause and course of the cancer. MAIN RESEARCH VARIABLES: Self-blame, controllability, and adjustment to illness. FINDINGS: 39% of the sample reported some self-blame. Analysis of variance indicated that subjects with high levels of self-blame had poorer scores on the PAIS and GAIS. CONCLUSIONS: The findings indicate the need for further study of the self-blame/adjustment relationship. Researchers must clarify the characteristics that compromise adjustment in patients with breast cancer. IMPLICATIONS FOR NURSING PRACTICE: The findings support the importance of assessing self-blame and providing information to discourage its use by patients with breast cancer.

Psychological intervention for older hip fracture patients.

1. Although there are sophisticated surgical procedures for hip fracture repair, a substantial proportion of patients never return to pre-fracture levels of physical function. Factors that influence the recovery of older hip fracture patients represent important areas to study in order to more precisely predict outcome. 2. Research findings suggest that elevated depressive symptoms and cognitive impairment may negatively affect recovery, while mental alertness, emotional stability, and social involvement positively affect recovery. Thus, hip fracture and its subsequent disability must be studied as a biopsychosocial phenomenon, rather than merely as a physiological event. 3. Older hip fracture patients may be at higher risk for psychological problems related to the traumatic nature of the injury. A comprehensive psychological assessment at admission can assist the nursing staff to determine which patients are at higher risk for emotional distress.

Relaxation training and psychoimmunological status of bereaved spouses. A pilot study.

The death of a family member is one of the most stressful and disruptive life events. Although the literature abounds with subjective pieces concerning bereavement, little is known about the complex biological processes that follow in its wake. However, there is a growing body of evidence that psychological distress may compromise immunocompetence and that support strategies may enhance immune function. Our exploratory study examined the influence of relaxation training on the immunological and psychological status (including anxiety and depression) of bereaved spouses. Nine female spouses, all survivors of patients who died from cancer, were recruited from two hospice programs to participate in this relaxation-training program. Standardized psychological instruments and immunological assays were completed at three data-collection points: before the initiation of the relaxation training (approximately 6 weeks after the death of the spouse); at the conclusion of the training; and 4 weeks after the relaxation training. The subjects received a 1-h relaxation-training program weekly for 4 weeks. It included progressive muscle relaxation training and guided imagery supervised by a psychiatric nurse clinical specialist. The results indicated that the relaxation-training program was well-received by the subjects, with promising psychoimmunological trends that merit more rigorous investigation. This exploratory study has demonstrated the feasibility of conducting a relaxation-training intervention for bereaved spouses and has laid the foundation for continuing research to study the physiological and psychological responses of the bereaved.

Nursing students' personalities as measured by the California Psychological Inventory: participants vs nonparticipants in a program of research.

The purpose of this study was to use the California Psychological Inventory to assess whether certain personality variables would differ for two groups of nursing students who were participating in an experimental, longitudinal clinical education study. The inventory was administered to 28 nursing students during the spring semester of their senior year. Analysis indicated that the 12 students in the control group scored significantly higher on three subscales, Capacity for Status, Sociability, and Social Presence, than did the 16 in the special program.

Toddler temperament and quality of the child-rearing environment.

The interactional process between mother and child is complex and critically important to understanding the mother-child dyad. This study examines components of the mother's description of toddler temperament and assesses the home environment.

A clinical teaching project: examination of a clinical teaching model.

This project, started in 1985 by Dr Infante, is based on theory of the use of the clinical laboratory in nursing education. It fully recognizes the complementary roles of nursing education and nursing service by having practitioners participate as preceptors, role models, and mentors. Six clinical agencies participated in this innovative clinical teaching project with the goal of improving the effectiveness and efficiency of nursing education and nursing practice. It is hypothesized that the synchronization of clinical laboratory experiences with instruction in nursing theory and science and a closer collaboration among faculty, students, and nurse practitioners will give students an appropriate balance of academic and clinical practice perspectives and skills to prepare them effectively to meet the complex health care needs of patients. The subjects were 173 undergraduate baccalaureate nursing students enrolled in an upper-division generic program. For the purpose of testing Infante's clinical model, the students were randomly assigned to a control or experimental group for two successive incoming classes of nursing students. Each student's academic and clinical progression was monitored. Data were gathered using grade point average, a standardized test for nursing knowledge (Mosby Assesstest; Mosby, St Louis), college laboratory practicum, and simulated testing for clinical application skills.2+ Data were analyzed using independent t tests. The findings indicate that the students in the experimental group, who used the experimental clinical model, achieved higher grade point averages, higher scores on the Mosby Assesstest, and higher college laboratory practicum scores than the students in the control group. The findings support the need for further investigation of innovative clinical teaching models.

Infant temperament and the quality of the childrearing environment.

The purpose of this study was to determine the relationship between infant temperament and the quality of the childrearing environment by examining (a) maternal ratings of infant's behavior utilizing questionnaire category scores, (b) maternal impressions of infant's behavior, (c) the relationship of maternal ratings of infant's behavior to the quality of the childrearing environment, and (d) the relationship of maternal impressions of infant's behavior to the quality of the childrearing environment. Mothers of 20 normal, full-term infants with a mean age of 5.2 months were involved in the study. During a home visit, the Revised Infant Temperament Questionnaire (RITQ) and the Home Observational Measurement Evaluation Inventory (HOME) were completed. Pearson Product Moment Correlation, chi-square, and Z tests were used to analyze the data. The findings of the study suggested no significant difference in the quality of the childrearing environment with difficult or easy temperament infants as measured by the questionnaire category scores. There was a significant positive relationship between infants perceived as "easier-than-average" on the maternal impression responses and maternal organization and stimulation as measured by the HOME.