Level of Depression, Anxiety and Impairment of Social Relations with Regard to Pain Intensity in a Naturalistic Sample of Patients at the Outpatient Chronic Pain Clinic.

BACKGROUND: A high rate of concurrent depression and anxiety has been identified among the patients of pain clinics. Evaluation of own pain can appear as a perception of being negatively impacted by pain-related suffering in social relations. SUBJECTS AND METHODS: A questionnaire with 228 variables was applied to 109 randomly chosen patients at outpatient pain clinic of the Ljubljana University Clinical Centre. Following summative scores were treated as a set of dependent variables in MANOVA, as a set of predictors in discriminant analysis: level of depression (Zung), level of anxiety (Zung), evaluation of the nature of pain and perceptions of negatively impacted social relations. Actual pain has been self-evaluated on a visual-analogue pain scale from 0 to 10 and recorded in subgroups with a low, middle and high intensity of actual pain (criterion variable). RESULTS: The average age of the participants was M=52.7 years (SD 13.9), 70.9 % of them female. Participants with a high intensity of pain were found to have the highest level of depression, the highest level of anxiety and were negatively impacted in their social relations to the greatest extent. Only the first discriminant function was found to be significant (p<0.05). The structure matrix showed a high correlation between anxiety level (0.88) and depression level (0.86), and a low correlation with the perception of negatively impacted social relations (0.57). CONCLUSIONS: The results emphasize the connection between pain intensity, anxiety, depression and interpersonal relational issues in the context of patients with chronic pain at an outpatient pain clinic. Anxiety and mood were found to be the best predictors for the perception of pain intensity. The results are preliminary, but significantly support the multidisciplinary collaboration of treatment at a pain clinic with mental health professionals.

Intimate Partner Attachment Style and Antenatal Depression Symptoms in Nulliparas: Results from the ZRNO Study.

BACKGROUND: The purpose of this study was to examine the relationship between the important indicators that define mental health functioning during the first pregnancy: the level of depression, anxiety and fear of childbirth in the context of nulliparas' intimate partner attachment style type and older generation's emotional support. SUBJECTS AND METHODS: A group of 325 nulliparas in the third trimester of pregnancy were enrolled at the Childbirth preparation program of the University Medical Centre Ljubljana's Division of Gynaecology and Obstetrics. The following instruments were applied: Experiences in Close Relationships-Revised, The Edinburgh Depression Scale, two aspects of anxiety - Zung Anxiety Scale and a questionnaire regarding fear of childbirth. Attachment anxiety and avoidance scales were recoded into four categories of a prototypical attachment style: secure, fearful, preoccupied and dismissive. Two-way ANOVA and the chi-square test were used for the statistical analysis. RESULTS: All indicators of mental health functioning of our sample of nulliparas differed significantly regarding their partner attachment style. Nulliparas with a fearful, but also with a preoccupied type of attachment, showed less optimal mental health indicators compared to those with a secure/dismissive type of attachment. A significant interactive effect of partner attachment and emotional support from the older generation was found on the level of depression. Partner attachment styles and emotional support from the older generation were found to be statistically dependent. CONCLUSIONS: In our sample a secure attachment seems to represent a protective buffer for the level of depression, even when a lower emotional support of the older generation was included. Screening and intervening on intimate attachment style as a protective factor for antenatal depression and different forms of anxiety is proposed.

Contextual-relationship and stress-related factors of postpartum depression symptoms in nulliparas: a prospective study from Ljubljana, Slovenia.

BACKGROUND: For a significant proportion of women, postpartum depression (PPD) is the first mood episode in their lives, yet its aetiology still remains unclear. Insecure attachment in close adult relationships is considered to be a risk factor for depressive symptoms. This study aimed to gain further insight into the risk factors for postpartum depression symptoms (PPDS) of nulliparas in Slovenia and to examine vulnerability to developing depressive symptoms, with an emphasis on contextual and stress-related characteristics. METHODS: The sample consisted of 156 nulliparas in the third trimester of pregnancy enrolled in a childbirth preparation program. The following instruments were applied: Experiences in Close Relationships-Revised, the Edinburgh Postpartum Depression Scale (EPDS), the Zung Anxiety Scale and a question battery designed by the research team including questions about emotional support and work-related stress. Logistic regression was used to test the association between demographic, social, environmental, personality and attachment variables and PPD of nulliparas (EPDS ≥10), controlling for baseline (prepartum) depression score. A multivariable linear regression model was built with the postpartum EPDS continuous score as a dependent variable. RESULTS: 28/156 (17,9%) were evaluated as being at risk for depression (EPDS≥10) in the last trimester and 25/156 (16%) at six weeks postpartum. The results of the logistic regression model controlled for prepartum depression score showed that increased risk for developing PPDS was associated with anxiety level postpartum, intimate-partner-attachment anxiety postpartum, and elevated stress due to loss of employment or an unsuccessful search for employment in the previous year. The results of the multivariable regression model, however, showed the association with education and postpartum anxiety with PPDS continuous score; EPDS after giving birth was higher for more educated and more anxious primiparas. CONCLUSIONS: Our findings demonstrate the importance of anxiety symptoms and higher education level in assessments of nulliparas' mental health. The results of our study show and confirm the results of previous research that anxiety symptoms in the immediate postpartum period are likely to be associated with depressive symptoms in nulliparas. The results also suggest that higher level of education of first-time mothers might not be a protective factor, especially for nulliparas with the university level of education. Further studies on larger samples should be considered.

A Temporal Profile of pro-abstinence-oriented Constructs from The Modified Theory of Planed Behavior in a Slovenian Clinical Sample of Treated Alcoholics - an 18-year Follow-up.

INTRODUCTION: Using the modified Theory of Planned Behaviour (mTPB), different indicators of therapeutic success were studied to understand pro-abstinence behavioural orientation during an 18-year after-care period following a 3-month intensive alcoholism treatment. The indicators were: perceived needs satisfaction (NS), normative differential (ND), perceived alcohol utility (UT), beliefs about treatment programme benefits (BE) and behavioural intentions (BI). METHODS: The sample of 167 patients who consecutively started an intensive alcoholism treatment programme has been followed-up for 18 years, using standardised ailed instruments at the end of the treatment, and in the years 4-5, 9 and 18 of follow-up. The last data collection was completed by 32 subjects in 2010. The analysis followed the standard explore-analyse-explore approach. After the initial descriptive exploration of data, multivariate analysis of variance (MANOVA) in SPSS statistical package was set to explore between-groups and within-groups differences over time. RESULTS: At the between-group level, BI remained stable at the same level as at the end of the treatment programme, whereas BE and UT robustly changed over time and levelled off after 10 years of follow-up. NS and ND show a trend of pro-abstinent orientation and level off after 10 years of follow-up, although the trend is not significant. The same results were confirmed by the within-subject level. CONCLUSIONS: Studied constructs stabilised after ten years of follow-up, apart from BI. The latter suggests that BI level needed for completion of an intensive treatment programme suffices for the maintenance of abstinence when accompanied by the change in perception of alcohol usefulness.

Self - Reported Depression, Anxiety and Evaluation of Own Pain in Clinical Sample of Patients with Different Location of Chronic Pain.

BACKGROUND: Depression, anxiety and chronic pain are frequent co-occurrent disorders. Patients with these mental disorders experience more intense pain that lasts for a longer time. METHOD: Questionnaire with 228 variables was applied to 109 randomly chosen patients that were treated at an outpatient clinic for treatment of chronic pain of the University Clinical Centre Ljubljana from March to June 2013. 87 patients responded to the questionnaire (79.8%). Location of pain considering diagnosis was the criterion in the discriminant analysis (soft tissue disorders; headache; symptoms not elsewhere classified; back pain) and following summative scores as predictors: level of depression and anxiety (The Zung Self-Rating Depression/Anxiety Scale), evaluation of pain and perceptions of being threatened in social relations. RESULTS: Average age of participants was M = 52.7 years (SD 13.9), with 70.9% female, 29.1% male participants. 63% of respondents achieved clinically important level of depression and 54% clinically important level of anxiety. On univariate level, the highest level of depression and anxiety was found for back pain and the lowest for headache. No significant difference was found in evaluation of pain and perceptions of being threatened in social relations regarding location of pain. Self-evaluation of depression has, in the framework of discriminant analysis, the largest weight for prediction of differentiation between different locations of pain. CONCLUSION: Different locations of pain have different connections with mood levels. The results of research on a preliminary level indicate the need to consider mental experience in the treatment of chronic pain.

Genetic variability in CYP2E1 and catalase gene among currently and formerly alcohol-dependent male subjects.

AIMS: The present study explored whether specific single-nucleotide polymorphisms in alcohol metabolic pathway are associated with alcohol dependence or alcohol-related psychopathological symptoms. METHODS: Three groups of male unrelated subjects were included: 101 currently alcohol-dependent patients, 100 formerly alcohol-dependent subjects and 97 healthy controls. The following questionnaires were implemented: AUDIT, Zung Depression and Anxiety scale, Brief Social Phobia Scale, Yale-Brown Obsessive Compulsive Scale, Obsessive Compulsive Drinking Scale and Buss-Durkee Hostility Inventory. All the subjects were genotyped for CYP2E1 c.-1053C>T and CAT c.-262C>T. RESULTS: Statistically significant differences in the distribution of genotypes and alleles for CAT c.-262C>T polymorphism were observed among the three investigated groups. We observed a higher frequency of CAT -262T allele in alcohol-dependent subjects (OR = 1.74, 95% CI = 1.164-2.610). Among currently dependent patients CAT -262T allele carriers had higher AUDIT scores (P = 0.023), while CYP2E1-1053T allele carriers had significantly higher YBOCS-obsession subscale scores (P = 0.005) and Zung Anxiety Scale scores (P = 0.011). CONCLUSIONS: Our findings suggest that the CAT c.-262C>T genetic polymorphism influences the susceptibility to alcohol dependence and severity of alcohol dependence, while CYP2E1 c.-1053C>T polymorphism influences the expression of obsessive-compulsive and anxiety symptoms.

Sick leave and its determinants in professional soldiers of the Slovenian Armed Forces.

AIM: To assess whether demographic characteristics, self-rated health status, coping behaviors, satisfaction with important interpersonal relationships, financial situation, and current overall quality of life are determinants of sick leave duration in professional soldiers of the Slovenian Armed Forces. METHODS: In 2008, 448 military personnel on active duty in the Slovenian Armed Forces were invited to participate in the study and 390 returned the completed questionnaires (response rate 87%). The questionnaires used were the self-rated health scale, sick leave scale, life satisfaction scale, Folkman-Lazarus' Ways of Coping Questionnaire, and a demographic data questionnaire. To partition the variance across a wide variety of indicators of participants' experiences, ordinal modeling procedures were used. RESULTS: A multivariate ordinal regression model, explaining 24% of sick leave variance, showed that the following variables significantly predicted longer sick leave duration: female sex (estimate, 1.185; 95% confidence interval [CI], 0.579-1.791), poorer self-rated health (estimate, 3.243; 95% CI, 1.755-4.731), lower satisfaction with relationships with coworkers (estimate, 1.333; 95% CI, 0.399-2.267), and lower education (estimate, 1.577; 95% CI, 0.717-2.436). The impact of age and coping mechanisms was not significant. CONCLUSION: Longer sick leave duration was found in women and respondents less satisfied with their relationships with coworkers, and these are the groups to which special attention should be awarded when planning supervision, work procedures, and gender equality policy of the Armed Forces. A good way of increasing the quality of interpersonal relationships at work would be to teach such skills in teaching programs for commanding officers.

Long-term abstinence and well-being of alcohol-dependent patients after intensive treatment and aftercare telephone contacts.

AIM: To identify whether intensive treatment and aftercare telephone contacts influence long-term abstinence and well-being of patients with alcohol dependency. METHODS: Six hundred and twenty two patients were evaluated at the beginning and end of intensive in-patient treatment. At the end of the treatment, the patients were divided into two recruitment cohorts--telephone contact group (n=347), in whom basic outcome criteria (abstinence, marital and employment status, self-evaluation of well-being) were evaluated 3, 6, 12, and 24 months after intensive treatment, and no contact group (n=275) in whom the basic outcome criteria were checked only at 24 months after the intensive treatment. At 24 months, response rate was 33.4% in telephone contact group (n=116) and 30.5% (n=84) in no contact group. RESULTS: Positive indicators of therapy success (abstinence or decrease in drinking, stabile social relations, and more positive self-evaluation of well-being) were found in 53.0% of patients at 3 months, 44.3% at 6 months, and 30.6% at 12 months in telephone contact group. Overall abstinence 24 months after the end of intensive treatment was reported in 25.7% of all patients, including non-respondents. Both groups achieved significant improvement in subjective well-being during intensive treatment. At 24 months, 3 attributes of subjective well-being (subjective psychological health, evaluation of financial status, general quality of life) were significantly higher in telephone contact group. However, groups did not significantly differ in the abstinence level (telephone contact group=27.7%, no contact group=24.4%). CONCLUSION: Significant differences in well-being variables between telephone contact group and no contact group at 24 months after the end of intensive treatment are at least partially due to phone contact/informative checking 3, 6, and 12 months after the end of intensive therapy. Telephone or any short and easy accessible communication checking is a promising as supportive and research tool in aftercare alcohol addiction treatment, especially because of its cost-benefit advantages.

Co-occurring mental and somatic diagnoses of alcohol dependent patients in relation to long-term aftercare alcohol abstinence and well-being.

OBJECTIVES: There are many evidences of co-morbidity influence on alcohol dependency treatment outcome. We were interested in the question 'Do alcohol dependent patients with different co-occurring mental and medical conditions significantly differ in subjective attributes of well-being and in abstinence rate two years after the end of intensive alcohol dependency treatment'. SUBJECTS AND METHODS: 222 ex - patients participated in the research 24 months after the end of intensive alcohol dependency treatment, 74% of them males (mean age = 46.17, SD = 8.79) and 26% females (mean age = 46.35, SD = 8.10). RESULTS: No significant differences were found in any dependent variable regarding any independent variable in "presence of any somatic diagnose" (yes/no) and "personality disorders". "Depressive vs. non depressive" differed significantly only in the evaluation of important interpersonal relations, while "anxious vs. non - anxious" and "benzodiazepine dependent vs. nondependent" significantly differed in all self - evaluations, except in evaluation of important interpersonal relations. No significant differences were found between (non)abstinents regarding any of six categories of mental disorder and medical conditions (yes/no) and no significant differences were found in any self - evaluation regarding the participation in different kinds of after-care. A greater number of patients continued to abstain from alcohol if they continued in aftercare 24 months after the end of intensive treatment. CONCLUSION: Patients with different somatic and mental co-occurring disorders did not differ in abstinence rate. However, membership in after-care 24 months after the end of intensive therapy significantly contributed to the abstinence rate. Abstinence was found to be connected with more positive self-evaluation. Patients with somatic co-occurring diagnoses tended to have more positive self-perceptions than patients with co-occurring mental disorders.