Longitudinal changes in young children's strategy use for emotion regulation.

The development of strategies that support autonomous self-regulation of emotion is key for early childhood emotion regulation. Children are thought to transition from predominant reliance on more automatic or interpersonal strategies to reliance on more effortful, autonomous strategies as they develop cognitive skills that can be recruited for self-regulation. However, there are few longitudinal studies documenting age-related changes in different forms and dimensions of strategies. The current study tested predicted age-related changes in strategy use in a task requiring children to wait for something they want. Specifically, we examined the longitudinal trajectories of 3 strategies commonly observed in delayed reward tasks: self-soothing, seeking attention about the demands of waiting (bids), and distracting oneself. We followed a sample of 120 children (54% male, 93.3% white, from semirural and rural economically strained households) from ages 24 months to 5 years who participated in a waiting task each year. Using growth curve modeling, we found declines in self-soothing, rises and then declines in bidding, and increases in distraction from 24 months to 5 years. Next, we investigated whether strategy use trajectories predicted adult ratings of children's emotion regulation during the task, that is, whether children appeared calm and acted appropriately while waiting. Growth in duration and dominance of distraction use predicted judgments that children were well-regulated by age 5 years, whereas growth in dominance of bidding use negatively predicted being rated as well-regulated. We discuss implications for the understanding of strategy development and future directions, including understanding strategy effectiveness. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Learning helplessness in the family: Maternal agency and the intergenerational transmission of depressive symptoms.

Children of mothers with elevated depressive symptoms may observe and learn a maladaptive cognitive style, including low perceptions of agency, that is, low perceived control over their emotions and circumstances. In turn, children may face increased cognitive vulnerability to depressive symptoms; however, this mediational model has yet to be tested. Using a longitudinal design and testing our hypotheses within a community sample, we investigated the mediating role of maternal agency in the associations between maternal depressive symptoms and child behavioral helplessness and depressive symptoms one and a half years later (M = 18.58 months, SD = 6.91 months). A diverse sample of school-age children (N = 137, 57.4% female, Mage = 9.74 years, SDage = 1.51 years) and their mothers (N = 122) reported on their depressive symptoms at Time 1. A subsample of children and mothers returned to report on depressive symptoms at Time 2 (N = 68 dyads; 49 with complete data prior to multiple imputation). Maternal agency was coded from narrative responses to the Parent Development Interview-Revised for Parents of School-aged Children (Slade et al., 2009), completed at Time 1. Child behavioral helplessness was indicated by low strategy use at the end of a challenging puzzle task at Time 2. Results revealed that lower maternal agency predicted higher child depressive symptoms at Time 2 and mediated the associations between higher maternal depressive symptoms at Time 1 and higher child behavioral helplessness and depressive symptoms at Time 2. Implications for clinical intervention and future investigations are discussed. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

High frequency heart-rate variability predicts adolescent depressive symptoms, particularly anhedonia, across one year.

BACKGROUND: Few prospective studies examine the link between lower heart rate variability (HRV) and depression symptoms in adolescents. A recent animal model specifically links HRV to anhedonia, suggesting a potential translational model for human research. METHOD: We investigated the association between spectral measures of resting HRV and depressive symptoms measured one year later, among 73 adolescents, aged 11-18 years. We evaluated (1) the predictive power of relative high frequency (HF) HRV, relative low frequency (LF) and relative very low frequency (VLF) HRV for depressive symptoms; and (2) the relative strength of association between HF HRV and depressive symptomatology (anhedonia, negative mood, interpersonal problems, ineffectiveness, negative self-esteem). RESULTS: HF HRV significantly predicted self-reported depressive symptoms across one year, controlling for age, puberty and sex. HF HRV was most strongly associated with anhedonia one year later, after considering other facets of depressive symptomatology. CONCLUSIONS: Results provide support for the prospective relationship between relative HF HRV and depressive symptoms among adolescents across one year. Findings concur with rodent models that suggest a specific link between HF HRV and anhedonia. LIMITATIONS: We investigated relative spectral power HF HRV and depressive symptom dimensions. We cannot make strong claims about these associations in clinical depression. Physical activity levels could be controlled in future work.

Natural History and Implantable Cardioverter-Defibrillator Implantation After Revascularization for Stable Coronary Artery Disease With Depressed Ejection Fraction.

BACKGROUND: Following revascularization, most payors require 3 months of medical therapy, followed by left ventricular ejection fraction (LVEF) reassessment, before implantable cardioverter-defibrillator (ICD) implantation possibly contributing to incomplete follow-up and suboptimal utilization of ICD therapy. The natural history of these patients, and their fate regarding ICD implantation, is unknown. HYPOTHESIS: We hypothesized that a waiting period after revascularization for stable CAD results in missed opportunities to provide care with regard to ICD implantation. METHODS: We followed patients with LVEF ≤ 35% and no ICD who underwent revascularization (coronary artery bypass grafting [CABG] or percutaneous coronary intervention [PCI]) for stable CAD. Follow-up used chart review and scripted telephone interviews. RESULTS: Among 3164 revascularized patients (2198 [69%] PCI, 966 [31%] CABG), only 62 (2%; 33 [53%] male, age 67 ± 12 y, LVEF 28% ± 6%) had stable CAD, depressed LVEF, and no ICD. Over 35 ± 19 months, 35 (56%) of these 62 patients were no longer candidates for ICD based on improved LVEF, 14 (23%) received an ICD, 5 (8%) declined ICD despite physician recommendation, 3 (5%) were not offered ICD despite continued eligibility, 2 (3%) died, 1 (2%) was not a candidate due to substance abuse, and 1 (2%) had ICD implantation temporarily deferred. Only 1 (2%) was lost to follow-up. CONCLUSIONS: Following revascularization for stable CAD with depressed LVEF, ≥50% of patients' ventricular function improved enough to make ICD implantation unnecessary. A waiting period after revascularization prior to ICD implantation appears appropriate and does not significantly negatively impact follow-up or the rate of appropriate ICD implantation.

The variable heart: High frequency and very low frequency correlates of depressive symptoms in children and adolescents.

BACKGROUND: Work examining the link between lower heart rate variability (HRV) and depression in children and adolescents is lacking, especially in light of the physiological changes that occur during pubertal development. METHOD: We investigated the association between spectral measures of resting HRV and depressive symptoms among 127 children and adolescents, ages 10-17. Using spectral analysis, we evaluated (1) the association between relative high frequency (HF) HRV and depressive symptoms; (2) the predictive power of relative HF HRV for depressive symptoms in the context of relative low frequency (LF) and relative very low frequency (VLF) HRV; and (3) the relationship between relative HF, LF, and VLF band activity, age and pubertal maturation. RESULTS: Consistent with previous work, results revealed that relative HF HRV was negatively associated with self-reported depressive symptoms. As well, relative VLF HRV was positively associated with depressive symptoms. Regression analyses revealed that relative HF HRV and relative VLF HRV significantly predicted self-report depressive symptoms while controlling for age, sex and pubertal maturation, with relative VLF HRV emerging as the strongest indicator of depressive symptoms. Developmental findings also emerged. Age and pubertal maturation were negatively associated with relative HF HRV and positively correlated with relative VLF HRV. CONCLUSIONS: Results provide support for the relationship between HRV and depression and suggest that both HF and VLF HRV are relevant to depression symptom severity. Findings also reinforce the importance of considering pubertal development when investigating HRV-depression associations in children and adolescents. LIMITATIONS: Influences on cardiac control including physical activity levels and exercise patterns could be controlled in future work. Our data speak to a depressive symptom dimension and relative spectral power HRV. Thus, we cannot make strong claims about relative spectral power HRV and clinical depression.

Submammary device implantation in women: a step-by-step approach.

INTRODUCTION: The frequency of device implantation is increasing in younger patients as our ability to diagnose long-QT syndrome, hypertrophic cardiomyopathy, Brugada Syndrome, and other life-threatening disorders earlier has improved. Similarly, use of cardiac resynchronization therapy and ICD therapies has increased in cardiomyopathy patients. METHODS AND RESULTS: Device implantation in young women has unique considerations. Standard pectoral implants lead to excessive scar formation due to skin tension and interfere with purse straps, bra straps, and seat belts. There are also privacy and body image concerns as the subclavian region is exposed with many contemporary fashions. RESULTS: Over an 11-year period, we implanted pacemakers, implantable converter-defibrillators (ICDs) and cardiac resynchronization therapy (CRT) devices (defibrillators or pacemakers) in 60 women, aged 13-70 years, using a 2-incision submammary approach. Follow-up surveys were performed using the Florida Patient Acceptance Survey (FPAS). Women with submammary device placement reported significantly greater device acceptance (M = 92.41, SD = 6.46) than women with standard implant technique (M = 70.29, SD = 17.85); t (54) =-6.08, P < 0.001, on the FPAS. Across subscales on the FPAS, women with submammary device placement also reported significantly less body image concern (P < 0.001), less device-related emotional distress (P < 0.001), and greater confidence in returning to life appropriately (P = 0.01) than women with standard device placement. CONCLUSION: We present here our technique for submammary device implantation.

Psychosocial End-of-Life Considerations for Healthcare Providers.

This article summarizes concepts related to psychosocial issues at the end of life with special attention directed to the rights of the mentally ill, issues related to mental capacity to consent, and suicidality and desire for hastened death in patients with a terminal illness. We discuss assessment tools and clinical decision-making strategies to guide the healthcare provider in dealing effectively with the often difficult situations involving patients facing the end of life.

Psychosocial functioning of patients after endoscopic thoracic sympathectomy.

OBJECTIVE: Endoscopic thoracic sympathectomy is considered the treatment modality of choice for patients with disabling hyperhidrosis. However, the psychosocial impact of the intervention has not been systematically studied in American samples before and after sympathectomy. It is expected that the reduction of symptoms is associated with improved psychosocial functioning and quality of life. The aim of this study was to examine psychosocial functioning in patients with hyperhidrosis undergoing thoracic sympathectomy. METHODS: Patients with hyperhidrosis undergoing evaluation for sympathectomy were recruited from Shands Hospital at the University of Florida. Fifty-one patients completed individual psychological assessment batteries prior to undergoing sympathectomy and at 1-month follow-up, measuring the constructs of health-related quality of life, anxiety, and depression. RESULTS: Repeated-measures analyses of variance revealed that 1 month after sympathectomy, patients reported significant improvements across the domains of physical quality of life (p=0.01), mental quality of life (p=0.005), trait anxiety (p<0.001), and depression (p=0.007). CONCLUSIONS: Sympathectomy resulted in increases in health-related quality of life, and decreases in anxiety and depression within 1 month post procedure. Results suggest that sympathectomy exists as an effective treatment choice for both medical and psychosocial outcomes in patients with hyperhidrosis.

Quality of life in pediatric patients with implantable cardioverter defibrillators.

Psychosocial and quality-of-life (QOL) outcomes in adult patients with implantable cardioverter-defibrillators (ICDs) are well studied. Minimal research exists regarding pediatric adjustment, despite a potentially more challenging adjustment process. The purpose of the present study was to examine psychosocial and QOL functioning of pediatric ICD patients from patient and parent self-reports. Children and primary caregiver dyads from several university hospitals were analyzed using the PedsQL, the Device Severity Index, the ICD and Avoidance Survey, and demographic information. Sixty children (25 female, 35 male) were enrolled. The present pediatric sample reported lower psychosocial and physical QOL scores than healthy children's normative scores. In comparison with a sample of chronically ill children, pediatric ICD patients reported lower physical QOL. Parent-observed QOL reports revealed lower psychosocial and physical QOL than parent-observed healthy norms and lower psychosocial and physical QOL than chronically ill norms. There were no QOL differences by ICD shocks or medical severity. Female patients reported lower psychosocial, physical, and cardiac QOL scores. Children reported better QOL than parent observations on psychosocial and physical health. Finally, 84.7% of children reported avoidance behaviors since ICD implantation, with female children avoiding places more than male children. In conclusion, pediatric ICD patients are comparable to children with other chronic illnesses with the exception of lower physical QOL. Similar to adult samples, female children reported poorer QOL and were more likely to engage in avoidance behaviors. Patients indicated better QOL perceptions than their parents' reports. ICD discharges and medical severity did not negatively affect QOL.

Female-specific education, management, and lifestyle enhancement for implantable cardioverter defibrillator patients: the FEMALE-ICD study.

BACKGROUND: Significant rates of psychological distress occur in implantable cardioverter defibrillator (ICD) patients. Research has demonstrated that women are particularly at risk for developing distress and warrant psychosocial attention. The major objectives were to implement and test the effectiveness of a female-specific psychosocial group intervention on disease-specific quality of life outcomes in outpatient female ICD recipients versus a wait-list control group. METHOD: Twenty-nine women were recruited for the study. Fourteen women were randomized to the intervention group and participated in a psychosocial intervention focused on female-specific issues; 15 were randomized to the wait-list control group. All women completed individual psychological batteries at baseline and at 1-month follow-up measuring shock anxiety and device acceptance. RESULTS: Pre-post measures of shock anxiety demonstrated a significant time by group interaction effect with the intervention group having a significantly greater decrease (Pillai's trace = 5.58, P = 0.026). A significant interaction effect (Pillai's trace = 5.05, P = 0.046) was found, such that women under the age of 50 experienced greater reduction in shock anxiety than their middle-aged cohorts. Pre-post measures of device acceptance revealed a significant time by group interaction effect with the intervention group having significantly greater increases (Pillai's trace = 5.80, P = 0.023). CONCLUSIONS: Structured interventions for female ICD patients involving ICD-specific education, cognitive behavioral therapy strategies, and group social support provide improvements in shock anxiety and device acceptance at 1-month re-assessment. Young women appear to be an at-risk subgroup of this population and may experience more benefit from psychosocial treatment targeting device-specific concerns.

Cardiac resynchronization therapy: a pilot study examining cognitive change in patients before and after treatment.

BACKGROUND: Cardiovascular patients with reduced cardiovascular output and capacity such as those with congestive heart failure (CHF) have demonstrated cognitive-related dysfunction. The use of cardiac resynchronization therapy (CRT) is considered standard care for CHF patients who do not improve despite optimal medical therapy. Cardiac resynchronization therapy may improve neurocognitive and psychosocial functioning in patients by increasing cardiac output and cerebral perfusion. METHODS: A total of 20 patients were examined before and 3 months after CRT device implantation, via administration of standard neurocognitive and psychosocial testing measures. RESULTS: Significant improvements in neurocognitive measures of attention (Digit Span: t[20] = - 2.695 [55.94+/-9.27-62.31+/-10.05], P = 0.015) and information processing (Digit Symbol: t[20] = - 4.577, P < 0.001; Controlled Oral Word Association Test: t[20] = - 3.338, P = 0.004) were demonstrated. Improvements in cardiac-specific quality of life were also significant (Minnesota Living with Heart Failure Questionnaire: t[16] = 3.544, P = 0.005 [55.17+/-18.23-36.75+/-18.00]; The Left Ventricular Dysfunction Questionnaire: t[16] = 3.544, P = 0.003 [63.43+/-23.35-43.29+/-21.62]). CONCLUSION: These results represent clinically significant, qualitative, and quantitative cognitive functional benefits for patients from a neurocognitive and psychosocial perspective. Results suggest that biventricular pacing improves cardiovascular outcome and psychosocial functioning in patients with CHF. The future investigation of a larger sample would be beneficial in establishing the depth and breadth of this improvement.

Patient-assisted computerized education for recipients of implantable cardioverter defibrillators: a randomized controlled trial of the PACER program.

BACKGROUND AND RESEARCH OBJECTIVE: Patients with implantable cardioverter defibrillators (ICDs) are at risk for postimplant anxiety. Computerized treatments for anxiety are well supported and desirable because of accessibility, anonymity, and cost-effectiveness. However, there currently exists no computerized psychosocial treatment for ICD populations. Our objective was to evaluate whether a pilot program (patient-assisted computerized education for recipients of ICDs [PACER of ICDs]) of a computerized intervention for ICD patients would improve ICD-related knowledge and psychological outcomes versus usual care. Outcomes were also compared with those from a related study that used the same intervention but in an in-person format. SUBJECTS AND METHODS: Patients (N = 30) with an ICD were randomized to PACER or usual care. Mean time from implantation was 10.71 months (SD, 21.81 months). Outcomes included ICD-related knowledge, trait anxiety, defibrillation-related anxiety, patient acceptance of the ICD, and quality of life. Patients were assessed at baseline and at 1 month follow-up. RESULTS AND CONCLUSIONS: Knowledge score over time did not differ by treatment group, although both groups improved their scores. Among treatment patients, increased knowledge accounted for a significant amount of variance in device acceptance (R2 change = 0.30, P =.02), irrespective of age, education, ejection fraction, and time from implantation. There was no relationship between knowledge and device acceptance among control patients. Compared with previous recipients, new device recipients (< 3 months) were more likely to demonstrate an increase in knowledge (P =.01), greater defibrillation anxiety (P =.02), and worse patient acceptance (P =.04). Patient-assisted computerized education for recipients of ICDs resulted in comparable improvements in trait anxiety, quality of life, and device acceptance as the in-person treatment. The potential utility of PACER to enhance device acceptance lends support for further testing among larger samples.

Age-specific differences in women with implantable cardioverter defibrillators: an international multi center study.

BACKGROUND: Common psychological adjustment difficulties have been identified for groups of implantable cardioverter defibrillator patients, such as those who are young (<50 years old), have been shocked, and are female. Specific aspects and concerns, such as fears of death or shock and body image concerns, that increase the chance of distress, have not been examined in different aged female implantable cardioverter defibrillator (ICD) recipients. The aim of the study was to investigate these areas of adjustment across three age groups of women from multiple centers. METHODS: Eighty-eight female ICD patients were recruited at three medical centers: Shands Hospital at the University of Florida, Brigham and Women's Hospital in Boston, and Royal North Shore Hospital in Sydney, Australia. Women completed individual psychological assessment batteries, measuring the constructs of shock anxiety, death anxiety, and body image concerns. Medical record review was conducted for all patients regarding cardiac illnesses and ICD-specific data. RESULTS: Multivariate and univariate analyses of variance revealed that younger women reported significantly higher rates of shock and death anxiety (Pillai's F=3.053, P=0.018, eta2p=0.067) and significantly greater body image concerns (Pillai's F=4.198, P=0.018, eta2p=0.090) than middle- and older-aged women. CONCLUSIONS: Women under the age of 50 appear to be at greater risk for the development of psychosocial distress associated with shock anxiety, death anxiety, and body image. Clinical-based strategies and interventions targeting these types of adjustment difficulties in younger women may allow for improved psychosocial and quality of life outcomes.