Coping strategies and depressive symptoms in cancer patients.

INTRODUCTION: Depression in cancer patients is prevalent and negatively impacts their quality of life. Likewise, it correlates with lower overall survival. The aim of this work is to analyze whether different coping strategies, as well as sociodemographic and clinical factors are associated with the presence of depressive symptoms in individuals with a resected, non-metastatic neoplasm about to initiate adjuvant chemotherapy. METHODS: NEOcoping is a cross-sectional, prospective, observational, multicenter study. Clinical (tumor site and stage, time to diagnosis, risk of recurrence, and type of adjuvant treatment) and sociodemographic characteristics (age, gender, marital status, educational level, occupational sector, and employment status), coping strategies (Mini-MAC scale), and depressive symptoms (BSI scale) were collected. A two-block linear regression model was performed to determine the predictive variables of depressive symptoms. RESULTS: 524 adults with resected, non-metastatic cancer were recruited. Twenty-six percent of patients have clinically significant depressive symptoms. Being female, < 40 years of age, having breast and stomach cancer, and > 50% chance of recurrence were associated with increased risk of depression. Likewise, depression was associated with greater helplessness and anxious preoccupation, and less fighting spirit. Age, gender, and risk of recurrence accounted for only 7% of the variance in depressive symptoms. Including coping strategies in the regression analysis significantly increased the variance explained (48.5%). CONCLUSION: Early psychological intervention in patients with maladaptive coping strategies may modulate the onset of depressive symptoms, especially in those at higher risk for depression.

Psychometric properties of the Brief Symptom Inventory-18 in a heterogeneous sample of adult cancer patients / Propiedades psicométricas del Inventario Breve de Síntomas-18 en una muestra heterogénea de pacientes de cáncer adulto

Abstract The Brief Symptom Inventory-18 (BSI-18) is a self-reporting screening instrument that is widely used to assess global psychological distress and three kinds of symptoms: anxiety, depression, and somatization. The present study tests the factor structure of the BSI-18 using confirmatory factor analysis (CFA), its reliability, convergent validity, and invariance for both sexes. A heterogeneous sample of 1183 cancer patients completed the BSI 18 and the NCCN Problem List. Hierarchical models of three and four subscales with GSI as a main factor provided an adequate and similar model fit. Nonetheless, the hierarchical three-factor model (the theoretical proposal) was selected for methodological and theoretical reasons. Reliability indexes (Cronbach's alpha and Composite Reliability) were satisfactory. The positive significant associations between BSI-18 (GSI and subscales) and emotional and physical categories of the Problem List showed the suitable convergent validity of the instrument. Finally, multigroup CFA revealed an essentially invariant structure of the BSI-18 for both sexes. The BSI-18 is a short instrument that can be used by researchers and health professionals to assess the psychological distress of cancer survivors.

Resumen El Inventario Breve de Síntomas-18 (BSI-18) es un instrumento de cribado ampliamente utilizado para evaluar distrés emocional (GSI) y tres tipos de síntomas: ansiedad, depresión, y somatización. Este trabajo estudia la estructura factorial del BSI-18, utilizando análisis factorial confirmatorio (AFC), su fiabilidad y validez convergente, así como su invarianza factorial a través del sexo. Una muestra de 1183 pacientes de cáncer completó el BSI 18 y la lista de problemas de la NCCN. Los modelos jerárquicos de tres y cuatro factores proporcionaron ajustes adecuados y similares. Sin embargo, el modelo de tres factores (propuesta teórica) fue seleccionado por razones metodológicas y teóricas. Los índices de fiabilidad (alfa de Cronbach y fiabilidad compuesta) fueron satisfactorios y las correlaciones positivas y significativas entre el BSI-18 (GSI y subescalas) y las categorías emocionales y físicas del listado de problemas evidenciaron la adecuada validez convergente del instrumento. Finalmente, el AFC multigrupo reveló una estructura básicamente invariante del BSI-18 a través del sexo. El BSI-18 es un instrumento breve que puede ser utilizado por investigadores y profesionales de la salud para evaluar el malestar psicológico en la población con cáncer.

Resilience Rather than Medical Factors: How Parents Predict Quality of Life of Their Sick Newborn.

OBJECTIVE: To assess the influence of resiliency and stress on parental perspectives of the future quality of life (QOL) of neonatal intensive care unit (NICU) newborns at high risk of neurodevelopmental disability. STUDY DESIGN: We conducted a prospective multicenter questionnaire study. Perspectives from parents of newborns at high risk of disability as per neonatal follow-up criteria were compared with a low-risk group consisting of parents of all other NICU newborns. Parental anxiety and resiliency, measured using Brief Symptom Inventory and Sense of Coherence scales, respectively, were associated with QOL projections. RESULTS: Parents returned 129 (81%) questionnaires. Parents considering their newborn as currently sicker were more stressed (P = .011) and worried about future physical (P < .001) and mental (P < .001) health, QOL (P < .001), coping (P = .019), and financial (P < .001) and emotional (P = .002) impact on the family. Ooverall, there was no difference between parents of high-risk and low-risk newborns on QOL projections. Almost all parents projected a good future QOL. Less resilient parents projected more pain (P = .04), more financial (P = .019), and emotional (P = .031) impact on their family, and were 10 times more likely to predict that their newborn would remain chronically ill. CONCLUSIONS: Parental projection of future QOL of NICU newborns is not associated with risk of disability. Most parents predict overall a good future QOL and focus more on familial impact. The Sense of Coherence scale may be used in clinical settings to identify less resilient parents.

Early adversity, socioemotional development, and stress in urban 1-year-old children.

OBJECTIVE: To determine demographic, maternal, and child factors associated with socioemotional (SE) problems and chronic stress in 1-year-old children. STUDY DESIGN: This was a prospective, longitudinal, community-based study, which followed mother-infant dyads (n = 1070; representative of race, education, and income status of Memphis/Shelby County, Tennessee) from midgestation into early childhood. Child SE development was measured using the Brief Infant-Toddler Social and Emotional Assessment in all 1097 1-year-olds. Chronic stress was assessed by hair cortisol in a subsample of 1-year-olds (n = 297). Multivariate regression models were developed to predict SE problems and hair cortisol levels. RESULTS: More black mothers than white mothers reported SE problems in their 1-year-olds (32.9% vs 10.2%; P < .001). In multivariate regression, SE problems in blacks were predicted by lower maternal education, greater parenting stress and maternal psychological distress, and higher cyclothymic personality score. In whites, predictors of SE problems were Medicaid insurance, higher maternal depression score at 1 year, greater parenting stress and maternal psychological distress, higher dysthymic personality score, and male sex. SE problem scores were associated with higher hair cortisol levels (P = .01). Blacks had higher hair cortisol levels than whites (P < .001). In the entire subsample, increased hair cortisol levels were associated with higher parenting stress (P = .001), lower maternal depression score (P = .01), lower birth length (P < .001), and greater length at 1 year of age (P = .003). CONCLUSION: Differences in maternal education, insurance, mental health, and early stress may disrupt SE development in children. Complex relationships between hair cortisol level in 1-year-olds and maternal parenting stress and depression symptoms suggest dysregulation of the child's hypothalamic-pituitary-adrenal axis.