In 2017, a reform of the German outpatient psychotherapy guideline was carried out, aiming to reduce waiting times and facilitate low-threshold access. This study analyzes the extent to which the ...implementation of the two new service elements 'psychotherapeutic consultation times' and 'acute short-term psychotherapeutic interventions' improved psychotherapeutic care for patients with mental disorders and chronic physical conditions (cMPs), for patients with mental disorders without chronic physical conditions (MnoP), and elderly patients.
In a quantitative secondary analysis, we analyzed health insurance data of patients with psychotherapy billing codes obtained from the National Association of Statutory Health Insurance Physicians (KBV) for the years 2015-2019, evaluating descriptive statistical parameters for specific patient groups and care services.
Between 2015 and 2019, the number of mentally ill receiving psychotherapy at least once in the corresponding year increased by 30.7%. Among these, the proportion of cMPs-patients increased from 26.8% to 28.2% (+1.4%), while that of MnoP-patients decreased from 68.3% to 66.4% (-1.9%). The number of elderly people receiving treatment also increased.
Since increases and decreases in the percentage shares occur evenly over the years investigated, it is questionable whether the reform in 2017 has had a direct influence on these changes.
ID DRKS00020344, URL: https://www.bfarm.de/DE/Das-BfArM/Aufgaben/Deutsches-Register-Klinischer-Studien/_node.html.
Objective: Participation in cardiac rehabilitation (CR) is associated with reduced morbidity and mortality. However, most programs rely on self-report measures when assessing the critical risk factor ...of smoking. This study examined smoking status using self-report versus objective measurement using expired carbon monoxide (CO) and compared patient characteristics by CO level. Method: Patients were screened for smoking status when entering CR by self-report and by objectively measured CO. Measures of aerobic fitness, educational attainment, depressive symptoms, and self-reported physical function were also collected. The discrepancy between smoking status based on self-report and objective measurement was examined and patient characteristics by CO measurement were compared. Results: Of the 853 patients screened, 62 self-reported current smoking and 112 had a CO of ≥4 ppm. Using a cut-off of ≥4 ppm encompassed almost all self-reported smokers (specificity: 98.5%) and identified 61 patients (not reporting current smoking) needing further screening. Further questioning yielded an additional 21 patients with combusted use (tobacco/cannabis), six nonsmoking patients with environmental CO exposure, and 34 where the reason for elevated CO was unknown. CO ≥4 ppm patients were younger (62.2 vs. 67.7, p < .01), had higher depression scores (5.6 vs. 3.7, Patient Health Questionairre-9, p < .01), had lower educational attainment (59.0% ≤high school vs. 31.3%, p < .01), had lower levels of fitness (after controlling for clinical characteristics, p < .01), and completed fewer CR sessions (18 vs. 22, p < .01). Conclusions: A substantial number of patients who are actively smoking may be misclassified by relying on patient report alone. CO monitoring provides a simple and objective method of systematically screening patients.
Duane F. Alexander (1940-2020) Friedman, Sarah L.; Bachrach, Christine; Scheidt, Peter
The American psychologist,
04/2022, Letnik:
77, Številka:
3
Journal Article
Recenzirano
This article is in memory of Duane F. Alexander, who directed the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) from 1986 to 2009. (PsycInfo Database Record ...(c) 2022 APA, all rights reserved).
Objective: The Cancer Threat Interpretation model proposes that clinically significant fear of cancer recurrence/progression (FCR/P) can occur when people misinterpret ambiguous physical symptoms as ...a sign of recurrence. The aim of this research is to test whether interpretation biases moderate the relationship between pain and FCR/P in women with breast cancer, as predicted. Method: One hundred forty-seven women with breast cancer completed questionnaire measures of demographic and medical information, FCR/P, interpretation bias, and symptom burden, as well as other known predictors of FCR/P. Results: Women with clinically significant levels of FCR/P were more likely to interpret ambiguous words as health-related and experienced more pain than women with levels of FCR/P in the nonclinical range. FCR was associated with both pain (r = .40, p < .001) and interpretation bias (r = .45, p < .001). Interpretation bias and pain (r = .31, p < .001) were also associated with each other. Moderation analyses confirmed that interpretation bias moderated the relationship between pain and FCR (F(1, 143) = 5.76; p = .01). However, this was not the case with FOP (F(1, 143) = .21; p = .65). Conclusion: We found that women with breast cancer with clinically significant FCR/P interpreted ambiguous words as health-related more often and experienced more pain than those with nonclinical FCR/P. Moreover, we found that among those with higher levels of pain, FCR was also higher only among those with higher levels of interpretation bias, as the threat interpretation model predicts.
The authors forward
the hypothesis that social exclusion is experienced as painful because reactions to
rejection are mediated by aspects of the physical pain system. The authors begin by
presenting ...the theory that overlap between social and physical pain was an evolutionary
development to aid social animals in responding to threats to inclusion. The authors then
review evidence showing that humans demonstrate convergence between the 2 types of pain in
thought, emotion, and behavior, and demonstrate, primarily through nonhuman animal
research, that social and physical pain share common physiological mechanisms. Finally,
the authors explore the implications of social pain theory for rejection-elicited
aggression and physical pain disorders.
This study examined whether various levels of physical activity among older adults predicted levels of depression and whether there were racial differences in the levels and types of physical ...activities engaged in by adults aged 50 and older. Method: Data from the 2015-2016 National Health and Nutrition Examination Survey (NHANES) were analyzed for 2,474 adults aged 50 years and older. Variables of focus were demographics, physical activity and depression, assessed using the Physical Activity Questionnaire and the Mental Health - Depression Screener. Results: There was a significant positive relationship between income and depression; individuals with higher income had lower levels of depression. Simple linear regression revealed income significantly predicted depression scores, b = -.20, F(1, 2296) = 96.35, p < .001, explaining 4% of the variance, R2 = .04. As age increased, all levels of physical activity declined, regardless of the category. Vigorous recreation-related activity and moderate recreation-related activity each made significant, unique contributions to depression scores. Conclusion: Findings from the current study suggest that physical activity interventions should be culturally appropriate and tailored to the needs and abilities of individual older adults to maximize benefits and minimize adverse events, particularly among community dwelling older adults.
Objective: It has been proposed that cumulative stress, one's experience of chronic stressors across multiple domains, worsens health by altering the extent to which daily stressors impact daily ...affect and physical symptoms. Recent work confirms that high cumulative stress exacerbates the association between daily stressor exposure and increased daily negative affect, though it remains untested the extent to which cumulative stress and daily stressor exposure interact to predict daily symptoms. Method: We employed data from the second wave of the midlife in the U.S. Survey (N = 2,022; Mage = 56.2; 57.2% female) to examine whether levels of cumulative stress compound daily symptoms on days with (vs. without) stressful events. Experiences of life stressors across eight domains, occurrence of daily stressors, and occurrence, number, and severity of daily physical symptoms were analyzed using multilevel modeling. Results: Greater cumulative stress and experiencing (vs. not experiencing) a daily stressor independently increased the odds of occurrence, number, and severity of daily symptoms (ps ≤ .016). Moreover, after adjusting for covariates (e.g., sociodemographic characteristics, chronic health conditions, percent of days with reported stressors, and health behaviors), the associations between daily stressor exposure and odds of occurrence, number, and severity of daily symptoms were potentiated as levels of cumulative stress increased (ps ≤ .009). Conclusions: The negative implications of daily stressor exposure for daily health may be most pronounced in those who report higher levels of cumulative stress across multiple life domains and across time.
Job insecurity is a work stressor that employees often experience in today's organizations. In this study, we explored the relative importance of quantitative and qualitative job insecurity in ...predicting employee stress symptoms (i.e., physical and behavioral stress symptoms) and motivational state (i.e., work engagement). Moreover, by integrating the regulatory focus theory with the job insecurity research, we then examined how one's regulatory focus moderated his or her responses to the different types of job insecurity. Three-wave data were collected from a sample of 270 Chinese employees. Results revealed that quantitative job insecurity was more related to employee physical and behavioral stress symptoms, whereas qualitative job insecurity was more related to employee work engagement. Prevention focus attenuated the positive association of quantitative job insecurity and employee stress symptoms, whereas promotion focus attenuated the negative effects of qualitative job insecurity on employee work engagement. Our findings suggest that quantitative job insecurity and qualitative job insecurity have differentiated effects on employee stress and motivation. Prevention focus is more helpful for employees to cope with stress associated with quantitative job insecurity, whereas promotion focus is more beneficial for employees to maintain work motivation in the face of qualitative job insecurity.
Objective: To investigate the impact of disability simulations on mood, self-ascribed disability stereotypes, attitudes about interacting with disabled individuals, and behavioral intentions for ...improving campus accessibility. Design: Experiment 1 evaluated disability-awareness simulations by randomly assigning undergraduates (N = 60) with and without disabilities to stations simulating either dyslexia, hearing or mobility impairments. Experiment 2 extended the field study into the lab where undergraduates (N = 50) with and without disabilities each completed low vision, hearing impairment, and dyslexia simulations. Both studies incorporated pretest-posttest measures of mood, self-ascribed disability stereotypes, and attitudinal measures. Results: In both experiments, disability simulations made participants feel more confused, embarrassed, helpless, and more vulnerable to becoming disabled themselves compared to baseline. Following the simulations, empathetic concern (warmth) toward disabled people increased in both studies, but attitudes about interacting did not improve. In Experiment 1, postsimulation anxiety, embarrassment, and helplessness were highest for those who used wheelchairs or simulated dyslexia. In Experiment 2, participants judged themselves less competent, expressed more pity, expressed more interaction discomfort, and were not more willing to interview disabled students for an accessibility project following the simulations compared to baseline. In addition, Experiment 2 found frustration, guilt, anxiety, and depression were most pronounced among those who interacted with disabled people less than once per month. Conclusions: Simulating disabilities promotes distress and fails to improve attitudes toward disabled people, undermining efforts to improve integration even while participants report more empathetic concern and "understanding of what the disability experience is like."
Impact and Implications
Few have published empirically reliable studies evaluating the effects of simulating physical, cognitive, and sensory disabilities on emotions, self-stereotyping, and attitudes about improving the integration of people with disabilities. This article is the first to integrate and extend the often-contradictory literatures on perspective taking and disability simulation, advancing a critique of some of the most popular, albeit controversial, disability awareness activities practiced. Using both disabled and nondisabled participants, these two experimental studies provide convergent support for the negative consequences of artificially simulating disability- consequences that vary by simulation type and frequency of contact with disabled people. These findings confirm what disability advocates have long expressed-that simulations can subvert their intended educational value and distort the realities of life with disability. Based on this review of evidence, rehabilitation providers and educators should consider alternatives to traditional disability simulations which continue to reinforce outdated, ableist ideas by emphasizing early-onset limitations, and failing to expose structural barriers to participation or disability as a lived experience and cultural identity (Nario-Redmond, Noel, & Fern, 2013; Nario-Redmond & Oleson, 2016). Recommendations are provided for more inclusive curricula that incorporates contemporary representations of disability, insider expertise, and awareness of strategies for challenging discrimination and promoting disability justice.
Objective: Of all cancers, advanced nonsmall cell lung cancer (NSCLC) is associated with the highest burden on mental and physical health-related quality of life (HRQoL). Patients' subjective beliefs ...about their cancer (i.e., illness perceptions) may influence coping responses and treatment decisions and affect health. To identify cognitive and emotional perceptions and their association with patient characteristics and illness circumstances, the relationship between illness perception schemas and psychological and physical responses and symptoms were studied. Method: Patients newly diagnosed with stage IV NSCLC (N = 186) enrolled in a prospective cohort study (NCT03199651) completed measures of illness perceptions; anxiety, depression, and physical symptoms; and health status. Latent profile analysis identified illness perception profiles. Hierarchical linear regressions tested profile assignment as a correlate of responses and symptoms. Results: A three-profile solution was optimal. Patients with a "struggling" profile (n = 83; 45%) reported the most negative perceptions; patients with a "coping" profile (n = 41; 22%) reported relatively positive perceptions; and patients with a "coping but concerned" profile (n = 62; 33%) endorsed high illness concern but relatively positive perceptions otherwise. Patients with a "struggling" profile reported the highest levels of anxiety and depression symptoms, overall physical symptoms, cough, dyspnea, and pain, and the poorest self-rated health. Conclusions: New data add to the clinical portrayal of patients coping with NSCLC since the availability of new therapies and survival improvements. Other disease groups have reported a predominance of positive perceptions, rather than ones of significant cognitive and emotional struggles found here. Illness perception data may provide content-rich resources for intervention tailoring.
