Search

Soft-tissue sarcoma (STS) is a rare cancer of the connective tissues requiring invasive treatment. Due to the complexity of treatment, STS patients experience more functional impairment and disability than other oncologic populations. Given that extant literature is unclear and exclusively focused on physical function, the objectives of this study were to use the Wilson-Cleary Model of HRQL to evaluate the extent to which biological function (tumor site, depth and size), symptoms (fatigue, pain, anxiety/depression), and functional status are associated with the health perceptions of soft-tissue sarcoma patients 12 months post-op.

Fear of negative evaluation is a common concern among individuals with visible differences but has received limited attention in systemic sclerosis (SSc), which can involve substantial changes to appearance. The Brief Fear of Negative Evaluation Scale (BFNE) was specifically designed to evaluate fear of negative evaluation. There are currently 3 versions of the BFNEwith strong demonstrated measurement properties: two 8‐item versions (BFNE‐S, BFNE‐8) and one 12‐item version (BFNE‐II). The present study evaluated these versions in SSc, and identified the most appropriate version for use among SSc patients. Participants were 1,010 patients with SSc enrolled in the Scleroderma Patient‐Centered Intervention Network cohort. Multiple group confirmatory factor analysis, Cronbach's alpha, and Pearson's product‐moment correlations were used to evaluate structural validity, internal consistency reliability, and convergent and divergent validity, respectively. Confirmatory factor analysis demonstrated that 1‐factor models fit acceptably well for the 12‐item BFNE‐II, the 8‐item BFNE‐S, and the 8‐item BFNE‐8. Additionally, all Cronbach's alphas demonstrated excellent internal consistency reliability (BFNE‐II = 0.98, BFNE‐S = 0.97, BFNE‐8 = 0.96), and all versions had comparable associations with measures of social anxiety, body‐related attitudes, depression, age, and education. Psychometric support was found for all 3 versions of the BFNE, although the longer 12‐item BFNE‐IIdid not improve measurement compared to the shorter 8‐item versions (BFNE‐S and BFNE‐8). Of these 2, the BFNE‐S has been more widely studied, with strong validity data in a greater number of populations. Therefore, the BFNE‐S is recommended to assess fear of negative evaluation among patients with SSc.

Systemic sclerosis (SSc) is an autoimmune disease that can cause disfiguring changes in appearance. This study examined the structural validity, internal consistency reliability, convergent validity, and measurement equivalence of the Social Appearance Anxiety Scale (SAAS) across SSc disease subtypes. Patients enrolled in the Scleroderma Patient‐centered Intervention Network Cohort completed the SAASand measures of appearance‐related concerns and psychological distress. Confirmatory factor analysis (CFA) was used to examine the structural validity of the SAAS. Multiple‐group CFAwas used to determine whether SAASscores can be compared across patients with limited and diffuse disease subtypes. Cronbach's alpha was used to examine internal consistency reliability. Correlations of SAASscores with measures of body image dissatisfaction, fear of negative evaluation, social anxiety, and depression were used to examine convergent validity. SAASscores were hypothesized to be positively associated with all convergent validity measures, with correlations significant and moderate to large in size. A total of 938 patients with SSc were included. CFAsupported a 1‐factor structure (Comparative Fit Index 0.92, Standardized Root Mean Residual 0.04, and Root Mean Square Error of Approximation 0.08), and multiple‐group CFAindicated that the scalar invariance model best fit the data. Internal consistency reliability was good in the total sample (α = 0.96) and in disease subgroups. Overall, evidence of convergent validity was found with measures of body image dissatisfaction, fear of negative evaluation, social anxiety, and depression. The SAAScan be reliably and validly used to assess fear of appearance evaluation in patients with SSc, and SAASscores can be meaningfully compared across disease subtypes.

Body concealment is a component of social avoidance among people with visible differences from disfiguring conditions, including systemic sclerosis (SSc). The study objective was to develop a measure of body concealment related to avoidance behaviors in SSc. Initial items for the Body Concealment Scale for Scleroderma (BCSS) were selected using item analysis in a development sample of 93 American SSc patients. The factor structure of the BCSS was evaluated in 742 Canadian patients with single‐factor, 2‐factor, and bifactor confirmatory factor analysis models. Convergent and divergent validity were assessed by comparing the BCSS total score with the Brief‐Satisfaction with Appearance Scale (Brief‐SWAP) and measures of depressive symptoms and pain. A 2‐factor model (Comparative Fit Index [CFI] 0.99, Tucker‐Lewis Index [TLI] 0.98, Root Mean Square Error of Approximation [RMSEA] 0.08) fit substantially better than a 1‐factor model (CFI 0.95, TLI 0.94, RMSEA 0.15) for the 9‐item BCSS, but the Concealment with Clothing and Concealment of Hands factors were highly correlated (α = 0.79). The bifactor model (CFI 0.99, TLI 0.99, RMSEA 0.08) also fit well. In the bifactor model, the omega coefficient was high for the general factor (ω = 0.80), but low for the Concealment with Clothing (ω = 0.01) and Concealment of Hands (ω = 0.33) factors. The BCSS total score correlated more strongly with the Brief‐SWAP Social Discomfort (r = 0.59) and Dissatisfaction with Appearance (r = 0.53) subscales than with measures of depressive symptoms and pain. The BCSS sum score is a valid indicator of body concealment in SSc that extends the concepts of body concealment and avoidance beyond the realms of body shape and weight to concerns of individuals with visible differences from SSc.

Self‐management programs for patients with chronic illnesses, including rheumatic diseases, seek to enhance self‐efficacy for performing health management behaviors. No measure of self‐efficacy has been validated for patients with systemic sclerosis (SSc; scleroderma). The objective of this study was to assess the validity and internal consistency reliability of the Self‐Efficacy for Managing Chronic Disease (SEMCD) scale in SSc. English‐speaking SSc patients enrolled in the Scleroderma Patient‐centered Intervention Network Cohort who completed the SEMCD scale at their baseline assessment between March 2014 and June 2015 were included. Patients were enrolled from 21 sites in Canada, the US, and the UK. Confirmatory factor analysis (CFA) was used to evaluate the factor structure of the SEMCD scale. Cronbach's alpha was calculated to assess internal consistency reliability. Hypotheses on the direction and magnitude of Pearson's correlations with psychological and physical outcome measures were formulated and tested to examine convergent validity. A total of 553 patients were included. CFA supported the single‐factor structure of the SEMCD scale (Tucker Lewis Index = 0.99, comparative fit index = 0.99, root mean square error of approximation = 0.10). Internal consistency was high (α = 0.93), and correlations with measures of psychological and physical functioning were moderate to large (|r| = 0.48–0.67, P< 0.001), confirming study hypotheses. Scores from the SEMCD scale are valid for measuring self‐efficacy in patients with SSc, and results support using the scale as an outcome measure to evaluate the effectiveness of self‐management programs in SSc.

Numerous studies have examined which individual defense mechanisms are related with mental health, and which are linked with psychopathology. However, the idea that a flexible use of defensive mechanisms is related to psychological wellbeing remained a clinical assumption, which this study sought to test empirically. A total of 62 (N62) outpatients participated in the study and were assessed with the Symptom Checklist-90R and the Social Adjustment Self-rated Scale. A subsample of 40 participants was further assessed using the Hamilton Depression (HAMD-21) and Anxiety scales (HAMA-21). The first therapy session of all participants was transcribed and rated using the Defense Mechanisms Ratings Scales (Perry, 1990b), and the Overall Defensive Functioning (ODF) score, which indicates the maturity of one's defensive functioning, was computed. An indicator of flexible use of defenses was also calculated based on the Gini Concentration C measure. Results showed that defensive flexibility, but not ODF, could predict anxiety scores. Symptom severity was predicted by both ODF and defensive flexibility, although in directions opposite to our predictions. Results suggest that defensive flexibility captures another aspect of an individual's functioning not assessed by the ODF, and that it is a promising new way of documenting defensive functioning.

Zusammenfassung.Das maligne Melanom ist die häufigste Krebserkrankung im mittleren Erwachsenenalter. Es zeichnet sich durch besonders hohe Heilungschancen in frühen Krankheitsstadien und Therapieresistenz metastasierter Melanome aus. Zudem ist das Melanom einer der wenigen soliden Tumore, die sich – beobachtbar für den Fachmann aber auch für den medizinischen Laien – an der Hautoberfläche entwickeln. Die Überlebenswahrscheinlichkeit wird primär durch das Melanomstadium zum Zeitpunkt der Diagnose bestimmt. Die frühzeitige Behandlung von Krankheitsprogression ist von entscheidender Bedeutung für die Dauer und Qualität der verbleibenden Lebenszeit. Dementsprechend fokussieren Interventionen zur Senkung melanombedingter Morbidität und Mortalität auf die frühestmögliche Entdeckung der Melanome und der Krankheitsprogression. Regelmäßige Hautselbstuntersuchungen als sekundäre und tertiäre Präventionsmaßnahme stellen ein hocheffektives Komplement zu ärztlicher Vor- und Nachsorge dar, da die Mehrzahl der Melanome sowie die Krankheitsprogression von Patienten, deren Familie und Freunden selbst entdeckt werden. Eine wichtige Fragestellung stellt daher das auf die Melanomerkrankung bezogene Selbstuntersuchungsverhalten und Möglichkeiten seiner Optimierung dar. Psychoonkologische Forschung hat bisher darauf fokussiert, Handlungsergebniserwartung und Selbstwirksamkeitserwartung durch dermatologische Patientenschulung zu erhöhen. Die vorliegende Studie untersucht psychosoziales Belastungserleben und Krankheitsbewältigung in ihrer Bedeutung für das Selbstuntersuchungsverhalten in einer Stichprobe von 164 Patienten in der Melanomnachsorge. Mehr als 70 der Patienten gaben an, nicht von ihrem Arzt zur Selbstuntersuchung angeleitet worden zu sein. Angeleitete Patienten maßen der Selbstuntersuchung höhere Bedeutung bei und praktizierten diese häufiger, obwohl sie sich dadurch unangenehm an die Krebserkrankung erinnert fühlten. Nichtinstruierte Patienten zeigen ein weniger funktionales Verhaltensmuster: Die Selbstuntersuchungshäufigkeit wurde u.a. durch erlebte Selbstunsicherheit, mangelnde ärztliche Unterstützung und berufliche/finanzielle Probleme bestimmt, während das objektive Rückfallrisiko keine Rolle spielte. Auf Basis dieser sowie weiterer psychoonkologischer Befunde und gesundheitspsychologischer Paradigmen wird ein integratives Modell für die dringend notwendige Forschung und evidenzbasierte Praxis der individuellen Gesundheitsfürsorge bei Personen mit erhöhtem Melanomrisiko vorgeschlagen.

Zusammenfassung.Theoretischer Hintergrund:Interpersonelle Schuldgefühle sind klinisch relevant, bisher aber kaum empirisch untersucht. Fragestellung:Es soll zur Validierung des “Fragebogens zu interpersonellen Schuldgefühlen“ (FIS) beigetragen werden. Methode:Zusammenhänge zwischen interpersonellen Schuldgefühlen (FIS) und psychischer Beeinträchtigung (Beck-Depressions-Inventar, SCL-90-R, U-Bogen-24, IIP-D) wurden an 308 PsychotherapiepatientInnen untersucht. Ergebnisse:Auf den Skalen Überlebensschuldgefühl, Schuldgefühl aus Verantwortungund Gesamtwertzeigten PsychotherapiepatientInnen höhere Werte als ProbandInnen einer repräsentativen Bevölkerungsstichprobe. Frauen gaben mehr Schuldgefühle an als Männer. Interpersonelle Schuldgefühle standen in positivem Zusammenhang mit psychischer Beeinträchtigung. PatientInnen gaben zum Therapieende niedrigere Werte für Trennungsschuldgefühl, Schuldgefühl aus Verantwortungund den Gesamtwertan als zu Therapiebeginn. Schlussfolgerungen:Der “Fragebogen zu interpersonellen Schuldgefühlen“ scheint eine klinisch relevante, valide und zeitökonomische Erfassung interpersoneller Schuldgefühle zu erlauben.

In einer Stichprobe von n=497 über 60-Jährigen aus der Normalbevölkerung wurden die Persönlichkeitsmerkmale Neurotizismus, Extraversion, Offenheitfür Erfahrungen, Verträglichkeitund Gewissenhaftigkeitmit dem NEO-Fünf-Faktoren Inventar (NEO-FFI; 2, 6), erhoben. Die Werte wurden mit den Daten von n=339 18- bis 30-Jährigen und n=1051 31- bis 60-Jährigen verglichen. Die Älteren beschrieben sich als weniger extravertiert, weniger offen, verträglicherund gewissenhafter. Jenseits des 60. Lebensjahres fanden sich keine Alterseffekte mehr. Über 60-jährige Frauen beschrieben sich als neurotischerund verträglicherals Männer. Personen aus Ostdeutschland wiesen eine größere Offenheitund Verträglichkeitauf. Eine größere Offenheitfand sich außerdem bei Personen mit höherer Schulbildung. Personen mit höheren Neurotizismus-Werten lebten häufiger ohne Partner als jene mit niedrigeren Neurotizismus-Werten. The personality factors neuroticism, extraversion, openness for experiences, agreeablenessand conscientiousnesswere investigated in a random population sample of n=497 people over 60 years old with the help of a German version of the NEO Five-Factor Inventory – NEO-FFI (2, 6). The results were compared with those from n=497 people between 18 and 30 years old and with those from n=1051 people between 31 and 60 years old.    The elderly described themselves as being less extrovert, less open, more agreeableand more conscientiousthan the people under 60 years old. Means of the personality factors were not associated with age in the over 60 years old. The average level of neuroticismand conscientousnesswas significantly higher in women over 60 years old than in men. People living in the former Eastern Germany were more openand conscientiousnessthan those living in former Western Germany. A higher level of opennesswas found in people with a higher educational level. There was a higher level of neuroticismin people living without a partner than in those living with a partner.