Search

Preoperative distress is associated with poor postoperative outcomes, such as increased risk of surgical site infection and readmission, and brief psychosocial interventions delivered during the perioperative period may improve postoperative mental and physical health. However, there are few protocols for screening and treating distress in the surgical oncology setting. The current article describes the development and feasibility pilot testing of a four-session intervention (Behavioral Intervention for Wellness and Engaged Living [Be-WEL]) that combines behavioral and self-management strategies to manage preoperative distress and improve postoperative recovery. Data from three patients who participated in an ongoing open clinical trial are reviewed to illustrate the feasibility, acceptability, and potential strengths and limitations of this intervention. • Depression and anxiety before surgery are common and are associated with poor postoperative recovery. • Preoperative behavioral interventions may improve postoperative outcomes. • There are few protocols for treating distress in the surgical oncology setting. • A 4-session telephone intervention that integrates behavioral techniques with illness self-management strategies is feasible and acceptable to patients. • Three case examples illustrate challenges to and outcomes of implementing this intervention with distressed patients undergoing surgery for gastrointestinal cancer. [ABSTRACT FROM AUTHOR]

Cognitive–behavioral therapy (CBT) is an evidence-based treatment for anxiety; however, a growing body of research suggests that CBT effect sizes are smaller in Veteran samples. The aim of this study was to perform secondary data analyses of a randomized controlled trial of CBT for late-life generalized anxiety disorder compared with treatment as usual (TAU) in a Veteran ( n = 101) and community-based ( n = 122) sample. Veterans had lower income and less education than community participants, greater severity on baseline measures of anxiety and depression, poorer physical health, and higher rates of psychiatric comorbidity. Treatment effects were statistically significant in the community sample (all ps < 0.01), but not in Veterans (all ps > 0.05). Further analyses in Veterans revealed that poorer perceived social support significantly predicted poorer outcomes (all ps < 0.05). Our results underscore the complexity of treating Veterans with anxiety, and suggest that additional work is needed to improve the efficacy of CBT for Veterans, with particular attention to social support. [ABSTRACT FROM AUTHOR]

The article reports on research which was conducted to investigate alcohol consumption among older patients with generalized anxiety disorder (GAD) in primary care and alcohol's relationship to insomnia, worry and anxiety. Researchers evaluated 223 patients aged 60 and older with generalized anxiety disorder. They found that older adults with GAD used alcohol at an increased rate and that mild to moderate drinkers did not experience sleep problems and concluded that a modest amount of alcohol may minimize anxiety and insomnia.

Objectives: To determine the association of early and long-term reductions in worry symptoms after cognitive behavior therapy (CBT) for generalized anxiety disorder (GAD) in older adults. Design: Substudy of larger randomized controlled trial. Setting: Family medicine clinic and large multispecialty health organization in Houston, TX, between March 2004 and August 2006. Participants: Patients (N = 76) aged 60 years or older with a principal or coprincipal diagnosis of GAD, excluding those with significant cognitive impairment, bipolar disorder, psychosis, or active substance abuse. Intervention: CBT, up to 10 sessions for 12 weeks, or enhanced usual care (regular, brief telephone calls, and referrals to primary care provider as needed). Measurements: Penn State Worry Questionnaire (PSWQ) administered by telephone at baseline, 1 month (mid treatment), 3 months (posttreatment), and at 3-month intervals through 15 months (1-year follow-up). The authors used binary logistic regression analysis to determine the association between early (1 month) response and treatment responder status (reduction of more than 8.5 points on the PSWQ) at 3 and 15 months. The authors also used hierarchical linear modeling to determine the relationship of early response to the trajectory of score change after posttreatment. Results: Reduction in PSWQ scores after the first month predicted treatment response at posttreatment and follow-up, controlling for treatment arm and baseline PSWQ score. The magnitude of early reduction also predicted the slope of score change from posttreatment through the 15-month assessment. Conclusion: Early symptom reduction is associated with long-term outcomes after psychotherapy in older adults with GAD. [ABSTRACT FROM AUTHOR]

Abstract: Medically ill patients face unique physical and emotional challenges that place them at increased risk for symptoms of depression and anxiety. Despite high prevalence and significant impact, depression and anxiety are infrequently treated in the medically ill because of a variety of patient, provider, and system factors. The current article describes the development of an innovative, modular-based cognitive-behavioral intervention (Adjusting to Chronic Conditions Using Education Support and Skills [ACCESS]) that integrates treatment for symptoms of anxiety and depression with medical disease self-management in patients with heart failure and chronic obstructive pulmonary disease. Data from 3 patients who participated in an ongoing open clinical trial are reviewed to illustrate the feasibility, acceptability, and potential strengths and limitations of this intervention. [Copyright &y& Elsevier]

Abstract: Cully JA, Gfeller JD, Heise RA, Ross MJ, Teal CR, Kunik ME. Geriatric depression, medical diagnosis, and functional recovery during acute rehabilitation. Objective: To examine and compare the prevalence and functional impact of depressive symptoms for older adult stroke and nonstroke rehabilitation inpatients. Design: Case-control study examining functional outcome using a 2 (stroke, nonstroke) by 2 (depression, no depression) design. Setting: Urban hospital rehabilitation unit. Participants: A total of 509 rehabilitation inpatients (age, ≥60y) were included and grouped by diagnosis of stroke (n=207) and nonstroke (n=302). Interventions: Not applicable. Main Outcome Measures: Geriatric Depression Scale and FIM instrument. Analysis of covariance procedures examined the impact of depressive symptoms on discharge functional ability controlling for age, sex, admission functional ability, and hospital length of stay. Results: Prevalence of depressive symptoms was similar for stroke (31.8%) and nonstroke (31.5%) and negatively associated with functional ability at discharge for both groups. Overall, the stroke and nonstroke groups did not differ significantly with respect to functional recovery. Conclusions: Depression, and its impact on acute rehabilitation, is significantly related to functional recovery but does not differ in its frequency or impact for stroke patients. Because depressive symptoms do not appear to discriminate across diagnostic groups, routine screening for depression is recommended for all rehabilitation inpatients. [Copyright &y& Elsevier]

Introduction: HIV pre-exposure prophylaxis has been proven to be an effective tool in HIV prevention. However, numerous barriers still exist in pre-exposure prophylaxis implementation.Methods: The framework of Intervention Mapping was used from August 2016 to October 2017 to describe the process of adoption, implementation, and maintenance of an HIV prevention program from 2012 through 2017 in Houston, Texas, that is nested within a county health system HIV clinic. Using the tasks outlined in the Intervention Mapping framework, potential program implementers were identified, outcomes and performance objectives established, matrices of change objectives created, and methods and practical applications formed.Results: Results include the formation of three matrices that document program outcomes, change agents involved in the process, and the determinants needed to facilitate program adoption, implementation, and maintenance. Key features that facilitated successful program adoption and implementation were obtaining leadership buy-in, leveraging existing resources, systematic evaluation of operations, ongoing education for both clinical and nonclinical staff, and attention to emergent issues during launch.Conclusions: The utilization of Intervention Mapping to delineate the program planning steps can provide a model for pre-exposure prophylaxis implementation in other settings. [ABSTRACT FROM AUTHOR]

Objective This study sought to identify patient factors associated with mental health (MH) recognition and treatment in medically ill Veterans. Method Retrospective data from patient electronic medical records (EMR) and self-report data were reviewed for 180 Veterans with cardiopulmonary conditions who met diagnostic criteria for anxiety, depression, or posttraumatic stress disorder on the Mini-International Neuropsychiatric Interview. Multivariate logistic regression examined the association of medical record MH recognition and MH service use with patient factors, including anxiety and depression severity, self-efficacy, locus of control, coping, illness intrusiveness, and health-related quality of life (QOL). Results Seventy veterans (39%) had an MH diagnosis documented in their EMR, and 101 (56%) received at least one MH service (≥ 1 MH encounter or psychiatric medications). Greater depression (p = 0.047) and adaptive coping (p = 0.012) were associated with increased likelihood of EMR documentation of MH diagnoses. EMR MH diagnosis (p < 0.001), higher internal locus of control (p = 0.037), and poorer physical health-related QOL (p = 0.014) were associated with greater likelihood of MH service use. Discussion Veterans with cardiopulmonary conditions experiencing MH problems are under-recognized. Improved MH screening is needed, particularly for patients with poor adaptive coping skills, low internal locus of control, or poor physical health-related QOL. [ABSTRACT FROM AUTHOR]

Abstract: Objective: This study examined rates of specific anxiety diagnoses (posttraumatic stress disorder, generalized anxiety disorder, panic disorder, obsessive-compulsive disorder, social anxiety disorder, and specific phobia) and anxiety disorder not otherwise specified (anxiety NOS) in a national sample of Veterans and assessed their mental health service utilization. Method: This study used administrative data extracted from Veteran Health Administration outpatient records to identify patients with a new anxiety diagnosis in fiscal year 2010 (N = 292,244). Logistic regression analyses examined associations among diagnostic specificity, diagnostic location, and mental health service utilization. Results: Anxiety NOS was diagnosed in 38% of the sample. Patients in specialty mental health were less likely to receive an anxiety NOS diagnosis than patients in primary care (odds ratio [OR] = 0.36). Patients with a specific anxiety diagnosis were more likely to receive mental health services than those with anxiety NOS (OR = 1.65), as were patients diagnosed in specialty mental health compared with those diagnosed in primary care (OR = 16.29). Conclusion: Veterans diagnosed with anxiety NOS are less likely to access mental health services than those with a specific anxiety diagnosis, suggesting the need for enhanced diagnostic and referral practices, particularly in primary care settings. [Copyright &y& Elsevier]

Abstract: Cognitive and behavioral therapies emphasize the importance of skill acquisition and use, and these skills are proposed to mediate treatment outcomes. Despite its theoretical importance, research on skill use as a mechanism of change in CBT and its measurement is still in its infancy. A search of online databases was conducted to identify and review the literature testing the meditational effect of CBT skills on treating depression in adults. Additionally, we reviewed the various methods to assess a patient''s use of CBT skills. We identified 13 studies examining the frequency of CBT skill use and 11 studies examining the quality of CBT skill use. While the literature provides preliminary evidence for the mediational role of CBT skill use frequency and quality on depression treatment outcomes, methodological limitations in much of the existing literature prevent firm conclusions about the role of skills use on treatment outcomes. [Copyright &y& Elsevier]