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Author(s): C. S. Kelly [sup.1] [sup.3] , C. A. Berg [sup.1] , V. S. Helgeson [sup.2] Author Affiliations: (1) grid.223827.e, 0000 0001 2193 0096, Department of Psychology, University of Utah, [...], Anxious and avoidant attachment may be detrimental for diabetes distress and management. Additionally, individuals' perceptions of their partner's involvement may affect these associations. The study explored cross-sectionally and at the daily level whether anxious and avoidant attachment associated with diabetes distress or stressors and diabetes management, and whether higher perceived collaboration and support (C&S) moderated associations between attachment and diabetes management. Individuals with type 1 diabetes (N = 199; M age = 46.82; 52.3% women) completed measures of diabetes distress, diabetes-related C&S, self-care, average blood glucose (hemoglobin A1c), and attachment insecurity, and daily diary measures of diabetes-related C&S, diabetes stressors, mean blood glucose, and self-care. Higher anxious and avoidant attachment associated with higher diabetes distress. Higher anxious attachment associated with more daily stressors. Anxious attachment associated with lower self-care. C&S did not moderate any associations. Findings highlight the need to consider attachment when designing interventions to reduce diabetes-related distress.

Agency and communion are broad dimensions of personality that reflect a focus on the self and a focus on others, respectively. In this article, we distinguish unmitigated agency, a focus on the self to the exclusion of others, flom agency, and we distinguish unmitigated communion, a focus on others to the exclusion of self, from communion. We argue that it is unmitigated agency and unmitigated communion that are linked to domains of problem behavior, in particular relationship difficulties and poor health behavior. Unmitigated agency and unmitigated communion are associated with a lack of support from others, a reluctance to ask others for help, and a range of poor health behaviors. The reasons for these links differ. The links to problem behavior for unmitigated communion individuals stem from their tendency to subjugate their own needs to the needs of others and their dependence on others for esteem. The links to problem behavior for unmitigated agency individuals stem from their unwillingness to attend to relationships and their negative view of others. [ABSTRACT FROM AUTHOR]

Objective: We tested whether the psychological components of cognitive adaptation theory would predict new coronary events after a first percutaneous transluminal coronary angioplasty (PTCA).Methods: A consecutive sample of patients treated successfully with PTCA were enrolled in the study. Of 343 patients approached, 303 (88%) agreed to participate and were interviewed shortly before hospital discharge. We measured the components of cognitive adaptation theory (optimism, self-esteem, and mastery) during the interview. Five patients were excluded from the analysis because of early, in-hospital reocclusion. New cardiac events (coronary artery bypass grafting, PTCA, myocardial infarction, or disease progression) were examined within 6 months of the first PTCA. We obtained 6-month follow-up data on 98% of patients.Results: The cognitive adaptation index predicted new cardiac events, even when demographic variables and medical variables thought to predict restenosis were statistically controlled (p = .02).Conclusions: These results suggest that persons who respond to their illness by perceiving control over their futures, by having positive expectations about their futures, and by holding a positive view of themselves seem to be at less risk for a new cardiac event after a first PTCA. [ABSTRACT FROM AUTHOR]

Objective: Benefit-finding and growth is an important process across a range of medical populations. However, it has been understudied in the context of lifelong chronic conditions, such as spina bifida (SB). This study aimed to develop a new measure of benefit-finding and growth for youth with SB, confirm its factor structure, and examine its psychometric properties., Method: To generate items for the new measure, 20 adolescents and young adults with SB completed qualitative interviews regarding their experience of living with SB. Interviews were coded for benefits. Questionnaire items were generated from these benefits, and an expert panel refined the wording of these items. The resultant 31-item measure was shared with six of the 20 participants for feedback and then piloted among 251 youth with SB. The factor structure of the measure was confirmed and reliability and convergent validity were assessed., Results: Both a one- and four-factor structure were supported. The four factors include: Life Perspectives and Priorities, Personal Characteristics and Traits, Connections and Opportunities, and Problem Solving. Higher total and factor scores represent greater benefit-finding and growth. The measure demonstrated excellent internal consistency (α = 0.95). The new measure also showed significant positive correlations with optimism, positive affect, and life satisfaction., Conclusions: This study produced a measure of benefit-finding and growth for youth with SB. Clinically, information about what youth with SB perceive to be their areas of strength and growth from their condition provides crucial insight into which factors to enhance in this population., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Importance: Lifestyle change is central to diabetes risk reduction in youth with overweight or obesity. Feeling susceptible to a health threat can be motivational in adults., Objective: To evaluate associations between diabetes risk perception and/or awareness and health behaviors in youth., Design, Setting, and Participants: This cross-sectional study analyzed data from the US National Health and Nutrition Examination Survey 2011 to 2018. Participants included youths aged 12 to 17 years with body mass index (BMI) in the 85th percentile or higher without known diabetes. Analyses were conducted from February 2022 to February 2023., Main Outcomes and Measures: Outcomes included physical activity, screen time, and attempted weight loss. Confounders included age, sex, race and ethnicity, and objective diabetes risk (BMI, hemoglobin A1c [HbA1c])., Exposures: Independent variables included diabetes risk perception (feeling at risk) and awareness (told by clinician), as well as potential barriers (eg, food insecurity, household size, insurance)., Results: The sample included 1341 individuals representing 8 716 794 US youths aged 12 to 17 years with BMI in the 85th percentile or higher for age and sex. The mean age was 15.0 years (95% CI, 14.9-15.2 years) and mean BMI z score was 1.76 (95% CI 1.73-1.79). Elevated HbA1c was present in 8.6% (HbA1c 5.7%-6.4%: 8.3% [95% CI, 6.5%-10.5%]; HbA1c ≥6.5%: 0.3% [95% CI, 0.1%-0.7%]). Nearly one-third of youth with elevated HbA1c reported risk perception (30.1% [95% CI, 23.1%-38.1%), while one-quarter (26.5% [95% CI, 20.0%-34.2%]) had risk awareness. Risk perception was associated with increased TV watching (β = 0.3 hours per day [95% CI, 0.2-0.5 hours per day]) and approximately 1 less day per week with at least 60 minutes of physical activity (β = -1.2 [95% CI, -2.0 to -0.4) but not with nutrition or weight loss attempts. Awareness was not associated with health behaviors. Potential barriers had mixed associations: larger households (≥5 members vs 1-2) reported lower consumption of non-home-prepared meals (OR 0.4 [95% CI, 0.2-0.7]) and lower screen time (β = -1.1 hours per day [95% CI, -2.0 to -0.3 hours per day), while public insurance (vs private) was associated with approximately 20 fewer minutes per day of physical activity (β = -20.7 minutes per day [95% CI, 35.5 to -5.8 minutes per day])., Conclusions and Relevance: In this cross-sectional study including a US-representative sample of adolescents with overweight or obesity, diabetes risk perception and awareness were not associated with greater engagement in risk-reducing behaviors in youth. These findings suggest the need to address barriers to engagement in lifestyle change, including economic disadvantage.

Objective: Limited clinical resources create barriers to quality management of cancer-related distress. CaringGuidance After Breast Cancer Diagnosis is a web-based, patient-controlled, psychoeducational program of cognitive-behavioral, coping and problem-solving strategies aimed at early post-diagnosis distress reduction without clinical resources. This study evaluated the feasibility of recruiting and retaining newly diagnosed women to 12 weeks of CaringGuidance and program acceptance., Methods: Women with stage 0 to II breast cancer diagnosed within the prior 3 months were recruited from clinics and communities in four states, from 2013 to 2015 and randomized to 12 weeks of CaringGuidance plus usual care (n = 57) or usual care alone (n = 43). Recruitment, retention, and program use were tracked. Using standard and study-derived measures, demographic and psychological variables were assessed at baseline and monthly and program satisfaction at 12 weeks., Results: Of 139 women screened, 100 enrolled, five withdrew, and 12 were lost to follow-up (83% retention rate). Total program engagement was positively associated with greater baseline intrusive/avoidant thoughts. Intervention participants (92%) believed CaringGuidance would benefit future women and was easy to use. Sixty-six percent believed CaringGuidance helped them cope. Women used program content to change thoughts (49%) or behaviors (40%). Stress in the previous year was positively associated with reports that CaringGuidance was reassuring and helpful., Conclusions: Feasibility and acceptance of CaringGuidance was demonstrated pointing to the program's potential as a cancer-distress self-management intervention. Future research will explore program feasibility and acceptability in other regions of the United States, leading to clinical implementation trials., (© 2019 John Wiley & Sons, Ltd.)

Diabetes self-management is crucial to maintaining quality of life and preventing long-term complications, and it occurs daily in the context of close interpersonal relationships. This article examines how social relationships are central to meeting the complex demands of managing Type I and Type 2 diabetes across the life span. The social context of diabetes management includes multiple resources, including family (parents, spouses), peers, romantic partners, and health care providers. We discuss how these social resources change across the life span, focusing on childhood and adolescence, emerging adulthood, and adulthood and aging. We review how diabetes both affects and is affected by key social relationships at each developmental period. Despite high variability in how the social context is conceptualized and measured across studies, findings converge on the characteristics of social relationships that facilitate or undermine diabetes management across the life span. These characteristics are consistent with both Interpersonal Theory and Self-Determination Theory, 2 organizing frameworks that we utilize to explore social behaviors that are related to diabetes management. Involvement and support from one's social partners, particularly family members, is consistently associated with good diabetes outcomes when characterized by warmth, collaboration, and acceptance. Underinvolvement and interactions characterized by conflict and criticism are consistently associated with poor diabetes outcomes. Intrusive involvement that contains elements of social control may undermine diabetes management, particularly when it impinges on self-efficacy. Implications for future research directions and for interventions that promote the effective use of the social context to improve diabetes self-management are discussed. (PsycINFO Database Record, ((c) 2016 APA, all rights reserved).)

Background: The aim of this study was to examine the efficacy of a collaborative care intervention in reducing depression, pain, and fatigue and improve quality of life., Methods: A total of 261 patients with advanced cancer and 179 family caregivers were randomized to a web-based collaborative care intervention or enhanced usual care. The intervention included the following: 1) a web site with written and audiovisual self-management strategies, a bulletin board, and other resources; 2) visits with a care coordinator during a physician's appointment every 2 months; and 3) telephone follow-up every 2 weeks. Primary patient outcomes included measures of depression, pain, fatigue, and health-related quality of life. Secondary outcomes included Interleukin (IL)-1α, IL-1β, IL-6, and IL-8 levels, Natural Killer (NK) cell numbers, and caregiver stress and depression., Results: At the baseline, 51% of the patients reported 1 or more symptoms in the clinical range. For patients who presented with clinical levels of symptoms and were randomized to the intervention, reductions in depression (Cohen's d = 0.71), pain (Cohen's d = 0.62), and fatigue (Cohen's d = 0.26) and improvements in quality of life (Cohen's d = 0.99) were observed when compared to those in the enhanced usual car arm at 6 months. Reductions in IL-6 (φ = 0.18), IL-1β (φ = 0.35), IL-1α (φ = 0.19), and IL-8 (φ = 0.15) and increases in NK cell numbers (φ = 0.23) were observed in comparison with enhanced usual care arm at 6 months. Reductions in caregiver stress (Cohen's d = 0.75) and depression (Cohen's d = 0.37) were observed at 6 months for caregivers whose loved ones were randomized to the intervention arm., Conclusions: The integration of screening and symptom management into cancer care is recommended., (© 2016 American Cancer Society.)

Type 1 diabetes has traditionally been studied as a chronic illness of childhood. However, young adulthood is a critical time for the development and integration of lifelong diabetes management skills, and research is starting to identify unique challenges faced by youth with diabetes as they age into adulthood. Most young adults experience multiple transitions during this unstable developmental period, including changes in lifestyle (e.g., education, occupation, living situation), changes in health care, and shifting relationships with family members, friends, and intimate others. Young adults with type 1 diabetes must navigate these transitions while also assuming increasing responsibility for their diabetes care and overall health. Despite these critical health and psychosocial concerns, there is a notable lack of evidence-based clinical services and supports for young adults with type 1 diabetes. We review relevant evolving concerns for young adults with type 1 diabetes, including lifestyle considerations, health care transitions, psychosocial needs, and changes in supportive networks, and how type 1 diabetes impacts and is impacted by these key developmental considerations. Specific avenues for intervention and future research are offered.

Background: Collaborative care interventions to treat depression have begun to be tested in settings outside of primary care. However, few studies have expanded the collaborative care model to other settings and targeted comorbid physical symptoms of depression., Purpose: The aims of this report were to: (1) describe the design and methods of a trial testing the efficacy of a stepped collaborative care intervention designed to manage cancer-related symptoms and improve overall quality of life in patients diagnosed with hepatobiliary carcinoma; and (2) share the lessons learned during the design, implementation, and evaluation of the trial., Methods: The trial was a phase III randomized controlled trial testing the efficacy of a stepped collaborative care intervention to reduce depression, pain, and fatigue in patients diagnosed with advanced cancer. The intervention was compared to an enhanced usual care arm. The primary outcomes included the Center for Epidemiological Studies-Depression scale, Brief Pain Inventory, and Functional Assessment of Cancer Therapy (FACT)-Fatigue, and the FACT-Hepatobiliary. Sociodemographic and disease-specific characteristics were recorded from the medical record; Natural Killer cells and cytokines that are associated with these symptoms and with disease progression were assayed from serum., Results:   and  Discussion The issues addressed include: (1) development of collaborative care in the context of oncology (e.g., timing of the intervention, tailoring of the intervention, ethical issues regarding randomization of patients, and changes in medical treatment over the course of the study); (2) use of a website by chronically ill populations (e.g., design and access to the website, development of the website and intervention, ethical issues associated with website development, website usage, and unanticipated costs associated with website development); (3) evaluation of the efficacy of intervention (e.g., patient preferences, proxy raters, changes in medical treatment, and inclusion of biomarkers as endpoints); and (4) analyses and interpretation of the intervention (e.g., confounding factors, dose and active ingredients, and risks and benefits of collaborative care interventions in chronically ill patients)., Limitations: The limitations to the study, although not fully realized at this time as the trial is ongoing, include: (1) heterogeneity of the diagnoses and treatments of participants; and (2) inclusion of caregivers as proxy raters but not as participants in the intervention., Conclusions: Collaborative care interventions to manage multiple symptoms in a tertiary cancer center are feasible. However, researchers designing and implementing interventions that are web-based, target multiple symptoms, and for oncology patients may benefit from previous experiences.

Background/purpose: This study examined the relation of age to genitourinary functioning and depressive symptoms over time and examined how age influences the relation between genitourinary functioning and depressive symptoms over time in men treated for localized prostate cancer., Methods: Participants were 234 men who completed interviews that assessed genitourinary functioning and depressive symptoms at 2, 4, 10 and 16 months after treatment. Analyses were statistically controlled for potential confounds., Results: Compared with younger men (≤ 65.5), older men had significantly poorer sexual function and slower improvement. Level of urinary functioning was inversely associated with level of depressive symptoms regardless of age. Level of sexual functioning was inversely associated with level of depressive symptoms but only in younger men., Conclusion: Interventions may be particularly helpful for all men with urinary dysfunction and for younger men with sexual dysfunction in order to improve symptoms of depression.

This study examined whether social support might enhance health-related quality of life in men (n=89) treated for localized prostate cancer by improving their ability to cognitively process their cancer experience. Data were collected using two, structured in-person interviews and abstracting medical records. The baseline interview was within several months (T1) after treatment for cancer, and follow-up was 3 months later (T2). Most men (61.8%) were treated by radical prostatectomy. Results showed that T1 social support was positively related to T2 mental functioning, and this relation appeared to be mediated by T1 indicators of cognitively processing, intrusive thoughts and searching for meaning. These findings suggest that supportive social relations may improve mental functioning by helping men cognitively process their prostate cancer experience.

The authors report a 3-year follow-up of the effects of 8-week support group interventions on the quality of life of women with early stage breast cancer. Shortly after diagnosis, women were randomly assigned to 1 of 4 conditions: control, education, peer discussion, and education plus peer discussion. The education group intervention focused on providing information to enhance control over the illness experience, whereas the peer discussion group intervention focused on providing emotional support through the expression of feelings. Consistent with the results that emerged 6 months after the interventions (V. S. Helgeson, S. Cohen, R. Schulz, & J. Yasko, 1999), the authors found that the benefits of the education intervention were maintained over a 3-year period (N=252), although effects dissipated with time. The authors continued to find no benefits of the peer discussion intervention, either alone or in combination with education.

Research on the benefits of social support groups has been inconclusive. One reason is that individual differences in intervention responses have rarely been examined. The authors determined the extent to which individual difference variables moderated the effects of an information-based educational group and an emotion-focused peer discussion group on the mental and physical functioning of women with breast cancer (n = 230). The authors administered the SF-36 (S.E. Ware, K.K. Snow, M. Kosinski, & B. Gandek, 1993), a multidimensional quality of life instrument, pre- and postintervention. Educational groups showed greater benefits on the physical functioning of women who started the study with more difficulties compared with less difficulties (e.g., lacked support or fewer personal resources). Peer discussion groups were helpful for women who lacked support from their partners or physicians but harmful for women who had high levels of support. Implications of these results for clinical interventions are discussed.

The purpose of this study was to determine whether cognitive adaptation theory (i.e., cognitively responding to challenges to world assumptions) would predict positive adjustment to heart disease in the face of a recurrent event. Men and women who were treated for a coronary event with percutaneous transluminal coronary angioplasty (N = 278) were interviewed in the hospital and then 6 months later. Indicators of cognitive adaptation theory (self-esteem, optimism, mastery) and adjustment were assessed. In general, cognitive adaptation indicators predicted positive adjustment, sometimes showing stronger relations for those who faced a recurrent event. In addition, patients' cognitions were robust over time, meaning that they were not affected by recurrent events. Patients' beliefs about the angioplasty decision, however, showed differential relations to adjustment, depending on whether they sustained a recurrence.

Background: We report a clinical trial comparing the effectiveness of education-based and peer discussion-based group interventions on adjustment to breast cancer., Methods: Women with stage I, II, or III breast cancer (n = 312) were randomly assigned to 1 of 4 group conditions: control, education, peer discussion, or education plus peer discussion (combination). Seven groups (each comprising 8-12 women) were conducted in each of the 4 conditions (28 groups total). Adjustment was measured before the intervention, immediately after the intervention, and 6 months after the intervention., Results: Consistently positive effects on adjustment were seen in the education groups both immediately following and 6 months after the intervention. There were no benefits of participation in peer discussion groups, and some indications of adverse effects on adjustment at both follow-up examinations. The effects could be explained by changes in self-esteem, body image, and intrusive thoughts about the illness., Conclusions: Education-based group interventions facilitated the initial adjustment of women diagnosed with early stage breast cancer. There was no evidence of benefits from peer discussion group interventions.

The authors sought to distinguish unmitigated communion, a focus on others to the exclusion of the self, from communion, a positive caring orientation toward others. Across four studies, the authors showed that unmitigated communion and communion are correlated, but that unmitigated communion is distinct from communion in terms of a negative view of the self, turning to others for self-evaluative information, and psychological distress. They also sought to explain the relation of unmitigated communion to distress. It was found that unmitigated communion individuals' reliance on others for self-esteem leads to overinvolvement with others and a neglect of the self, which, in turn, account for the relation of unmitigated communion to distress.

Research has established that women suffer more often than men from depression. Sex role socialization has been offered as one explanation for this sex difference, but traditional measures of female gender-related traits are not related to depressive symptoms. We argue that thus far research has failed to distinguish the traditional measure of female gender-related traits, communion, from another set of gender-related traits, unmitigated communion. Unmitigated communion is a focus on and involvement with others to the exclusion of the self. Unmitigated communion, but not communion, is related to psychological distress, including depressive symptoms, and accounts for sex differences in distress. We examine the relation of unmitigated communion to communion as well as other personality constructs and then describe the cognitive and behavioral features of unmitigated communion. We note the implications of unmitigated communion for physical and psychological well-being and speculate on possible origins.

Several research literatures are reviewed that address the associations of emotional, informational, and instrumental social support to psychological adjustment to cancer. Descriptive studies suggest that emotional support is most desired by patients, and correlational studies suggest that emotional support has the strongest associations with better adjustment. However, the evidence for the effectiveness of peer discussion groups aimed at providing emotional support is less than convincing. Moreover, educational groups aimed at providing informational support appear to be as effective as, if not more effective than, peer discussions. Reasons for inconsistencies between the correlational and intervention literatures are discussed, and future directions are outlined.

The present study examined the effects of agency and communion on psychological adjustment to a 1st coronary event. Patients were interviewed about agency and communion and psychological adjustment in the hospital shortly before discharge (Time 1) and then reinterviewed along with spouses in their homes 3 months after discharge (Time 2). It was hypothesized that the extreme agentic orientation (unmitigated agency) and the extreme communal orientation (unmitigated communion) would be associated with poor adjustment for patients and spouses but that agency would promote self adjustment and communion would promote partner adjustment. In general, results confirmed predictions. It was suggested that the most distressed couples consist of a patient high in unmitigated agency and a spouse high in unmitigated communion. Although patients in such couples did not evidence the most distress, spouses did.

It was predicted that the relation between perceived control and adjustment to chronic illness would be stronger when (a) perceptions of control were based in reality and (b) the threat was severe. Perceived control was assessed during the hospitalization of 80 first cardiac event patients, and adjustment was assessed during hospitalization and 3-month follow-up. Results indicated that perceptions of vicarious control (perception that other people and things have control) were related to better adjustment only for patients who had undergone invasive procedures by physicians. The relation between control and adjustment was stronger under more severe threat conditions (poor prognosis and rehospitalization).

We describe the construction of a scored form for the neurological examination of the full-term neonate. Extensive data analyses were obtained from a large sample of neonatal neurological examinations performed by one examiner (MSP). Examinations were used from neonates with ages less than or equal to 48 hours (n = 727) and 72 hours to 1 week (n = 510) with gestational ages greater than or equal to 37 weeks. Forty-four items from several neonatal assessments were used in these neurological examinations. Further subdivision yielded a total of 65 items. Correlations were obtained for the 65 items. We factored the matrix of these correlations, using several solutions of factor analysis. Thirty-two items were thus grouped and pruned into seven dimensions (factors) to provide a scorable neonatal neurological examination (Neoneuro) with an internal consistency or reliability of 0.80. From the total scores, cut points are recommended for categories of normality/abnormality: normal, mildly abnormal, moderately abnormal, and severely abnormal. This scoring system is well-based both theoretically and psychometrically. The quantified computer-compatible scoring system permits evaluation of individual neonates, as well as comparison of samples of neonates on item scores, subscores (factor scores), and total scores. Such quantification will permit documentation of the natural history of specific abnormalities and the evaluation of various therapies.

Previous research indicates that many primate species are more likely to give birth at night than during the day. This study attempted to determine whether temporal patterns of birth are discernible in a number of non-primate mammals. In addition, it sought to relate time of birth to the sleep/wake cycle and to the level of predation on the species. Data were collected and analyzed on birth hours in 26 mammalian species from two Chicago area zoos . Although temporal patterns of parturition were discernible for many species, the hypothesis that most birth would occur during the restive phase was not supported. However, a significant positive correlation between level of predation and the likelihood that birth would occur during the restive phase was found (n = 0.40). These findings are discussed in terms of predator/prey interaction and the protection (or lack of protection) that restive birthing might afford the mother and offspring at this vulnerable time.

Coronary heart disease remains the leading cause of morbidity and mortality in the United States today. Type A behavior pattern has emerged as an important contributor to coronary heart disease. This review describes the development of the concept of type A behavior, definitions, and measurement. Early research that led to the prominence of type A behavior is reviewed, as are recent trends in the literature. Supporting theories such as the Western civilization work ethic, enhanced need for control, self-involvement, and ambiguous standards of evaluation are presented. The controversy over changing type A behavior is also discussed.