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This article examines the concept of emodiversity, put forward by Quoidbach et al. (2014) as a novel source of information about "the health of the human emotional ecosystem" (p. 2057). Quoidbach et al. drew an analogy between emodiversity as a desirable property of a person's emotional make-up and biological diversity as a desirable property of an ecosystem. They claimed that emodiversity was an independent predictor of better mental and physical health outcomes in two large-scale studies. Here, we show that Quoidbach et al.'s construct of emodiversity suffers from several theoretical and practical deficiencies, which make these authors' use of Shannon's (1948) entropy formula to measure emodiversity highly questionable. Our reanalysis of Quoidbach et al.'s two studies shows that the apparently substantial effects that these authors reported are likely due to a failure to conduct appropriate hierarchical regression in one case and to suppression effects in the other. It appears that Quoidbach et al.'s claims about emodiversity may reduce to little more than a set of computational and statistical artifacts. (PsycINFO Database Record

Sanders et al.'s proposal for a management framework for conflicting interests among program developers is very welcome. The underlying principles of such a framework must nevertheless prioritise t...

We comment on Eichstaedt et al.’s (2015a) claim to have shown that language patterns among Twitter users, aggregated at the level of US counties, predicted county-level mortality rates from atherosclerotic heart disease (AHD), with “negative” language being associated with higher rates of death from AHD and “positive” language associated with lower rates. First, we examine some of Eichstaedt et al.’s apparent assumptions about the nature of AHD, as well as some issues related to the secondary analysis of online data and to considering counties as communities. Next, using the data files supplied by Eichstaedt et al., we reproduce their regression- and correlation-based models, substituting mortality from an alternative cause of death—namely, suicide—as the outcome variable, and observe that the purported associations between “negative” and “positive” language and mortality are reversed when suicide is used as the outcome variable. We identify numerous other conceptual and methodological limitations that call into question the robustness and generalizability of Eichstaedt et al.’s claims, even when these are based on the results of their ridge regression/machine learning model. We conclude that there is no good evidence that analyzing Twitter data in bulk in this way can add anything useful to our ability to understand geographical variation in AHD mortality rates.

Objective:Patients with incurable cancer and their informal caregivers have numerous psychological and psychosocial needs. Many of these patients wish to receive their care and die at home. Few home-based specialized palliative care (SPC) interventions systematically integrate psychological support. We present a psychological intervention for patient–caregiver dyads developed for an ongoing randomized controlled trial (RCT) of home-based SPC, known as Domus, as well as the results of an assessment of its acceptability and feasibility.Method:The Domus model of SPC for patients with incurable cancer and their caregivers offered systematic psychological assessment and dyadic intervention as part of interdisciplinary care. Through accelerated transition to SPC, the aim of the model was to enhance patients' chances of receiving care and dying at home. Integration of psychological support sought to facilitate this goal by alleviating distress in patients and caregivers. Psychologists provided needs-based sessions based on existential-phenomenological therapy. Feasibility and acceptability were investigated by examining enrollment, nonparticipation, and completion of psychological sessions.Results:Enrollment in the RCT and uptake of the psychological intervention indicated that it was feasible and acceptable to patients and caregivers. The strengths of the intervention included its focus on dyads, psychological distress, and existential concerns, as well as interdisciplinary collaboration and psychological interventions offered according to need. Its main limitation was a lack of an intervention for other family members.Significance of Results:Our results show that psychological intervention can be systematically integrated into SPC and that it appears feasible to provide dyadic needs-based sessions with an existential therapeutic approach. The Domus RCT will provide evidence of the efficacy of a novel model of multidisciplinary SPC.

This national investigation utilizes qualitative data to evaluate an implementation model regarding factors influencing provider use of two evidence-based treatments for posttraumatic stress disorder (PTSD). Semi-structured qualitative interviews with 198 mental health providers from 38 Department of Veterans Affairs' (VA) residential treatment programs were used to explore these issues regarding prolonged exposure (PE) and cognitive processing therapy (CPT) in VA residential PTSD programs. Several unique and some overlapping predictors emerged. Leadership was viewed as an influence on implementation for both CPT and PE, while a lack of dedicated time and resources was viewed as a deterrent for both. Compatibility of CPT with providers' existing practices and beliefs, the ability to observe noticeable patient improvement, a perceived relative advantage of CPT over alternative treatments, and the presence of a supportive peer network emerged as influential on CPT implementation. Leadership was associated with PE implementation. Implications for the design and improvement of training and implementation efforts are discussed.

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: 1) To examine the effectiveness of psychological interventions that are offered to cancer patients who have survived the disease for at least one year. Related aims include: 2) to describe the components of psychological interventions that are offered to patients who survived the disease for at least one year; 3) to explore whether the effectiveness of the interventions varies according to whether interventions are given to all available patients (universal) or whether they are targeted at patients with symptoms.

Background: The long-term course of symptoms in patients with mild-to-moderate depression is not well understood. A 12-month-follow-up analysis was performed on those participants from a randomized controlled 10-week trial (RCT, MIND-study), who had received either treatment with an antidepressant (sertraline) or a psychotherapeutic intervention (group cognitive-behavioral therapy (CBT)).Methods: The longitudinal interval follow-up evaluation (LIFE) was applied to 77 patients with mild-to moderate depression. The primary outcome was the number of weeks in the one-year follow-up period spent completely recovered from all depressive symptoms. Functional outcome was measured with the Global Assessment of Functioning (GAF) scale. Further outcomes were relapse and remission rates based on weekly psychiatric rating scales (PSR) and the number of weeks in the follow-up period during which patients had a depressive disorder or subthreshold symptoms of depression.Results: Patients with acute treatment (10 weeks) with SSRI and those with acute treatment with CBT (also 10 weeks) did not differ significantly concerning the number of weeks in the follow-up period in which they were completely recovered (primary outcome) (SSRI: 31.6 weeks (standard deviation (SD): 23.7), CBT: 27.8 weeks (SD: 24.3)). Sertraline was superior to CBT regarding GAF scores by trend (p = 0.06).Limitations: The generalizability of the findings is limited by the moderate sample size and missing values (LIFE).Conclusions: Sertraline and group CBT have similar anti-depressive effects in the long-term course of mild-tomoderate depression. Regarding long-term global functioning, sertraline seems to be slightly superior to CBT.

ObjectivesPsychological interventions show greater efficacy when evaluated with distressed patients. We report on the feasibility of implementing screening for recruiting distressed cancer patients to a randomized controlled trial of problem-solving therapy (PST), characteristics associated with enrolment, and time investment and challenges of implementing screening. MethodsThree medical settings implemented screening of patients, directly after cancer treatment (T1) and 2months later (T2), using Hopkins Symptom Checklist-25 and one question about need for services. Distressed patients indicating need for services were interviewed. Eligible patients were offered the possibility to participate in the trial. Consenting patients were randomized to PST or waitlist. ResultsAt T1, 366 of 970 screened patients (37%) scored above the cutoff and at T2, 208 of 689 screened patients (30%). At either or both T1 and T2, 423 patients reported distress, of whom 215 indicated need for services. Only 36 (4% of 970) patients consented to trial participation. Twenty-seven patients needed to be screened to recruit a single patient, with 17h required for each patient recruited. Barriers to screening were time constraints and negative attitudes of oncology staff towards screening. ConclusionsImplementing screening proved inefficient for recruiting distressed cancer patients post-treatment to a randomized controlled trial on PST, with need for services being much less than anticipated. Consecutively screening patients did not result in a sample representative of the larger pool of distressed patients, which may lower generalizability. An adequately powered intervention trial using screening requires a feasibility study establishing recruitment rates and dedicated, funded staff assistance. Copyright (c) 2013 John Wiley & Sons, Ltd.

We critically re-examine Fredrickson et al.'s renewed claims concerning the differential relationship between hedonic and eudaimonic forms of well-being and gene expression, namely that people who experience a preponderance of eudaimonic well-being have gene expression profiles that are associated with more favorable health outcomes. By means of an extensive reanalysis of their data, we identify several discrepancies between what these authors claimed and what their data support; we further show that their different analysis models produce mutually contradictory results. We then show how Fredrickson et al.'s most recent article on this topic not only fails to adequately address our previously published concerns about their earlier related work, but also introduces significant further problems, including inconsistency in their hypotheses. Additionally, we demonstrate that regardless of which statistical model is used to analyze their data, Fredrickson et al.'s method can be highly sensitive to the inclusion (or exclusion) of data from a single subject. We reiterate our previous conclusions, namely that there is no evidence that Fredrickson et al. have established a reliable empirical distinction between their two delineated forms of well-being, nor that eudaimonic well-being provides any overall health benefits over hedonic well-being.

Aims To investigate: (1) the willingness of patients with diabetes to participate in a screening programme; (2) the extent to which patients with diabetes who screen positive endorse need for psychosocial care; (3) the rate of referral to psychosocial care during screening vs. usual care. Methods Four hundred and ninety-nine patients with diabetes were invited to complete the Center for Epidemiologic Studies Depression and the Problem Areas in Diabetes questionnaires. Patients screening positive on either instrument were invited for an interview. One year after screening was withdrawn, rates of referral to psychosocial care were assessed from physician reports of patient referrals. Results In total, 349/499 (70%) patients with diabetes completed the questionnaire. Patients who did not take up the screening were younger, smoked more often and had higher HbA1c values. No-shows for clinical appointments accounted for 74% of non-participation. Of the 104 (30% of 349) patients screening positive, 45 accepted an invitation for an interview. Finally, 36/104 (35%) would like a referral for psychological care. Seven per cent of patients were referred to psychological care during screening compared with 1% when screening was withdrawn. Conclusions Results raise questions as to whether screening is the most efficient way to identify patients with psychological problems. Many patients did not take up the screening, especially those with low adherence to diabetes care in general. Furthermore, few patients screening positive wanted to be referred. Screening should be evaluated in the context of consideration of alternative ways to identify at-risk patients, including providing resources to deal with patients with already known adjustment and adherence problems. Diabet. Med. 30, 88-94 (2013)

The respective roles of expressed emotion and dysfunctional cognitive processes are well documented in depression, but their interplay has seldom been given attention. We examined the patients' and partners' expressed emotion (EE) and dysfunctional attitudes in predicting depressive symptoms in a sample of N = 63 couples with one clinically-depressed partner (37 females and 26 males). Partners' EE played a more important role for patients' dysfunctional attitudes and their depressive symptoms; nondepressed partners' dysfunctional attitudes and depressive symptoms were unaffected by patients' EE. In contrasting two models that predict self-reported and clinician-rated depression, we found more support for dysfunctional attitudes serving as a mediator rather than a moderator for the association between partners' EE and patients' depressive symptoms. Partners' criticism may play a role worthy of more attention in depressed patients' dysfunctional attitudes and maintenance of their depressive symptoms.

Screening for depression in primary care is an issue that is highly contentious and hotly debated, and recommendations have evolved over time. For example, early policy statements from the 1990s in Canada[1][1] and the United States[2][2] recommended against screening for depression in primary care[

Objective: The heightened risk of persons with serious mental illness to contract and transmit HIV is recognized as a public health problem. Persons with HIV and mental illness may be at risk for poor treatment adherence, development of treatment-resistant virus, and worse outcomes. The objective of this study was to test the effectiveness of a communitybased advanced practice nurse (APN) intervention (PATH, Preventing AIDS Through Health) to promote adherence to HIV and psychiatric treatment regimens. Methods: Community-dwelling HIV-positive participants with co-occurring serious mental illnesses (N=238) were recruited from community HIV provider agencies from 2004 to 2008 to participate in the randomized controlled trial. Participants in the intervention group (N=128) were assigned an APN who provided community-based care management at a minimum of one visit per week and coordinated clients’ medical and mental health care for one year. Viral load and CD4 cell count were evaluated at baseline and 12 months. Results: Longitudinal models for continuous log viral load showed that compared with the control group, the intervention group exhibited a significantly greater reduction in log viral load at 12 months (d=–.361 log 10 copies per milliliter, p

A NIH Consensus Conference Statement1 and an IOM report 2 have identified detection and management of distress and psychiatric disorder among cancer patients as a priority. Screening is often proposed as a first step in providing appropriate psychosocial and mental health care, and as a means of reducing morbidity and improving quality of life 3–5. Evidence-based guidelines for managing distress, however, are still being developed 6. Moreover, a considerable proportion of positive screens for distress represents psychiatric disorder, typically 30 to 45%7–8. Such disorders tend to be chronic, episodic, and recurrent. They require more intensive care and longer follow-up, but have the advantage of an agreed upon nosology and well-defined, empirically-based treatment guidelines. Evaluations of screening instruments, therefore, typically make gold standard comparisons against validated diagnostic interviews for psychiatric disorders9–10. Questions have been raised about the appropriateness of particular screening instruments for specific subgroups of cancer patients 11–12, though most screening instruments appear to have moderate performance compared to diagnoses based on psychiatric interviews10. Even the best performing instrument cannot be used diagnostically, and so screening is best construed as an initial step in a process in which positive screens are followed by a diagnostic interview13. Given the modest prevalence of psychiatric disorder in most cancer populations, however, most positive screens will be found to be false positives, rendering screening potentially inefficient8. Routine screening programs assume that screening provides a means of uncovering distress and psychiatric disorder that would not otherwise be identified and treated14–15. In clinical practice, the interest is not in detecting patients already being treated, but in those who would otherwise be missed. A shortcoming of existing studies of the accuracy and yield of screening tools in cancer care is that they are almost always conducted with all available patients, including patients who have already been recognized and are receiving treatment for psychiatric disorder, inflating estimates of the number of patients in need of treatment that screening can yield. A recent systematic review of the diagnostic accuracy of screening instruments for depression found only 8 of 197 (4.1%) unique publications from 17 systematic reviews and meta-analyses specifically excluded patients already diagnosed or being treated for depression15. Only 2 of the 8 concerned cancer patients11,17, both of which were from the same sample, and these simply excluded diagnosed or currently treated depression without determining the effect of doing so on screening performance. Patients with a psychiatric disorder who are already in treatment may differ from those who are not by having more conspicuous disorder or more positive attitudes about treatment 18. Patients for whom screening represents the only means of identifying psychiatric morbidity may, therefore, be more difficult to diagnose and require additional resources to overcome resistance to treatment, while those already in treatment but remaining sufficiently symptomatic to screen positive may require improved surveillance and greater coordination of care with outside providers. Routine care for depression in the community tends to be inadequate, with low adherence, high rates of unsupervised discontinuation of treatment, and a lack of scheduled follow-up visits19–20. These problems suggest the value of surveillance of existing treatment, with a recognition that the clinical resources required would differ substantially from those required if the goal were simply initiation of new treatment based on screening. We sought to evaluate the performance of screening among newly diagnosed breast cancer patients, comparing screening results to a validated diagnostic interview, first, as is typically done, ignoring whether patients were already in treatment, and, second, taking existing psychotropic treatment into account. We chose newly diagnosed patients as there is evidence that distress is most prominent early in the cancer trajectory 21–26 and predicts long term adaptation27. Our objectives were to (1) evaluate the ability of a screening instrument to detect depression and other psychiatric disorders among a sample of patients in early treatment for breast cancer, and (2) determine how screening performance is affected when existing treatment for disorder is taken into account.

Background: Type D personality has been proposed as a prognostic indicator for mortality in cardiovascular disease. Most research examining this construct originates from one research group, and it is critical that the predictive value of Type D personality for adverse outcomes is independently cross-validated. This study examined its prognostic value in heart failure, relative to B-type natriuretic peptide (BNP) and depressive symptoms. Methods: We studied 706 patients with complete BNP, depressive symptom, and Type D personality and mortality data from 958 patients with heart failure enrolled after hospitalization for a multisite study of a disease management program. Multivariable models were adjusted for BNP and depression. Results: At 18 months, there were 192 deaths (27.2%). No evidence was found for a prognostic value of Type D personality in the unadjusted model (hazard ratio [HR] = 0.893, 95% confidence interval [CI] = 0.582-1.370). In contrast, BNP was significantly predictive of mortality (HR = 1.588, 95% CI = 1.391-1.812), whereas depression was not (HR = 1.011, 95% CI = 0.998-1.024). Type D was also not predictive in covariate-adjusted models (HR = 0.779, 95% CI = 0.489-1.242). Similar results were obtained when analyzing Type D as the interaction between continuous z scores of its two components, negative affectivity and social inhibition (p = .144). Conclusions: In the largest study to date, Type D does not predict mortality. Future research should construe Type D as the interaction of continuous negative affectivity and social inhibition z scores, rather than as a typology, and consider analyses replacing negative affectivity with depression.

Although colorectal cancer (CRC) is the second leading cause of cancer death among adults in the US and colonoscopy is efficacious in reducing morbidity and mortality from CRC, screening rates are sub-optimal. Understanding the socioeconomic, cultural, and health care context within which decisions about colonoscopy are made allows physicians to address patients' most salient beliefs and values and other constraints when making screening recommendations.To evaluate the direct and interactive effects of socioeconomics, health care variables, psychological characteristics, and cultural values on colonoscopy use.National survey completed between January-August 2009 in a random sample of African American, white, and Hispanic adults ages 50-75 without cancer (n = 582).Self-reported colonoscopy use.Only 59% of respondents reported having a colonoscopy. The likelihood of colonoscopy increased with having health insurance (OR = 2.82, 95% CI = 1.24, 6.43, p = 0.004), and increasing age (OR = 1.40, 95% CI = 1.11, 1.77, p = 0.001). In addition, respondents with greater self-efficacy were more likely to have a colonoscopy (OR = 2.41, 95% CI = 1.35, 4.29, p = 0.003).Programs that help patients to overcome access and psychological barriers to screening are needed.

Background: The capacity of friends and family member informants to make judgments about the presence of a mood disorder history in an older primary care patient has theoretical, clinical, and public health significance. This study examined the accuracy of informant-reported mood disorder diagnoses in a sample of primary care patients aged 65 years or older. We hypothesized that the accuracy (sensitivity and specificity) of informant reports would vary with the patient's personality.Methods: Hypotheses were tested in 191 dyads consisting of patients and their friends or relatives (informants) recruited from primary care settings. Gold-standard mood disorder diagnoses were established at consensus conferences based on a review of medical charts and data collected in a structured interview with the patient. Patients completed an assessment battery that included the NEO-Five Factor Inventory.Results: Sensitivity and specificity of informant-derived mood disorder diagnoses were related to patient personality. Sensitivity of informant-derived lifetime mood disorder diagnoses was compromised by higher Extraversion and higher Agreeableness. Specificity of informant-derived lifetime mood disorder diagnoses was compromised by lower Agreeableness and higher Conscientiousness.Conclusion: Patient personality has implications for the accuracy of mood disorder histories provided by friends and family members. Given that false negatives can have grave consequences, we recommend that practitioners be particularly vigilant when interpreting collateral information about their extraverted, agreeable patients.

A limited body of evidence suggests that sleep problems are common in prostate cancer patients undergoing androgen deprivation therapy, yet little is known about sleep characteristics and the effects of poor sleep on daily functioning in this population. This study assessed sleep in 60 prostate cancer patients taking androgen deprivation therapy with wrist actigraphy and daily diaries for 7 days. The Epworth Sleepiness Scale and the general version of the Functional Assessment of Cancer Therapy scale were also administered. On average, total sleep time was 5.9 (SD = 1.4) h, and sleep efficiency was 75% (SD = 12.0) as assessed by actigraphy. There was generally poor concordance between actigraphy and daily diary for most sleep metrics. Subjects reported awakening, on average, 2.7 times per night, most commonly for nocturia and hot flashes. Assessment of daily functioning showed that participants had mild daytime sleepiness, which was predicted by total sleep time (F(1,47) = 4.5, P= 0.04) General quality of life was not impaired. This study supports more research on the predictors of poor sleep in order to identify effective interventions.

OBJECTIVES To evaluate the effects of race on QOL while adjusting for subjective stress and religiosity among African American and white prostate cancer patients. Although racial differences in quality of life (QOL) have been examined between African American and white prostate cancer patients, it is not known whether differences exist while adjusting for psychological and cultural factors. We predicted that African American men would report poorer emotional and physical functioning after adjusting for these factors and that greater subjective stress and lower levels of religiosity would be associated with poorer well-being. METHODS We conducted an observational study of QOL among 194 African American and white men who were recruited from February 2003 through March 2008. RESULTS Race had a significant effect on emotional functioning after adjusting for perceptions of stress and religiosity. Compared with white men, African American men (P = .03) reported significantly greater emotional well-being. Greater subjective stress was associated significantly with poorer emotional functioning (P = .0001) and physical well-being (P = .0001). There were no racial differences in physical functioning (P = .76). CONCLUSIONS The results of this study highlight the importance of developing a better understanding of the context within which racial differences in QOL occur and translating this information into support programs for prostate cancer survivors.

Objectives Adverse childhood experiences (ACEs) are risk factors for health problems later in life. This study aims to assess the influence of ACEs on risky health behaviors among mothers-to-be and determine whether a dose response occurs between ACEs and risky behaviors. Methods A prospective survey of women attending health centers was conducted at the first prenatal care visit, and at 3 and 11 months postpartum. Surveys obtained information on maternal sociodemographic and health characteristics, and 7 ACEs prior to age 16. Risky behaviors included smoking, alcohol use, marijuana use, and other illicit drug use during pregnancy. Results Our sample (N = 1476) consisted of low-income (mean annual personal income, $8272), young (mean age, 24 years), African American (71%), single (75%) women. Twenty-three percent of women reported smoking even after finding out they were pregnant, 7% reported alcohol use, and 7% reported illicit drug use during pregnancy. Nearly three fourths (72%) had one or more ACEs. There was a higher prevalence of each risky behavior among those exposed to each ACE than among those unexposed. The exception was alcohol use during pregnancy, where there was not an increased risk among those exposed when compared with those unexposed to witnessing a shooting or having a guardian in trouble with the law or in jail. The adjusted odds ratio for each risky behavior was >2.5 for those with >3 ACEs when compared with those without. Conclusions ACEs were associated with risky health behaviors reported by mothers-to-be. Greater efforts should target the prevention of ACEs to lower the risk for adverse health behaviors that have serious consequences for adults and their children.

Women with low socioeconomic status are at greater risk of depressive symptomatology and health-compromising behaviors in pregnancy than women from less vulnerable populations (1-4). These characteristics are all associated with poor maternal-child outcomes, including low birthweight, developmental delay, and chronic illness in infancy (5-9). Smoking in pregnancy is associated with placental insufficiency, low birthweight, and preterm birth (5). Fetal exposure to alcohol is related to poor neurodevelopmental outcomes (7). Depressive symptoms, smoking, and alcohol use are all targets of major public health interventions for pregnant women, and the identification of social factors that contribute to their disproportional prevalence among vulnerable populations is critical to the development of effective risk reduction strategies. Perceived discrimination, or unfair treatment based on personal characteristics identifying membership in a group perceived as inferior (e.g., racism, classism, sexism), is associated, in nonpregnant samples, with poor mental and physical health as well as health compromising behaviors among adults in low-income populations (10-13). Framed as a psychosocial stressor linking the social environment with physiologic state, perceived discrimination has been proposed to have negative consequences for mental and physical health (11). Adults who report discrimination are more likely to report greater depressive symptoms and major depression, poor cardiovascular health, and health compromising behaviors including smoking and alcohol use (13-15). Interestingly, the type of discrimination has also been suggested to influence the strength of the association with outcomes; chronic low level “everyday” discrimination has been theorized to have a stronger association with health outcomes than more severe but infrequent discrimination (13). This suggestion has important implications for the design of potential mitigating strategies. Despite the evidence of links between depressive symptoms, health compromising behaviors, and perceived discrimination, little research has been conducted on this topic among pregnant women. In the few studies that have explored consequences of perceived discrimination in pregnancy, this exposure has been associated with higher levels of self-rated stress and adverse birth outcomes, including low birthweight and preterm birth for women with high depressive symptoms compared with women who have lower levels of symptoms (12, 16-20). In the only published study to date that assessed discrimination and depressive symptomatology in pregnancy, a positive and significant association was found (16). However, no analysis of links to health behaviors has been undertaken. In the present study we investigated whether perceived discrimination was associated with depressive symptoms and two health-compromising behaviors -- smoking during pregnancy and recent alcohol use -- in a sample of pregnant low- income inner-city women. We also assessed the relative contribution of chronic, low level “everyday” discrimination versus reported experiences of major discrimination.

ObjectiveA meta-analysis was conducted to determine the influence of gender, race, and marital status on overall survival (OS) in Radiation Therapy Oncology Group nonoperative non-small cell lung cancer trials.Materials and MethodsData from 1365 patients treated on nine prospective Radiation Therapy Oncology Group studies activated during the 1990s were analyzed. Impact of gender, marital status, and race was considered in the Cox proportional hazards models. Age, Karnofsky performance status, weight loss, stage, histology, location of primary tumor, biologic equivalent dose, deviation from protocol dose, and education level were adjusted in the model. A two-sided p value

Objective: We examined four meta-analyses of behavioral interventions for adults (Dixon, Keefe, Scipio, Perri, & Abernethy, 2007; Hoffman, Papas, Chatkoff, & Kerns, 2007; Irwin, Cole, & Nicassio, 2006; and Jacobsen, Donovan, Vadaparampil, & Small, 2007) that have appeared in the Evidence Based Treatment Reviews section of Health Psychology. Design: Narrative review. Main Outcome Measures: We applied the following criteria to each meta-analysis: (1) whether each meta-analysis was described accurately, adequately, and transparently in the article; (2) whether there was an adequate attempt to deal with methodological quality of the original trials; (3) the extent to which the meta-analysis depended on small, underpowered studies; and (4) the extent to which the meta-analysis provided valid and useful evidence-based recommendations. Results: Across the four meta-analyses, we identified substantial problems with the transparency and completeness with which these meta-analyses were reported, as well as a dependence on small, underpowered trials of generally poor quality. Conclusion: Results of our exercise raise questions about the clinical validity and utility of the conclusions of these meta-analyses. Results should serve as a wake up call to prospective authors, reviewers, and end-users of meta-analyses now appearing in the literature.

Claims of positive psychology about people with cancer enjoy great popularity because they seem to offer scientific confirmation of strongly held cultural beliefs and values.Our goal is to examine critically four widely accepted claims in the positive psychology literature regarding adaptational outcomes among individuals living with cancer.We examine: (1) the role of positive factors, such as a "fighting spirit" in extending the life of persons with cancer; (2) effects of interventions cultivating positive psychological states on immune functioning and cancer progression and mortality; and evidence concerning (3) benefit finding and (4) post-traumatic growth following serious illness such as cancer and other highly threatening experiences.Claims about these areas of research routinely made in the positive psychology literature do not fit with available evidence. We note in particular the incoherence of claims about the adaptational value of benefit finding and post-traumatic growth among cancer patients, and the implausibility of claims that interventions that enhance benefit finding improve the prognosis of cancer patients by strengthening the immune system.We urge positive psychologists to rededicate themselves to a positive psychology based on scientific evidence rather than wishful thinking.

Background: In 2008, Leichsenring and Rabung performed a meta-analysis of 8 studies of longer-term psychodynamic psychotherapy (LTPP). The work was published in the Journal of the American Medical Association (vol. 300, pp 1551–1565), and they concluded that LTPP was more effective than shorter-term therapies. Method: Given that such claims have the potential to influence treatment decisions and policies, we re-examined the meta-analysis and the 8 studies. Results: We found a miscalculation of the effect sizes used to make key comparisons. Claims for the effectiveness of LTPP depended on a set of small, underpowered studies that were highly heterogeneous in terms of patients treated, interventions, comparison-control groups, and outcomes. LTPP was compared to 12 types of comparison-controls, including control groups that did not involve any psychotherapy, short-term psychodynamic psychotherapy, and unvalidated treatments. Additionally, the studies failed to protect against threats to bias, and had poor internal validity. Conclusion: Overall, we found no evidence to support claims of superiority of LTPP over shorter-term methods of psychotherapy.

Over 2,200 North American psychotherapists completed a Web-based survey concerning their clinical work, including theoretical orientation, client characteristics, and use of specific psychotherapy techniques. Psychotherapeutic integration was common, with the majority of respondents identifying with more than one theoretical orientation or as having an eclectic orientation. The modal patient was a White female adult suffering from a mood or anxiety disorder and interpersonal problems. Individual psychotherapy was the preferred treatment modality. The most frequently endorsed techniques were relationship-oriented such as conveying warmth, acceptance, understanding, and empathy. The least frequently endorsed techniques were biofeedback, neurofeedback, body and energy therapies, and hypnotherapy. Efforts to disseminate empirically based therapies require understanding and accommodating clinicians' tendencies to integrate techniques.

Many women rely on their obstetrician/gynecologist (OB/GYN) as their primary contact with the health care delivery system. There have been few studies exploring patient views on getting help for depression from these providers. The purpose of this study is to assess help seeking intention for depression and identify beliefs which moderate this intention. Telephone interviews of women following a routine gynecologic visit or in the immediate postpartum period (regarding prenatal care) were used to assess intention to seek help from their providers in a case of depression. For women who lacked this intention, related beliefs were elicited with the open ended question “why not?” Among the 225 women in the study more than half receiving gynecologic care (59%) and nearly a third of women who received prenatal care (29%; p < 0.001) stated they would not seek help from their OB/GYN for depression. Report that a prenatal provider had mentioned depression was associated with help seeking intention for depression but was not independent of confounding variables. Beliefs among women who lacked help seeking intention clustered into two attitude themes: 1) an OB/GYN is the wrong doctor for depression care and 2) OB/GYN is not a good setting for depression care. Many women have attitudes which reduce their intention to seek help for depression from their OB/GYN. Interventions aiming to increase delivery of depression care in these settings should consider these beliefs in their design.

Objective: To develop a better understanding of how men react to being diagnosed with prostate cancer and identify factors that influence these responses, we conducted an observational study to identify sociocultural predictors of men's psychological reactions. Methods: Participants were 70 African American and 124 white prostate cancer patients who completed a structured telephone interview that evaluated psychological reactions in terms of intrusive thoughts about cancer and attempts to avoid cancer-related thoughts and feelings. Perceptions of disease-specific stress, cultural beliefs and values, and social constraints were also assessed during the interview. Results: There were no racial differences in men's reactions to being diagnosed with prostate cancer; however, greater perceptions of disease-specific stress, increasing levels of present temporal orientation, and more social constraints had significant positive effects on avoidant reactions. Greater perceptions of stress also had a significant positive effect on intrusive thoughts. Conclusions: The results of this study highlight the need for individualized approaches to help men address their thoughts and feelings about being diagnosed with prostate cancer. These efforts should include strategies that help men to communicate more effectively with social support resources and address cultural beliefs and values related to temporal orientation. Copyright © 2009 John Wiley & Sons, Ltd.

The purpose of this investigation was to identify influences on the current clinical practices of a broad range of mental health providers as well as influences on their adoption and sustained use of new practices.U.S. and Canadian psychotherapists (N=2,607) completed a Web-based survey in which they rated factors that influence their clinical practice, including their adoption and sustained use of new treatments.Empirical evidence had little influence on the practice of mental health providers. Significant mentors, books, training in graduate school, and informal discussions with colleagues were the most highly endorsed influences on current practice. The greatest influences on psychotherapists' willingness to learn a new treatment were its potential for integration with the therapy they were already providing and its endorsement by therapists they respected. Clinicians were more often willing to continue to use a new treatment when they were able to effectively and enjoyably conduct the therapy and when their clients liked the therapy and reported improvement.Implications for dissemination and sustained use of new psychotherapies by community psychotherapists are discussed. For example, evidence-based treatments may best be promoted through therapy courses and workshops, beginning with graduate studies; to ensure future use of new therapies, developers of training workshops should emphasize ways to integrate their approaches into clinicians' existing practices.

The authors recently reviewed evidence related to the notion that psychotherapy extends survival in cancer patients (J. C. Coyne, M. Stefanek, & S. C. Palmer, 2007). The authors found that no study to date, including several designed and powered to test this hypothesis, can be reasonably interpreted as evidence that cancer patients live longer as a result of receiving psychotherapy. The authors concluded that the evidence against psychotherapy as a life-prolonging intervention in cancer is sufficiently robust to discontinue funding studies in this area. H. C. Kraemer, T. Kuchler, and D. Spiegel (2009) critiqued the authors' review. The authors respond directly to numerous misrepresentations made by Kraemer et al. More importantly, the authors provide readers with an accurate overview of the main issues being debated and the reasons for their conclusions.

Objective: Prognostic studies of mortality in patients with COPD have mostly focused on physiologic variables, with little attention to depressive symptoms. This stands in sharp contrast to the attention that depressive symptoms have been given in the outcomes of patients with other chronic health conditions. The present study investigated the independent association of depressive symptoms in stable patients with COPD with all-cause mortality.Methods: The baseline characteristics of 121 COPD patients (78 men and 43 women; mean [+/- SDI age, 61.5 +/- 9.1 years; and mean FEV(1), 36.9 +/- 15.5% predicted) were collected on hospital admission to a pulmonary rehabilitation center. The data included demographic variables, body mass index (BMI), post-bronchodilator therapy FEV(1), and Wpeak (peak workload [Wpeak]). Depressive symptoms were assessed using the Beck depression inventory. The vital status was ascertained using municipal registrations. In 8.5 years of follow-up, 76 deaths occurred (mortality rate, 63%). Survival time ranged from 88 days to 8.5 years (median survival time, 5.3 years). The Cox proportional hazard model was used to quantify the association of the baseline characteristics (ie, age, sex, marital status, smoking behavior, FEV(1), BMI, Wpeak, and depressive symptoms) with mortality.Results: Depressive symptoms (odds ratio [OR], 1.93; 95% confidence interval [CI], 1.12 to 3.33) were associated with mortality in patients with COPD, independent of other factors including male sex (OR, 1.73; 95% CI, 1.03 to 2.92), older age (OR, 1.05; 95% CI, 1.02 to 1.08), and lower Wpeak (OR, 0.98; 95% CI, 0.97 to 0.99).Conclusions: This study provides evidence that depressive symptoms assessed in stable patients with COPD are associated with their subsequent all-cause mortality.

Background: Comparisons of heart failure (FIF) patients with an unselected healthy sample in terms of quality of life (QoL) and depressive symptoms might prove misleading. We compared QoL, and depressive symptoms of a HF population with an age- and gender-matched sample of community dwelling elderly.Methods and Results: Data were collected from 781 HF patients (36% female., age 72 +/- 9; New York Heart Association II-IV) and 781 age- and gender-matched community-dwelling elderly. Participants Completed the Medical Outcome Study 36-item General Health Survey, the Cantril's Ladder of life, and the Center for Epidemiological Studies-Depression scale (CES-D). Analysis of variance techniques e with Welch F test and chi-square tests were used to describe differences in QoL and depressive symptoms between different groups. For both men and women with HF, QoL was reduced and depressive symptoms were elevated when compared with their elderly counterparts (CES-D >= 16: 39% vs. 21 %, P Conclusions: HF has it large impact on QoL and depressive symptoms, especially in women with HF. Differences persist, even in the absence of common comorbidities. Results demonstrate the need for studies of representative HF patients with direct comparisons to age- and gender-matched controls. (J. Cardiac Fail 2009;15:17-23)

Objective. To validate the Canine Brief Pain Inventory (CBPI), which is based on the human Brief Pain Inventory (BPI), in a canine model of spontaneous bone cancer. Design and Participants. One hundred owners of dogs with bone cancer self-administered the CBPI on three occasions to test the reliability, validity, and responsiveness of the measure. Outcome Measures. Factor analysis, internal consistency, convergent validity, and an extreme group validation assessment were completed using the responses from the first administration of the CBPI. Test–retest reliability was evaluated using two administrations of the instrument, 1 week apart. Responsiveness was tested by comparing responses 3 weeks apart. Results. The “severity” and “interference” factors hypothesized based on the BPI were demonstrated in the CBPI in dogs with bone cancer. Internal consistency was high (Cronbach's alpha, 0.95 and 0.93), as was test–retest reliability (kappa, 0.73 and 0.65). Convergent validity was demonstrated with respect to quality of life (r = 0.49 and 0.63). Extreme group validation against normal dogs showed significantly higher factor scores (P

Over 1,600 North American psychotherapists from a wide range of disciplines and practice settings completed an open-ended question on perceived barriers to adoption of new treatments as part of an internet survey. Content analysis indicated that there were five overall themes: clinician attitudes, client characteristics, contextual or institutional factors, training issues and other. The most frequently endorsed theme revolved around training issues, particularly, insufficient time and cost for training, lack of confidence in mastering the technique, and lack of opportunities for refining skills. Specific ideas for overcoming these barriers are identified.

Objective: An effective and safe alternative treatment to hormone replacement therapy for hot flashes is needed for cancer patients. Interventions targeting the triggering mechanisms of hot flashes hold promise. Increases in core body temperature are a precursor of most hot flashes in women, and similar findings in prostate cancer patients undergoing androgen deprivation therapy would support further research in this area. We present preliminary findings of physiological changes in a prostate cancer patient with frequent hot flashes. Methods: Physiological changes in sternal skin conductance, heart rate, and core body temperature were continuously measured during two 3.5 h laboratory sessions. Perceived characteristics of hot flashes were recorded in a diary. Results: Five hot flashes were reported during laboratory sessions. Severity and bother ratings were low. All hot flashes were accompanied by large increases in sternal skin conductance and moderate increases in heart rate. Core body temperature increased 0.11–0.32°C prior to and fell 0.23–0.44°C following the peak increase in skin conductance. Conclusions: This case study suggests that hot flashes in men may be preceded by increases in core body temperature. Identification of behavioral factors that raise core body temperature may lead to specific treatment strategies to reduce the frequency of hot flashes. Copyright © 2008 John Wiley & Sons, Ltd.

Although heterogeneity in the timing and persistence of maternal depressive symptomatology has implications for screening and treatment as well as associated maternal and child health outcomes, little is known about this variability. A prospective observational study of 1,735 low-income, multiethnic, inner-city women recruited in pregnancy from 2000 to 2002 and followed prospectively until 2004 (1 prenatal and 3 postpartum interviews) was used to determine whether distinct trajectories of depressive symptomatology can be defined from pregnancy through 2 years postpartum. Analysis was carried out through general growth mixture modeling. A model with 5 trajectory classes characterized the heterogeneity seen in the timing and magnitude of depressive symptoms among the study participants from Philadelphia, Pennsylvania. These classes included the following: 1) always or chronic depressive symptomatology (7%); 2) antepartum only (6%); 3) postpartum, which resolves after the first year postpartum (9%); 4) late, present at 25 months postpartum (7%); and 5) never having depressive symptomatology (71%). Women in these trajectory classes differed in demographic (nativity, education, race, parity) health, health behavior, and psychosocial characteristics (ambivalence about pregnancy and high objective stress). This heterogeneity should be considered in maternal depression programs. Additional research is needed to determine the association of these trajectory classes with maternal and child health outcomes.

BACKGROUND: Previous studies offer a limited perspective on the dynamic course of distress in cancer patients and their partners, owing to a restricted number of assessment points and the absence of comparison controls drawn from the general population. PURPOSE: This study investigated the course of distress among breast cancer patients and their partners (N = 92 couples) in comparison to matched control couples (N = 64). Furthermore, the influence of neuroticism on distress was investigated. METHOD: The Hospital Anxiety and Depression Scale was administered nine times over a 12-month period, and neuroticism was assessed at the beginning of the study using the Eysenck Personality Questionnaire. RESULTS: Multilevel analyses revealed that patients were more distressed during the first 15 months after diagnosis than nonpatients. A significant portion of the distress that could not be explained by the cancer experience was explained by neuroticism. CONCLUSION: Differences in distress between patients and comparison-control women are relatively small and decreased over time, while distress in male partners was not elevated in comparison to their controls.

Historically, obstetrical outcomes research has focused mainly on maternal and neonatal mortality, or life-threatening and serious illnesses resulting in hospitalization during pregnancy or following childbirth (1-8). A small number of more recent studies have addressed a much wider range of health problems that childbearing women may experience in the postpartum period – including, for example, backaches, headaches, fatigue, and perineal or pelvic pain. Albers has referred to this category of health problems as the “hidden morbidity” (1). Empirical findings suggest that such problems are quite common and can persist over time, and thus should be regarded as having considerable importance for the functional health status and the overall quality of life of women, during the postpartum period (3,9-14). The absence of better information about the extent and nature of this hidden morbidity has been identified by patients as a significant problem, since women are surprised by and may be unprepared to deal with the attendant discomfort and limitations. Similarly, obstetrical providers see the lack of epidemiological data as a significant barrier to the provision of optimal postpartum care (3). While awareness of the scope, prevalence and persistence of postpartum morbidity has improved, further research is needed to reveal its causes, correlates and consequences (13). Emotional health, for example, has been the subject of longstanding concern in obstetric and psychological literature (15-20), but surprisingly there are no known large-scale studies in the U.S. examining the link between the varying degrees and types of physical morbidity and depression or depressive symptoms in the postpartum period. This is in spite of well-documented comorbidity of physical illnesses, and depressive and emotional disorders in the wider adult and elderly populations,(21-25) which has arguably informed practice in ways that have improved the quality of care. The current study explores the relationships between postpartum physical health, functional impairment and the emotional well-being of postpartum women. Specifically, data from a community-based observational study are examined to determine the associations between some of the more commonly occurring postpartum morbidities, the presence of work, child care, daily activity functional limitations, depressive symptomatology, and overall self-rated emotional health of new mothers in the study sample.

Objective: Systems for efficient case finding of women with major depression during pregnancy and postpartum are needed. Here we assess the diagnostic accuracy of a modified 2-item patient health questionnaire (PHQ-2) as a pre-screen in assessing depression. Methods: Cross-sectional assessments at 15 weeks9 gestation (n = 414), 30 weeks9 gestation (n = 334), and 6 to 16 weeks postpartum (n = 193) among women from a diverse set of races/ethnicities, participating in the IMPLICIT maternal care quality improvement network. The Edinburgh Postnatal Depression Scale score (≥13) was used as the criterion measure for the PHQ-2. Results: A positive 2-item screen had sensitivity of 93%, 82%, and 80% and specificity of 75%, 80%, and 86% for Edinburgh Postnatal Depression Scale score of ≥13 for assessment at 15 and 30 weeks gestational age and postpartum, respectively. The positive/negative predictive values for the PHQ-2 were 44/98, 24/91, and 30/98 for each time point, respectively. Areas under the receiver operating characteristic curve analysis suggested that 2-item assessments at each time point had approximately equal diagnostic validity. Conclusions: Two questions were efficient to rule out depression and reduced the need for further screening of approximately 60% to 80% of women, depending on the point in pregnancy or postpartum. A diagnostic interview follow-up of women screening positive is still required.

Purpose: To analyze the prospectively collected health-related quality-of-life (HRQOL) data from patients enrolled in two Radiation Therapy Oncology Group randomized Phase III head and neck cancer trials (90-03 and 91-11) to assess their value as an independent prognostic factor for locoregional control (LRC) and/or overall survival (OS).Methods and Materials: HRQOL questionnaires, using a validated instrument, the Functional Assessment of Cancer Therapy-Head and Neck (FACT-H&N), version 2, were completed by patients before the start of treatment. OS and LRC were the outcome measures analyzed using a multivariate Cox proportional hazard model.Results: Baseline FACT-H&N data were available for 1,093 patients and missing for 417 patients. No significant difference in outcome was found between the patients with and without baseline FACT-H&N data (p = 0.58). The median follow-up time was 27.2 months for all patients and 49 months for surviving patients. Multivariate analyses were performed for both OS and LRC. Beyond tumor and nodal stage, Karnofsky performance status, primary site, cigarette use, use of concurrent chemotherapy, and altered fractionation schedules, the FACT-H&N score was independently predictive of LRC (but not OS), with p = 0.0038. The functional well-being component of the FACT-H&N predicted most significantly for LRC (p = 0.0004).Conclusions: This study represents, to our knowledge, the largest analysis of HRQOL as a prognostic factor in locally advanced head and neck cancer patients. The results of this study have demonstrated the importance of baseline HRQOL as a significant and independent predictor of LRC in patients with locally advanced head and neck cancer. (C) 2008 Elsevier Inc.

Despite decades of research, the causal mechanisms of hot flashes are not adequately understood, and a biopsychosocial perspective on hot flashes remains underdeveloped. This article explores overlooked parallels between hot flashes and panic attacks within 5 areas: course and symptomatology, physiological indicators, neurocircuitry and biochemical mechanisms, pharmacotherapy, and psychological treatment, noting both similarities and important differences between the 2 events. An integrative conceptual model is presented that identifies key ways in which psychological factors may influence the experience of hot flashes, with clinical implications and areas of future research. This model yields readily testable hypotheses and may provide a template for exploring the role of cognition in the frequency and severity of hot flashes and, in turn, a basis for the development of nonpharmacological treatments.

BACKGROUND: We examined the utility of an index of clinical exacerbations of heart failure (HF) as a surrogate measure of outcome for use in modestly sized clinical trials and observational studies.METHODS: Electronic records of 189 outpatients with HF in a US Veterans Affairs Medical Center were examined over a 2- to 3-year period. Data collected included patient characteristics, clinical exacerbations of HF, hospitalizations, and deaths. Subsets of patient were also assessed for HF-related level of functioning.RESULTS: Episodes of clinical exacerbation could be detected reliably (kappa = .83). An index of episodes (number of episodes divided by the time in years) was associated with lower quality of life, higher functional class, increased rate of HF hospitalization, poorer exercise tolerance, and up to 30% increased risk of mortality across 2 years.CONCLUSIONS: The index of HF exacerbations is potentially a useful surrogate end point for use in clinical HF research.

Research concerning distress in couples coping with cancer was integrated using meta-analysis and narrative critical appraisal. Individual levels of distress were determined more by gender than by the role of being the person with cancer versus that person's partner. That is, women reported consistently more distress than men regardless of their role (standardized mean difference = 0.31). The association between patient and partner distress within couples was only moderate (r = .29) but is sufficient to warrant further consideration of the notion that these couples react as an emotional system rather than as individuals. It is noteworthy that this association is not moderated by gender. With a general lack of comparison groups, the question of how much distress can be ascribed to the cancer experience cannot be answered decisively; elevations in distress are probably modest. We critically discuss these results, identify important unanswered questions, and indicate directions for future research. Attention needs to be directed toward factors other than cancer as direct influences of distress in these couples and to mediators and moderators of the cancer experience.