ORCID Profile
0000-0002-6460-9881
Current Organisations
Royal Melbourne Hospital
,
University of the Witwatersrand
,
University of Cape Town
,
University of Melbourne
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Publications
Screening for depression and anxiety in women with breast and gynaecologic cancer: course and prevalence of morbidity over 12 months
Publisher: Wiley
Date: 12-02-2013
DOI: 10.1002/PON.3253
Abstract: This study aims to investigate the course and prevalence of anxiety and depression symptoms over 56 weeks in women with newly diagnosed breast and gynaecologic cancer and determine the acceptability and efficiency of incorporating routine screening into practice. Participants completed the anxiety subscale of the Hospital Anxiety and Depression Scale (HADS-A) and Centre for Epidemiological Studies Depression Scale (CES-D) at diagnosis and again every 8 weeks for 56 weeks. Changes over time were analysed with repeated measures ANOVA adjusted for post hoc comparisons. Thresholds for caseness/referral to mental health were ≥ 11 and ≥ 16 on the HADS-A and CES-D, respectively. Participants were 167 women (101 breast, 66 gynaecologic). Mean ± SD age was 57.63 ± 22.66 years. Rates of anxiety (17.7%), depression (32.5%) and combined anxiety and depression (35%) symptoms were highest at diagnosis. Mean ± SD scores of anxiety (6.43 ± 3.83) and depression symptoms (12.68 ± 9.47) were highest at diagnosis with significant improvements observed by 8 and 24 weeks, respectively, and maintained thereafter. Overall rates of anxiety, depression and combined symptoms were 7.5%, 23.4% and 24.1%, respectively. Patients with breast and gynaecologic cancer did not differ. Referral was offered at least once to 94 women (56.3%), of whom 45 (47.9%) declined, 23 (24.5%) accepted and 26 (27.7%) were already receiving treatment. Patient evaluation was favourable. Women are most vulnerable to psychological morbidity at diagnosis. Symptoms improve significantly over time. Reported rates are lower than those in the literature. Regular screening by self-report is acceptable to patients but may not be the most efficient method of improving patient outcomes.
Tobacco smoking predicts depression and poorer quality of life in heart disease
Publisher: Springer Science and Business Media LLC
Date: 24-05-2013
Feasibility of Enhancing Parenting in Cancer, a psychoeducational intervention for communicating with children about parental cancer
Publisher: Wiley
Date: 06-03-2021
DOI: 10.1002/PON.5655
Maternal breast cancer and communicating with children: A qualitative exploration of what resources mothers want and what health professionals provide
Publisher: Hindawi Limited
Date: 11-2019
DOI: 10.1111/ECC.13153
Abstract: To explore the communication and resource needs of mothers diagnosed with breast cancer treated with curative intent in communicating with their young children and to identify gaps in the resources and support provided to these women. Data were collected via semi-structured telephone interviews from 13 mothers who were diagnosed with breast cancer while parenting a young child (age 3-12 years), and 10 health professionals in Victoria, Australia. Data were analysed qualitatively using the Framework Method. Mothers and health professionals prioritised communication with children about the cancer diagnosis however, health professionals and mothers differed in their views of parents' communication needs both in terms of the nature of the support/information needed and the delivery of this support/information. Mothers wanted easily accessible resources that were both instructive and practical. Mothers also emphasised quality over quantity of support. Health professionals were mostly aware of mothers' needs, however, emphasised less instructive support and information. This study highlights the need for improved coordination and tailoring of psychosocial resources and supports for these parents and families communicating about a cancer diagnosis with their young children.
Association between attributions of responsibility for motor vehicle crashes, depressive symptoms, and return to work.
Publisher: American Psychological Association (APA)
Date: 2014
DOI: 10.1037/REP0000012
Abstract: Perceptions surrounding the underlying causes of accidents and injuries may be a key mechanism influencing postaccident health and functional outcomes among people injured in road crashes. In particular, attributions of responsibility may influence rates of postcrash depressive symptomatology and return-to-work. We studied a large s le of people injured in motor vehicle crashes who were working at their time of accident and needed to take time off as a result of their injuries. Interviews took place at 2 time points, 12 months apart (T1: n = 1,024, T2: n = 303). Comparisons were made between participants' levels of depressive symptoms and rates of return to work based on their assessment of responsibility for their accident. People who did not attribute responsibility to themselves for their accident were 3 times more likely to exhibit symptoms of depression at follow-up than those who attributed responsibility to themselves. People with depressive symptoms were 3.5 times less likely to have returned to work. The effect of attributions of responsibility for accidents on return to work was mediated by the presence of depressive symptoms. Functional and psychological recovery from road trauma is closely associated with the assessment of responsibility for accidents. Findings are discussed in light of established posttrauma cognitive theories, the potential explanatory power of broader, more socially oriented models, and the changing nature of road trauma populations.
Cardiac-self efficacy predicts adverse outcomes in coronary artery disease (CAD) patients
Publisher: Scientific Research Publishing, Inc.
Date: 2013
Attributions of responsibility and recovery within a no-fault insurance compensation system.
Publisher: American Psychological Association (APA)
Date: 2014
DOI: 10.1037/A0036543
Abstract: Although a great deal of literature supports the negative relationship between postinjury health outcomes and compensation, it has not fully examined the relative influence of the erse factors that underlie compensable status. In particular, this study sought to understand the relative influence that attributions of responsibility for accidents have on mental and physical health outcomes. Using a structural equation modeling approach, we assessed the strength of relationships between demographic and accident circumstance variables, and postinjury mental and physical health for 934 road-trauma survivors compensated under a single no-fault insurance system. Analysis of direct and indirect effects demonstrated that although a range of standard demographic and accident circumstance variables influenced health outcomes, by far the greatest effect was generated from perceptions of responsibility for the accident. People who reported lower levels of responsibility for their accident showed significantly poorer mental and physical health outcomes. Perceptions of responsibility for accidents are strongly associated with postaccident mental and physical health outcomes within compensable road trauma populations. Future studies should control for attributions of responsibility when assessing the effect of compensation, or any other variable, on health outcomes among injured populations. Mechanisms underlying the effect of attributions of responsibility on outcomes, particularly in relation to its association with self-blame, warrant further exploration.
The Use of Statins After a Cardiac Intervention Is Associated With Reduced Risk of Subsequent Depression
Publisher: Physicians Postgraduate Press, Inc
Date: 14-12-2010
Sexual functioning after ovarian cancer: are women receiving the information and support they need?
Publisher: Springer Science and Business Media LLC
Date: 14-01-2022
DOI: 10.1007/S00520-021-06733-5
Abstract: Ovarian cancer (OC) can significantly impact sexual functioning beyond initial treatment and into survivorship. However, research suggests that the information and advice women want on this topic may not be readily provided by health professionals (HPs). We explored the psychological and sexual wellbeing of a s le of Australian women diagnosed with OC, to inform the development of effective, targeted sexuality resources. This paper presents a subset of our findings. Participants were recruited nationwide via social media, print advertisement and the database of a support organisation, Ovarian Cancer Australia. Self-reported demographic and clinical survey data were collected including perceptions of the availability and adequacy of sexuality support post-OC. Participants (n = 98) were on average 52.8 years old and 5.5 years post-diagnosis. A minority (22%) reported that the impact of OC on their sexuality was discussed by HPs and 46% were satisfied with that discussion. Approximately half (52%) had wanted to discuss sexuality concerns with a HP during treatment and 43% still felt the need for this discussion. Open-ended responses revealed the need for more information that was detailed and specified what to expect post-diagnosis. Shortcomings of HPs in addressing sexuality were also revealed. This research provides further evidence that sexual health remains inadequately addressed in OC care across the trajectory for the majority of women, and is an area of unmet need.
Mental health and occupational wellbeing of Australian gynaecologic oncologists
Publisher: Elsevier BV
Date: 03-2010
DOI: 10.1016/J.YGYNO.2009.10.080
Abstract: To investigate the prevalence of psychiatric morbidity and occupational burnout among Australian gynaecologic oncologists and to assess job stress and job satisfaction in this group. Anonymous, self-report questionnaires containing validated measures were sent to all practicing Australian gynaecologic oncologists in October 2008. The response rate was 78.4% (N=29). More than one-third (35.7%) had high levels of emotional exhaustion, the central component of burnout. In the past 6 months, 42.9%, 57.1%, and 28.6% had seriously considered leaving for another position, reducing the number of hours worked, and taking early retirement, respectively. The most commonly reported source of stress (80.8%) was home-life disruption due to work. Compared to general population data and recommended national guidelines, rates of alcohol consumption were high. Psychological morbidity, global job stress and burnout were significantly correlated and each was associated with harmful alcohol use. Other factors associated with burnout were administrative/organizational demands and patient volume. More than half of respondents (58.6%) had high levels of job satisfaction and most had high levels of personal accomplishment (70.4%). Perceived adequacy of the training curriculum and proposed changes to the curriculum are reported. Australian gynaecologic oncologists experience considerable occupational distress while possessing high levels of personal accomplishment and job satisfaction. To maintain a healthy workforce, it is important to build on existing supports while conducting further research to identify suitable evidence-based strategies for improving the mental health of these surgeons.
Long-Term Psychological Morbidity, Sexual Functioning, and Relationship Outcomes in Women With Gestational Trophoblastic Disease
Publisher: BMJ
Date: 07-2011
What Do Women With Gestational Trophoblastic Disease Understand About the Condition?
Publisher: BMJ
Date: 2011
DOI: 10.1097/IGC.0B013E31820156D8
Abstract: Little is known about patients' understanding of the causes, treatments, and implications of gestational trophoblastic disease (GTD). Clinical observation suggests that such health literacy is limited. We report on the perceptions of causes and treatment of GTD and its impact on fertility and reproductive outcomes. Cross-sectional analysis of 176 Australian women previously diagnosed with GTD (no longer receiving follow-up/treatment) recruited from a state-wide registry. Participants comprised 149 (85%) women with GTD who did not require chemotherapy and 27 (15%) women who required chemotherapy for malignancy or persistent molar disease. Data were collected from medical records and via self-report questionnaire. Participants were 94 women (53%) with partial mole, 75 (43%) with complete mole, 4 (2%) with choriocarcinoma, and 3 (2%) with hydatidiform mole not otherwise specified. Mean (SD) age at diagnosis and time since diagnosis were 32.1 (6.3) and 4.7 (3.3) years, respectively. Chance/bad luck was the most endorsed cause (n = 146, 83%) 23 (13%) thought GTD was hereditary and 10 (6%) identified a chromosomal etiology. Between 24% and 32% were unsure of the role of alcohol/drugs, venereal diseases, smoking, pollution, contraceptives, and lowered immunity. Surgical/medical procedure (n = 127, 72%) and healthy diet (n = 53, 30%) were the most endorsed treatments. Between 18% and 23% were unsure of the treatment effectiveness of diet, vitamins, exercise, complementary therapy, and contraception. All women treated with chemotherapy understood the rationale thereof 23 (85%) perceived chemotherapy to be successful, and 19 (70%) could name the agent. Few women perceived a negative impact on their fertility (n = 28, 16%) 52 (30%) were reluctant to conceive again and 100 (57%) questioned their ability to have healthy children. After diagnosis, 111 (63%) had at least 1 live birth. Notwithstanding limitations, this study is the largest of its type to date. These descriptive data enhance our understanding of patients' experience on GTD, highlight the scope of GTD health literacy, and may be useful for clinicians to adjust the content of their patient education.
Isolation experienced by women with gestational cancer
Publisher: Springer Science and Business Media LLC
Date: 03-07-2021
Psychometric properties of a scale to measure investment in the sick role: the Illness Cognitions Scale
Publisher: Wiley
Date: 25-10-2010
DOI: 10.1111/J.1365-2753.2010.01570.X
Abstract: A person's beliefs about their illness may contribute to recovery and prognosis. Some degree of acceptance of illness and its impact is necessary to integrate the presence of a chronic disorder into one's lifestyle and adhere to necessary components of illness management however, some in iduals can become 'stuck' and have difficulty adjusting out of the sick role. Inventories exist to measure illness cognitions, attitudes and behaviours as they relate to hypochondria and psychosomatic illness, but there is no extant measure of sick role inertia. We describe the psychometric properties of a new scale, the Illness Cognitions Scale (ICS), a metric of investment in the sick role. The ICS was administered to 97 in iduals with bipolar or schizoaffective disorder, and the psychometric properties of the scale measured. Dimensionality was assessed using Principal Components Analysis with Oblimin rotation. The scale has a strong internal consistency, with a Cronbach's alpha of 0.858. Results of a factor analysis suggested the presence of one main factor, with three other smaller, related sub-factors, capturing aspects of maladaptive illness beliefs. The ICS is a 17-item, internally validated scale measuring difficulty adjusting out of the sick role. The scale predominantly measures a single construct. Further research on external validity of the ICS is required as well as determination of the clinical significance and patient acceptability of the scale.
Consultation-Liaison Psychiatry in a Maternity Hospital
Publisher: SAGE Publications
Date: 04-2010
DOI: 10.3109/10398560903314120
Abstract: Objective: The aim of the study was to describe referral patterns of maternity inpatients to the consultation-liaison psychiatry (CLP) service at a large women's hospital in metropolitan Melbourne, Australia. Method: Clinicians recorded socio-demographic data, referring unit, consultee's reason for referral, psychiatric diagnosis made, and treatment provided for all maternity inpatients referred from 2004 to 2008. Results: Main reasons for referral were detection of depression, past psychiatric history, and concern regarding a woman's coping. Most common diagnoses were depression, substance use disorders and anxiety disorders. Many women referred for assessment while inpatients were initially seen in the antenatal period. Conclusions: Pregnant women referred to a CLP service present with a range of mental health problems, most often depression, anxiety and substance use disorders. Many of these problems are evident in and require intervention during the antenatal period as well as at the time of confinement. CLP services to maternity hospitals should be provided in the antenatal as well as the inpatient setting.
Psychological aspects of gestational cancer: A systematic review
Publisher: Wiley
Date: 22-09-2020
DOI: 10.1002/PON.5502
Abstract: Gestational cancer is defined as any type of cancer diagnosed during pregnancy or within 12 months of delivery. To date, existing studies on the psychological aspects of this type of cancer have not been evaluated for methodological quality. The aim of this systematic review was to identify the psychological aspects of gestational cancer. Five journal databases were searched to identify peer‐reviewed articles reporting upon the psychological aspects of women with gestational cancer. Studies published from journal inception to December 2019 were included, and Preferred Reporting Items for Systematic Reviews and Meta‐analyses (PRISMA) guidelines were followed. The Mixed‐Method Appraisal Bias Tool was used, to assess the methodological quality of the studies. A narrative description was developed for the psychological outcomes reported in quantitative studies. Qualitative data was synthesized using thematic analysis. Five papers were eligible for inclusion (two qualitative and three quantitative studies). Factors that contributed to women's psychological distress during gestational cancer included disease characteristics, sociodemographic factors, the baby's health, pregnancy‐related factors and cognitive emotion regulation. Four main themes emerged from the qualitative studies concerns about the baby's health, lost opportunities, “not fitting in,” and healthcare decision‐making. These findings suggest that (a) women with gestational cancer experience psychological distress that is associated with concerns about their babies' health, and (b) their healthcare experiences are affected by communication within multidisciplinary care teams.
Comparison of the Hospital Anxiety and Depression Scale and the Center for Epidemiological Studies Depression Scale for detecting depression in women with breast or gynecologic cancer
Publisher: Elsevier BV
Date: 2014
DOI: 10.1016/J.GENHOSPPSYCH.2013.08.010
Abstract: Depression is common in cancer patients but frequently undetected. Consensus regarding validity and optimal thresholds of screening measures is lacking. We investigated the validity of the Hospital Anxiety and Depression Scale (HADS-D) and Center for Epidemiological Studies Depression Scale (CES-D) relative to a referent diagnostic standard in women with breast or gynecologic cancer. Participants were 100 patients who completed the CES-D and HADS-D within a larger study. The Mini International Neuropsychiatric Interview was the criterion standard. Sensitivity, specificity, predictive values and likelihood ratios for various thresholds were calculated using receiver operating characteristics. Participants were assigned to two diagnostic groups: 'major depressive disorder' or 'any depressive disorder'. Separate analyses were conducted whereby participants found to be receiving depression/anxiety treatment at the time of validation (n=28) were excluded. Both measures had good internal consistency and criterion validity. There were no statistical differences in global accuracy between the measures for detecting either group. For optimal sensitivity and specificity in both groups, generally recommended thresholds were lowered for the HADS-D. For the CES-D, the threshold was lowered for 'any depressive disorder' and raised for 'major depressive disorder'. Negative predictive values associated with our recommended cutoffs were excellent, but positive predictive values were poor. The HADS-D and CES-D have acceptable properties and are equivalent for detecting depression in this population. Depending on the purpose of screening, the CES-D may be more suitable for identifying major depression. Threshold choice may have serious implications for screening program effectiveness, and the use of generally recommended thresholds should be cautious.
Should Every Woman with Gynecologic Cancer Undergo Routine Screening for Psychological Distress and Sexual Dysfunction?
Publisher: Springer London
Date: 16-10-2013
Validity of the Hospital Anxiety and Depression Scale and Patient Health Questionnaire-9 to screen for depression in patients with coronary artery disease
Publisher: Elsevier BV
Date: 09-2007
DOI: 10.1016/J.GENHOSPPSYCH.2007.06.005
Abstract: Depression is common but frequently undetected in patients with coronary artery disease (CAD). Self-report screening instruments for assessing depression such as the Hospital Anxiety and Depression Scale (HADS) and the Patient Health Questionnaire-9 (PHQ-9) are available but their validity is typically determined in depressed patients without comorbid somatic illness. We investigated the validity of these instruments relative to a referent diagnostic standard in recently hospitalized patients with CAD. Three months post-discharge for a cardiac admission, 193 CAD patients completed the HADS and PHQ-9. The Mini International Neuropsychiatric Interview (MINI) was the criterion standard. Scale reliability was calculated using Cronbach's alpha. Convergent validity was computed using Pearson's intercorrelations. Sensitivity and specificity for various cut-off scores for both measures and for the PHQ-9 categorical algorithm were calculated using receiver operating characteristics (ROC). For analyses, participants were assigned to two groups, 'major depressive disorder' or 'any depressive disorder'. For all calculations, alpha was 0.05 and tests were two-tailed. Internal consistencies for the two measures were excellent. Criterion validity for the PHQ-9 and HADS was good. We found no statistical differences between the PHQ-9 and HADS for detecting either group however, the categorical algorithm of the PHQ-9 for diagnosing major depression had a superior LR+ when compared with the summed HADS or PHQ-9. The operating characteristics of the screening instruments for 'any depressive disorder' were slightly lower than for 'major depressive disorder'. Some optimum cut-off scores were lower than the generally recommended cut-off scores, particularly when screening for major depression (e.g., > or = 5/6 vs. > or = 10 and > or = 8 for PHQ-9 and HADS, respectively). Lowering the cut off scores substantially improved the sensitivity of these instruments while retaining specificity, thereby improving their usefulness to screen for CAD patients with depression. Both instruments have acceptable properties for detecting depression in recently hospitalized cardiac patients, and neither scale is statistically superior when summed scores are used. The categorical algorithm of the PHQ-9 for diagnosing major depression has a superior LR+ compared to the summed PHQ-9 and HADS scores. Use of the generally recommended cut-off scores should be cautious. In light of the aversive outcomes associated with depression in CAD, screening for depression is a clinical priority.
Fear of cancer recurrence as a pathway from fatigue to psychological distress in mothers who are breast cancer survivors
Publisher: Wiley
Date: 08-07-2022
DOI: 10.1002/SMI.3180
Abstract: Fatigue is prevalent and pervasive among breast cancer survivors. Mothers are particularly susceptible to fatigue due to the ongoing demands of their caring role. While fatigue has been associated with psychological distress in prior research, the pathway by which fatigue translates into psychological distress is unclear. Given the theoretical and empirical links between fatigue, fear of cancer recurrence (FCR) and psychological distress, the role of FCR in mediating the relationship between fatigue and psychological distress in mothers who are breast cancer survivors was investigated. Ninety‐two mothers who were breast cancer survivors completed the Depression, Anxiety and Stress Scale, PROMIS‐Cancer Fatigue Short Form and Concerns About Cancer Recurrence scale in an online survey. Mediation analysis via PROCESS was used to examine whether fatigue predicted depression, anxiety or stress through FCR. Fear of cancer recurrence mediated the relationships between fatigue and anxiety and fatigue and stress, while fatigue directly predicted depression. This study highlights FCR as a potential pathway to anxiety and stress in response to ongoing fatigue, and as a mechanism of action to reduce psychological distress among mothers who are breast cancer survivors. Future research examining this pathway from fatigue to psychological distress should also explore the nature of mothers' fears about their cancer recurring.
Illness beliefs about heart disease and adherence to secondary prevention regimens
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2008
The sick role, illness cognitions and outcomes in bipolar disorder
Publisher: Elsevier BV
Date: 03-2013
DOI: 10.1016/J.JAD.2012.07.003
Abstract: In some in iduals, recovery from episodes of mental illness may be impeded by maladaptive illness beliefs and behaviors. For in iduals with chronic illness, acceptance of its presence and consequences is necessary to seek appropriate treatment, adjust their lifestyle, and adhere to recommended management strategies. Some have difficulty adjusting out of the sick role or develop a degree of illness investment. The Illness Cognitions Scale (ICS) is a 17-item validated scale that measures cognitive factors associated with the sick role. We conducted analyses to test the hypothesis that there may be an association between illness cognitions and clinical and functional measures. The ICS was administered to 89 participants at the final study visit of a 24-month observational study involving patients with bipolar I disorder or schizoaffective disorder. Higher scores on the ICS were correlated with more severe depression (p<0.0001), worse general health (p=0.0002), worse functioning (p=0.0001), and worse scores in psychosocial measures including the State Hope Scale (p=0.0082), the Social Provisions Scale (p=0.0054) and the Rosenberg Self-Esteem Scale (p=0.0025). Illness cognitions and behavior may be a neglected factor that could influence treatment outcomes in bipolar disorder. The ICS might be useful for identifying in iduals whose recovery may be facilitated by targeted psychological intervention that addresses these factors.
Comorbid depression and health-related quality of life in patients with coronary artery disease
Publisher: Elsevier BV
Date: 04-2007
DOI: 10.1016/J.JPSYCHORES.2006.12.009
Abstract: This article reviews recent studies relating to the impact of depression and its treatment on the health-related quality of life (HRQOL) of patients with coronary artery disease (CAD). Articles for the primary review were identified via MEDLINE and PsycINFO (1995-2006). Evidence suggests that depression has an aversive impact on the HRQOL of patients with stable CAD as well as on patients hospitalized for acute myocardial infarction and coronary artery bypass graft surgery. Unfortunately, there are few depression treatment studies in patients with CAD that make use of standardized HRQOL measures, but the limited evidence suggests that successful treatment has positive implications for HRQOL in these patients. The mechanisms through which depression impacts on HRQOL require further study but are likely to be behavioral. Depressive symptoms significantly undermine HRQOL in patients with CAD despite successful medical and surgical management. Although successful treatment of depression has not been shown to reduce mortality rates in patients with CAD, further study may find that the HRQOL benefits of such treatment are equally valuable.
Anxiety and depression symptoms in the 2 years following diagnosis of breast or gynaecologic cancer: prevalence, course and determinants of outcome
Publisher: Springer Science and Business Media LLC
Date: 06-01-2015
DOI: 10.1007/S00520-014-2571-Y
Abstract: The purposes of this study are to examine the course and prevalence of anxiety and depression over 24 months in women with newly diagnosed breast and gynaecologic cancer and, controlling for demographic and clinical confounders, to test the role of neuroticism and psychiatric history in determining outcome 6, 12, 18 and 24 months post-diagnosis. Participants completed the Hospital Anxiety and Depression Scale-anxiety subscale and Centre for Epidemiological Studies Depression Scale on an 8-weekly basis from diagnosis until 96 weeks. Changes over time were analyzed with repeated measures ANOVA. Hierarchical linear regression, adjusted a priori for age, chemotherapy and radiation treatment, living alone, education and tumour stream were used to predict anxiety and depression. Participants were 105 women (66 breast, 39 gynaecologic). Rates of anxiety (18.1 %) and depression (33.3 %) were highest at diagnosis. Average rates of anxiety and depression were 5.9 and 22.4 %, respectively. Average scores of anxiety and depression were highest at diagnosis, with improvement at 8 and 40 weeks, respectively, subsequently maintained. Morbidity at diagnosis was particularly acute among women with a treatment history of anxiety/depression or with high neuroticism. These three variables were the best and only predictors over 24 months. Women are most vulnerable to anxiety and depression at diagnosis, with improvement over time. Morbidity rates are lower than reported elsewhere. Women with high neuroticism and a psychiatric history are at greatest risk for future morbidity after adjusting for confounders. Early identification of these women plus heightened surveillance or early referral to psychosocial services may protect against longer-term morbidity.
Why did we fail? Challenges recruiting parents with cancer into a psycho‐educational support program
Publisher: Wiley
Date: 31-10-2019
DOI: 10.1002/PON.5226
Experiences and interpretations of BRCA1/2 testing among women affected by breast or ovarian cancer who received a negative result
Publisher: Springer Science and Business Media LLC
Date: 27-03-2019
Partners of long-term gynaecologic cancer survivors: Psychiatric morbidity, psychosexual outcomes and supportive care needs
Publisher: Elsevier BV
Date: 09-2010
DOI: 10.1016/J.YGYNO.2010.05.019
Abstract: To describe long-term psychological morbidity, unmet supportive care needs, positive changes, sexual outcomes and relationship satisfaction in partners of gynaecologic cancer survivors, as compared with respective survivors. Self-report measures were administered to a cross-sectional s le of 68 partners recruited via patient survivors. Rates of depression and anxiety among partners were 8.8% and 10.3%, respectively. Anxiety was higher among survivors than partners (P=0.003). Partners reported a mean of 3.25 unmet needs and 48.5% had at least one unmet need. At least one positive change was reported by 66.2% of partners. Greater number of unmet needs was the most important predictor of both anxiety (beta=0.39 P=0.001) and depression (beta=0.45 P<0.001). Poor relationship satisfaction independently predicted greater anxiety (beta=-0.28 P=0.01). Perceptions of relationship satisfaction did not differ within couples. Half of couples had been sexually active in the preceding month. Most reported no change in interest in physical contact (76.4%) or sex (70.6%), had excellent sexual function and high levels of satisfaction with sex life. Compared to partners, survivors perceived worse vaginal stenosis and dryness (both P=0.002) and worse satisfaction with (survivors') appearance (P<0.001). Partner outcomes were not associated with demographic variables or survivors' clinical characteristics. The majority of partners reported excellent sexual outcomes and little perceived change since the survivors' diagnosis. The association between unmet needs and psychological morbidity suggests a useful target for further intervention. Despite methodological limitations, these data are novel and present a starting point for further investigation to improve outcomes for survivors and partners.
Contemporary Topics in Women's Mental Health: Global Perspectives in a Changing Society
Publisher: SAGE Publications
Date: 02-2011
‘Sometimes I can't look in the mirror’: Recognising the importance of the sociocultural context in patient experiences of sexuality, relationships and body image after ovarian cancer
Publisher: Hindawi Limited
Date: 05-07-2022
DOI: 10.1111/ECC.13645
Abstract: Ovarian cancer (OC) can significantly change the way women feel about their body. However, personal accounts regarding these changes are lacking in the literature. Therefore, the aim of this study was to gain an understanding of the ways in which OC can affect relationships, sexuality, womanhood and body image. Ninety-eight Australian women aged 18 and over diagnosed with OC completed an online survey that invited narrative responses to open-ended questions about relationships, sexuality, body image and womanhood following OC treatment. Responses were analysed thematically while applying a sociocultural lens. Three themes and two subthemes were identified: Failure and Loss of Femininity and Womanhood, Internalising Public Perception of Body and Illness and Altered Relationships which comprised two subthemes, Loss of the Sexual Self and Relationship Burden. These themes suggest women view themselves and their relationships in comparison with sociocultural understandings of body normalcy. Women often questioned their self-worth, their relationships and place within society due to changes in fertility, sexuality and bodily functioning. These results highlight a need for health care professionals to open dialogue with women about sexuality and ensure information and support is given to reduce stigma and positively influence self-perception and increase body acceptance.
Cancer during pregnancy
Publisher: Hindawi Limited
Date: 10-02-2021
DOI: 10.1111/ECC.13425
Long-term quality of life in Australian women previously diagnosed with gynaecologic cancer
Publisher: Springer Science and Business Media LLC
Date: 31-12-2010
DOI: 10.1007/S00520-010-1064-X
Abstract: The purpose of this study is to investigate challenges to quality of life (QOL) among women previously diagnosed with gynaecologic cancer accessing a metropolitan Australian oncology service. Indices of QOL investigated were anxiety, depression, sexual morbidity, body image and supportive care needs. Findings are to inform service planning and research priorities. This study is a cross-sectional analysis of 176 women diagnosed with gynaecologic cancer from 1997 to 2006. Data were collected from medical records and via self-report questionnaire comprising validated measures of QOL indices. Respondents have cancers of the endometrium (n = 56, 32%), ovary (n = 71, 40%), cervix (n = 27, 15%) and other less common types (n = 22, 13%). Mean (SD) age and time since diagnosis were 58.6 (13.2) and 4.7 (2.9) years, respectively. Using cut-offs of ≥ 8 and ≥ 11 on the Hospital Anxiety and Depression Scale, 55 (31%) and 27 (15%) women reported anxiety and 28 (16%) and 10 (6%) women reported depression, respectively. On average, 5.26 unmet needs were reported. Concerns about recurrence were the most common unmet need (30%). Two thirds had not been sexually active in the preceding month. Most (87%) were not worried about their sex life or lack thereof. Mean (SD) score on the Body Image Scale was 7.21 (7.37). Tumour groups did not differ on any outcomes. Despite limitations, these data shed light on challenges to QOL of a heterogeneous group of gynaecologic cancer survivors. Sexual and psychological morbidity outcomes compare favourably with the literature while body image disturbance may present a useful target for clinical intervention.
Cognitive-personality style as vulnerability to depression in patients with coronary artery disease: Roles of sociotropy and autonomy
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2009
Mindfulness-based cognitive group therapy for women with breast and gynecologic cancer: A pilot study to determine effectiveness and feasibility
Publisher: Springer Science and Business Media LLC
Date: 18-06-2013
DOI: 10.1007/S00520-013-1880-X
Abstract: Group-based mindfulness training is frequently described in psycho-oncology literature, but little is known of the effectiveness of mindfulness-based cognitive therapy (MBCT). We investigated the effectiveness and acceptability of MBCT for women with breast and gynecologic cancer. Fifty women were recruited to participate in eight weekly 2-h mindfulness sessions. Outcomes of distress, quality of life (QOL), post-traumatic growth, and mindfulness were assessed pre-intervention, post-intervention, and again 3 months later using validated measures. Data were analyzed with repeated measures ANOVAs with a Bonferroni correction. Participant satisfaction and evaluation were also assessed. Forty-two women completed the program, and complete data were available for 36 women. Significant improvements with large effect sizes (ηρ(2)) were observed for distress (P < 0.001 ηρ(2) = 0.238), QOL (P = 0.001 ηρ(2) = 0.204), mindfulness (P < 0.001 ηρ(2) = 0.363) and post-traumatic growth (P < 0.001 ηρ(2) = 0.243). Gains were maintained 3 months post-intervention. Improvements in outcomes did not differ based on diagnostic group, psychological status, or physical well-being at entry. Change indices further support these findings. Scores on measures of distress, QOL, and post-traumatic growth decreased as a function of increased mindfulness at each time point (all P < 0.05). Participants reported experiencing the program as beneficial, particularly its group-based nature, and provided positive feedback of the therapy as a whole as well as its in idual components. Within the limits of a non-randomized trial, these findings provide preliminary support for the potential psychosocial benefits of MBCT in a heterogeneous group of women with cancer. Future, more comprehensive trials are needed to provide systematic evidence of this therapy in oncology settings.
Comparison of the acceptability and benefits of two mindfulness-based interventions in women with breast or gynecologic cancer: a pilot study
Publisher: Springer Science and Business Media LLC
Date: 04-10-2015
DOI: 10.1007/S00520-014-2442-6
Abstract: The aim of this study was to compare the relative benefits and acceptability of two different group-based mindfulness psychotherapy interventions among women with breast and gynecologic cancer. Data from 42 women who completed an 8-week mindfulness-based cognitive therapy (MBCT) program comprising 22 contact hours were compared to data from 24 women who completed a 6-week mindfulness meditation program (MMP) comprising 9 contact hours. Distress, quality of life (QOL), and mindfulness were evaluated pre- (T1) and post-intervention (T2). ANCOVA was used to analyse the relationship between intervention type and T1 score on outcome variable change scores. Participants' perceptions of benefit and acceptability were assessed. The participants did not differ on clinical or demographic variables other than MBCT participants were more likely than MMP participants to have a past history of anxiety or depression (p = .01). Scores on distress, QOL, and mindfulness improved from T1 to T2 with medium to large effect sizes for the MMP (p=.002, d=.7 p=.001, d=.8 p=.005, d=.6, respectively) and MBCT (p<.001,d = .6 p=.008, d = .4 p<.001, d=.9, respectively) interventions. [correted]. ANCOVA showed no main effect for intervention type on outcome change scores and no interaction between intervention type and respective T1 score. Distress and mindfulness scores at T1 had a main effect on respective change scores (p = .02, ηp (2) = .87 p = .01, ηp (2) = .80, respectively). Both programs were perceived as beneficial and acceptable with no differences between the intervention types. Within the limits of a small, non-randomized study, these findings provide preliminary support for the utility of a brief mindfulness intervention for improving distress and QOL in a heterogeneous group of women with cancer. Abbreviated interventions are less resource intensive and may be attractive to very unwell patients.
Are illness perceptions about coronary artery disease predictive of depression and quality of life outcomes?
Publisher: Elsevier BV
Date: 03-2009
DOI: 10.1016/J.JPSYCHORES.2008.09.005
Abstract: Depression occurs commonly in coronary artery disease (CAD) and is associated with substantial disability. Modifiable cognitive determinants of depression in this population have not been identified. We investigated the impact of potentially modifiable illness beliefs about CAD on depressive symptomatology. We also examined the association between these beliefs and health-related quality of life (HRQOL) and socio-demographic variations in illness beliefs. A prospective study of 193 recently hospitalized CAD patients was conducted. Data were collected from medical records and by self-report 3 and 9 months post-discharge. Socio-demographic differences were analysed with independent s le t-tests. Predictive models were tested in a series of hierarchical linear regression equations that controlled for known clinical, psychosocial, and demographic correlates of outcome. Negative illness beliefs, particularly those associated with the consequences of CAD, were significantly predictive of higher levels of depressive symptomatology at 3 and 9 months. Positive illness perceptions were significantly associated with better HRQOL outcomes. Older and less socially advantaged patients demonstrated more negative illness beliefs. Illness beliefs are significantly associated with depressive symptomatology and HRQOL in CAD patients. These beliefs can be easily identified and constitute a meaningful and clinically accessible avenue for improving psychological morbidity and HRQOL in CAD patients. Older and more socially vulnerable patients may require heightened monitoring of their illness beliefs. Research needs to translate these and other predictive findings into interventions.
The Early Motherhood Service: An Acceptable and Accessible Perinatal Mental Health Service
Publisher: SAGE Publications
Date: 06-2011
DOI: 10.3109/10398562.2011.562294
Abstract: Objectives: The aims of this paper are to quantify the effect of an innovative perinatal mental health program, the Early Motherhood Service, to identify factors contributing to its success, and to make recommendations as to its general applicability across other rural services. Method: The study involved stakeholder evaluation, analysis of available outcome data and analysis of consumer feedback data. Results: Service functions were grouped into four key areas: increasing awareness of perinatal mental health problems providing information and advice providing treatment and support and education, training and capacity building. Women accessing the service showed significant improvement in outcomes as measured by change over time in the Edinburgh Postnatal Depression Scale and the Health of the Nation Outcome Scale. Consumer feedback demonstrated that the service was highly valued. Key factors identified as contributing to the service's success were broad coverage of perinatal mental health problems inclusion of early intervention and prevention outreach capacity partnership with, support for and capacity building of other health providers a location which is accessible and non-stigmatizing and staff comprising senior and skilled clinicians. Conclusions: The Early Motherhood Service is an innovative perinatal mental health service. It provides a useful model for the development of such services in rural communities.
Psychological distress, role, and identity changes in mothers following a diagnosis of cancer: A systematic review
Publisher: Wiley
Date: 19-10-2018
DOI: 10.1002/PON.4904
Abstract: To systematically review findings of the impact of cancer diagnosis and treatment on mothers' psychological well-being, roles, and identity and to explore the psychosocial factors that contribute to mothers' psychological well-being. Six databases were searched for research articles and theses exploring the association between the impact of cancer diagnosis and treatment on mothers' psychological well-being, identity, and role, and the psychosocial factors contributing to mothers' psychological distress regardless of their cancer type and stage. The Mixed-Method Appraisal Bias Tool was used to assess the selected studies' methodological quality. A total of 30 qualitative, quantitative, and mixed-method studies were deemed eligible for inclusion. Most studies reported that mothers experienced significant psychological distress, changes to or loss of parenting efficacy, maternal identity, and role. Psychosocial factors that contributed to mothers' distress included mothers' young age, presence of metastases, lower parenting efficacy, fear of cancer recurrence, higher illness intrusiveness, and lack of appropriate support. Four main themes emerged from the qualitative studies: psychological impact of cancer on mothers, changes in maternal identity and role, relationship changes and concerns for their children, and meaning-making in cancer experience. Changes in mothers' psychological well-being, role, and identity occurred across cancer diagnoses, treatment, and recovery trajectories. The evidence suggests that mothers may benefit from continued and tailored psychosocial support to cope with these challenges, even after treatment is completed. Further studies with improved methodological quality are needed to explore these issues in depth.
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