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BMC Pediatrics Jan 2009Children with congenital heart defects (CHD) requiring open-heart surgery are a group at high risk for health-related sequelae. Little consensus exists regarding their... (Review)
Review
BACKGROUND
Children with congenital heart defects (CHD) requiring open-heart surgery are a group at high risk for health-related sequelae. Little consensus exists regarding their long-term psychological adjustment (PA) and health-related quality of life (QoL). Thus, we conducted a systematic review to determine the current knowledge on long-term outcome in this population.
METHODS
We included randomized controlled trials, case control, or cohort studies published between 1990-2008 evaluating self- and proxy-reported PA and QoL in patients aged between two and 17 years with a follow-up of at least two years after open heart surgery for CHD.
RESULTS
Twenty-three studies assessing psychological parameters and 12 studies assessing QoL were included. Methodological quality of the studies varied greatly with most studies showing a moderate quality. Results were as follows: (a) A considerable proportion of children experienced psychological maladjustment according to their parents; (b) studies on self-reported PA indicate a good outcome; (c) the studies on QoL suggest an impaired QoL for some children in particular for those with more severe cardiac disease; (d) parental reports of psychological maladjustment were related to severity of CHD and developmental delay.
CONCLUSION
A significant proportion of survivors of open-heart surgery for CHD are at risk for psychological maladjustment and impaired QoL. Future research needs to focus on self-reports, QoL data and adolescents.
Topics: Adaptation, Psychological; Adolescent; Cardiac Surgical Procedures; Child; Child, Preschool; Heart Defects, Congenital; Humans; Quality of Life; Time Factors; Treatment Outcome
PubMed: 19161602
DOI: 10.1186/1471-2431-9-6 -
BMJ (Clinical Research Ed.) Dec 2020To evaluate evidence from randomised controlled trials and non-randomised controlled trials on the effectiveness of hospital clowns for a range of symptom clusters in...
OBJECTIVE
To evaluate evidence from randomised controlled trials and non-randomised controlled trials on the effectiveness of hospital clowns for a range of symptom clusters in children and adolescents admitted to hospital with acute and chronic conditions.
DESIGN
Systematic review of randomised and non-randomised controlled trials.
DATA SOURCES
Medline, ISI of Knowledge, Cochrane Central Register of Controlled Trials, Science Direct, Scopus, American Psychological Association PsycINFO, Cumulative Index to Nursing and Allied Health Literature, and Latin American and Caribbean Health Sciences Literature.
STUDY SELECTION
Randomised and non-randomised controlled trials were peer reviewed using the following eligibility criteria: children and adolescents who were admitted to hospital for acute conditions or chronic disorders, studies comparing use of hospital clowns with standard care, and studies evaluating the effect of hospital clowns on symptom management of inpatient children and adolescents as a primary outcome.
DATA EXTRACTION AND SYNTHESIS
Two investigators independently screened studies, extracted data, and appraised the risk of bias. Methodological appraisal was assessed by two investigators independently using the Jadad scale, the revised Cochrane risk-of-bias tool for randomised controlled trials (RoB 2), and the risk of bias in non-randomised studies (ROBINS-I) tool for non-randomised controlled trials.
RESULTS
24 studies (n=1612) met the inclusion criteria for data extraction and analysis. Most studies were randomised controlled trials (n=13). Anxiety was the most frequently analysed symptom (n=13), followed by pain (n=9), psychological and emotional responses and perceived wellbeing (n=4), stress (n=4), cancer related fatigue (n=3), and crying (n=2). Five studies used biomarkers, mainly cortisol, to assess stress or fatigue outcome following hospital clowns. Most of the randomised controlled trials (n=11; 85%) were rated as showing some concerns, and two trials were rated with a high risk of bias. Most non-randomised controlled trials (n=6; 55%) were rated with a moderate risk of bias according to ROBINS-I tool. Studies showed that children and adolescents who were in the presence of hospital clowns, either with or without a parent present, reported significantly less anxiety during a range of medical procedures, as well as improved psychological adjustment (P<0.05). Three studies that evaluated chronic conditions showed favourable results for the intervention of hospital clowns with significant reduction in stress, fatigue, pain, and distress (P<0.05).
CONCLUSIONS
These findings suggest that the presence of hospital clowns during medical procedures, induction of anaesthesia in the preoperative room, and as part of routine care for chronic conditions might be a beneficial strategy to manage some symptom clusters. Furthermore, hospital clowns might help improve psychological wellbeing in admitted children and adolescents with acute and chronic disorders, compared with those who received only standard care.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO CRD42018107099.
Topics: Acute Disease; Anxiety; Child; Child, Hospitalized; Chronic Disease; Fatigue; Humans; Laughter Therapy; Non-Randomized Controlled Trials as Topic; Pain Management; Randomized Controlled Trials as Topic; Stress, Psychological
PubMed: 33328164
DOI: 10.1136/bmj.m4290 -
Journal of the National Cancer Institute Dec 2018We aimed to systematically review the evidence on adverse mental health outcomes in breast cancer survivors (≥1 year) compared with women with no history of cancer. (Meta-Analysis)
Meta-Analysis
BACKGROUND
We aimed to systematically review the evidence on adverse mental health outcomes in breast cancer survivors (≥1 year) compared with women with no history of cancer.
METHODS
Studies were identified by searching MEDLINE, PsycINFO, the Cumulative Index to Nursing and Allied Health Literature, and the Social Sciences Citation Index, and through backward citation tracking. Two researchers selected the studies, extracted data, and assessed the risk of bias.
RESULTS
Sixty studies were included. Of 38 studies of depression, 33 observed more depression in breast cancer survivors; this was statistically significant in 19 studies overall, including six of seven where depression was ascertained clinically, three of four studies of antidepressants, and 13 of 31 that quantified depressive symptoms. Of 21 studies of anxiety, 17 observed more anxiety in breast cancer survivors, statistically significant in 11 studies overall, including two of four with clinical/prescription-based outcomes, and in eight of 17 of anxiety symptoms. Breast cancer survivors also had statistically significantly increased symptoms/frequency of neurocognitive dysfunction (18 of 24 studies), sexual dysfunctions (5 of 6 studies), sleep disturbance (5 of 5 studies), stress-related disorders/PTSD (2 of 3 studies), suicide (2 of 2 studies), somatisation (2 of 2 studies), and bipolar and obsessive-compulsive disorders (1 of 1 study each). Studies were heterogeneous in terms of participants' characteristics, time since diagnosis, ascertainment of outcomes, and measures reported. Approximately one-half of the studies were at high risk of selection bias and confounding by socio-economic status.
CONCLUSIONS
There is compelling evidence of an increased risk of anxiety, depression and suicide, and neurocognitive and sexual dysfunctions in breast cancer survivors compared with women with no prior cancer. This information can be used to support evidence-based prevention and management strategies. Further population-based and longitudinal research would help to better characterize these associations.
Topics: Anxiety; Breast Neoplasms; Cancer Survivors; Cognitive Dysfunction; Depression; Humans; Mental Health; Outcome Assessment, Health Care; Publication Bias; Survivorship
PubMed: 30403799
DOI: 10.1093/jnci/djy177 -
International Psychogeriatrics Dec 2013Many people with mild cognitive impairment (MCI) or early dementia suffer from concomitant depression and anxiety disorders, which in some cases, may be related... (Review)
Review
BACKGROUND
Many people with mild cognitive impairment (MCI) or early dementia suffer from concomitant depression and anxiety disorders, which in some cases, may be related difficulties adjusting to their diagnosis and associated cognitive problems. Successful adjustment and alleviation of depression and anxiety symptoms in these people is of critical importance for quality of life and may also help prevent, or delay, further cognitive decline. A variety of psychosocial intervention approaches has been trialed with this group.
METHOD
The literature was systematically searched for community-based intervention studies that aim to improve depression, anxiety, or adjustment. Studies were included or excluded using a priori criteria. Once included, the quality of studies was evaluated using pre-set criteria.
RESULTS
Seventeen of 925 studies identified through literature databases and manual searches met the inclusion criteria. Of these, 16 were considered to be of at least "adequate quality." These included seven randomized controlled trials and eight pre-post studies. A diverse range of psychotherapeutic approaches, formats (individual or group), outcome measures, inclusion criteria, and cultural contexts were apparent, making comparisons between studies challenging.
CONCLUSIONS
Several studies have demonstrated positive findings in the treatment of depression in older adults with early dementia using problem solving and modified cognitive behavior therapy (CBT) approaches. Amongst the large range of approaches trialed to improve adjustment and quality of life for patients with MCI and early dementia, some approaches, such as modified CBT, have shown promise. There is a need for replication studies using more rigorous methodology before clear clinical recommendations can be made.
Topics: Adaptation, Psychological; Anxiety; Cognitive Dysfunction; Dementia; Depression; Humans; Psychotherapy
PubMed: 24125507
DOI: 10.1017/S104161021300152X -
Orphanet Journal of Rare Diseases Oct 2014In recent decades, considerable progress in diagnosis and treatment of patients with intoxication-type inborn errors of metabolism (IT-IEM) such as urea cycle disorders... (Review)
Review
BACKGROUND
In recent decades, considerable progress in diagnosis and treatment of patients with intoxication-type inborn errors of metabolism (IT-IEM) such as urea cycle disorders (UCD), organic acidurias (OA), maple syrup urine disease (MSUD), or tyrosinemia type 1 (TYR 1) has resulted in a growing group of long-term survivors. However, IT-IEM still require intense patient and caregiver effort in terms of strict dietetic and pharmacological treatment, and the threat of metabolic crises is always present. Furthermore, crises can affect the central nervous system (CNS), leading to cognitive, behavioural and psychiatric sequelae. Consequently, the well-being of the patients warrants consideration from both a medical and a psychosocial viewpoint by assessing health-related quality of life (HrQoL), psychological adjustment, and adaptive functioning. To date, an overview of findings on these topics for IT-IEM is lacking. We therefore aimed to systematically review the research on HrQoL, psychological adjustment, and adaptive functioning in patients with IT-IEM.
METHODS
Relevant databases were searched with predefined keywords. Study selection was conducted in two steps based on predefined criteria. Two independent reviewers completed the selection and data extraction.
RESULTS
Eleven articles met the inclusion criteria. Studies were of varying methodological quality and used different assessment measures. Findings on HrQoL were inconsistent, with some showing lower and others showing higher or equal HrQoL for IT-IEM patients compared to norms. Findings on psychological adjustment and adaptive functioning were more consistent, showing mostly either no difference or worse adjustment of IT-IEM patients compared to norms. Single medical risk factors for HrQoL, psychological adjustment, or adaptive functioning have been addressed, while psychosocial risk factors have not been addressed.
CONCLUSION
Data on HrQoL, psychological adjustment, and adaptive functioning for IT-IEM are sparse. Studies are inconsistent in their methodological approaches, assessment instruments and norm populations. A disease-specific standard assessment procedure for HrQoL is not available. Psychosocial risk factors for HrQoL, psychological adjustment, or adaptive functioning have not been investigated. Considering psychosocial variables and their corresponding risk factors for IT-IEM would allow evaluation of outcomes and treatments as well as the planning of effective social and psychological interventions to enhance the patients' HrQoL.
Topics: Adaptation, Psychological; Humans; Metabolism, Inborn Errors; Quality of Life; Risk Factors
PubMed: 25344299
DOI: 10.1186/s13023-014-0159-8 -
Psycho-oncology Oct 2014The objective of this works is to report the results of a systematic review to evaluate the role of attachment in adjustment to cancer for patients and those close to... (Review)
Review
OBJECTIVE
The objective of this works is to report the results of a systematic review to evaluate the role of attachment in adjustment to cancer for patients and those close to them.
METHODS
A systematic search of electronic databases was undertaken, identifying literature published up to June 2013. PsychINFO, Medline and the Cumulative Index to Nursing & Allied Health Literature were searched using search strings related to cancer, relationships, attachment and commonly assessed self-report psychosocial outcome measures. Extracted papers were assessed for their relevance. Key data were extracted to spreadsheets, and two raters coded the quality of the research.
RESULTS
Following inclusion assessment, data were extracted from 15 quantitative studies. Scores from patients or caregivers on attachment questionnaires did not differ greatly from normative data. A more insecure attachment style has poorer outcomes for patients in terms of their psychological adjustment to cancer and their ability to perceive and access social support. A secure attachment style is associated with positive growth and better well-being. A more insecure attachment style in caregivers was associated with depression, higher caregiving stress, less autonomous motivations for caregiving and difficulties with caregiving.
CONCLUSIONS
An awareness of attachment theory and the ways in which different forms of insecure attachment impact on patients and caregivers and their well-being may substantially improve the ability of those working with cancer patients and their families to better understand and provide for their support needs. The development and evaluation of support interventions tailored to different attachment styles remains a longer-term goal.
Topics: Adaptation, Psychological; Caregivers; Depression; Female; Humans; Male; Motivation; Neoplasms; Object Attachment; Personal Satisfaction; Quality of Life; Social Support; Spouses; Stress, Psychological; Surveys and Questionnaires
PubMed: 25156192
DOI: 10.1002/pon.3664 -
Endocrine Oct 2018Congenital adrenal hyperplasia (CAH) has been shown to potentially affect psychological adjustment. However, most research has focused on females, and knowledge about...
PURPOSE
Congenital adrenal hyperplasia (CAH) has been shown to potentially affect psychological adjustment. However, most research has focused on females, and knowledge about psychological challenges in males remains sparse. The aim of this systematic review was therefore to assess these in males with CAH.
METHODS
We systematically searched the OVID Medline, PsycINFO, CINAHL, and Web of Science databases, for articles published up to April 20, 2018, investigating psychological adjustment in males with CAH.
RESULTS
Eleven studies were included in the review. Three main health domains were identified: psychological and psychiatric health, quality of life (QoL), and self-perceptions of reproductive health. Some studies covered more than one health domain. Seven studies explored psychological adjustment and/or the presence of psychiatric symptoms or disorders. Results indicated that males with CAH had more problems related to internalizing behaviors (negative behaviors directed toward the self) and more negative emotionality compared to reference groups. Six studies examined QoL, five of them reporting reduced QoL compared to reference groups. Three studies explored the impact of fertility and sexual health issues on psychological health with varying results from impaired to normal sexual well-being.
CONCLUSIONS
CAH seems to have an impact on males' psychological health. However, the number of identified studies was limited, included few participants, and revealed divergent findings, demonstrating the need for larger studies and highlighting a number of methodological challenges that should be addressed by future research.
Topics: Adrenal Hyperplasia, Congenital; Emotional Adjustment; Humans; Male; Mental Health; Quality of Life; Self Concept
PubMed: 30128958
DOI: 10.1007/s12020-018-1723-0 -
International Journal of Environmental... Oct 2021The current systematic review aimed to evaluate the variables influencing foster parents' parenting stress, distress and parenting style, thereby supporting their... (Review)
Review
The current systematic review aimed to evaluate the variables influencing foster parents' parenting stress, distress and parenting style, thereby supporting their adjustment and well-being as well as that of foster children. A PRISMA-guided search was conducted in three databases. Observational studies examining parenting stress, parenting distress (subsuming anxiety, depression and stress symptoms) and parenting style-all assessed through validated tools-were considered. A total of 16 studies were included, comprising N = 1794 non-relative foster parents (age range = 30-67 years). Results showed heightened parenting stress over time, both overall and compared to parents at large. Neither foster parents' nor foster children's socio-demographic characteristics significantly contributed to the increase in parenting stress; yet child-related stress and children's externalizing problems were its main predictors. Foster parents' couple cooperation was associated with reduced parenting stress. Moreover, the authoritative parenting style was associated with parental warmth, while the authoritarian style was associated with foster parents' greater perceived burden, greater criticism and rejection toward the foster child. Evidence supports the mutual influence between foster parents and children. Foster care services should support foster parents' needs within a concentric modular system, to ultimately provide better care for both foster parents and children.
Topics: Adult; Aged; Child, Foster; Emotional Adjustment; Foster Home Care; Humans; Middle Aged; Parent-Child Relations; Parenting; Parents; Stress, Psychological
PubMed: 34682659
DOI: 10.3390/ijerph182010916 -
Omega Sep 2021Research articles examining psychological adjustment to spousal bereavement in older adults (65+) were identified through searches on five electronical databases...
Research articles examining psychological adjustment to spousal bereavement in older adults (65+) were identified through searches on five electronical databases alongside forward citation and reference list searches. A total of 15 articles involving 686 unique participants were identified. Five characteristics were discovered which can facilitate and inhibit psychological adjustment to spousal bereavement in older adults: the pre-loss spousal relationship, social support, finding meaning and spirituality in loss, the surviving spouse's personality traits, and death characteristics. These findings support that concepts of 'meaning making' and social support should be incorporated into therapeutic work with bereaved spouses to help facilitate psychological adjustment.
PubMed: 34470527
DOI: 10.1177/00302228211043702 -
International Journal of Environmental... Aug 2022The present meta-analysis investigated the overall and differential efficacy of digital cognitive-behavioral therapies (CBTs) vs. third-generation CBTs deployed to... (Meta-Analysis)
Meta-Analysis Review
The Efficacy of Digital Cognitive-Behavioral Interventions in Supporting the Psychological Adjustment and Sleep Quality of Pregnant Women with Sub-Clinical Symptoms: A Systematic Review and Meta-Analysis.
The present meta-analysis investigated the overall and differential efficacy of digital cognitive-behavioral therapies (CBTs) vs. third-generation CBTs deployed to pregnant women in reducing sub-clinical depression, anxiety, and stress symptoms while fostering sleep quality and quality of life. A PRISMA-guided systematic search was used, including randomized controlled trials (RCTs) evaluating the above-mentioned interventions. Data were pooled using either the mean difference (MD) or standardized MD (SMD). Sub-group analyses were carried out when appropriate. The primary outcomes were depression, anxiety, and stress symptoms, as well as sleep quality and quality of life. The interventions' acceptability was evaluated through the odds ratio (OR) of drop-out rates. Seven RCTs were included, comprising 1873 pregnant women. The results showed the interventions' efficacy in terms of reducing depression symptoms (SMD = -0.36, CI = 0.61, -0.11, k = 9) at the endpoint, although it was not maintained at follow-up during the postpartum period. The interventions' efficacy in terms of reducing anxiety symptoms (SMD = 1.96, CI = -2.72, -1.21, k = 3) at the endpoint was also significant, while having no effect on sleep quality. The interventions were well accepted (OR = 1.68; 95% CI = 0.84, 3.35; k = 7). Although no sound conclusions can be drawn concerning the joint or differential efficacy of the considered interventions, this study was useful in highlighting the need to develop evidence-based digital prevention programs for pregnant women with sub-clinical symptoms.
Topics: Cognition; Cognitive Behavioral Therapy; Depression; Emotional Adjustment; Female; Humans; Pregnancy; Pregnant Women; Sleep Quality
PubMed: 35954901
DOI: 10.3390/ijerph19159549