PaperScreening for anxiety and depression in cancer patients: the effects of disease and treatment
The General Health Questionnaire 28 (GHQ 28), Hospital Anxiety and Depression Scale (HADS), and Rotterdam Symptom Checklist (RSCL) seemed promising in their ability to detect anxiety and depression in cancer patients. To compare their screening performance, 513 patients were recruited from four cancer centres, and visited at home by a trained interviewer. Paired combinations of questionnaires (GHQ 28 + HADS, GHQ 28 + RSCL or RSCL + HADS) were used, and then the Psychiatric Assessment Schedule was administered to enable a psychiatric diagnosis to be made using DSM III diagnostic criteria. A receiver operating characteristics curve was drawn by plotting the true positive rate (sensitivity) against the false positive rate (1 -specificity) for each possible score on each questionnaire. In the overall sample, the HADS and RSCL performed well comparably. The HADS did best in those free of disease and when the disease was judged to be stable. Only the RSCL performed well in those with progressive disease. Both the HADS and RSCL were effective in those on treatment. The GHQ was superior to the RSCL in those off treatment. The choice of questionnaire and threshold score should take disease and treatment status into account, but all three questionnaires have a definite role in screening out anxiety and depression.
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Quantitative survey on French teenagers’ sleep: Insomnia, anxiety-depression and circadian rhythms
2023, EncephaleL’insomnie est un trouble du sommeil qui touche particulièrement les adolescents. Ses conséquences psychiques et physiques sont majeures et en font une priorité de santé publique.
L’objectif de l’étude était de proposer des données sur le sommeil des adolescents et d’explorer les intrications entre insomnie et troubles de l’humeur tout en investiguant la place du chronotype.
Une batterie de questionnaires a été proposée à 1 036 adolescents tout-venant français, scolarisés dans le secondaire, âgés de 12 et 20 ans et résidant en zone urbaine pour les collégiens et en zone rurale pour les lycéens. Elle était composée de l’Index de Sévérité de l’Insomnie (ISI), de la Hospital Anxiety and Depression Scale (HADS) et du Morningness-Eveningness Questionnaire (MEQ). Les différentes instances compétentes en matière d’éthique et de déontologie ont émis un avis favorable.
Cette étude a montré que l’anxiété, la dépression, le sexe et l’âge étaient des facteurs associés à l’insomnie, en réaffirmant une prédisposition féminine et en affirmant un effet de l’entrée au lycée (associée à l’âge de 15 ans). Les résultats ont indiqué également qu’une tendance à la vespéralité augmentait le risque et le niveau d’insomnie, pouvant évoquer alors la responsabilité des typologies circadiennes dans ce trouble du sommeil.
Cette étude souligne l’importance des préventions et des dépistages de l’insomnie à l’entrée au lycée ainsi que la nécessité, en clinique des troubles du sommeil et en psychothérapie, d’aborder les rythmes circadiens individuels, leurs conséquences et les choix organisationnels dans l’articulation veille-sommeil.
Insomnia is a sleep disorder that particularly affects teenagers. Its psychic and physical consequences are major and make it a public health priority. The main purpose of the study was to provide contemporary data on adolescent sleep and to explore the intrications between insomnia and mood disorders while investigating the chronotype responsibility.
A battery of questionnaires was offered to 1,036 French teenagers, enrolled in secondary school, aged between 12 and 20 years old and living in urban areas for middle school students and in rural areas for high school students. It was mainly composed of the Insomnia Severity Index (ISI), the Hospital Anxiety and Depression Scale (HADS) and the - Morningness-Eveningness Questionnaire (MEQ). The authorities responsible for ethics and professional conduct have issued a favorable opinion.
This study demonstrated that anxiety, depression, gender and age were factors linked to insomnia, reaffirming a female predisposition and asserting a high school entry effect (especially at 15 years old). The results also indicated that a tendency to vesperality increased the risk and the level of insomnia, thus evoking the responsibility of circadian typologies in this sleep disorder.
This study underlines the importance of prevention and screening for insomnia when entering high school, as well as the need, in sleep disorder clinics and in psychotherapy, to deal with individual circadian rhythms, their consequences and organizational choices in the sleep/wakefulness articulation.
Geriatric assessment tool application in treatment recommendations for older women with breast cancer
2022, BreastTreatment of early breast cancer in older women is usually not guideline concordant owing to lack of routine evaluation of their potential frailty. We assessed the feasibility and impact of a self-administered geriatric assessment on the decision-making process in women aged 65 and above treated in a UK District General Hospital.
One hundred and one patients, aged 65 and above, with early stage, non-metastatic breast cancer were prospectively recruited between Dec-2018 and March-2021. Patients with metastatic breast cancer, a previous history of cancer and dementia were excluded. All patients had a geriatric assessment with a self-administered questionnaire (mycarg.org). All cases were discussed in the multidisciplinary meeting (MDT) and a pre geriatric assessment recommendations was made, based on the tumour grade, size, node status and receptor status. The findings of the assessment were later discussed in a second meeting and a further recommendation was made based on the geriatric assessment. Any change in the proposed treatment was recorded. Potential factors (age, Body Mass Index, co-morbidities, medications, instrumental activities of daily living, and basic activities of daily living, social support and psychological status) associated with a change in the treatment recommendation were compared using Pearson's Chi square tests for categorized data, and Mann Whitney U test for continuous data. A multivariate logistic regression was performed to test the association between geriatric assessment domains and change in treatment decision. The multivariate model was built using variables which were associated in the bivariate analysis with a p-value< 0.20.
Patients aged less than 70 years were more likely to be diagnosed through screening programme as compared to older women (64.4% vs. 35.6%, p = 0.001).
Self-administered geriatric assessment identified patients who were requiring assistance in their daily routine activities, and hence, were assessed to have higher morbidity status. A third of patients required assistance in their routine activities, with 18/101 patients requiring significant help during self-care. 90% patients were independent for Activity of Daily Living (ADL) at baseline and 34.76% for Instrumental Activity of Daily Living (IADL).
Among the 101 patients evaluated, proposed change in the initial cancer treatment plan was made in 21.8% of patients after the second MDT. Omission of chemotherapy was recommended in 4 patients, omission of radiotherapy in 15 patients and omission of both chemo and radiotherapy in 2 patients. One patient was advised to omit Zolidronic acid, as she was noted to have renal impairment. No patient in this cohort had suggestion for omission of surgery or endocrine therapy. In the bivariate analysis, need for assistance for activities of daily living (ADLs), low physical performance (KPS), polypharmacy (3 or more medications), lack of social support as assessed using the Social Support: Medical Outcomes Study (MOS) Social Support Survey and high BMI (30 or more) all showed significance but on multivariate analysis only polypharmacy was significantly associated with change in the initial cancer treatment plan.
The results of this study of breast cancer patients aged 65 and above suggest that a self-administered geriatric assessment may influence treatment recommendations in a subset of patients. Recommendations that were influenced by the geriatric assessment mainly included those related to the significant morbidity that may have impacted the use of chemotherapy and/or radiotherapy.
“When I am harassed, I suffer from thinking of myself as an object”. Sexual self-objectification and sexual harassment in a French sample
2022, SexologiesCet article aborde les situations de harcèlement sexuel vécues par des femmes françaises. Il s’agit de comprendre l’impact psychologique du harcèlement sexuel à partir de la notion d’objectification sexuelle de soi . La littérature internationale a abondamment documenté l’impact des situations d’objectification sexuelle de soi sur la santé mentale. Pourtant, les travaux menés en France sont rares voire inexistants. Nous faisons l’hypothèse que plus une femme est confrontée à des situations de harcèlement, plus elle intériorise l’idée qu’elle est un objet au service des désirs d’autrui ce qui, en retour, a des effets délétères sur son état psychologique.
Afin d’étudier cette hypothèse, une enquête en ligne a été menée auprès de 292 femmes (âge moyen : 24,3 ans, ET = 6,41). La prévalence des situations de harcèlement a été évaluée à l’aide de l’échelle Sexual Experience Questionnaire (SEQ). Nous avons mesuré l’objectification sexuelle de soi avec la sexual objectification scale (SOS) et la détresse psychologique à partir de la Hospital Anxiety and Depression Scale (HADS).
Les participantes ont été confrontées à 10,8 situations de harcèlement sexuel différentes, en moyenne. Conformément à nos hypothèses, le nombre de situations de harcèlement sexuel rencontrées est significativement associé à la détresse psychologique, de même qu'à l’objectification de soi. Des analyses de médiation montrent par ailleurs que les effets du harcèlement sur la détresse psychologique sont à la fois directs (β = .299, p < .001) et indirects : 18,9 % des effets du harcèlement sur la détresse psychologique sont médiatisés par l'objectification sexuelle de soi.
Le harcèlement sexuel n’est pas anodin en termes de santé mentale. Son impact s’inscrit dans une dynamique processuelle. Ses effets concernent la façon dont les sujets se construisent et une représentation d’eux-mêmes et une représentation de leur futur. Si la recherche internationale s’est emparée de cette question ces dernières années, les travaux conduits en France doivent encore davantage être développés.
This article deals with the sexual harassment situations experienced by French women. The aim is to understand the psychological impact of sexual harassment based on the notion of sexual self-objectification (SSO). The international literature has abundantly documented the impact of situations of sexual self-objectification on mental health. However, works carried out in France are rare or non-existent. We hypothesize that the more a woman is confronted with harassment situations, the more she internalizes the idea that she is an object at the service of others’ desires, which in turn has deleterious effects on her psychological state.
In order to study this hypothesis, an online survey was conducted among 292 women (mean age: 24.3 years, SD = 6.41). The prevalence of sexual harassment was assessed using the Sexual Experience Questionnaire (SEQ). We measured sexual self-objectification with the Sexual Objectification Scale (SOS) and psychological distress with the Hospital Anxiety and Depression Scale (HADS).
The participants were confronted with an average of 10.8 different sexual harassment situations. In line with our hypotheses, the number of sexual harassment situations encountered was significantly associated with psychological distress, as was sexual self-objectification. Mediation analyses also showed that the effects of harassment on psychological distress were both direct (β = .299, P < .001) and indirect: 18.9% of the effects of harassment on psychological distress were mediated by the SSO.
Sexual harassment is not insignificant in terms of mental health. Its impact is part of a processual dynamic. Its effects concern the way in which subjects construct a representation of themselves and a representation of their future. Although international research has taken up this issue in recent years, the work carried out in France needs to be developed further.
Esthetic physiotherapy: Are we aware of psychosomatic disorders in patients?
2021, KinesitherapieDe nombreuses publications dénoncent les conflits psychosomatiques et précisent que l’enveloppe physique ne représente que la vitrine de l’estime de soi, de l’image de soi et donc de l’identité de soi. La kinésithérapie esthétique est en devoir de s’interroger sur ce qu’elle est amenée à traiter : le corps ou les émotions de l’usager ? L’objectif de cette étude était de mettre en évidence les troubles émotionnels chez des usagers de la kinésithérapie esthétique afin de sensibiliser les professionnels aux troubles psychosomatiques de ces usagers. Sur le plan méthodologique, trois questionnaires ont été proposés à une population de 104 usagers. Les facteurs de prévalence ont été identifiés au moyen d’une analyse bivariée pour élaborer le profil d’usagers de la kinésithérapie esthétique qui présentaient des troubles émotionnels. Cet article propose des recommandations émanant de ces résultats. Plus d’un tiers des usagers présentaient une symptomatologie émotionnelle avec une perturbation de l’estime de soi, de l’image de soi, associée un trouble anxio-dépressif. Ces données permettent au kinésithérapeute d’élaborer un bilan du profil psychologique afin d’adapter le traitement et surtout d’éviter les complications de type identitaire, anorexique ou même suicidaire.
5.
Many publications have highlighted psychosomatic conflicts, pointing out that the body as physical envelope is only the showcase of self-esteem, self-image and therefore identity. Aesthetic physiotherapy needs to examine what is it supposed to treat: the client's body, or emotions? The objective of that study was to identify emotional disorder in aesthetic physiotherapy clients, in order to raise professionals’ awareness of clients’ psychosomatic issues. To assess this purpose, 3 validated questionnaires, were used in a sample of 104 clients. Bivariate analysis identified prevalence factors to draw up a profile of aesthetic physiotherapy clients with emotional disorders. Recommendations are put forward based on the results. The results showed that more than a third of clients presented emotional symptomatology, with disturbed self-esteem and a self-image associated with anxiety-depression disorder. These data allow the physiotherapist to develop a psychological assessment profile in order to adapt treatment and especially to avoid complications such as identity disorder, anorexia or suicidal tendencies.
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Complexities of the diagnosis of insomnia in adolescence and considerations about its consequences
2021, Neuropsychiatrie de l'Enfance et de l'AdolescenceLa santé publique a ses propres records. En effet, un rapport de Santé Publique France (2019) montre un déclin du temps de sommeil : il passe pour la première fois au-dessous de sept heures. À l’ère du numérique, les adolescents sont une population particulièrement sensible à ces évolutions : 88 % des jeunes (15–24 ans) français évoquent un manque de sommeil. Les causes de l’insomnie sont multifactorielles et – alors même qu’ils semblent concernés par les conséquences de ce trouble – les adolescents ne se plaignent pas toujours directement. Cela pourrait induire une sous-estimation des dépistages et des diagnostics.
L’objectif est d’explorer les complexités du diagnostic d’insomnie à l’adolescence et de comprendre la particularité des liens entre ce trouble et certains paramètres que sont le temps de sommeil, la somnolence, l’agressivité et la symptomatologie anxio-dépressive.
Une batterie de questionnaires standardisés a été proposée à une population de 1250 adolescents tout-venant français, lycéens et collégiens (12–20 ans). Elle était composée principalement de l’index de sévérité de l’insomnie, de l’échelle de somnolence d’Epworth et de la Hospital Anxiety and Depression Scale. La méthodologie a reçu l’aval de comités d’éthique et de déontologie.
Les résultats confirment la proportion majeure d’insomnie dans cette population (54,9 %, n = 569) par rapport à une proportion moindre d’adolescents ayant la perception de l’être (27,4 %, n = 284). Cet écart diminue avec la sévérité de l’insomnie. L’insomnie corrèle avec la symptomatologie anxio-dépressive et l’autoagressivité, mais beaucoup moins avec le temps de sommeil total estimé, en semaine comme le week-end. La relation est significative avec d’autres dimensions comme la somnolence diurne.
Cette étude souligne la particularité du diagnostic d’insomnie pour cette population et la nécessité d’affiner les critères de prévention et de dépistage. L’insomnie à l’adolescence ne peut pas être définie uniquement par rapport au vécu subjectif du malade ou par rapport à des critères temporels.
Public health also has its own records. A report from Public Health France (2019) shows a decline in sleep time, which, for the first time, has fallen below seven hours. In the digital era, teenagers are susceptible to these changes: 88% of young people (15–24) are facing a lack of sleep. The causes of insomnia are multifactorial, and – even though they seem concerned with the potential consequences of the disorder – teenagers do not always complain directly. This could lead to an underestimation of screenings and diagnoses.
The objective was to explore the complexities of the diagnosis in adolescence and to understand the particularity of the links between this disorder and sleep time, drowsiness, aggressivity and anxio-depressive symptomatology.
A selection of standardised surveys, methodologically validated by ethics and deontology committees, was proposed to a population of 1250 French teenagers, high school and college students (12–20). It was mainly composed of the Insomnia Severity Index, the Epworth Sleepiness Scale and the Hospital Anxiety and Depression Scale.
The results confirm a major proportion of insomnia in that population (54,9%, n = 569) in comparison to a smaller portion of teenagers who have the perception of having insomnia (27,4%, n = 284). The gap decreases with the severity of the insomnia. The results show a significant correlation between insomnia and anxio-depressive symptomatology and self-aggression; however, they show an insignificant relationship between diagnosis and sleep time, during the week and on weekends. The relationship between insomnia and daytime sleepiness is also very important. Finally, this research highlights the significant gap between the complaint of insomnia and the actual diagnosis.
This study highlights the particularity of insomnia diagnosis for this population and the need to refine the criteria for prevention and screening. Insomnia during the teenager period cannot be defined solely by reference to the person's life or by time criteria.
Perceived problems with involvement in decision making about breast cancer treatment and care: A cross-sectional study
2021, Patient Education and CounselingTo examine perceived problems with involvement in medical decision making among people with breast cancer from various phases of the cancer care trajectory.
Breast cancer outpatients (n = 663) from 13 treatment centres completed a survey of perceived involvement in treatment and care decisions in the last month, psychological distress, demographic and clinical factors. A subsample (n = 98) from three centres completed a follow-up survey on preferred and perceived treatment decision making roles.
Overall, 112 (17 %) of 663 respondents from 13 oncology centres had experienced problems with involvement in decision making about their treatment and care in the last month, and of these, 36 (32 %) reported an unmet need for help with this problem. Elevated psychological distress was associated with 5.7 times the odds of reporting this problem and 6.6 times the odds of reporting this unmet need in the last month. Among the follow-up subsample (n = 98), 39% (n = 38) reported discordance between preferred and perceived role in a major treatment decision. Psychological distress was not associated with this outcome.
Psychological distress was significantly associated with recently experiencing problems with involvement in treatment and care decisions, but not with misalignment of preferred and perceived roles in prior major treatment decisions.
There is a need to maintain support for patient involvement in healthcare decisions across the cancer care continuum.