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The effects of groupwork on metabolic control, emotional adjustment, and perceived social support in diabetes patients
Poster abstracts / Journal of Psychosomatic Research 55 (2003) 147–178 Conclusion: The results of this study suggest that HD patients tend to exhibit depression or anxiety. In particular, we have to pay close attention to depressive symptoms in geriatric HD patients.
Depression in type II diabetes mellitus found in patients undergoing hemodialysis Kudo M, Akimoto M, Kanno K, Tsujino M, Nishida K, Momotsu T, Tamura N, Araki A, Ishiburo M, Urae J, Hisano T, Nagura Y, Takahashi S, Fukunishi I Background: Many studies have examined depression in type II diabetes mellitus (DM). However, there have been very few reports on the comparison of depression between DM patients without hemodialysis (HD) and DM patients with HD. Method: Using the Center for Epidemiologic Studies Depression Scale (CES-D), we compared the frequency and severity of depression among three groups; 682 DM patients without HD, 105 DM patients with HD, and 502 HD without DM. Results: The prevalence rate of depression assessed by the CES-D was 19.1% in DM patients without HD, 44.8% in DM patients with HD, and 34.1% in HD patients without DM. The prevalence rate of depression in DM patients with HD was the highest among three groups. CES-D scores in DM patients with HD were also the highest among three groups. The CES-D scores were significantly higher for HD patients with DM than for DM patients without HD and HD patients without DM, and for HD patients without DM than for DM patients without HD. Conclusion: The results suggest that type II DM patients tend to exhibit depression and that the frequency and severity of depression in DM patients become higher and stronger if they develop end-stage renal disease (ESRD) on HD.
Posttraumatic stress disorder in the families of cadaveric and living donor population Fukunishi I, Paris W Background: Posttraumatic stress disorder (PTSD) has been documented in the transplant recipient literature. PTSD has proven to produce poorer outcomes as measured by an increased mortality and morbidity. In this study, we examined PTSD and related emotional conditions in families of cadaveric and living donor population based on comparison of Japanese and American outcomes. Methods: The subjects were 41 American families of cadaveric donors and 66 Japanese families of living donor. In addition to the assessment of DSMIV PTSD, we estimated their emotional conditions using the Profile of Mood States (POMS), Family Environmental Scale (FES), Toronto Alexithymia Scale, and Stress and Coping Inventory (SCI). Results and discussion: Three major symptoms on PTSD, reexperiencing symptoms, avoidance behaviors, and hyperarousal symptoms were found in 61%, 59%, and 73% in American families of cadaveric donors. The rate of patients who was diagnosed as DSM-IV PTSD was 41%. In Japanese families of living donors, however, there were no patients with PTSD. Thus, the PTSD symptoms were significantly stronger for American cadaveric donors’ families than for Japanese living donors’ families. Among PTSD symptoms, the severity of avoidance behaviors was significantly related to poor social support and emotional disturbances including depression.
Paradoxical psychiatric syndrome among recipients after living-related liver transplantation Fukunishi I, Sugawara Y, Makuuchi M, Surman OS Background: Even if the postoperative outcome of living-related liver transplantation (LRLT) is favorable, recipients frequently exhibit psychiat-
171
ric symptoms afterward. The manifestation of psychiatric symptoms despite favorable postoperative outcome has been referred to as paradoxical psychiatric syndrome (PPS). We examined PPS, in particular the relationship between depression and guilt feelings among recipients and donors after LRLT. Methods: Subjects were 54 pairs of recipients and donors who underwent LRLT. We performed psychiatric interviews to assess depression using the Hamilton Rating Scale (HRS) and to judge the presence or absence of DSM-IV psychiatric disorders 1 month after transplantation. Results: HRS scores were significantly higher for recipients than for donors. Scores on guilt feelings in HRS items were significantly higher for recipients than for donors. Guilt feelings were directed at the donors who gave them their livers. The scores on guilt feelings were significantly and positively correlated with HRS scores. Among the 16 recipients with major depression, 14 recipients exhibited depressive symptoms in a paradoxical form. Conclusion: The results suggest that recipients tend to exhibit depressive symptoms following LRLT. Even if the postoperative outcome is favorable, medical staff must pay close attention to the manifestation of depressive symptoms including guilt feelings.
Psychosocial predictors of ‘‘relapse’’ of diabetes patients a two-years’ follow-up after an inpatient diabetes education Akimoto M, Kanno K, Oogai Y, Horikawa N, Yamazaki T, Kudo M, Morokuma Y, Fukunishi I Background: We performed a 2-years follow-up study of patients with diabetes mellitus (DM) receiving in-patient diabetes education. Method: Subjects were 309 DM patients. We administered the 20-item Toronto Alexithymia Scale, the Profile of Mood States, the NEO FiveFactor Inventory, and the Stress Coping Inventory before the start of inpatient diabetes education program for two weeks. The regular twoweek program provides several lectures on the etiology of diabetes, complications, treatment, diet, exercise, medication, and other aspects of self-management. We examined the relationships between various demographic, clinical and psychological factors and relapse (i.e., reworsening of glycemic control) after inpatient diabetes education program. Results and discussion: The DM patients who showed no acute effect of education were more depressive than those whose HbAlc successfully decreased. For long-term effect, Kaplan – Meier survival analyses showed that those who have no prior experience of diabetes, whose meals are prepared by their spouses, and those with less social support were likely to relapse within significantly shorter periods than those who have prior experience of diabetes, who cook for themselves, and those with more social support Future studies should explore what specific ‘‘social support’’ is beneficial for better diabetes management.
The effects of groupwork on metabolic control, emotional adjustment, and perceived social support in diabetes patients Akimoto M, Kanno K, Oogai Y, Kudo M, Morokuma Y, Fukunishi I Background: This study aims to investigate the effects of groupwork on metabolic control, emotional adjustment, and perceived social support. Method: Subjects were divided into two groups: those who participated in the groupwork besides the regular in-patient education program (G group, n = 130) and those who participated in the inpatient education program only (NG group, n = 94). The groupwork, which was based on counseling and cognitive – behavioral techniques, consisted of three sessions addressing: emotional responses to diabetes, diabetes in interpersonal and familial situations, and reexamining values and goals of life in relationship with diabetes. The subjects filled in three questionnaires, the Perceived Status of Diabetes (PSD), the Problem Areas In Diabetes (PAID), and the Diabetes Social Support (DSS) at five time points: the first and second week of hospitalization, 3, 6, and 12 months later.
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Poster abstracts / Journal of Psychosomatic Research 55 (2003) 147–178
Results: The G group showed a significant ( < .05) increase in satisfaction with social support, reflected by a smaller mean desired support score minus perceived support score, when analyzed by covariance analysis for three time points (i.e., first week, second week, and three months). Conclusion: The results indicated that the groupwork effectively enhanced the patients’ perception of social support.
Depression in type II diabetes mellitus Kudo M, Akimoto M, Kanno K, Tsujino M, Nishida K, Momotsu T, Tamura N, Fukunishi I Background: We examined the prevalence rate of depression and depression-related factors in a relatively large sample of DM patients. Methods: Subjects were 611 Type II DM patients (mean age, 61.2; mean DM duration, 10.0 years). We evaluated 123 healthy volunteers without any physical diseases and used them as a control group. We administered the Center for Epidemiologic Studies Depression Scale (CES-D). We designated depression as having a total score of the CES-D of 16 or over. We examined the prevalence rates of depression assessed by the CES-D and analyzed the depression-related factors for demographic, psychosocial, and medical variables. Results: Mean CES-D score was 13.1. The prevalence rate of depression assessed by the CES-D was approximately 19.3% (118 patients). The CES-D scores were significantly higher for DM group than for control group. The CES-D scores were significantly and positively correlated to three variables, including gender and the presence of complications (e.g., renal failure and peripheral nerve disturbance). Multiple regression analysis found that these three variables were significantly related to the CES-D scores. Conclusion: The results suggest that DM patients tend to exhibit depressive symptoms. We should pay close attention to the manifestation of depressive symptoms in female DM patients with complications.
Delirium in geriatric patients on hemodialysis therapy Miwa M, Fukunishi I Background: Patients on hemodialysis (HD) frequently exhibit various psychiatric symptoms including depression and cognitive disorders such as delirium. Cognitive disorders are often seen in geriatric patients who have undergone long-term HD therapy. We examined the incidence rates of delirium in HD patients over a 5-year long-term follow-up. Method: Subjects were 490 patients on HD therapy. Diagnosis of delirium was determined using the DSM-IV diagnostic criteria. Results: Over the 5 years, delirium was seen in 56 (11.4%). Among the 56 cases, 52 (92.9%) were geriatric patients (65 or higher). Over the 5-year follow-up period, delirium was seen in 56 of 224 geriatric patients (25.0%) and 4 of 266 nongeriatric patients (1.5%). The 1-year incidence rate of delirium was 5% in geriatric HD patients although very few nongeriatric patients exhibited delirium. Patients with delirium were significantly older than those who did not exhibit delirium. The prevalence rate of delirium was significantly higher for patients with an HD duration > 5 years compared with those HD patients who had a duration of < 5 years. Also, as patients’ age increases, the prevalence rate of delirium was significantly higher. Conclusion: These findings suggest that two factors, advanced-age and long-term HD therapy, are closely related to the development of delirium.
The relationship between expression of unfavorable emotions and alexithymic characteristics Yagi Y, Koyama K, Matsuno T, Murakami M, Fukunishi I Background: We have a hypothesis that unfavorable feelings such as hostility and anger may be manifested more easily by alexithymic
persons. In this study, we examined the association of alexithymic characteristics and the expression of unfavorable feelings including anger and hostility. Method: The subjects were 489 Japanese college students in Tokyo, Japan. We administered five psychological questionnaires including the 20-item Toronto Alexithymia Scale, the Profile of Mood States, and the NEO Five-Factor Inventory. Results and discussion: Alexithymic college students are prone to indicate not only emotional instability but also cynical hostility and anger. On the contrary, alexithymic college students indicated significantly higher scores on anger-in and anger control, which may be related to Japanese sociocultural aspects. In particular, anger control was stronger in male alexithymic college students, suggesting that they may unconsciously struggle for the suppression and/or control of unfavorable feelings such as anger and hostility to stabilize their inner emotions.
Intergenerational association of alexithymic characteristics for college students and their mothers Yagi Y, Koyama K, Fukunishi I Background: Several studies have indicated that the development of affect and affect-regulating capacities is facilitated early in life by the experience of affect sharing and mirroring of affective expressions with primary caregiver. In this study, we examined an intergenerational association of alexithymic characteristics of mothers and their children. Method: The subjects were 232 pairs of college students and their mothers. We administered five psychological questionnaires including the 20-item Toronto Alexithymia Scale (TAS), the Parental Bonding Inventory (PBI), and the Family Environmental Scale (FES). Results and discussion: Scores on the Toronto Alexithymia Scale, Parental Bonding Inventory, and the Family Environmental Scale of college students were significantly correlated with their mothers’ memories when they were also 20 years old. College students’ scores were significantly correlated with their mothers’ scores on each questionnaire. The student – mother pairs were further divided into two family types — nuclear and extended families. Correlations were higher for scores of the nuclear family than for those of the extended family. Such results suggest there may be intergenerational transmission of alexithymia and related factors from mothers to children.
Are there overlapping constructs between alexithymia and depression in hemodialysis patients Oogai Y, Ishiburo M, Urae J, Hisano T, Nagura Y, Takahashi S, Fukunishi I Background: Previous studies have examined the relationship between alexithymia and depression. However, much remain unknown. In this study, therefore, we examined the presence or absence of overlapping constructs between alexithymia and depression in a sample of patients with end-stage renal disease (ESRD) on hemodialysis (HD) treatment. Method: The subjects were 507 ESRD patients who had undergone HD in Tokyo, Japan. After obtaining their informed consent, we administered Japanese version of the 20-item Toronto Alexithymia Scale (TAS-20) and the Center for Epidemiologic Studies Depression Scale (CES-D) to all the subjects. Results and discussion: Simple correlational analysis found that there is a significantly positive correlation between the TAS-20 and CES-D, suggesting that alexithymia is closely related to depression. However, factor analysis revealed that a correlation matrix comprising items from both the TAS-20 and CES-D produced separate factors corresponding to their respective construct, suggesting the possibility that alexithymia and depression constructs are distinct. We also performed factor analysis by origin disease. In diabetes patients on HD, the same results were obtained. Although further examinations are needed, the results of this study indicated no overlapping constructs between alexithymia and depression.
Depression in type II diabetes mellitus found in patients undergoing hemodialysis Kudo M, Akimoto M, Kanno K, Tsujino M, Nishida K, Momotsu T, Tamura N, Araki A, Ishiburo M, Urae J, Hisano T, Nagura Y, Takahashi S, Fukunishi I Background: Many studies have examined depression in type II diabetes mellitus (DM). However, there have been very few reports on the comparison of depression between DM patients without hemodialysis (HD) and DM patients with HD. Method: Using the Center for Epidemiologic Studies Depression Scale (CES-D), we compared the frequency and severity of depression among three groups; 682 DM patients without HD, 105 DM patients with HD, and 502 HD without DM. Results: The prevalence rate of depression assessed by the CES-D was 19.1% in DM patients without HD, 44.8% in DM patients with HD, and 34.1% in HD patients without DM. The prevalence rate of depression in DM patients with HD was the highest among three groups. CES-D scores in DM patients with HD were also the highest among three groups. The CES-D scores were significantly higher for HD patients with DM than for DM patients without HD and HD patients without DM, and for HD patients without DM than for DM patients without HD. Conclusion: The results suggest that type II DM patients tend to exhibit depression and that the frequency and severity of depression in DM patients become higher and stronger if they develop end-stage renal disease (ESRD) on HD.
Posttraumatic stress disorder in the families of cadaveric and living donor population Fukunishi I, Paris W Background: Posttraumatic stress disorder (PTSD) has been documented in the transplant recipient literature. PTSD has proven to produce poorer outcomes as measured by an increased mortality and morbidity. In this study, we examined PTSD and related emotional conditions in families of cadaveric and living donor population based on comparison of Japanese and American outcomes. Methods: The subjects were 41 American families of cadaveric donors and 66 Japanese families of living donor. In addition to the assessment of DSMIV PTSD, we estimated their emotional conditions using the Profile of Mood States (POMS), Family Environmental Scale (FES), Toronto Alexithymia Scale, and Stress and Coping Inventory (SCI). Results and discussion: Three major symptoms on PTSD, reexperiencing symptoms, avoidance behaviors, and hyperarousal symptoms were found in 61%, 59%, and 73% in American families of cadaveric donors. The rate of patients who was diagnosed as DSM-IV PTSD was 41%. In Japanese families of living donors, however, there were no patients with PTSD. Thus, the PTSD symptoms were significantly stronger for American cadaveric donors’ families than for Japanese living donors’ families. Among PTSD symptoms, the severity of avoidance behaviors was significantly related to poor social support and emotional disturbances including depression.
Paradoxical psychiatric syndrome among recipients after living-related liver transplantation Fukunishi I, Sugawara Y, Makuuchi M, Surman OS Background: Even if the postoperative outcome of living-related liver transplantation (LRLT) is favorable, recipients frequently exhibit psychiat-
171
ric symptoms afterward. The manifestation of psychiatric symptoms despite favorable postoperative outcome has been referred to as paradoxical psychiatric syndrome (PPS). We examined PPS, in particular the relationship between depression and guilt feelings among recipients and donors after LRLT. Methods: Subjects were 54 pairs of recipients and donors who underwent LRLT. We performed psychiatric interviews to assess depression using the Hamilton Rating Scale (HRS) and to judge the presence or absence of DSM-IV psychiatric disorders 1 month after transplantation. Results: HRS scores were significantly higher for recipients than for donors. Scores on guilt feelings in HRS items were significantly higher for recipients than for donors. Guilt feelings were directed at the donors who gave them their livers. The scores on guilt feelings were significantly and positively correlated with HRS scores. Among the 16 recipients with major depression, 14 recipients exhibited depressive symptoms in a paradoxical form. Conclusion: The results suggest that recipients tend to exhibit depressive symptoms following LRLT. Even if the postoperative outcome is favorable, medical staff must pay close attention to the manifestation of depressive symptoms including guilt feelings.
Psychosocial predictors of ‘‘relapse’’ of diabetes patients a two-years’ follow-up after an inpatient diabetes education Akimoto M, Kanno K, Oogai Y, Horikawa N, Yamazaki T, Kudo M, Morokuma Y, Fukunishi I Background: We performed a 2-years follow-up study of patients with diabetes mellitus (DM) receiving in-patient diabetes education. Method: Subjects were 309 DM patients. We administered the 20-item Toronto Alexithymia Scale, the Profile of Mood States, the NEO FiveFactor Inventory, and the Stress Coping Inventory before the start of inpatient diabetes education program for two weeks. The regular twoweek program provides several lectures on the etiology of diabetes, complications, treatment, diet, exercise, medication, and other aspects of self-management. We examined the relationships between various demographic, clinical and psychological factors and relapse (i.e., reworsening of glycemic control) after inpatient diabetes education program. Results and discussion: The DM patients who showed no acute effect of education were more depressive than those whose HbAlc successfully decreased. For long-term effect, Kaplan – Meier survival analyses showed that those who have no prior experience of diabetes, whose meals are prepared by their spouses, and those with less social support were likely to relapse within significantly shorter periods than those who have prior experience of diabetes, who cook for themselves, and those with more social support Future studies should explore what specific ‘‘social support’’ is beneficial for better diabetes management.
The effects of groupwork on metabolic control, emotional adjustment, and perceived social support in diabetes patients Akimoto M, Kanno K, Oogai Y, Kudo M, Morokuma Y, Fukunishi I Background: This study aims to investigate the effects of groupwork on metabolic control, emotional adjustment, and perceived social support. Method: Subjects were divided into two groups: those who participated in the groupwork besides the regular in-patient education program (G group, n = 130) and those who participated in the inpatient education program only (NG group, n = 94). The groupwork, which was based on counseling and cognitive – behavioral techniques, consisted of three sessions addressing: emotional responses to diabetes, diabetes in interpersonal and familial situations, and reexamining values and goals of life in relationship with diabetes. The subjects filled in three questionnaires, the Perceived Status of Diabetes (PSD), the Problem Areas In Diabetes (PAID), and the Diabetes Social Support (DSS) at five time points: the first and second week of hospitalization, 3, 6, and 12 months later.
172
Poster abstracts / Journal of Psychosomatic Research 55 (2003) 147–178
Results: The G group showed a significant ( < .05) increase in satisfaction with social support, reflected by a smaller mean desired support score minus perceived support score, when analyzed by covariance analysis for three time points (i.e., first week, second week, and three months). Conclusion: The results indicated that the groupwork effectively enhanced the patients’ perception of social support.
Depression in type II diabetes mellitus Kudo M, Akimoto M, Kanno K, Tsujino M, Nishida K, Momotsu T, Tamura N, Fukunishi I Background: We examined the prevalence rate of depression and depression-related factors in a relatively large sample of DM patients. Methods: Subjects were 611 Type II DM patients (mean age, 61.2; mean DM duration, 10.0 years). We evaluated 123 healthy volunteers without any physical diseases and used them as a control group. We administered the Center for Epidemiologic Studies Depression Scale (CES-D). We designated depression as having a total score of the CES-D of 16 or over. We examined the prevalence rates of depression assessed by the CES-D and analyzed the depression-related factors for demographic, psychosocial, and medical variables. Results: Mean CES-D score was 13.1. The prevalence rate of depression assessed by the CES-D was approximately 19.3% (118 patients). The CES-D scores were significantly higher for DM group than for control group. The CES-D scores were significantly and positively correlated to three variables, including gender and the presence of complications (e.g., renal failure and peripheral nerve disturbance). Multiple regression analysis found that these three variables were significantly related to the CES-D scores. Conclusion: The results suggest that DM patients tend to exhibit depressive symptoms. We should pay close attention to the manifestation of depressive symptoms in female DM patients with complications.
Delirium in geriatric patients on hemodialysis therapy Miwa M, Fukunishi I Background: Patients on hemodialysis (HD) frequently exhibit various psychiatric symptoms including depression and cognitive disorders such as delirium. Cognitive disorders are often seen in geriatric patients who have undergone long-term HD therapy. We examined the incidence rates of delirium in HD patients over a 5-year long-term follow-up. Method: Subjects were 490 patients on HD therapy. Diagnosis of delirium was determined using the DSM-IV diagnostic criteria. Results: Over the 5 years, delirium was seen in 56 (11.4%). Among the 56 cases, 52 (92.9%) were geriatric patients (65 or higher). Over the 5-year follow-up period, delirium was seen in 56 of 224 geriatric patients (25.0%) and 4 of 266 nongeriatric patients (1.5%). The 1-year incidence rate of delirium was 5% in geriatric HD patients although very few nongeriatric patients exhibited delirium. Patients with delirium were significantly older than those who did not exhibit delirium. The prevalence rate of delirium was significantly higher for patients with an HD duration > 5 years compared with those HD patients who had a duration of < 5 years. Also, as patients’ age increases, the prevalence rate of delirium was significantly higher. Conclusion: These findings suggest that two factors, advanced-age and long-term HD therapy, are closely related to the development of delirium.
The relationship between expression of unfavorable emotions and alexithymic characteristics Yagi Y, Koyama K, Matsuno T, Murakami M, Fukunishi I Background: We have a hypothesis that unfavorable feelings such as hostility and anger may be manifested more easily by alexithymic
persons. In this study, we examined the association of alexithymic characteristics and the expression of unfavorable feelings including anger and hostility. Method: The subjects were 489 Japanese college students in Tokyo, Japan. We administered five psychological questionnaires including the 20-item Toronto Alexithymia Scale, the Profile of Mood States, and the NEO Five-Factor Inventory. Results and discussion: Alexithymic college students are prone to indicate not only emotional instability but also cynical hostility and anger. On the contrary, alexithymic college students indicated significantly higher scores on anger-in and anger control, which may be related to Japanese sociocultural aspects. In particular, anger control was stronger in male alexithymic college students, suggesting that they may unconsciously struggle for the suppression and/or control of unfavorable feelings such as anger and hostility to stabilize their inner emotions.
Intergenerational association of alexithymic characteristics for college students and their mothers Yagi Y, Koyama K, Fukunishi I Background: Several studies have indicated that the development of affect and affect-regulating capacities is facilitated early in life by the experience of affect sharing and mirroring of affective expressions with primary caregiver. In this study, we examined an intergenerational association of alexithymic characteristics of mothers and their children. Method: The subjects were 232 pairs of college students and their mothers. We administered five psychological questionnaires including the 20-item Toronto Alexithymia Scale (TAS), the Parental Bonding Inventory (PBI), and the Family Environmental Scale (FES). Results and discussion: Scores on the Toronto Alexithymia Scale, Parental Bonding Inventory, and the Family Environmental Scale of college students were significantly correlated with their mothers’ memories when they were also 20 years old. College students’ scores were significantly correlated with their mothers’ scores on each questionnaire. The student – mother pairs were further divided into two family types — nuclear and extended families. Correlations were higher for scores of the nuclear family than for those of the extended family. Such results suggest there may be intergenerational transmission of alexithymia and related factors from mothers to children.
Are there overlapping constructs between alexithymia and depression in hemodialysis patients Oogai Y, Ishiburo M, Urae J, Hisano T, Nagura Y, Takahashi S, Fukunishi I Background: Previous studies have examined the relationship between alexithymia and depression. However, much remain unknown. In this study, therefore, we examined the presence or absence of overlapping constructs between alexithymia and depression in a sample of patients with end-stage renal disease (ESRD) on hemodialysis (HD) treatment. Method: The subjects were 507 ESRD patients who had undergone HD in Tokyo, Japan. After obtaining their informed consent, we administered Japanese version of the 20-item Toronto Alexithymia Scale (TAS-20) and the Center for Epidemiologic Studies Depression Scale (CES-D) to all the subjects. Results and discussion: Simple correlational analysis found that there is a significantly positive correlation between the TAS-20 and CES-D, suggesting that alexithymia is closely related to depression. However, factor analysis revealed that a correlation matrix comprising items from both the TAS-20 and CES-D produced separate factors corresponding to their respective construct, suggesting the possibility that alexithymia and depression constructs are distinct. We also performed factor analysis by origin disease. In diabetes patients on HD, the same results were obtained. Although further examinations are needed, the results of this study indicated no overlapping constructs between alexithymia and depression.