Bailes, Sally/ Libmana, Eva/ Baltzan, Marc/ Amsele, Rhonda/ Schondorf, Ron/ Fichten, Catherine S. Brief and Distinct Empirical Sleepiness and Fatigue Scales. Journal of Psychosomatic Research 2006, 60, 605 – 613.
Abstract
Objective: Sleepiness and fatigue are conceptually distinct but pervasively confounded in research, measurement instruments, clinical settings, and everyday spoken language. The purpose of the present study was to construct two scales that represent unconfounded measures of sleepiness and fatigue, using widely used questionnaires.
Method: Four questionnaires purporting to measure sleepiness [Stanford Sleepiness Scale (SSS); Epworth Sleepiness Scale (ESS)] or fatigue [Fatigue Severity Scale (FSS); Chalder Fatigue Scale (CFS)] were administered, as well as a battery measuring sleep, psychological, and health functioning variables, to three samples: 19 individuals with chronic fatigue syndrome, 14 with narcolepsy, and 11 normal control subjects.
Results: Analyses revealed two distinct sets of items (six sleepiness and three fatigue items) that were combined into two scales. These newly formed scales are only minimally correlated and represent separate constructs that have reasonably distinctive patterns of association. Findings were replicated and validated in a sample of 128 older individuals complaining of daytime sleepiness and/or fatigue.
Conclusions: We conclude that (a) it is possible to derive empirically distinct sleepiness and fatigue scales from existing, commonly used self-report instruments, (b) the Empirical Sleepiness Scale is limited to the experience of daytime sleep tendency, while (c) the Empirical Fatigue Scale is associated more broadly with insomnia, psychological maladjustment, and poorer perceived health function. The important clinical implication of the new Empirical Sleepiness and Fatigue Scales is in the ability to identify “sleepiness which is not fatigue,” a construct closely related to primary sleep disorders, such as sleep apnea/hypopnea syndrome, for which there is both available and effective treatment.

Barsky, Arthur J./ Orav, E. John/ Bates, David W. Distinctive Patterns of Medical Care Utilization in Patients Who Somatize. Medical Care 2006, 44, 803–811.
Background: Somatizing patients have maladaptive and increased rates of medical care utilization. If there were a way of routinely identifying such patients, one that did not require intensive, case by-case review, they could be targeted for specific interventions to improve their use of medical care.
Objective: We sought to identify patterns of medical care utilization that would distinguish somatizing and nonsomatizing medical outpatients with acceptable sensitivity and specificity.
Design: Subjects completed questionnaires assessing somatization and sociodemographic characteristics. Their medical care utilization was obtained for the 12 months preceding the index visit. We then used multivariable logistic regression and recursive partitioning to identify patients with a provisional diagnosis of somatoform disorder. These exploratory models used various patterns of medical care utilization and sociodemographic characteristics as the independent variables.
Subjects: We studied consecutive adults attending 2 primary care practices on randomly chosen days.
Measures: The provisional diagnosis of a somatoform disorder was assessed with a 15-item self-report questionnaire. The number of primary care visits, specialty visits, mental health visits, emergency visits, and inpatient and outpatient costs were obtained for the 12 months preceding the index visit from our hospital’s automated medical records, which also provided a rating of aggregate medical morbidity. Self-reported utilization outside our hospital system was obtained from a subsample of patients.
Results: Complete data were obtained on 1440 patients. Somatizing patients had more specialty care than primary care visits, higher outpatient than inpatient costs, and more emergency visits than nonsomatizing patients. A regression model containing 7 measures of utilization and 4 sociodemographic characteristics distinguished somatizing and nonsomatizing patients with a c-statistic = 0.73. Recursive partitioning identified 10 terminal nodes with a very high specificity (99%) but a very low sensitivity (15%).
Conclusions: We identified 7 discrete patterns of medical care utilization that distinguished somatizing and nonsomatizing patients. However, they did so with only modest specificity and sensitivity. This algorithm might be used effectively as the first step in a 2-step screening procedure whose second step would entail more intensive screening or individual, case-by-case review to identify somatizing patients in primary care practice.

Block, Keith I./ Dafter, Roger/ Greenwald, Howard P. Cancer, the Mind, and the Problem of Self-blame. Integrative Cancer Therapies 2006, 5(2).

Engum, Anne. The Role of Depression and Anxiety in Onset of Diabetes in a Large Population-Based Study.  Journal of Psychosomatic Research 2007, 62, 31– 38.
Abstract
Objective: Recent research has shown that depression may predict incident diabetes. The aims of the study are to investigate if symptoms of depression and anxiety precede the onset of diabetes or vice versa and to examine if mediating factors may explain such associations.
Methods: A prospective population-based study (N=37,291) investigating the associations between symptoms of depression/anxiety and diabetes was conducted.
Results: Individuals reporting symptoms of depression and anxiety at baseline had increased risk of onset of type 2 diabetes at 10-year follow-up. No gender differences were found. The analyses did not reveal underlying factors that mediated the association. Baseline diagnosis of diabetes was not associated with subsequent symptoms of anxiety or depression among males or females.
Conclusion: Diabetes did not predict symptoms of depression or anxiety. Symptoms of depression and anxiety emerged as significant risk factors for onset of type 2 diabetes independent of established risk factors for diabetes, such as socioeconomic factors, lifestyle factors, and markers of the metabolic syndrome. The comorbidity between depression and anxiety may be the most important factor.

Frasure-Smith, Nancy/ Lespérance, François/ Talajic, Mario. Depression and 18-Month Prognosis After Myocardial Infarction. Circulation 1995, 91, 999-1005.
Abstract
Background We previously reported that major depression in patients in the hospital after a myocardial infarction (MI) substantially increases the risk of mortality during the first 6 months. We examined the impact of depression over 18 months and present additional evidence concerning potential mechanisms linking depression and mortality.
Methods and Results Two-hundred twenty-two patients responded to a modified version of the National Institute of Mental Health Diagnostic Interview Schedule (DIS) for a major depressive episode at approximately 7 days after MI. The Beck Depression Inventory (BDI), which measures depressive symptomatology, was also completed by 218 of the patients. All patients and/or families were contacted at 18 months to determine survival status. Thirty-five patients met the modified DIS criteria for major in-hospital depression after the MI. Sixty-eight had BDI scores 10, indicative of mild to moderate symptoms of depression. There were 21 deaths during the follow-up period, including 19 from cardiac causes. Seven of these deaths occurred among patients who met DIS criteria for depression, and 12 occurred among patients with elevated BDI scores. Multiple logistic regression analyses showed that both the DIS (odds ratio, 3.64; 95% confidence interval [CI], 1.32 to 10.05; P=.012) and elevated BDI scores (odds ratio, 7.82; 95% CI, 2.42 to 25.26; P=.0002) were significantly related to 18-month cardiac mortality. After we controlled for the other significant multivariate predictors of mortality in the data set (previous MI, Killip class, premature ventricular contractions [PVCs] of 10 per hour), the impact of the BDI score remained significant (adjusted odds ratio, 6.64; 95% CI, 1.76 to 25.09; P=.0026). In addition, the interaction of PVCs and BDI score marginally improved the model (P=.094). The interaction showed that deaths were concentrated among depressed patients with PVCs of  <10 per hour (odds ratio, 29.1; 95% CI, 6.97 to 122.07; P<.00001).
Conclusions Depression while in the hospital after an MI is a significant predictor of 18-month post-MI cardiac mortality. Depression also significantly improves a risk stratification model based on traditional post-MI risks, including previous MI, Killip class, and PVCs. Furthermore, the risk associated with depression is greatest among patients with <10 PVCs per hour. This result is compatible with the literature suggesting an arrhythmic mechanism as the link between psychological factors and sudden cardiac
death and underscores the importance of developing screening and treatment programs for post-MI depression.

Gold, Stefan M./ Irwin, Michael R. Depression and Immunity: Inflammation and Depressive Symptoms in Multiple Sclerosis. Neurol Clin 2006, 24, 507–519.

Kennya, M.A./ Williams, J.M.G. Treatment-Resistant Depressed Patients Show a Good Response to Mindfulness-Based Cognitive Therapy. Behaviour Research and Therapy Mar 2007, 45(3), 617-625.
Abstract
Mindfulness-based Cognitive Therapy (MBCT) is a class-based programme designed for use in the prevention of relapse of major depression. Its aim is to teach participants to disengage from those cognitive processes that may render them vulnerable to future episodes. These same cognitive processes are also known to maintain depression once established, hence a clinical audit was conducted to explore the use of MBCT in patients who were currently actively depressed, and who had not responded fully to standard treatments. The study showed that it was acceptable to these patients and resulted in an improvement in depression scores (pre-post Effect Size ¼ 1.04), with a significant proportion of patients returning to normal or near-normal levels of mood.

Maddi, Salvatore R./ Brow, Marnie/ Khoshaba, Deborah M./ Vaitkus, Mark.
Relationship of Hardiness and Religiousness to Depression and Anger. Consulting Psychology Journal: Practice and Research 2006, 58(3), 148–161.
Both hardiness and religiousness share spirituality, in the sense of searching for meaning in one’s life, and have been shown to have a buffering effect on stresses that maintains and enhances performance, morale, and health. This study investigates how hardiness and religiousness compare in their relationship to depression, anger, and the coping and social support mechanisms whereby they may have these relationships. Participants were military and governmental personnel who completed accepted measures of hardiness, religiousness, and other variables on a volunteer basis. Correlational and multiple regression analyses showed that, by comparison with religiousness, hardiness has the larger and more comprehensive negative relationship with depression and anger, and positive relationship with coping and social support. The conceptual and empirical implications of these findings are discussed.

Matheis, Elizabeth N./ Tulsky, David S./ Matheis, Robert J. The Relation Between Spirituality and Quality of Life Among Individuals With Spinal Cord Injury. Rehabilitation Psychology 2006, 51(3), 265–271.
Objective: To determine how spiritual-based coping relates to quality of life in individuals with spinal cord injury (SCI).
Design, Setting, & Participants: A telephone interview of 75 participants, primarily Caucasian single men aged 19 to 71 (enrolled in the Northern New Jersey Spinal Cord Injury Model System).
Measures: Ellison’s Spiritual Well-Being Scale, Duke Health Profile, Craig Handicap Assessment and Reporting Technique, Diener’s Satisfaction With Life Survey.
Results: Virtually all participants (98.7%) reported using some form of spiritual-based coping. Quality of life was highest among participants who use existential spiritual as opposed to religious spiritual coping. In particular, existential spirituality shared 27% variance with overall perceived life quality.
Conclusions: Spiritual-based coping might be encouraged as a possible strategy to improve life quality. Clinicians should be cognizant of ongoing spiritual practices among persons with SCI.

Maunder, Robert G./ Lancee, William J./ Nolan,  Robert P./ Hunter, Jonathan J./ Tannenbaum, David W.  The Relationship of Attachment Insecurity to Subjective Stress and Autonomic Function During Standardized Acute Stress in Healthy Adults. Journal of Psychosomatic Research 2006, 60, 283– 290.
Abstract
Objective: The purpose of this study was to test predicted relationships between adult attachment and stress using subjective and physiological measures.
Methods: Sixty-seven healthy adults completed measures of adult attachment and perceived chronic stress. Subjective stress and the high-frequency (HF) and lowfrequency (LF) spectral bandwidths of heart rate variability (HRV) were measured during a standardized stress protocol.
Results: Attachment anxiety is associated with between-subject differences in chronic perceived stress ( P=.001) and subjective acute stress ( P=.01). There is a main effect of attachment avoidance on between-subject differences in HF HRV ( P=.004). Attachment avoidance is inversely associated with HF HRV, independent of age and variability in respiration.
Conclusion: Attachment anxiety is associated with self-reported distress. Attachment avoidance is inversely associated with HF HRV, a marker of vagal influence on cardiac activity, but is not associated with subjective stress.

McIntyre, Roger S./ Konarskic, Jakub Z./ Mancini,Deborah A/ Zurowski, Mateusz/ Giacobbe, Peter/ Soczynska, Joanna K./ Kennedy,Sidney H. Improving Outcomes in Depression: A Focus on Somatic Symptoms. Journal of Psychosomatic Research 2006, 60, 279– 282.
Abstract
Background: It is hypothesized that somatic symptom alleviation is a significant predictor of overall outcome in depressed primary care patients.
Methods: Depressed primary care patients (N=205) meeting DSM-IV-TR criteria received open-label antidepressant therapy. The primary symptom measurement tool used was the 17-item Hamilton Depression Rating Scale (HAMD-17), with the Montgomery–Asberg Depression Rating Scale (MADRS) and the Clinical Global Impression Improvement/Severity (CGI-I/S) used as secondary measures. As proxies for somatic symptoms, 8 items from the HAMD-17 (HAMD-S) and 3 items from the MADRS (MADRS-S) that measure somatic symptoms were identified and extracted.
Results: There was a significant correlation between improvement on the HAMD-S score and overall reduction on the MADRS total score (r =.766, P <.001), response (r =.594, P < .001), and remission (r =.552, P <.001). Improvement on the MADRS-S also correlated with overall HAMD-17 improvement (r =.782, P <.001), along with response (r =.649, P <.001) and remission (r=.539, P <.001) rates. Both the HAMD-S and the MADRS-S correlated with global improvement as measured by the CGI-I/S ( P <.001).
Conclusions: A reciprocal interaction between somatic symptoms and other depressive-symptom domains is implied by this analysis. Clinicians are encouraged to identify, track, and target the somatic symptoms of depressive illnesses.

McMinn, Mark R./ Ruiz, Janeil N./ Marx, David/ Wright, J. Brooke/ Gilbert, Nicole B. Professional Psychology and the Doctrines of Sin and Grace: Christian Leaders’ Perspectives. American Psychological Association 2006, 37(3), 295–302.
What is a professional psychologist to do when a client brings up the concept of sin? To some, sin may seem like a stifling religious relic that has no place in contemporary psychology. But viewing sin from within the Christian faith, and in tandem with the doctrine of grace, can help psychologists understand why sin is such an important concept for many of their Christian clients. Psychologists’ misunderstanding of sin and grace may contribute to relatively low rates of referral from Christian leaders to clinical psychologists, and may sometimes hinder therapeutic progress. Two methods of data collection, involving a total of 171 respondents, were used to discern what Christian leaders wish psychologists understood regarding the doctrine of sin. Respondents emphasized the nature and consequences of sin, grace, and the importance of psychologists understanding sin and grace. Implications for professional psychologists are offered.

McNeely Pass, Olivia. Toni Morrison’s Beloved: A Journey through the Pain of Grief. J Med Humanit, 2006, 27, 117–124.
Abstract
This paper elucidates the structure of Toni Morrison’s novel, Beloved, using the framework of human emotions in response to grieving and death as developed by Elisabeth Kubler-Ross. Through her studies of terminally ill patients, Kubler-Ross identified five stages when approaching death: denial and isolation, anger, bargaining, depression and acceptance. These stages accurately fill the process that the character Sethe experiences in the novel as she learns to accept her daughter’s death.

Miah, Andy. Doctor, Can You Fix My Broken Heart? J Med Humanit 2006, 27, 127–129.

Peterson, Christopher. Strengths of Character and Happiness: Introduction To Special Issue. Journal of Happiness Studies, 2006, 7, 289–291.
Abstract
This special issue examines strengths of moral character and their relationship to happiness. Six papers are included that address this topic using a variety of samples and methods. The value of positive psychology in encouraging the juxtaposition of typically separate lines of research is underscored.

Rushton, Cynda Hylton. Defining and Addressing Moral Distress Tools for Critical Care Nursing Leaders. AACN Advanced Critical Care 17(2), 161–168.
Abstract
Nurse clinicians may experience moral distress when they are unable to translate their moral choices into moral action. The costs of unrelieved moral distress are high; ultimately, as with all unresolved professional conflicts, the quality of patient care suffers. As a systematic process for change, this article offers the AACN’s Model to Rise Above Moral Distress, describing four A’s: ask, affirm, assess, and act. To help critical care nurses working to address moral distress, the article identifies 11 action steps they can take to develop an ethical practice environment.

Segal, Zindel V./ Mark, J./ Williams, G./ Teasdale, John D. Combining Cognitive, Emotional, Behavioural and, Dare We Say It, The Spiritual: A Review of Mindfulness Based Cognitive Therapy for Depression: A New Approach to Preventing Relapse. New York, NY: The Guilford Press 2002.

Segal, Zindel V./ Mark, J./ Williams, G./ Teasdale, John D. The Canadian Journal of Psychiatry Mood Disorders Mindfulness-Based Cognitive Therapy for Depression. New York, NY: The Guilford Press 2002.

Stevens Barnum, Barbara. Why Freud and Jung Can’t Speak: A Neurological Proposal. Journal of Religion and Health Fall 2006, 45(3).
Abstract: This article provides a modern neurological explanation for the theoretical differences in psychoanalytic concepts and techniques between Freud and Jung. Specifically, the article contrasts their analytic skills as arising in the left and right brain, respectively. Modern neurological techniques reveal unique brain functions that explain many of the visionary and so-called mystic phenomena discussed by Jung. Many of his psychoanalytic concepts can be traced to right brain function. Modern research and philosophic analyses also provide light on Freud’s research method and its limitations.

Tolmacz, Rami . CONCERN A Comparative Look. Psychoanalytic Psychology 2006, 23(1), 143–158.
The concept of concern has received very little attention in the psychoanalytic literature. Aside from Winnicott’s “The Development of the Capacity for Concern” (1963), based on Kleinian approach, the subject has scarcely been addressed from an empirical or theoretical standpoint. Here an attempt is made to consider the concept from the perspective of 2 object relations theories that have come out against the classical approach: attachment theory and Suttie’s theory. The paper also looks at Winnicott’s thinking on the subject, from association with guilt to association with joy, as well as the association with intersubjective approaches. There follows a discussion of 4 points: motivation, nature versus nurture, time of appearance, and the object. Finally, several points are raised regarding related interpersonal and intrapersonal issues.

Tomich, Patricia L./ Helgeson, Vicki S. Cognitive Adaptation Theory and Breast Cancer Recurrence: Are There Limits? Journal of Consulting and Clinical Psychology 2006, 74(5), 980–987.
Relations of the components of cognitive adaptation theory (self-esteem, optimism, control) to quality of life and benefit finding were examined for 70 women (91% Caucasian) diagnosed with Stage I, II, or III breast cancer over 5 years ago. Half of these women experienced a recurrence within the 5 years; the other half remained disease free. Women were matched on age, race, stage of disease, and intervention condition. Baseline perceptions of personal control over illness, but not general self-esteem or optimism, were associated with women’s reports of worse physical functioning, worse mental functioning, and less benefit finding 5 years later for recurrent women but not disease-free women. These findings highlight the notion that there may be boundary conditions on the adaptiveness of perceived control.

Van Houdenhove, Boudewijn/ Bruyninckx, Karolien/ Luyteb, Patrick. In Search of a New Balance. Can High “Action-Proneness” in Patients with Chronic Fatigue Syndrome be Changed by a Multidisciplinary Group Treatment? Journal of Psychosomatic Research 2006, 60, 623 – 625.
Abstract
Objective: The purpose of this study is to investigate changes in “action-proneness” (a cognitive and behavioral tendency toward direct action) after a multidisciplinary group intervention, including cognitive behaviour therapy (CBT) and graded exercise therapy (GET).
Methods: Patients with chronic fatigue syndrome (n=62) completed three versions of a Dutch self-report questionnaire evaluating  action-proneness retrospectively that is (1) before illness onset, (2) before treatment and (3) after treatment. Significant others (n=62) also gave their opinion about the patients’ action-proneness at time points 1 and 2.
Results: Premorbid action-proneness levels considerably dropped after illness onset. After treatment, action-proneness levels significantly increased again, although levels remained below premorbid levels.
Conclusion: High action-proneness retrospectively reported by CFS patients can be adaptively modified by a multidisciplinary group treatment including CBT and GET.

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