Background: Depression and anxiety are common and associated with inflammation in patients with cancer. Inflammatory indices such as albumin and neutrophil-to-lymphocyte ratio (NLR) obtained from metabolic panels and complete blood counts should be available for mental health professionals treating anxiety and depression at cancer centers. We hypothesized that albumin and NLR extrapolated from non-mental health oncology appointments would be associated with anxiety and depression and drawn close enough to psychiatry visits to be useful for the psycho-oncologist. Materials & Methods: Depression and anxiety were evaluated in patients (n = 97) referred to a cancer center psychiatric service for depression using the Patient Health Questionnaire-9 and General Anxiety Disorder-7. Albumin concentration and NLR were assessed for timing and correlation strength with anxiety and depression by setting (localized/metastatic cancer). Results: Most patients (96%) had albumin or NLR available at any time point of which 45% were drawn within one week of the psychiatric appointment. No significant correlations were noted when evaluating localized cancer or NLR exclusively. For patients with metastatic cancer, anxiety and depression were correlated with albumin at any time point (r = −0.28, p < 0.05; r = −0.40, p < 0.01, respectively) and within a week of psychiatry appointment (r = −0.40, p < 0.05; r = −0.68, p < 0.001, respectively). Albumin evaluated within a week predicted 32% of depression score variance (β = −0.63, p = 0.002). Hypoalbuminemia (<3.8 g/ul) was associated with anxiety (χ2 = 4.43, p = 0.04) and depression (χ2 = 11.06, p = 0.001). Conclusion: Hypoalbuminemia in patients with metastatic cancer may help establish the presence or persistence of anxiety, depression, treatment refractoriness, and the use of inflammation in cancer-related psychological symptom management.
Objective
This pilot study examined whether breast cancer patients with childhood trauma exhibit increased fatigue, depression, and stress in association with inflammation as a result of whole breast radiotherapy (RT).
Methods
Twenty breast cancer patients were enrolled in a prospective, longitudinal study of fatigue, depression, and perceived stress prior to RT, week 6 of RT, and 6 weeks post-RT. Six weeks after RT, subjects completed the childhood trauma questionnaire (CTQ). Patients were also administered the multidimensional fatigue inventory, inventory of depressive symptomatology-self-reported, and perceived stress scale at all three time-points and underwent blood sampling prior to RT for gene expression and inflammatory markers previously associated with childhood trauma and behavioral symptoms in breast cancer patients.
Results
Eight subjects (40%) had past childhood trauma (CTQ+). Compared to CTQ- patients, CTQ+ patients had significantly higher fatigue, depression, and stress scores before, during, and after RT (p < 0.05); however, RT did not increase these symptoms in either group. CTQ+ patients also exhibited increased baseline expression of gene transcripts related to inflammatory signaling, and baseline inflammatory markers including c-reactive protein, interleukin (IL)-6, and IL-1 receptor antagonist were positively correlated with depression, fatigue, and stress scores in CTQ+ but not CTQ- patients.
Conclusions
Childhood trauma was prevalent and was associated with increased symptoms of fatigue, depression, and stress irrespective of RT. Increased symptoms in CTQ+ patients were also associated with baseline inflammatory markers. Treatments targeting childhood trauma and related inflammation may improve symptoms in breast cancer patients.
by
Courtland S. Hyatt;
Chelsea E. Sleep;
Joanna Lamkin;
Jessica L. Maples-Keller;
Jessica Keller;
Constantine Sedikides;
W. Keith Campbell;
Joshua D. Miller
Similarity between narcissism and self-esteem seems intuitive, as both capture positive perceptions of the self. In the current undertaking, we provide a broad comparison of the nomological networks of grandiose narcissism and explicit self-esteem. Pooling data from 11 existing samples (N = 4711), we compared the relations of narcissism and self-esteem to developmental experiences, individual differences, interpersonal functioning, and psychopathology. Both constructs are positively related to agentic traits and assertive interpersonal approaches, but differ in relation to agreeableness/communion. Self-esteem emerged as a wholly adaptive construct negatively associated with internalizing psychopathology and generally unrelated to externalizing behaviors. Unlike self-esteem, narcissism was related to callousness, grandiosity, entitlement, and demeaning attitudes towards others that likely partially explain narcissism’s links to maladaptive outcomes.
Institutional barriers in HIV primary care settings can contribute substantially to disparities in retention in HIV treatment and HIV-related outcomes. This qualitative study compared the perceptions of clinic experiences of persons living with HIV (PLWH) in a Veterans Affairs HIV primary care clinic setting who were retained in care with the experiences of those who were not retained in care. Qualitative data from 25 in-depth interviews were analyzed to identify facilitators and barriers to retention in HIV care. Results showed that participants not retained in care experienced barriers to retention involving dissatisfaction with clinic wait times, low confidence in clinicians, and customer service concerns. For participants retained in care, patience with procedural issues, confidence in clinicians, and interpersonal connections were factors that enhanced retention despite the fact that these participants recognized the same barriers as those who were not retained in care. These findings can inform interventions aimed at improving retention in HIV care.
Objective: Depression is highly prevalent in nonsmall cell lung cancer (NSCLC) and is associated with elevated inflammation. However, certain subtypes of driver mutation–associated NSCLC such as epidermal growth factor receptor (EGFR)–mutated NSCLC may be associated with less depression given the differences in their underlying biology and disease trajectories. Biological variables such as inflammation, measured by C-reactive protein (CRP), may provide insight into depression variability in EGFR mutant NSCLC. Methods: Patients with EGFR mutant and wild-type metastatic NSCLC were evaluated for depression using the Hospital Anxiety and Depression Scale (HADS) on a continuous scale and meeting depression screening criteria (HADS ≥ 8). Inflammation was measured using CRP. A mediation model was created to understand how inflammation mediates EGFR wild-type associated depression. Results: One hundred out of 120 patients with NSCLC were recruited (83.3% response rate). The 20 participants with EGFR mutant NSCLC had less depression (HADS-D 3.0 versus 5.4) (P <.001), met depression screening criteria less often (P =.047), and exhibited less inflammation (CRP = 0.23 mg/mL versus 2.71 mg/mL) (P <.001) in comparison with EGFR wild-type NSCLC. Multivariate linear regression model revealed that only CRP predicted depression (P =.015) while controlling for age and sex. Mediation analysis found that lower CRP partially mediated less depression in EGFR mutant NSCLC. Conclusions: EGFR mutant NSCLC is associated with less depression but the relationship is partially mediated by lower CRP-related inflammation, which is a stronger predictor of depression than EGFR status. Depression in lung cancer varies by subtype and is significantly related to inflammation.
Background:
The distress thermometer and problem list (DT&PL) is a recommended screening measure but the utility of the physical problem list (PPL) has not been evaluated in patients with metastatic lung cancer who typically have high rates of both physical and psychological symptoms. We hypothesized that the PPL will provide an accurate representation of lung cancer symptoms and be associated with concomitant distress, anxiety, depression, and worsened survival.
Methods:
Stage IV lung cancer patients (n = 116) reported physical symptoms from 22 PPL variables and completed the DT&PL for distress, general anxiety disorder-7 for anxiety, and Patient Health Questionnaire 9 for depression. Inferential analyses were controlled for demographic and clinical characteristics.
Results:
The average number of physical problems was 4.7 (SD = 3.8) while the median was 3.0. Fatigue, sleep, pain, and breathing problems were most common. Physical symptom burden was associated with nonmarried/partnered status (P = .003) and depression (P < .001) on multivariate analysis accounting for 43% of physical symptom burden variance. Greater number of physical symptoms and lower BMI were associated with worsened survival. Individual physical symptoms were most often associated with depression.
Conclusion:
The PPL of the DT&PL appears to have clinical utility given its associations with the most common lung cancer symptoms, depression, and worsened survival. In addition to its potential role in clinics worldwide already using the DT&PL, physical symptom burden on the DT&PL should trigger a concomitant psychological assessment.
This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Recent evidence suggests that grammatical aspect can bias how individuals perceive criminal intentionality during discourse comprehension. Given that criminal intentionality is a common criterion for legal definitions (e.g., first-degree murder), the present study explored whether grammatical aspect may also impact legal judgments. In a series of four experiments participants were provided with a legal definition and a description of a crime in which the grammatical aspect of provocation and murder events were manipulated. Participants were asked to make a decision (first- vs. second-degree murder) and then indicate factors that impacted their decision. Findings suggest that legal judgments can be affected by grammatical aspect but the most robust effects were limited to temporal dynamics (i.e., imperfective aspect results in more murder actions than perfective aspect), which may in turn influence other representational systems (i.e., number of murder actions positively predicts perceived intentionality). In addition, findings demonstrate that the influence of grammatical aspect on situation model construction and evaluation is dependent upon the larger linguistic and semantic context. Together, the results suggest grammatical aspect has indirect influences on legal judgments to the extent that variability in aspect changes the features of the situation model that align with criteria for making legal judgments.
The high prevalence of trauma among people living with HIV underscore the need for tailored, integrated trauma management (“trauma-informed care” or TIC) to improve retention, adherence to care, and overall well-being. Although TIC has been identified as a priority area for HIV care, uptake has been limited. To investigate barriers and facilitators to integrating trauma support services within HIV primary care, surveys (n=94) and interviews (n=44) were administered to providers, staff, and patients at a large HIV treatment center. Results highlighted the availability of several trauma services, including psychotherapy and support groups, but also revealed the absence of provider training on how to respond to patient trauma needs. Identified gaps in TIC services included written safety and crisis prevention plans, patient education on traumatic stressors, and opportunities for creative expression. Providers and staff supported implementation of trauma support services and employee trainings, but expressed a number of concerns including resource and skill deficiencies. Patient-reported barriers to TIC services included lack of awareness of services and difficulties navigating the healthcare system. This assessment revealed support and methods for strengthening integration of trauma support services within HIV primary care, which future TIC implementation efforts should address.