SEARCH · PubMed Health

Results for “Psychosocial functioning”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,009 records · Page 56Linked to original sources

PubMed2006

Postpartum depression: a randomized trial of sertraline versus nortriptyline.

Symptom reduction and improvement in functioning in women with postpartum major depression treated with a tricyclic antidepressant versus a serotonin reuptake inhibitor were compared. The design was a double-blind, 8-week comparative trial of nortriptyline (NTP) versus sertraline (SERT) with a 16-week continuation phase. Women aged 18 to 45 years with postpartum major depression and a 17-item Hamilton Rating Scale for Depression score of 18 or more were eligible. Subjects were randomized to NTP or SERT and treated with a fixed-dosing strategy. Of 420 women interviewed, 109 eligible women received medication, and 95 provided follow-up data. The proportion of women who responded and remitted did not differ between drugs at 4, 8, or 24 weeks. Times to response and remission also did not differ. Psychosocial functioning improved similarly in both drug-treated groups of mothers. The total side effect burden of each drug was similar, although side effect profiles differed between agents. No clinical or demographic variables differentiated responders by drug. Women who were responders and remitters at week 8 could be identified earlier if they were treated with SERT than with NTP. Breast-fed infant serum levels were near or below the level of quantifiability for both agents.

Adaptation, Psychological↗

PubMed2005

Recovery and functional outcomes following olanzapine treatment for bipolar I mania.

BACKGROUND: Typical experimental categorizations of treatment responses in bipolar disorder (BPD) patients may have limited relationship to clinical recovery or functional status, and there is inadequate research on such clinically important outcomes. METHODS: We analyzed data from a study of open continuation of olanzapine treatment following a 3-week placebo-controlled trial involving initially hospitalized adult subjects with DSM-IV BP-I mania to estimate rates and times to symptomatic remission (low scores on standardized symptomatic assessments) and clinical recovery (remission sustained>or=8 weeks), associated clinical factors, and functional outcomes. RESULTS: During treatment with olanzapine for 27.9+/-20.1 weeks, symptomatic remission was attained by 70% of subjects, half by 8 weeks (95% CI 6-10) weeks, and later lost by 82% of remitted subjects; remitted (versus non-remitted) subjects had slightly lower baseline clinical global impression scores and greater trial-completion. Sustained clinical recovery was attained by only 40 of 113 (35%) of subjects, half by 36 (95% CI 20-40) weeks, and later lost by 45%. Subjects with above-median (>12) initial Hamilton-Depression rating scale depression scores were half as likely to recover (p=0.016) and did so much later (36 versus 12 weeks) than those with lower scores. At final assessment, self-rated well being (SF-36 psychosocial functioning scores) improved substantially more among recovered versus non-recovered subjects (mean changes: 87% versus 23%), and two-thirds of recovered subjects remained unemployed-for-pay while half received disability-compensation. CONCLUSIONS: Clinically meaningful symptomatic remission and recovery in relatively severely ill adult bipolar I manic patients were achieved slowly and sustained by only some patients within an average of 7 months of continuous treatment. These clinically relevant outcomes were worse with relatively high initial dysphoria ratings. Well-being was rated higher by recovered subjects, but their ability to work and live independently were markedly impaired. These findings underscore the emerging view that BPD can often be severe, slow to remit, and disabling, particularly in association with prominent depression-dysphoria symptoms. Improved treatments for BPD are needed, guided by longitudinal assessments of clinically meaningful measures of symptomatic recovery and functional outcome.

Adult↗

PubMed2005

Functional impairment in clinical samples of Norwegian and Swedish children and adolescents with obsessive-compulsive disorder.

UNLABELLED: The aims of the present study were to examine OCD-related impairments in clinical cases of childhood OCD and to replicate and extend previous research on OCD-related impairments. METHOD: Sixty-eight patients aged 8-17 years recruited from four child psychiatric outpatient clinics in Norway and Sweden with a confirmed DSM-IV diagnosis of OCD were included in the study. All patients and their parents were interviewed for diagnosis and comorbidity (KSADS),OCD symptoms and severity (CY-BOCS), and global impairment (CGAS). OCD-specific impairments were assessed by means of the Child OCD Impact Scale (COIS), a 58 item questionnaire with parallel parent and child versions. RESULTS: Overall, the majority of patients suffered from substantial impairments. The impact of OCD symptoms was found to be most severe at home, but impairments were also prominent in situations related to school and social settings. CONCLUSIONS: Our study supports findings of previous research suggesting multiple impacts of OCD symptoms on children's psychosocial functioning. We conclude that impairment issues should be further addressed in future research to establish a better empirical basis for the understanding of different aspects of OCD-related impairment.

Adolescent↗

PubMed1993

Mental health and psychiatric disorders in older women.

An increase in the number and diversity of resources designed to optimize psychosocial function in people and especially women over age 65 is inevitable in the next decade as both the size and political influence of this group increase. The successful implementation of such programs is dependent on widespread change throughout society, involving many disparate groups, including older people themselves, politicians, health care administrators, and researchers from a range of disciplines. Clinicians in medicine and allied professions have a pivotal role in this regard. At present there are many reversible causes of psychiatric morbidity in the elderly, including depression, anxiety, cognitive defects, sensory impairment, malnutrition, and adverse effects of alcohol abuse and polypharmacy that are often not recognized or treated appropriately. It is therefore essential that family practitioners receive both undergraduate and postgraduate training to recognize and manage the wide range of psychosocial disorders prevalent in older women. Intervention may require little more than an opportunity for the women to ventilate concerns or obtain information and advice about community resources. In other circumstances in which there are complex interactions of physical, social, and psychological factors, optimal management may involve interventions that require specific skills beyond the scope of the individual practitioner. Referral to a psychogeriatric team is likely to be helpful in such situations. The team, with its access to a full range of health professionals and community resources, is well placed to deal economically with complex issues. The special care units are best equipped to manage the tertiary care of the chronically ill who do not have adequate community-based support available. Increased information derived from research relating to the spectrum of mental ill health and mental health is essential to adequately address the causes, correlates, and treatments of illness, and to answer questions about the positive aspects of mental health that may have implications for all age groups and both sexes. For example, it is intriguing that older women maintain a high level of psychological health despite greater social disadvantages than any other major section of the community. It is likely that psychological factors, such as better coping skills and ability to adapt to stressful life events, influence both the quality of life in older women and possibly also its duration. Alternatively, it is possible that the commonly held view that the life expectancies of women and men will converge as women undertake more of the roles and activities currently the province of men may occur.(ABSTRACT TRUNCATED AT 400 WORDS)

Aged↗

PubMed2001

Quality of life and psychosocial adjustment in patients after Roux-en-Y gastric bypass: a brief report.

BACKGROUND: While Roux-en-Y gastric bypass (RYGBP) appears to be the most effective procedure for weight loss in morbidly obese patients, objective outcome data regarding quality of life (QoL) and psychosocial status following surgery are lacking. METHODS: The present study examined the effects of RYGBP in 32 morbidly obese subjects on a variety of outcome measures including QoL and psychosocial functioning. Assessments were conducted before surgery, 1 to 3 weeks post-surgery, and at 6-month follow-up. RESULTS: In addition to weight loss, results show significant improvements in health-related QoL, depression, and self-esteem, as well as a significant reduction in eating pathology following surgery. Results also show that neither the presence of binge-eating disorder nor clinical depression predicted poorer outcome post-surgery. CONCLUSION: RYGBP results in a dramatic reduction in weight, and marked improvements in health-related QoL, depression, self-esteem, and eating pathology, including binge-eating in the short term. These findings need to be replicated in a larger cohort of patients and followed for a longer time before we can reach more definitive conclusions regarding the psychosocial outcome in RYGBP.

Activities of Daily Living↗

PubMed2005

The psychosocial effects of cleft lip and palate: a systematic review.

This systematic review examined the published scientific research on the psychosocial impact of cleft lip and palate (CLP) among children and adults. The primary objective of the review was to determine whether having CLP places an individual at greater risk of psychosocial problems. Studies that examined the psychosocial functioning of children and adults with repaired non-syndromal CLP were suitable for inclusion. The following sources were searched: Medline (January 1966-December 2003), CINAHL (January 1982-December 2003), Web of Science (January 1981-December 2003), PsycINFO (January 1887-December 2003), the reference section of relevant articles, and hand searches of relevant journals. There were 652 abstracts initially identified through database and other searches. On closer examination of these, only 117 appeared to meet the inclusion criteria. The full text of these papers was examined, with only 64 articles finally identified as suitable for inclusion in the review. Thirty of the 64 studies included a control group. The studies were longitudinal, cross-sectional, or retrospective in nature.Overall, the majority of children and adults with CLP do not appear to experience major psychosocial problems, although some specific problems may arise. For example, difficulties have been reported in relation to behavioural problems, satisfaction with facial appearance, depression, and anxiety. A few differences between cleft types have been found in relation to self-concept, satisfaction with facial appearance, depression, attachment, learning problems, and interpersonal relationships. With a few exceptions, the age of the individual with CLP does not appear to influence the occurrence or severity of psychosocial problems. However, the studies lack the uniformity and consistency required to adequately summarize the psychosocial problems resulting from CLP.

Adult↗

PubMed2001

Exploring the management of bone metastasis according to the Roy Adaptation Model.

PURPOSE/OBJECTIVES: To explore bone metastasis using Roy's Adaptation Model as a conceptual framework. DATA SOURCES: Published articles, conference abstracts, recent texts, and prescribing information. DATA SYNTHESIS: Bone metastasis has a significant impact on the patient's ability to maintain physical and psychosocial functions. Primary (self), secondary (family and occupation), and tertiary (community) roles, as identified by the Roy Adaptation Model, may be impaired as a result of bone metastasis. Patient education is a nursing intervention that frequently is used, as it allows an individual to interpret an aversive event and take action, thus promoting adaptation to illness. Medications for the underlying disease, bone metastasis, pain, and other symptoms warrant consideration. Active interventions, such as relaxation therapy, guided imagery, music, meditation, and therapeutic touch, also promote adaptation. CONCLUSIONS: Bone is a common and potentially debilitating site of metastasis. The presence of bone metastasis indicates progressive and, almost always, incurable disease. Patient adaptation can be enhanced through the proper use of palliative therapies and other nursing measures. IMPLICATIONS FOR NURSING PRACTICE: Oncology nurses can assist in the physical and psychosocial adaptation of patients with bone metastasis through assessment, patient education, and symptom management.

Adaptation, Psychological↗

PubMedDate not supplied

[Vulnerability to depression in children and adolescents: update and perspectives].

Depression in children and adolescents is associated with poor psychosocial functioning, high psychiatric comorbidity, risk of recurrent episodes or onset of bipolar disorder. These findings emphasize the importance of early identification of children and adolescents having elevated risk for future depression and further development, evaluation and greater availability of prevention strategies. Our review aims an update about depressive vulnerability in children and adolescents in the perspective of better identification of at-risk populations and targeting of prevention programs. Psychopathology, in particular anxiety and disruptive disorders are well identified risk-factors for later depression. Subclinical depressive symptomatology, also termed "demoralization", also identifies high-risk populations, likely to become incident cases of depression. It is still unclear whether this condition is prodromal depression, a specific clinical entity or the expression of biological and/or cognitive vulnerability. Familial risk for depressive disorders involves both genetic and psychosocial factors. Marital discord, poor communication and dysfunctional parenting practices are often present in families with affective disorders and can be implicated in increased depressive vulnerability in the offspring. Research on individual vulnerability in children and adolescents has focused on temperamental and cognitive characteristics. Temperament traits describe individual differences in reactivity and behavior. High emotionality, defined as the tendency to become upset easily and intensely has been associated with an increased risk for subsequent major depression. However, as the majority of high scorers will not become depressive cases, emotionality should not be the only criterion for selection of at-risk populations. Cognitive style including poor self esteem, low social competence and negative attributions are also associated with increased likelihood of depressive symptoms, but their predictive value for the onset of clinical depressive episodes needs further investigation. Familial and individual vulnerability is likely to heighten the depressogenic impact of life events and psycho-social adversity. Prevention interventions have been developed in the United States for children and adolescents at-risk for depression. In France, clinicians witness growing demands from families with affective illness concerned with risk of parent-child transmission of depressive vulnerability, prevention and early identification of symptoms. To meet this kind of emerging needs and to prevent family dysfunction, a preventive program targets offspring of depressed parents and uses clinician-based family approaches. Family and individual sessions aim a better understanding of illness experience and encourage the parents to identify and foster resilience in their children. Another type of preventive intervention focuses on children and adolescents with subclinical depressive symptoms, eventually associated with behavioral problems ou high level of parental conflict, recruited in school settings. These school-based interventions combine cognitive and social problem-solving techniques. Both familial and school-based preventive interventions have proven applicable and promising in high-risk children and adolescents. Perspectives are more systematic identification of risk groups, including youngsters with past or current non affective symptoms who might benefit from depression prevention, long-term evaluation and cross-cultural applications of prevention programs.

Adolescent↗

PubMed2000

Quality of life in individuals with anxiety disorders.

OBJECTIVE: Quality-of-life indices have been used in medical practice to estimate the impact of different diseases on functioning and well-being and to compare outcomes between different treatment modalities. An integrated view of the issue of quality of life in patients with anxiety disorders can provide important information regarding the nature and extent of the burden associated with these disorders and may be useful in the development of strategies to deal with it. METHOD: A review of epidemiological and clinical studies that have investigated quality of life (broadly conceptualized) in patients with panic disorder, social phobia, posttraumatic stress disorder, generalized anxiety disorder, and obsessive-compulsive disorder was conducted by searching MEDLINE and PsycLIT citations from 1984 to 1999. A summary of the key articles published in this area is presented. RESULTS: The studies reviewed portray an almost uniform picture of anxiety disorders as illnesses that markedly compromise quality of life and psychosocial functioning. Significant impairment can also be found in individuals with subthreshold forms of anxiety disorders. Effective pharmacological or psychotherapeutic treatment has been shown to improve the quality of life for patients with panic disorder, social phobia, and posttraumatic stress disorder. Limitations in current knowledge in this area are identified, and suggestions for needed future research are provided. CONCLUSIONS: It is expected that a more thorough understanding of the impact on quality of life will lead to increased public awareness of anxiety disorders as serious mental disorders worthy of further investment in research, prevention, and treatment.

Adaptation, Psychological↗

PubMed2005

Impact of epilepsy in adolescence: a UK controlled study.

PURPOSE: The goals of the work described here were to investigate the psychological and social impact of epilepsy on adolescents and to identify to what degree clinical and demographic variables and knowledge of epilepsy could influence psychosocial functioning. METHODS: Seventy adolescents with epilepsy were compared with healthy controls (matched for age, sex, and reading ability) on measures of self-esteem, social adjustment, depression, and obsession. Within the epilepsy group, the impact of seizure frequency, seizure severity, and knowledge of epilepsy on the above measures was also determined. RESULTS: Adolescents with epilepsy showed significantly higher levels of depression, anhedonia, and social anxiety and significantly higher numbers of obsessive symptoms than the adolescents without epilepsy. Among the adolescents with epilepsy, high seizure frequency was significantly associated with low self-esteem, and tonic-clonic seizures were specifically associated with higher levels of depression. Finally, low levels of epilepsy knowledge were significantly associated with higher levels of depression, lower levels of self-esteem, and higher levels of social anxiety. CONCLUSIONS: Epilepsy has a significant psychosocial impact on adolescents at this difficult time of life. Social support and access to appropriate information about epilepsy could be of help.

Adolescent↗

PubMed2006

[Subjective quality of life of patients with obsessive-compulsive disorder compared to the general population].

BACKGROUND: Patients with obsessive-compulsive disorder (OCD) not only suffer from obsessive-compulsive symptoms, but also the disorder is associated with impaired social functioning, which impact their everyday life negatively. OBJECTIVE: Subjective quality of life (QoL) in patients with OCD was examined and compared to the general German population. METHODS: 75 patients with OCD (ICD-10 F42.0-F42.2) were recruited from the outpatient clinic for anxiety disorders at the Department of Psychiatry of the University of Leipzig. Patients showing psychiatric co-morbidity were excluded. By means of the WHOQOL-BREF, QoL was assessed in patients with OCD and in a sample of the general population of Saxony/Germany. RESULTS: Compared with the general population, QoL in patients with obsessive-compulsive disorders was lower in all domains of the WHOQOL-BREF. CONCLUSION: OCD has a substantial adverse effect on patients' subjective QoL. Therefore, it will be necessary to include interventions in the treatment of OCD aimed at improving residual deficits in psychosocial functioning and QoL.

Adolescent↗

PubMed1995

Neuroleptic dosing and neuroleptic plasma levels in schizophrenia: determining the optimal regimen.

OBJECTIVE: To recommend dose range and therapeutic plasma concentration for several neuroleptics, and to discuss conditions under which neuroleptic plasma levels are clinically useful. METHOD: Neuroleptic drug therapy is a major component of the acute and maintenance treatment of schizophrenia. However, there is no consensus on what constitutes an appropriate or optimal dose of antipsychotic drug in individual patients. Low-dose medication has the potential to improve psychosocial function and reduces the frequency of side effects but can lead to an increase in positive symptoms and schizophrenic relapse. High doses may be associated with behavioural toxicity, symptom exacerbation, a worsening of secondary deficit symptoms, impaired social functioning and increased adverse effects such as acute extrapyramidal symptoms and tardive dyskinesia. Numerous clinical studies have attempted to determine the degree of correlation between dose, neuroleptic blood levels, and clinical response. RESULTS: To date, this approach has met with only limited success: neuroleptic dose overall appears to be a poor predictor of clinical outcome, and the suggested therapeutic plasma level concentrations of some antipsychotic drugs cannot be regarded as established by any means. Furthermore, the ability to conduct neuroleptic plasma levels is not readily accessible in the usual clinical setting. In the acute treatment phase, titrating the dose until the onset of minimal cogwheel rigidity or hypokinesia (neuroleptic threshold dose) has met with some success and is preferable to standard dosing as a means of individualizing pharmacotherapy. During the maintenance phase, a slow and gradual dosage reduction with adjunctive psychosocial and psychotherapeutic intervention is the preferred strategy. CONCLUSION: Reinforcing patient and physician compliance is a key element in achieving an optimal treatment regimen.

Antipsychotic Agents↗

PubMed1995

Suicide among female adolescents: characteristics and comparison with males in the age group 13 to 22 years.

OBJECTIVE: To characterize female suicides (n = 19) in an unselected nationwide youth suicide population aged 13 to 22 years (n = 116) and to compare them with male suicides with respect to variables indicating psychopathology and psychosocial functioning. METHOD: The data were collected in a psychological autopsy study of all suicides (N = 1,397) in Finland during a 12-month period. Data collection included interviews of next of kin and professionals and information from records after the suicide. RESULTS: Two thirds (68%) of the female victims had suffered from a mood disorder, and 73% had communicated their suicidal intent. Half (47%) of the female subjects had been in psychiatric care at some point in their lives, and 42% had been hospitalized. Compared with young male suicides, the young female victims more often had made previous suicide attempts (63% versus 30%), received more often a diagnosis of major depression (37% versus 14%), and had more often been in psychiatric care (47% versus 21%) during the year preceding the suicide. The females were more often incapable of working, and their psychosocial impairment was more severe during the final week. Alcohol abuse was almost as common among the female as the male victims (21% versus 26%). CONCLUSION: The results suggest that young females who commit suicide may have suffered from more severe psychopathology than young male victims. Substance abuse seems to be a major factor also in female suicides. Preventive efforts within psychiatric care are likely to reach a higher proportion of the young females than males at high risk for suicide.

Adolescent↗

PubMed1985

Proximity and hierarchy: orthogonal dimensions of family interconnectedness.

The purpose of this research was to develop logical and empirically valid conceptual tools for investigating relationships between family patterns of interconnectedness and psychosocial functioning of children in the family. The family systems concept of boundary was analyzed into two component concepts: Proximity (interpersonal boundaries) and generational Hierarchy (subsystem boundaries). These concepts were operationalized as dimensions, and eight families were assessed by means of interaction coding, interview, and Kinetic Family Drawing to yield empirical verification of these dimensions. Findings indicated that Proximity and Hierarchy are reliable, valid, and independent dimensions of family interconnectedness. Weak generational Hierarchy was associated with increased levels of psychological dysfunction for both identified patients and their siblings. High Proximity was similarly associated with psychological dysfunction, but only for identified patients. The hypothesis that enmeshment is a composite pattern of high Proximity and weak Hierarchy was disconfirmed. Suggestions for future research include systemic analysis of deviation-counteracting and -amplifying relationships between patterns of Proximity and Hierarchy, on the one hand, and psychosocial dysfunction, on the other.

Child↗

PubMed2001

Effect of concurrent anxiety on response to sertraline and imipramine in patients with chronic depression.

Anxiety commonly complicates the clinical presentation of depression and has been associated with poorer long-term outcome, but little information is available on the clinical correlates, and comparative effect on treatment response, of subsyndromic or secondary anxiety. Patients diagnosed with chronic major or double depression were randomized to 12 weeks of double-blind treatment with either sertraline or imipramine in a 2:1 ratio. A high anxiety subgroup was operationally defined by a HAM-D anxiety/somatization factor score > or = 7. The effect of study treatment was measured utilizing the HAM-D, CGI, HAM-D anxiety/somatization factor, as well as a quality of life measure (Q-LES-Q) and a measure of psychosocial functioning (the MOS-SF-36). Two hundred nine patients were treated with imipramine and 426 patients were treated with sertraline. Thirty-six percent of the total met criteria for the high anxiety subgroup. According to Kaplan-Meier probability estimates, patients with significant concurrent anxiety symptoms were more likely to respond by 12 weeks (66.4%) than those without significant anxiety symptoms (54.2%). There was no significant difference in response rates for sertraline vs. imipramine. Both drugs were effective at treating high baseline levels of anxiety, with 60% of sertraline patients and 58% of imipramine patients having 50% or greater reduction from baseline in HAM-D anxiety/somatization factor scores, and only 4.6% and 9.9%, respectively, reporting treatment-emergent worsening in anxiety at study endpoint. Despite the chronicity of depressive illness, acute treatment with both sertraline and imipramine significantly improved psychosocial and quality of life measures. High baseline levels of anxiety did not reduce overall antidepressant response but did somewhat delay the onset of response to sertraline or imipramine in patients with chronic depression.

Adrenergic Uptake Inhibitors↗

PubMed2005

The association between attentional and executive controls in the expression of borderline personality disorder features: a preliminary study.

BACKGROUND: Basic neurocognitive functions such as attention and executive cognitive control represent promising endophenotypes that may improve understanding of the development and expression of borderline personality disorders (BPD). We evaluated the association between performance on the Attention Network Task (ANT) and the Wisconsin Card Sorting Test (WCST), two neurocognitive laboratory instruments, and the extent of BPD psychopathology. SAMPLING AND METHODS: We studied 22 BPD-diagnosed individuals who were independently administered these two laboratory assays. Performance on these tests was used as a predictor of the extent of BPD psychopathology. RESULTS: Indexes of the ANT and the WCST were correlated with one another in this sample. Further, the extent of impairment in attention networks, specifically the orienting network, was associated with a greater spectrum of BPD psychopathology, independent of the effects of age and medication status. Finally, ANT and WCST performance were uncorrelated with general psychosocial functioning in this sample, implicating relative specificity to the extent, as contrasted with functional severity, of BPD psychopathology. CONCLUSIONS: Attentional and executive functions are promising endophenotypic markers of BPD psychopathology. The implications of these findings are considered from developmental, experimental, and clinical perspectives.

Adolescent↗

PubMed2001

Living with lupus: a prospective pan-Canadian study.

OBJECTIVE: To portray life with lupus for women affected by this disease and to identify predictors of fatigue, a common symptom that compromises patients' quality of life. METHODS: A sample of 120 female patients (mean age 42.5 yrs) with systemic lupus erythematosus (SLE) from 9 rheumatology clinics across Canada were followed prospectively for 15 months. Assessments of psychosocial functioning took place at baseline, and at 3, 9, and 15 months. Physician examinations were conducted at baseline and 15 months. RESULTS: Significant time effects were found for: global psychological distress (p < 0.001), stress (p < 0.01), emotion-oriented coping (p < 0.001), physical health status (p < 0.001), and fatigue (p < 0.001), indicating that patients improved from baseline to 15 months. Disease activity worsened for 40.3%, improved for 50.8%, and remained the same for 8.8% of the patients from baseline to 15 months. Controlling for baseline disease activity and fatigue, and considering sleep problems, decreases in stress and depression predicted less fatigue at 15 months (p < 0.001; adjusted R2 = 0.43). CONCLUSION: Despite fluctuations in disease activity, patients with SLE, as a group, cope adequately with their disease over time. There is, nonetheless, a subset of patients (about 40%) who remain distressed and who may benefit from psychosocial interventions.

Adolescent↗

PubMed2000

Parent-training programmes for improving maternal psychosocial health.

BACKGROUND: The prevalence of mental health problems in women is 1:3 and such problems tend to be persistent. There is evidence from a range of studies to suggest that a number of factors relating to maternal psychosocial health can have a significant effect on the mother-infant relationship, and that this can have consequences for the psychological health of the child. It is now thought that parenting programmes may have an important role to play in the improvement of maternal psychosocial health. OBJECTIVES: The objective of this review is to address whether group-based parenting programmes are effective in improving maternal psychosocial health including anxiety, depression and self-esteem. SEARCH STRATEGY: A range of biomedical, social science, educational and general reference electronic databases were searched including MEDLINE, EMBASE CINAHL, PsychLIT, ERIC, ASSIA, Sociofile and the Social Science Citation Index. Other sources of information included the Cochrane Library (SPECTR, CENTRAL), and the National Research Register (NRR). SELECTION CRITERIA: Only randomised controlled trials were included in which participants had been randomly allocated to an experimental and a control group, the latter being either a waiting-list, no-treatment or a placebo control group. Studies had to include at least one group-based parenting programme, and one standardised instrument measuring maternal psychosocial health. DATA COLLECTION AND ANALYSIS: A systematic critical appraisal of all included studies was undertaken using the Journal of the American Medical Association (JAMA) published criteria. The data were summarised using effect sizes but were not combined in a meta-analysis due to the small number of studies within each group and the presence of significant heterogeneity. MAIN RESULTS: A total of 22 studies were included in the review but only 17 provided sufficient data to calculate effect sizes. These 17 studies reported on a total of 59 outcomes including depression, anxiety, stress, self-esteem, social competence, social support, guilt, mood, automatic thoughts, dyadic adjustment, psychiatric morbidity, irrationality, anger and aggression, mood, attitude, personality, and beliefs. Approximately 22% of the outcomes measured suggested significant differences favouring the intervention group. A further 40% showed differences favouring the intervention group but which failed to achieve conventional levels of statistical significance, in some cases due to the small numbers that were used. Approximately 38% of outcomes suggested no evidence of effectiveness. REVIEWER'S CONCLUSIONS: It is suggested that parenting programmes can make a significant contribution to the improvement of psychosocial health in mothers. While the critical appraisal suggests some variability in the quality of the included studies, it is concluded that there is sufficient evidence to support their use with diverse groups of parents. However, it is also suggested that some caution should be exercised before the results are generalised to parents irrespective of the level of pathology present, and that further research is still required.

Anxiety↗