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• 1. [Article] Racial and Ethnic Differences in Smoking Changes after Chronic Disease Diagnosis Among Middle-Aged and Older Adults in the United States

  Background Middle-aged and older Americans from underrepresented racial and ethnic backgrounds are at risk for greater chronic disease morbidity than their white counterparts. Cigarette smoking increases ...

  Citation × Citation Citation Abstract Copy Title: Racial and Ethnic Differences in Smoking Changes after Chronic Disease Diagnosis Among Middle-Aged and Older Adults in the United States Author: Quinones, Ana R., Nagel, Corey L., Newsom, Jason T., Huguet, Nathalie, Sheridan, Paige, Thielke, Stephen M. Year: 2017 Background Middle-aged and older Americans from underrepresented racial and ethnic backgrounds are at risk for greater chronic disease morbidity than their white counterparts. Cigarette smoking increases the severity of chronic illness, worsens physical functioning, and impairs the successful management of symptoms. As a result, it is important to understand whether smoking behaviors change after the onset of a chronic condition. We assessed the racial/ethnic differences in smoking behavior change after onset of chronic diseases among middle-aged and older adults in the US. Methods We use longitudinal data from the Health and Retirement Study (HRS 1992–2010) to examine changes in smoking status and quantity of cigarettes smoked after a new heart disease, diabetes, cancer, stroke, or lung disease diagnosis among smokers. Results The percentage of middle-aged and older smokers who quit after a new diagnosis varied by racial/ethnic group and disease: for white smokers, the percentage ranged from 14% after diabetes diagnosis to 32% after cancer diagnosis; for black smokers, the percentage ranged from 15% after lung disease diagnosis to 40% after heart disease diagnosis; the percentage of Latino smokers who quit was only statistically significant after stoke, where 38% quit. In logistic models, black (OR = 0.43, 95% CI: 0.19–0.99) and Latino (OR = 0.26, 95% CI: 0.11–0.65) older adults were less likely to continue smoking relative to white older adults after a stroke, and Latinos were more likely to continue smoking relative to black older adults after heart disease onset (OR = 2.69, 95% CI [1.05–6.95]). In models evaluating changes in the number of cigarettes smoked after a new diagnosis, black older adults smoked significantly fewer cigarettes than whites after a new diagnosis of diabetes, heart disease, stroke or cancer, and Latino older adults smoked significantly fewer cigarettes compared to white older adults after newly diagnosed diabetes and heart disease. Relative to black older adults, Latinos smoked significantly fewer cigarettes after newly diagnosed diabetes. Conclusions A large majority of middle-aged and older smokers continued to smoke after diagnosis with a major chronic disease. Black participants demonstrated the largest reductions in smoking behavior. These findings have important implications for tailoring secondary prevention efforts for older adults. Title: Racial and Ethnic Differences in Smoking Changes after Chronic Disease Diagnosis Among Middle-Aged and Older Adults in the United States Author: Quinones, Ana R., Nagel, Corey L., Newsom, Jason T., Huguet, Nathalie, Sheridan, Paige, Thielke, Stephen M. Year: 2017 Background Middle-aged and older Americans from underrepresented racial and ethnic backgrounds are at risk for greater chronic disease morbidity than their white counterparts. Cigarette smoking increases the severity of chronic illness, worsens physical functioning, and impairs the successful management of symptoms. As a result, it is important to understand whether smoking behaviors change after the onset of a chronic condition. We assessed the racial/ethnic differences in smoking behavior change after onset of chronic diseases among middle-aged and older adults in the US. Methods We use longitudinal data from the Health and Retirement Study (HRS 1992–2010) to examine changes in smoking status and quantity of cigarettes smoked after a new heart disease, diabetes, cancer, stroke, or lung disease diagnosis among smokers. Results The percentage of middle-aged and older smokers who quit after a new diagnosis varied by racial/ethnic group and disease: for white smokers, the percentage ranged from 14% after diabetes diagnosis to 32% after cancer diagnosis; for black smokers, the percentage ranged from 15% after lung disease diagnosis to 40% after heart disease diagnosis; the percentage of Latino smokers who quit was only statistically significant after stoke, where 38% quit. In logistic models, black (OR = 0.43, 95% CI: 0.19–0.99) and Latino (OR = 0.26, 95% CI: 0.11–0.65) older adults were less likely to continue smoking relative to white older adults after a stroke, and Latinos were more likely to continue smoking relative to black older adults after heart disease onset (OR = 2.69, 95% CI [1.05–6.95]). In models evaluating changes in the number of cigarettes smoked after a new diagnosis, black older adults smoked significantly fewer cigarettes than whites after a new diagnosis of diabetes, heart disease, stroke or cancer, and Latino older adults smoked significantly fewer cigarettes compared to white older adults after newly diagnosed diabetes and heart disease. Relative to black older adults, Latinos smoked significantly fewer cigarettes after newly diagnosed diabetes. Conclusions A large majority of middle-aged and older smokers continued to smoke after diagnosis with a major chronic disease. Black participants demonstrated the largest reductions in smoking behavior. These findings have important implications for tailoring secondary prevention efforts for older adults. Close

• 2. [Article] Collaborative Treatment of Late-Life Depression in Primary Care (GermanIMPACT): Study Protocol of a Cluster-Randomized Controlled Trial

  Background: Depression is not a normal side effect of aging, however it is one of the most prevalent mental health issues in later life, imposing a tremendous burden on patients, their families, and the ...

  Citation × Citation Citation Abstract Copy Title: Collaborative Treatment of Late-Life Depression in Primary Care (GermanIMPACT): Study Protocol of a Cluster-Randomized Controlled Trial Author: Wernher, Iris, Bjerregaard, Frederike, Tinsel, Iris, Bleich, Christiane, Boczor, Sigrid, Kloppe, Thomas, Scherer, Martin, Härter, Martin, Niebling, Wilhelm, König, Hans-Helmut, Hüll, Michael Year: 2014 Background: Depression is not a normal side effect of aging, however it is one of the most prevalent mental health issues in later life, imposing a tremendous burden on patients, their families, and the healthcare system. We describe the experimental implementation of a collaborative, stepped-care model for the treatment of late-life depression (GermanIMPACT trial) in the German primary care context. GermanIMPACT was developed as an adaptation of a successful and widely used American model. The aim of the study is to evaluate the model’s applicability to the German primary care setting and its cost-effectiveness. Methods/Design: The study will be conducted as a cluster-randomized controlled trial comparing the development of depressive symptoms in primary care patients who either receive treatment as usual (control arm) or treatment according to the GermanIMPACT model (intervention arm). In two German cities (Freiburg and Hamburg), a total of 60 general practice offices will be selected and randomized. Each general practice office will be asked to enroll five patients into the trial who are 60 years of age or older and who show moderate depressive symptoms in the scope of a diagnosed depressive episode, recurrent depressive disorder, or dysthymia. General practices in the control arm will provide treatment as usual; general practices in the intervention arm will work closely with a specially trained care manager and a supervising mental health specialist. Evidence-based elements of the treatment plan manual include patient education, identification and integration of positive activities into the daily routine, relapse prevention, and training of problem-solving techniques as needed. The intervention period per patient will be one year. Data will be collected at baseline, 6, and 12 months. Primary outcome is the patient-reported change of depressive symptoms (Patient Health Questionnaire, PHQ-9). Secondary outcomes include measures of quality of life, anxiety, depression-related behavior, problem-solving skills, resilience, and an overall economic evaluation of the program. Discussion: The GermanIMPACT trial will provide evidence about the effectiveness, feasibility, and cost-effectiveness of collaborative stepped care in treating late-life depression in German primary care. Positive results will be a first step toward integrating specialized depression care managers into the primary care setting. Title: Collaborative Treatment of Late-Life Depression in Primary Care (GermanIMPACT): Study Protocol of a Cluster-Randomized Controlled Trial Author: Wernher, Iris, Bjerregaard, Frederike, Tinsel, Iris, Bleich, Christiane, Boczor, Sigrid, Kloppe, Thomas, Scherer, Martin, Härter, Martin, Niebling, Wilhelm, König, Hans-Helmut, Hüll, Michael Year: 2014 Background: Depression is not a normal side effect of aging, however it is one of the most prevalent mental health issues in later life, imposing a tremendous burden on patients, their families, and the healthcare system. We describe the experimental implementation of a collaborative, stepped-care model for the treatment of late-life depression (GermanIMPACT trial) in the German primary care context. GermanIMPACT was developed as an adaptation of a successful and widely used American model. The aim of the study is to evaluate the model’s applicability to the German primary care setting and its cost-effectiveness. Methods/Design: The study will be conducted as a cluster-randomized controlled trial comparing the development of depressive symptoms in primary care patients who either receive treatment as usual (control arm) or treatment according to the GermanIMPACT model (intervention arm). In two German cities (Freiburg and Hamburg), a total of 60 general practice offices will be selected and randomized. Each general practice office will be asked to enroll five patients into the trial who are 60 years of age or older and who show moderate depressive symptoms in the scope of a diagnosed depressive episode, recurrent depressive disorder, or dysthymia. General practices in the control arm will provide treatment as usual; general practices in the intervention arm will work closely with a specially trained care manager and a supervising mental health specialist. Evidence-based elements of the treatment plan manual include patient education, identification and integration of positive activities into the daily routine, relapse prevention, and training of problem-solving techniques as needed. The intervention period per patient will be one year. Data will be collected at baseline, 6, and 12 months. Primary outcome is the patient-reported change of depressive symptoms (Patient Health Questionnaire, PHQ-9). Secondary outcomes include measures of quality of life, anxiety, depression-related behavior, problem-solving skills, resilience, and an overall economic evaluation of the program. Discussion: The GermanIMPACT trial will provide evidence about the effectiveness, feasibility, and cost-effectiveness of collaborative stepped care in treating late-life depression in German primary care. Positive results will be a first step toward integrating specialized depression care managers into the primary care setting. Close

• 3. [Article] Increased risk and related factors of depression among patients with COPD: a population-based cohort study

  Background Depression is a common and mostly undertreated problem in patients with chronic diseases. However, population-based studies on the association between chronic obstructive pulmonary disease (COPD) ...

  Citation × Citation Citation Abstract Copy Title: Increased risk and related factors of depression among patients with COPD: a population-based cohort study Author: Tsai, Tzung-Yi, Livneh, Hanoch, Lu, Ming-Chi, Tsai, Pang-Yau, Chen, Pei-Chun, Sung, Fung-Chang Year: 2013 Background Depression is a common and mostly undertreated problem in patients with chronic diseases. However, population-based studies on the association between chronic obstructive pulmonary disease (COPD) and subsequent depression are limited in Asian populations. This study evaluated the incidence and risk factors of depression for patients with COPD in Taiwan. Methods Using the claims data from the National Health Insurance of Taiwan, we identified 38,010 COPD patients newly diagnosed in 2000–2004 and 38,010 subjects without COPD frequency, matched by sex, age and index date. The incidence rate and hazard ratio for depression were estimated by the end of 2008. Results The incidence rate of depression was 1.88 folds higher in the COPD cohort than in the non-COPD cohort (12.2 versus 6.47 per 1,000 person-years, p < 0.0001). The depression risk was the greatest within the first year following COPD diagnosis and tended to decline with follow-up time. Among COPD patients, multivariate analysis showed that younger women and low-income patients were at higher risk of depression. Hospitalization and comorbidities such as hypertension, arthritis, cancer, and heart disease were also significant predictors for depression risk. Conclusion This population-based cohort study demonstrated a strong relationship between COPD and subsequent depression. These findings could assist healthcare providers to pinpoint individuals with a higher predisposition to having depression, which could then facilitate the provision of culturally appropriate rehabilitation within the first year after the diagnosis of COPD. Title: Increased risk and related factors of depression among patients with COPD: a population-based cohort study Author: Tsai, Tzung-Yi, Livneh, Hanoch, Lu, Ming-Chi, Tsai, Pang-Yau, Chen, Pei-Chun, Sung, Fung-Chang Year: 2013 Background Depression is a common and mostly undertreated problem in patients with chronic diseases. However, population-based studies on the association between chronic obstructive pulmonary disease (COPD) and subsequent depression are limited in Asian populations. This study evaluated the incidence and risk factors of depression for patients with COPD in Taiwan. Methods Using the claims data from the National Health Insurance of Taiwan, we identified 38,010 COPD patients newly diagnosed in 2000–2004 and 38,010 subjects without COPD frequency, matched by sex, age and index date. The incidence rate and hazard ratio for depression were estimated by the end of 2008. Results The incidence rate of depression was 1.88 folds higher in the COPD cohort than in the non-COPD cohort (12.2 versus 6.47 per 1,000 person-years, p < 0.0001). The depression risk was the greatest within the first year following COPD diagnosis and tended to decline with follow-up time. Among COPD patients, multivariate analysis showed that younger women and low-income patients were at higher risk of depression. Hospitalization and comorbidities such as hypertension, arthritis, cancer, and heart disease were also significant predictors for depression risk. Conclusion This population-based cohort study demonstrated a strong relationship between COPD and subsequent depression. These findings could assist healthcare providers to pinpoint individuals with a higher predisposition to having depression, which could then facilitate the provision of culturally appropriate rehabilitation within the first year after the diagnosis of COPD. Close

• 4. [Article] The Relationship between Mindfulness and Burnout among Master of Social Work Students

  Social work students frequently endure elevated levels of prolonged stress and psychological affliction that might result in serious consequences, such as development of burnout. Some experts suggest that ...

  Citation × Citation Citation Abstract Copy Title: The Relationship between Mindfulness and Burnout among Master of Social Work Students Author: Piatkowska, Jolanta Maria Year: 2014 Social work students frequently endure elevated levels of prolonged stress and psychological affliction that might result in serious consequences, such as development of burnout. Some experts suggest that burnout originates in the exposure to chronic interpersonal stressors in the work environment. Yet, there is emerging evidence suggesting that mindfulness practice might be beneficial in alleviating stress. Thus, the purpose of this exploratory study was to examine the relationship between mindfulness and burnout among Master of Social Work students. Burnout, mindfulness, religiosity, spirituality and their potential relationship were discussed and related to previous scholarly literature. Specifically, this study focused on testing the hypothesis that current MSW students who demonstrate higher levels of mindfulness will report less burnout, regardless of the year in the MSW program and regardless of the years of practice in human services. In addition, the hypothesis that students currently involved in direct social work practice (either outside of the MSW program, in the MSW field placement, or both) experience higher levels of burnout than students not yet practicing was scrutinized. Moreover, the hypothesis that as students progress in their studies they will exhibit progressively more burnout was explored. Finally, one of this study's goals was to explore whether patterns/relationships between the religious and spiritual beliefs and practices predict burnout levels among Master of Social Work students. Participants were mostly non-Hispanic White females, with a mean age of 35, married (or in legally recognized unions), and first year students enrolled full-time in the Direct Human Services track. Two years was the most common length of their experience in human services. They came from the metropolitan Portland area (on-campus students) and other regions of Oregon (off-site students). The mindfulness of the participants was measured with the Five Facets Mindfulness Scale and the levels of their burnout with the Maslach Burnout Inventory. Study results indicated that the more mindful the MSW students were, the less burnout they reported experiencing. A large correlation of mindfulness to reduced burnout (p < .001) was found, a relationship that persisted when controlling for other significant variables through sequential regression analysis. However, neither year in the MSW program, length of practicing in human services, nor religious/spiritual affiliation and practices had any significant influence on burnout among participants. Given the results of this study demonstrated statistically significant relationships between mindfulness and burnout among social work students, it is recommended that appropriate training in mindfulness for the students (and social workers) affected by secondary trauma and burnout should be incorporated in social work education, either as a part of curricula, or in an extra-curricular training program. Title: The Relationship between Mindfulness and Burnout among Master of Social Work Students Author: Piatkowska, Jolanta Maria Year: 2014 Social work students frequently endure elevated levels of prolonged stress and psychological affliction that might result in serious consequences, such as development of burnout. Some experts suggest that burnout originates in the exposure to chronic interpersonal stressors in the work environment. Yet, there is emerging evidence suggesting that mindfulness practice might be beneficial in alleviating stress. Thus, the purpose of this exploratory study was to examine the relationship between mindfulness and burnout among Master of Social Work students. Burnout, mindfulness, religiosity, spirituality and their potential relationship were discussed and related to previous scholarly literature. Specifically, this study focused on testing the hypothesis that current MSW students who demonstrate higher levels of mindfulness will report less burnout, regardless of the year in the MSW program and regardless of the years of practice in human services. In addition, the hypothesis that students currently involved in direct social work practice (either outside of the MSW program, in the MSW field placement, or both) experience higher levels of burnout than students not yet practicing was scrutinized. Moreover, the hypothesis that as students progress in their studies they will exhibit progressively more burnout was explored. Finally, one of this study's goals was to explore whether patterns/relationships between the religious and spiritual beliefs and practices predict burnout levels among Master of Social Work students. Participants were mostly non-Hispanic White females, with a mean age of 35, married (or in legally recognized unions), and first year students enrolled full-time in the Direct Human Services track. Two years was the most common length of their experience in human services. They came from the metropolitan Portland area (on-campus students) and other regions of Oregon (off-site students). The mindfulness of the participants was measured with the Five Facets Mindfulness Scale and the levels of their burnout with the Maslach Burnout Inventory. Study results indicated that the more mindful the MSW students were, the less burnout they reported experiencing. A large correlation of mindfulness to reduced burnout (p < .001) was found, a relationship that persisted when controlling for other significant variables through sequential regression analysis. However, neither year in the MSW program, length of practicing in human services, nor religious/spiritual affiliation and practices had any significant influence on burnout among participants. Given the results of this study demonstrated statistically significant relationships between mindfulness and burnout among social work students, it is recommended that appropriate training in mindfulness for the students (and social workers) affected by secondary trauma and burnout should be incorporated in social work education, either as a part of curricula, or in an extra-curricular training program. Close

• 5. [Article] Psychosocial Challenges Facing Women Living with HIV During the Perinatal Period in Rural Uganda

  The complexities of navigating pregnancy while living with HIV predispose women to additional stress. Finding ways to minimize psychosocial challenges during the perinatal period may maximize the well-being ...

  Citation × Citation Citation Abstract Copy Title: Psychosocial Challenges Facing Women Living with HIV During the Perinatal Period in Rural Uganda Author: Ashaba, Scholastic, Kaida, Angela, Coleman, Jessica N., Burns, Bridget F., Dunkley, Emma, O'Neil, Kasey, Kastner, Jasmine, Sanyu, Naomi, Akatukwasa, Cecilia, Bangsberg, David R., Matthews, Lynn T., Psaros, Christina Year: 2017 The complexities of navigating pregnancy while living with HIV predispose women to additional stress. Finding ways to minimize psychosocial challenges during the perinatal period may maximize the well-being of mothers living with HIV and their children. The goal of this study was to explore psychosocial challenges experienced by women living with HIV (WLWH) during pregnancy and the postpartum. We conducted individual in-depth interviews with 20 WLWH recruited from an HIV treatment cohort study in Mbarara, Uganda as part of a larger study exploring perinatal depression. We conducted content analyses to identify themes related to challenges of WLWH during pregnancy and the postpartum. Participants had a median age of 33 years [IQR: 28± 35], a median of 3 living children [IQR: 2±5], and 95% had achieved HIV-RNA suppression. Challenges were organized around the following themes: HIV -related stigma from health professionals, HIV status disclosure dilemma, unintended pregnancy and intimate partner violence, HIV and environmental structural barriers and distress and fear related to maternal and child health. Stigma centered on discrimination by health care professionals and personal shame associated with being pregnant as a WLWH. This led to difficulty engaging in HIV care, particularly when coupled with structural barriers, such as lack of transportation to clinic. Participants experienced intimate partner violence and lacked support from their partners and family members. Distress and fear about the health and uncertainty about the future of the unborn baby due to maternal deteriorating physical health was common. The perinatal period is a time of stress for WLWH. Challenges experienced by WLWH may compromise successful engagement in HIV care and may reduce quality of life for women and their children. Strategies aimed at alleviating the challenges of WLWH should involve the larger structural environment including partners, family and community member as well as policy makers, funders and program implementers to work together for the common cause. These consolidated efforts may not only lower the risk of psychological distress but has potential to create long lasting solutions to benefit the wider community. Title: Psychosocial Challenges Facing Women Living with HIV During the Perinatal Period in Rural Uganda Author: Ashaba, Scholastic, Kaida, Angela, Coleman, Jessica N., Burns, Bridget F., Dunkley, Emma, O'Neil, Kasey, Kastner, Jasmine, Sanyu, Naomi, Akatukwasa, Cecilia, Bangsberg, David R., Matthews, Lynn T., Psaros, Christina Year: 2017 The complexities of navigating pregnancy while living with HIV predispose women to additional stress. Finding ways to minimize psychosocial challenges during the perinatal period may maximize the well-being of mothers living with HIV and their children. The goal of this study was to explore psychosocial challenges experienced by women living with HIV (WLWH) during pregnancy and the postpartum. We conducted individual in-depth interviews with 20 WLWH recruited from an HIV treatment cohort study in Mbarara, Uganda as part of a larger study exploring perinatal depression. We conducted content analyses to identify themes related to challenges of WLWH during pregnancy and the postpartum. Participants had a median age of 33 years [IQR: 28± 35], a median of 3 living children [IQR: 2±5], and 95% had achieved HIV-RNA suppression. Challenges were organized around the following themes: HIV -related stigma from health professionals, HIV status disclosure dilemma, unintended pregnancy and intimate partner violence, HIV and environmental structural barriers and distress and fear related to maternal and child health. Stigma centered on discrimination by health care professionals and personal shame associated with being pregnant as a WLWH. This led to difficulty engaging in HIV care, particularly when coupled with structural barriers, such as lack of transportation to clinic. Participants experienced intimate partner violence and lacked support from their partners and family members. Distress and fear about the health and uncertainty about the future of the unborn baby due to maternal deteriorating physical health was common. The perinatal period is a time of stress for WLWH. Challenges experienced by WLWH may compromise successful engagement in HIV care and may reduce quality of life for women and their children. Strategies aimed at alleviating the challenges of WLWH should involve the larger structural environment including partners, family and community member as well as policy makers, funders and program implementers to work together for the common cause. These consolidated efforts may not only lower the risk of psychological distress but has potential to create long lasting solutions to benefit the wider community. Close