Journal of Psychosomatic Research最新文献

Objective: Preoperative anxiety is common among patients undergoing cardiac surgery and may influence early postoperative recovery. Evidence linking anxiety to clinically relevant postoperative outcomes remains limited, particularly in non-Western populations. This study examined the association between preoperative anxiety and multiple postoperative outcomes in patients undergoing cardiac surgery in Taiwan.

Methods: In this prospective observational study, 113 adult patients scheduled for elective cardiac surgery were enrolled at a tertiary medical center in Eastern Taiwan. Preoperative anxiety was assessed using the Visual Analogue Scale for Anxiety (VAS-A; 0-10 scale). Outcomes included cardiovascular adverse events and non-arrhythmia-related cardiovascular events within 30 days postoperatively, delayed extubation (≥6 h), and mean 7-day postoperative pain, defined as a Critical-Care Pain Observation Tool score ≥ 2. Associations were evaluated using multivariable Firth's penalized logistic regression. Absolute risk estimates were derived at representative low and high anxiety levels.

Results: Higher preoperative VAS-A scores were independently associated with increased odds of cardiovascular adverse events (adjusted odds ratio [aOR], 1.34), non-arrhythmia-related cardiovascular events (aOR, 1.40), and delayed extubation (aOR, 1.40). The association with mean 7-day postoperative pain approached but did not reach conventional statistical significance after adjustment (aOR, 1.18). Absolute risk estimates demonstrated substantial differences across anxiety levels for all outcomes.

Conclusion: Preoperative anxiety is independently associated with several adverse postoperative outcomes after cardiac surgery. These findings support the potential value of brief preoperative anxiety screening as a pragmatic tool for perioperative risk identification. Further studies are needed to determine whether targeted anxiety management can improve postoperative clinical outcomes.

Objective: To investigate the prevalence of fibromyalgia (FM) and its psychosocial correlates in mothers of children diagnosed with attention-deficit/hyperactivity disorder (ADHD), compared with mothers of healthy peers.

Methods: This controlled cross-sectional study included 81 mothers of children with ADHD and 80 mothers of typically developing peers. FM was evaluated according to the American College of Rheumatology 2016 criteria. Psychometric evaluations included the Fibromyalgia Impact Questionnaire (FIQ), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), and Autism-Spectrum Quotient (AQ), along with a structured sociodemographic form. Group comparisons and multivariable logistic regression analyses were conducted to identify independent predictors of FM.

Results: FM prevalence was significantly higher in mothers of children with ADHD compared with controls (38.3% vs. 7.5%, p < 0.001). Mothers in the ADHD group also reported markedly elevated anxiety and depressive symptoms. In univariate analyses, higher maternal anxiety, depressive symptoms, autistic traits, and a history of psychiatric disorder were associated with FM. In the fully adjusted model, however, only higher maternal anxiety and older child age remained independent predictors of FM in the ADHD group. When the full sample was analyzed, having a child with ADHD was also independently associated with maternal FM. FM severity demonstrated moderate positive correlations with anxiety and depression.

Conclusion: Mothers of children with ADHD constitute a high-risk group for FM, likely driven by chronic caregiving stress and associated psychological burden. Routine screening and early psychosocial support interventions targeting parental mental health may help prevent or mitigate FM-related disability in this vulnerable population.

Purpose: To evaluate the effectiveness of Progressive Muscle Relaxation (PMR) in improving sleep quality and mental health in adults.

Methods: This systematic review and meta-analysis followed PRISMA 2020 guidelines. Randomized controlled trials assessing PMR's effect on sleep quality were included. Databases searched included PubMed, Embase, Cochrane and Web of Science. Outcomes included sleep quality, anxiety, and quality of life. Effect sizes were pooled using Standard Mean Difference (SMD) or Mean Difference (MD), and heterogeneity was assessed with the I². Subgroup analysis was performed according to the duration of PMR intervention in weeks. Statistical analysis was conducted with Rstudio version 4.4.1.

Results: Thirty-one RCTs involving 2277 patients were included. PMR significantly improved sleep quality compared to the control group, with a SMD of -1.74 (95% CI -2.14 to -1.34; I² = 92.1%). Pittsburgh Sleep Quality Index (PSQI) showed a mean difference of -3.79 (95% CI -4.78 to -2.79; I² = 94.2%), also indicating statistical significance. Furthermore, PMR significantly reduced anxiety, with an SMD of -1.11 (95% CI -1.69 to -0.53; I² = 85%), and improved quality of life, which had an SMD of 1.32 (95% CI 0.53 to 2.12; I² = 83%). Subgroup analysis by PMR duration showed effectiveness across all intervention periods. Despite the high heterogeneity, sensitivity analyses confirmed consistent beneficial effects across all outcomes.

Conclusion: PMR is a non-pharmacological intervention that improves sleep quality and mental health in adults, with effects that vary across populations and settings.

Background: Lipoedema is a condition of abnormal accumulation of painful adipose tissue, usually in the lower body of women. The disproportionate subcutaneous adipose tissue may negatively impact health-related quality of life (HRQoL). There are currently no patient reported outcome measures (PROM) specifically designed to assess the HRQoL in individuals with lipoedema. The aim of this study was to compare scores on validated lower limb lymphoedema PROMs between females with lipoedema and lymphoedema.

Methods: In a private lymphoedema clinic in Australia between 1 October 2021 and 22 August 2023, individuals assigned female at birth, aged 18 years and older who consented to the entry of de-identified data into a research databank and completed the Lymphoedema Quality of Life tool (LYMQOL-leg) and/or Lymphoedema Symptoms Intensity and Distress Survey (LSIDS-L) for the legs were included in this study. Between group analysis was conducted on 151 participants who were either diagnosed with lipoedema (N = 90) or bilateral leg lymphoedema (N = 61). Participants with both conditions were excluded.

Results: Participants with lipoedema reported significantly higher burden scores for symptoms (p = 0.003), appearance (p = 0.003) and mood (p = 0.011) in the LYMQOL-leg survey when compared to participants with bilateral leg lymphoedema. Participants with lipoedema also reported significantly worse LSIDS-L scores for neurological sensation (p = 0.003), biobehavioral (p = 0.016) and resource (p = 0.008) questions compared to participants with lymphoedema.

Conclusions: This study highlights that although females with lipoedema and lymphoedema experience similar symptoms, their experiences differ in specific outcomes that influence their HRQoL. These findings warrant further investigation into the HRQoL concerns of individuals with lipoedema.

Background: Self-esteem often changes during weight-loss treatment, and these fluctuations play a crucial role in shaping patients' adherence and clinical outcomes. Understanding the psychological factors that predict self-esteem trajectories during treatment-as-usual programs is therefore essential.

Aim: This longitudinal study investigated whether weight change, alexithymia and its facets, psychological distress, and binge-eating disorder predicted self-esteem after a 9-month clinical weight-loss program.

Methods: A consecutive sample of 155 adults with overweight or obesity completed assessments at baseline (T0) and at 9-month follow-up (T1) during standard non-pharmacological weight-loss treatment. Baseline measures included self-esteem (RSES), alexithymia (TAS-20), perceived stress (PSS), depressive symptoms (SDS), and binge-eating symptoms (BES). Percentage of total weight loss (%TWL) was calculated at T1. Hierarchical multiple regression models examined longitudinal predictors of self-esteem at follow-up, controlling for baseline self-esteem.

Results: Difficulty Describing Feelings (DDF) was the only one among the three TAS-20 facets that significantly predicted self-esteem at the 9-month follow-up, showing a negative association independent of weight change and other psychological factors. Percentage of total weight loss (%TWL) and diagnosis of binge eating disorder (BED) were also associated with self-esteem, whereas psychological distress did not show independent effects.

Discussion: DDF emerged as the main factor shaping the changes in self-esteem during weight-loss treatment. This suggests that the ability to articulate emotional experiences plays a central role in supporting positive self-evaluations over time. Enhancing patients' ability to describe emotions could help to consolidate gains in self-esteem.

Objectives: Five-Factor Model personality traits differ in their associations with health outcomes after therapeutic interventions. In the specific context of inpatient pulmonary rehabilitation (PR), higher levels of openness to experience have been associated with greater risk of non-response in terms of health-related quality of life. This study aimed to examine the effect of psychoeducational information aligned with characteristics associated with higher levels of openness on health-related quality of life in inpatient PR.

Methods: A single-blind multicenter randomized controlled trial was conducted in the context of inpatient PR with 136 participants diagnosed with chronic respiratory disease. Participants in the intervention group received an openness-based psychoeducational booklet, while the control group received a neutral booklet. Health-related quality of life was measured at baseline and at PR completion using the St George's Respiratory Questionnaire (SGRQ), which includes a total score and three sub-dimensions (i.e., symptoms, activities, impact). Mixed ANOVA was conducted to investigate group differences in changes in health-related quality of life.

Results: While no significant difference in SGRQ total score was found between the groups, the intervention group exhibited significantly greater improvement in the SGRQ "activities" sub-dimension compared to the control group (η²ₚ = 0.04, p < .05). Exploratory analyses showed that this effect was not moderated by participants' level of openness.

Conclusions: This study highlights that an openness-based intervention can improve a sub-dimension of health-related quality of life in inpatient PR and offers valuable insights for the conception of future personality-based interventions in PR.

Background: Depression is common yet underdiagnosed in patients receiving renal replacement therapies (RRT). Several questionnaires have shown utility for depression screening, mainly among in-centre haemodialysis patients; however, no instruments have been evaluated for diagnostic accuracy in home dialysis or kidney transplant populations. This study aimed to assess the diagnostic performance of the Beck Depression Inventory-Second Edition (BDI-II), the Beck Depression Inventory-Fast Screen (BDI-FS), and the Depression Subscale of the Hospital Anxiety and Depression Scale (HADS-D) across RRT modalities and to identify the most efficient tool for clinical use.

Methods: Adult patients across RRT modalities completed the BDI-II, BDI-FS, and HADS-D, and were evaluated with the Structured Clinical Interview as the reference standard.

Results: Among the 203 included patients (mean age 67.3 years; 65% male), 18.2% met SCID-I criteria for depression. Optimal cut-offs were BDI-II ≥15 for in-centre haemodialysis and ≥ 16 for home dialysis and transplantation; BDI-FS ≥3 for in-centre and home dialysis and ≥ 4 for transplantation; and HADS-D ≥ 5 for in-centre haemodialysis and ≥ 6 for home dialysis and transplantation. Sensitivity and negative predictive values exceeded 90% for all instruments except the HADS-D, which showed lower sensitivity in transplanted (86.7%) and home dialysis patients (70%).

Conclusions: The BDI-II, BDI-FS, and HADS-D are useful for depression screening in renal populations, though the HADS-D demonstrated reduced performance in home dialysis. Standard cut-offs were inadequate, and modality-specific thresholds improved diagnostic accuracy. The BDI-FS, combining strong accuracy with brevity and ease of use, emerged as the most efficient tool for routine screening across RRT modalities.