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Videnscenterets forskning om kroniske og livstruende sygdomme

Oversigt over de kroniske og livstruende sygdomme som nedenstående studier involverer:

- HIV

- Piskesmæld

- PTSD

  • PTSD som følge af 'Intense Care Unit treatment'
  • PTSD hos kræftpatienter
  • PTSD efter hjertesygdom

 - Pårørende

  • Pårørende, PTSD og epilepsi
  • Pårørende og generelle sygdomme 

HIV

Elklit, A. (1998). Psykisk sundhed, symptomatologi, social støtte og mestring hos HIV-positive: En litteraturoversigt. Nordisk Psykologi, 50 (2), 120-134.

 

The literature from 1990-96 on psychiatric morbidity, depression, social support and coping in hiv+ subjects is reviewed and discussed. Studies of psychiatric morbidity are divergent: Some find no effect of hiv-seropositivity others find an increase in psychiatric disorders. The studies on depression, social support, and coping present a more unequivocal picture. 1) The degree of depression is positively associated to the degree of hiv-related symptoms. 2) Social support and active coping have positive affect on health, levels of symptoms, and social functioning. Degree of traumatisation and psychological defence in hiv-positives do not seem to have been investigated.  

 

The article has not included data about the information of the danger of infection,

risky behaviour or psychological intervention. Likewise, most of the research so far has only examined people recruited from therapy clinics such as medical, psychological and social. This gives the implication that the study only includes hiv-positive that already have acknowledged their disease and have chosen to receive some kind of help.

 

 
 

Pedersen, S.S & Elklit, A. (1998). Traumatisation, Psychological Defense Style, Coping, Symptomatology, and Social Support in HIV-positive: A Pilot Study. Scandinavian Journal of Psychology, 39 (2), 55-60.

 

This paper examines degree of traumatisation, defence styles, coping strategies, symptomatology, and social support in a small sample of HIV-positive men and women in an effort to ascertain the psychological implications of living with Human Immunodeficiency Virus (HIV).

Traumatisation and the potentially mediating effects of defence styles have only been the subject of a few studies of HIV positives. The study is based on a socio-demographic questionnaire, the Impact of Event Scale, the Defence Style Questionnaire, the Coping Styles Questionnaire, the Trauma Symptom Checklist, and the Crisis Support Scale. A degree of traumatisation that warrants treatment was found together with an association between particular coping strategies and symptomatology, and particular defence styles and symptomatology, respectively. Social support had increased over time, which is contrary to other research findings on social support.

This article includes participants who were already seeking support through a support

group and therefore may be significantly from those who do not seek outside help. Moreover, the causes and effect cannot be determined because of the method used, which based on correlational data.

 

Sørensen, H. & Elklit, A. (2005). Tidlige intervention over for HIV-positive: En psykosocial model for kriseintervention efter overbringelse af fatale diagnoser. Månedsskrift for praktisk lægegerning, 83, (3), 365-379.

  

The purpose of this article is to describe an intervention to prevent the expected psychological damages following a fatal diagnose.. Conclusions are that patients should be offered help immediately after receiving the diagnose.

 

Piskesmæld

 

Elklit, A. (2000). Følger af whiplash. København: PTU.

 

 

The article reviews a number of factors following a whiplash injury: Demographic Factors, Circumstances of the Accident, Treatment at the Hospital, Work and Economic Related Loses, Treatment of Pain, Help Opportunities and Offers, and Changes of Life. A large amount of the factors has an impact on the psychological state. The final regression analyses showed that especially emotional coping has a large impact on the prevalence of PTSD and the extent of the symptoms.

Furthermore, the article concludes that psychological traumatisation is a major problem to which psychological trauma-focused therapy should be a natural part of the healing process.

 

Elklit, A., Hansen, L. J., Lærum, H & Olesen, A. S. (2004). WAD – statusartikel om whiplashrelateret sygdom. Fysioterapeuten, 86, (14), 16-20

Elklit, A., Hansen, L. J., Lærum, H & Olesen, A. S. (2004). WAD – statusartikel om whiplashrelateret sygdom. Månedsskrift for praktisk lægegerning, 82, 505-511

 

The article gives an overview of the psychological and somatic related disorders following whiplash. The aim was to develop a method for the medical staff in helping identify WAD.

 

Elklit, A. & Jones, A. (2006). The Association between Anxiety and Chronic Pain After Whiplash Injury: Gender-specific Effects. Clinical Journal of Pain, 22 (5), 487-490

 

The article identifies gender-specific associations between anxiety and chronic pain experiences in men and women exposed to whiplash trauma. It concludes that men have stronger associations between anxiety and symptoms of whiplash trauma compared to women.

 

Jones, A. & Elklit, A. (2007). The Association between Gender, Coping, and Whiplash Related Symptoms in Sufferers of Whiplash Associated Disorder. Scandinavian Journal of Psychology, 48 (1), 75-80

The article concludes that men and women do not differ significantly in their use of coping strategies, however emotion focused coping strategies were related significantly more strongly to whiplash related symptoms in men compared to women. Women were found to display more symptoms related to whiplash injury compared to men.

 

 

PTSD som følge af 'Intense Care Unit treatment':

Ratzer, M., Romano, E. & Elklit, A. (2014). Posttraumatic Stress Disorder in Patients Following Intensive Care Unit Treatment: A Review of Studies Regarding Prevalence and Risk Factors. Journal of Treatment and Trauma, 3(2), 1-15.

 

This article reviews extant research on the prevalence of Posttraumatic Stress Disorder (PTSD) in patients following treatment in an intensive care unit (ICU) and the impact of various factors on the development of PTSD. A systematic review of the databases PubMed, PsycINFO, and PILOTS was conducted.

 

Fifty-four articles were included. The mean point prevalence of PTSD/clinically significant PTSD symptoms (PTSS) was 17% (N=7943). Consistent risk factors were pre-ICU psychopathology and traumatic and/or frightening memories from ICU. Less consistent risk factors were younger age, female gender, lower educational level, higher number of biographical risk factors, administration of benzodiazepines, and sedation practice. Severity of illness was not a predictor. Post ICU PTSD/PTSS was associated with lower health related quality of life (HRQOL), comorbid anxiety, and depression.

It is concluded that post-ICU PTSD is common and that health care professionals should be aware of potential risk factors and early signs of PTSD and monitor the patients’ need for intervention. Future research should focus on estimating potential psychological risk factors, and attempt to explain the relation between potential person and treatment related risk factors, as well as their contribution to the development of PTSD.

 

                     

 

PTSD hos kræftpatienter:

 

Houlind, M. & Elklit, A. (2002). Post-traumatic Stress Disorder in Breast Cancer Survivors: A Review. Psykologi Institut, Aarhus Universitet.

 

The eleven reviewed studies showed that a considerable number of women diagnosed and treated for breast cancer (BC) had posttraumatic stress disorder (PTSD). Somewhere between 5-15% of these women suffer from so many symptoms that they meet a formal PTSD diagnosis according to DSM-IV. Another 5-15% meet a sub-clinical PTSD diagnosis.

A fairly large variation exists among the results of the eleven studies. Green et al. (1998) found less that 2% of possible PTSD cases. In contrast to this, Naidich & Motta (2000) found a 32,3% prevalence of current PTSD

 

Elklit, A. & Blum, A. (2011). Psychosocial adjustment one year after the diagnosis of breast cancer: a prototype study of delayed PTSD. British Journal of Psychology, 50(4): 350-63.

 

The article studied the prevalence of PTSD and predictors for PTSD. Following 64 early BC patients. For one year 13% of the patients showed full symptoms of disease-related PTSD compared with 7% at the initial study (6 weeks after diagnosis). Considerable changes were observed in all PTSD clusters (intrusion, avoidance, and arousal), in most cases representing a decrease in symptom level. Immature defence style, emotional coping, avoidant behaviour, and negative affectivity were all implicated as predicting variables in a hierarchical multiple regression analysis which explained 65% of the variability of PTSD severity one year after diagnosis. Conclusions: This study highlights the PTSD diagnosis as being highly relevant in oncology settings. Early screening for the above-mentioned four variables may help early identification of the patients most at risk of developing PTSD.

Although there was a general decrease in post-traumatic symptomatology and general distress in the first year after diagnosis, more than twice as many women met criteria for a PTSD diagnosis at T2 compared to T1.

 

Jeggesen, A., Gudmundsdóttir, D. B. & Elklit, A. (2012). Predictors of Posttraumatic Stress Disorder in Adolescent and Young Adult Survivors of Childhood Cancer. Nordic Psychology, 64: 291-302. 

The aim of the study was to compare the prevalence of posttraumatic stress disorder (PTSD) in 44 adolescent and young adult survivors of childhood cancer and identify which psychological factors predicted the degree of traumatization. Mean time since diagnosis was 76 months. The PTSD prevalence was 18%. Time since diagnosis was associated with less PTSD severity. Females had higher level of PTSD than males. Aga at diagnosis and treatment types were not associated with PTSD. Female gender, low self-worth, immature defence style, lack of close attachment, emotional coping and somatization explained 70% of the total traumatization variance.

 

PTSD efter hjertesygdom:

 

Spindler, H., Pedersen, S.S. (2005). Post-traumatic stress disorder in the wake of heart disease: Prevalence, risk factors, and future research directions. Psychosomatic Medicine, 67, s. 715-723

 

There is increasing recognition that patients after a cardiac event may be at risk of posttraumatic stress disorder (PTSD). The article reviewed studies looking at PTSD as a sequel of heart disease with a focus on prevalence, risk factors, and future research directions. Results: We identified 25 studies that fulfilled the inclusion criteria, of which 7 reported on the follow-up of previously published studies. The prevalence of PTSD after heart disease varied from 0% to 38% across studies. PTSD has been most rigorously researched after myocardial infarction with the best-powered studies finding a prevalence rate of 15%. Studies including control groups showed that cardiac patients were at risk of developing PTSD. Risk factors included sociodemographic and psychological characteristics and aspects related to the cardiac event. Conclusion: Despite substantial heterogeneity in the methodology of studies and differences in prevalence across studies, this review indicated that subgroups of patients are at risk of PTSD after a cardiac event. Future studies investigating PTSD as a sequel of heart disease should be more systematic, use a prospective study design with multiple assessments, and include sufficiently large samples. PTSD should not be ignored as a sequel of heart disease, given preliminary evidence that PTSD may be associated with nonadherence with medication and an increased risk of clinical adverse events

 

Spindler, H., Pedersen, S, S. & Elklit, A. (2008). The role of posttraumatic stress disorder in coronary artery disease: epidemiology, risk factors, and potential mechanisms. In Sher, L. (Ed.) Psychological Factors and Cardiovascular Disorders. New York: Columbia Press, 67:715-723

 

The psychological impact of coronary artery disease (CAD) has mainly been studied in the realm of depression; however, the experience of cardiac event may also result in the development of posttraumatic stress disorder (PTSD). PTSD in cardiac patients has been associated with non-adherence to medication, increased emotional distress, impaired health-related quality of life, and adverse prognosis, suggestion a potential role for PTSD as a risk factor in CAD. To evaluate the impact of PTSD on CAD prognosis current research on the prevalence of PTSD, the associated risk factors, and the potential mechanisms linking CAD and PTSD were reviewed in order to examine the current status of PTSD as a potential risk factor in CAD.

Current evidence suggest that CAD patients are at increased risk of PTSD, with the prevalence of PTSD in MI patients being around 15%.  In general, there is an urgent need for sufficiently powered studies on PTSD in CAD patients, using systematic and sound methodology to accurately evaluate the prevalence rate of PTSD, to establish the clinical course of PTSD, as well as the prognostic consequences of PTSD across CAD patient groups.

 

 

Pårørende

Pårørende, PTSD og epilepsi:

 

 

Elklit, A. & Reinholt, N. (2007). Efterladte til kræftramt - En undersøgelse af psykologiske og sociale forhold. Psykologisk Skriftserie, 28 (3), 1-73.

  

The purpose of the pilot study was to investigate the prevalence of post-traumatic stress symptoms (PTSD) in the bereaved in cases of cancer patients, and to identify risk factors in development of PTSD. The measures were conducted 1 month after the bereavement and followed up 6 months after.

The study indicated that 50% of the bereaved had symptoms of a full PTSD-diagnosis. 32% had subclinical symptoms of PTSD on the first approach. 32% of the bereaved still had symptoms of a full PTSD-diagnosis 6 months later, while 28% still had subclinical symptoms of PTSD 6 month later.

Further, the study identified several predictors and moderators of PTSD symptoms in the bereaved in cases of cancer patients. The model explained 74% of the variation. Child neglect (incest, physical and psychological maltreatment), to have experienced several larger life incidents within the last year, anxious-avoidant attachment, high level of affective negative and somatisation were all risk factors that predicted the development of PTSD symptoms. Secure attachment had a protective effect on PTSD symptoms, moderated by the social support available. Likewise, social support had a protective effect on PTSD symptoms, moderated by the level of negative affect and somatisation. 

 

Norup, D. A. & Elklit, A. (2013). PTSD in Partners of People with Epilepsy. Epilepsy & Behavior, 27, 225-232. Doi: 10.1016/j.yebeh.2012.11.039.

 

The objectives of the present study were to examine whether living with an individual who suffered from epilepsy was a potentially traumatizing event and to identify predictive risk factors in developing post-traumatic stress disorder (PTSD). Likewise, most research is conducted from the point of view of patients focusing on the psychological, physical and social consequences following the illnesses, and few have studied these issues from the perspective of partners.

 Six hundred fourteen respondents completed the Harvard Trauma Questionnaire, the Crisis Support Scale, the Hopkins Symptom Checklist—25, and the Dyadic Adjustment Scale. In addition, demographic variables were included in order to identify factors that might predict PTSD.

The percentage of the participants that fulfilled the symptom criteria of PTSD was 7.7%, and an additional 43.9% reported a subclinical level of PTSD. Clinical and subclinical anxiety was unveiled in 9.3% of the respondents. The conclusions were that partners were at risk of PTSD when living with a patient with epilepsy. Identified variables that explained PTSD were frequency and types of seizures medication, side effects, and objective and subjective epilepsy severity, anxiety, and depression. High level of social support decreased the level of traumatic stress

 

Pårørende og generel sygdom:

Guðmundsdóttir, H., Guðmundsdóttir, D., & Elklit, A. (2006). Risk and resistance factors for psychological distress in Icelandic parents of chronically ill children: An application of the the Wallander and Varni’s disability-stress coping model. Clinical Psychology in Medical Settings, 13, 299-306.

 

The purpose of the study was to investigate psychological distress and the prevalence of PTSD among Icelandic parents of chronically ill children, and the potential effects of social support on distress, at two points in time. The Impact on Family scale (IFS), the Trauma Symptom Checklist (TSC), the Harvard Trauma Questionnaire (HTQ) and the Crisis Support Scale (CSS) were completed by 105 parents of children with various diseases (69 mothers and 36 fathers). Despite the heterogeneity of the sample in terms of disease type, PTSD was present in 13.2% of the parents and an additional 28.6% had subclinical PTSD (missing the full diagnosis by only one symptom). Time since diagnosis, length of hospitalizations and disease-related daily care predicted 40% of the HTQ total score.

 

The lack of social support did not predict parental distress or more trauma symptoms measured with the TSC and the HTQ.

 
 

Guðmundsdóttir, H. S., Elklit, A., & Guðmundsdóttir, D. B. (2006). PTSD and psychological distress in Icelandic parents of chronically ill children. Does social support mediate psychological distress? Scandinavian Journal of Pscyhology, 47 (2), 77-93.

 

                                           

The purpose of the study was to investigate Wallander and Varni’s (1998) disability-stress coping model in a sample of 105 Icelandic parents of chronically ill children. The Revised Adult Attachment Scale (RAAS), the Attributional Scale (AS), the Defence Style Questionnaire (DSQ), the Sense of Coherence Scale (SOC), World Assumption scale (WAS), the Coping Style Questionnaire (CSQ), the Impact on Family scale (IFS), the Trauma Symptom Checklist (TSC), and the Harvard Trauma Questionnaire (HTQ), were completed by the parents of children with various diseases. Despite the heterogeneity of the sample in terms of disease type, PTSD was present in 13.2% of the parents and an additional 28.6% had subclinical PTSD. Emotional coping, extent of daily care, time since diagnosis, and changes in employment due to the disease explained 71% of the variance in HTQ total score.

 

Mortensen, J., Simonsen, B. O., Eriksen, S. B., Skovby, P., Dall, R & Elklit, A. (2014). Family-centred care and traumatic symptoms in parents of children admitted to PICU. Scandinavian Journal of Caring Sciences, 29, 495-500. DOI: 10.111/scs.12179

The aim of the study was to investigate the association between parents’ experience of nursing care and levels of traumatisation to identify potential gender differences within this group, and to examine the possible relationships among the severity of a child’s illness, the parents’ fear of losing their child, and the parents’ experience of support and development of acute stress disorder (ASD) symptoms.

The conclusions were that participants were very satisfied with the support of the nurses at PICU at the University Hospital in Aarhus. However, in spite of this high level of satisfaction, more than a third of the mothers and almost 30% of the fathers meet the diagnostic criteria for ASD or subclinical ASD. The experienced care was therefore positively associated with ASD, but not with illness severity, or fear of losing of child.

 

 

 

                     

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