Religious involvement and depressive symptoms in primary care elders.

Background: Multiple lines of evidence indicate relationships between religious involvement and depression, although the specific nature of the relationships is yet to be clarified. Moreover, there appear to be no well controlled longitudinal studies to date examining this issue in primary care elders.

Method: The authors assessed the linear and non-linear relationships between three commonly identified types of religious involvement and observer-rated depressive symptoms in 709 primary care elders assessed at baseline and 1-year follow-up.

Personality and medical illness burden among older adults in primary care.

Objective: To examine the association between Five Factor Model personality traits (Neuroticism, Extraversion, Openness to experience, Agreeableness, Conscientiousness) and physician-quantified aggregate morbidity in a sample of older adults in primary care.

Methods: A total of 449 primary care patients, ranging in age from 65 to 97 years (75 +/- 6.9 (mean +/- standard deviation)), completed the Neo-Five Factor Inventory (NEO-FFI) and extensive interviews.

Personality traits and the reporting of affective disorder symptoms in depressed patients.

Background: A deeper understanding of the influences on self-reported mood symptoms could inform the debate about the utility of self-report instruments and enhance the assessment and treatment of affective disorders. We tested the hypotheses that higher Neuroticism is associated with the over-reporting of affective symptoms and lower Openness to Experience is associated with the under-reporting of affective symptoms.

Methods: Subjects were 134 inpatients of ages 50 and over diagnosed with a mood disorder.

Influences on patients' ratings of physicians: Physicians demographics and personality.

Objective: There is considerable interest in the influences on patients' ratings of physicians.

Methods: In this cross-sectional study, patients (n = 4616; age range: 18-65 years) rated their level of satisfaction with their primary care physicians (n = 96). Patients and physicians were recruited from primary care practices in the Rochester, NY metropolitan area.

Personality and perceived health in older adults: the five factor model in primary care.

Responses to specific questions tapping perceived health are associated with morbidity, mortality, and the use of health services, yet there has been little research on their personality correlates. We examined the associations between Five Factor Model personality traits and responses to four items extracted from the Medical Outcomes Study Short Form-36 in 266 primary care patients who were 65 years of age or older. Multivariate analyses controlling for age, gender, depressive symptoms, and physical disease burden showed that having a higher Neuroticism score was associated with worse perceived health in response to all items except "I am as healthy as anybody I know.

Dementia care: mental health effects, intervention strategies, and clinical implications.

Caring for elderly people with dementia is associated with well-documented increases in burden, distress, and decrements in mental health and wellbeing. More severe behavioural, cognitive, and functional impairments in a patient are associated with higher levels of burden and distress. Distress increases with care hours per week, number of tasks, and declining coping and support resources.

Treatments for later-life depressive conditions: a meta-analytic comparison of pharmacotherapy and psychotherapy.

Objective: To improve interventions for depressed older adults, data are needed on the comparative effects of pharmacotherapy versus psychotherapy. Given that most older adults with clinically significant depressive symptoms do not have major depression, data on treatments for minor depression and dysthymia are especially needed.

Method: Meta-analysis was used to integrate the results of 89 controlled studies of treatments focused on acute major depression (37 studies) and other depressive disorders (52 studies conducted with mixed diagnostic groups, including patients with major depression, minor depression, and dysthymia).

What drives referral from primary care physicians to mental health specialists? A randomized trial using actors portraying depressive symptoms.

Background: Referral from primary care to the mental health specialty sector is important but poorly understood.

Objective: Identify physician characteristics influencing mental health referral.

Design: Randomized controlled trial using Standardized Patients (SPs).

Personality and the association of pain and depression.

Objectives: The objectives of this study were to test the hypotheses that pain is associated with depression independent of personality and that neuroticism moderates this association.

Method: Multiple regression analyses were conducted in a group of 404 older primary care patients assessed with validated measures.

Results: Bodily pain was independently associated with depression.

Childhood sexual abuse and depressive symptom severity: the role of neuroticism.

This study examined neuroticism's role in the association between childhood sexual abuse and severity of depressive symptoms in a sample of 105 psychiatric patients 50 years of age and older diagnosed with major depressive disorder. As hypothesized, men and women who reported histories of childhood sexual abuse had more severe depressive symptoms than those without abuse histories. Further, neuroticism partially accounted for the association between severe childhood sexual abuse and depressive symptom severity.

Physicians' responses to patients' medically unexplained symptoms.

Objective: To understand how physicians communicate may contribute to the mistrust and poor clinical outcomes observed in patients who present with medically unexplained symptoms (MUS).

Methods: After providing informed consent, 100 primary care physicians in greater Rochester, New York, were visited by two unannounced covert standardized patients (actors, or SPs) portraying two chest pain roles: classic symptoms of gastroesophageal reflux disease (GERD) with nausea and insomnia (the GERD role) and poorly characterized chest pain with fatigue and dizziness (the MUS role). The visits were surreptitiously audiorecorded and analyzed using the Measure of Patient-Centered Communication (MPCC), which scores physicians on their exploration of the patients' experience of illness (component 1) and psychosocial context (component 2), and their attempts to find common ground on diagnosis and treatment (component 3).

Health locus of control and perceived risk for breast cancer in healthy women.

Although early detection is closely linked to survival of breast cancer, many women do not adhere to recommended screening guidelines. One of the most studied factors that contribute to women's screening behavior is their perceived risk of developing breast cancer. In this study, the authors examined contributions of general health locus of control and breast cancer-specific control to understanding perceived risk.

Measuring patient-centered communication in patient-physician consultations: theoretical and practical issues.

The goal of patient-centered communication (PCC) is to help practitioners provide care that is concordant with the patient's values, needs and preferences, and that allows patients to provide input and participate actively in decisions regarding their health and health care. PCC is widely endorsed as a central component of high-quality health care, but it is unclear what it is and how to measure it. PCC includes four communication domains: the patient's perspective, the psychosocial context, shared understanding, and sharing power and responsibility.

Are patients' ratings of their physicians related to health outcomes?

Purpose: Observational studies using patient reports suggest associations between physician interpersonal styles and patient outcomes. Possible confounding of these associations has not been carefully examined.

Methods: Approximately 4,700 patients of 96 physicians completed a survey instrument that included reported health status changes during the previous year, perceptions of their physician (satisfaction, trust, knowledge of patient, and autonomy support), and sociodemographic and clinical covariates.

Emotion language in primary care encounters: reliability and validity of an emotion word count coding system.

Objectives: To develop a reliable and valid computer coded measure to assess emotional expression from transcripts of physician-patient interactions.

Methods: Physician encounters with two standardized patients (SPs) were audiotaped. Fifty patients from each physician (n = 100 primary care physicians) completed surveys that assessed patients' perceptions of their relationships with physicians.