Browsing by Author "Steiner, Jennifer L."

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    (506) The complex relationship between pain intensity and physical functioning in fibromyalgia: the mediating role of depression
    (The Journal of Pain, 2016) Steiner, Jennifer L.; Bigatti, Silvia M.; Slaven, James E.; Ang, Dennis C.
    Fibromyalgia (FM) is typically associated with the experience of diffuse pain and physical impairment. Depression also commonly co-exists in patients with FM, and it has been correlated with pain intensity and physical functioning. Previous research suggests an association between pain intensity and physical functioning; however, the direct causal relationship between improvements in pain intensity and in functioning is not observed in many FM patients. This may suggest that another factor such as depression is mediating this relationship. The present work examined the possibility of a mediating role of depression in the relationship between pain intensity and functioning over the course of time. 216 patients with FM completed self-report measures of pain intensity, depression, and physical impairment as part of a larger longitudinal study which investigated interventions to increase physical activity among FM patients. Assessments were completed at baseline, 12 weeks, 24 weeks, and 36 weeks. Longitudinal mediational analyses indicated that depression is a statistically significant partial mediator of the relationship between pain intensity and self-reported physical functioning at all four assessment points. To the authors’ knowledge, this is the first study to explicitly examine this relationship in a sample of FM patients, as well as the first to do so using a longitudinal design; this may significantly add to our understanding of the complexities behind creating improvements in physical functioning in this population. Clinical implication for these findings include focusing on depression and psychological correlates of depression as first line therapeutic targets in improving physical functioning of patients with FM, and treating co-morbid depression in patients with fibromyalgia earlier in the course of treatment to prevent engagement in and the perpetuation of the cycle of disability. This work was a secondary data analysis from a study funded by the National Institute of Arthritis and Musculoskeletal and Skin Diseases.
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    The Complex Relationship between Pain Intensity and Physical Functioning in Fibromyalgia: The Mediating Role of Depression
    (Journal of Applied Biobehavioral Research, 2017) Steiner, Jennifer L.; Bigatti, Silvia M.; Slaven, James E.; Ang, Dennis C.
    Fibromyalgia (FM) is typically associated with the experience of diffuse pain and physical impairment.Depression also commonly co-exists in patients with FM, and has been correlated with pain intensity and physical functioning.Previous research suggests an association between pain intensity and physical functioning; however, the direct causal relationship between improvements in pain intensity and in functioning is not observed in many FM patients.This may suggest that another factor such as depression is mediating this relationship. The present work examinedmediating role of depression. METHODS: 216 patients with FM completed measures of pain intensity, depression, and physical functionas part of a larger longitudinal study.Assessments were completed at baseline, 12, 24, and 36 weeks.RESULTS: Longitudinal mediational analyses indicated that depression is a partial mediator of the relationship between pain intensity and physical functioningat all four assessment points.Beta coefficients for the path from pain to physical functioning ranged from 0.18 –0.36, with attenuated path coefficients ranging from 0.03 –0.08, still showing significant but decreased associations when depression was added as a mediator. CONCLUSIONS: Clinical implication includes the importance of treating co-morbid depression in patients with fibromyalgia early in the course of treatment to prevent engagement in the cycle of disability.
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    Depression in Husbands of Breast Cancer Patients: Relationships to Coping and Social Support
    (Springer, 2011) Bigatti, Silvia M.; Wagner, Christina D.; Lydon, Jennifer R.; Steiner, Jennifer L.; Miller, Kathy D.
    PURPOSE: The purpose of the present study was to examine depression in husbands of women with breast cancer, as depression is typically as high in husbands as in patients, and impacts functioning in both. METHODS: We compared husbands of patients to husbands of women without chronic illness on depressive symptoms with the Center for Epidemiological Studies Depression Scale, social support with the Interpersonal Support Evaluation List, and coping with the Ways of Coping Questionnaire. Using the stress and coping model, we examined whether coping mediated social support and depression differently by group, as has been found in the literature. RESULTS: Husbands of patients reported higher scores on the measure of depression and lower use of problem-focused coping, while groups reported equivalent social support. Escape-avoidance coping emerged as a full mediator between social support and depression in husbands of patients, but only a partial mediator in comparison husbands. Accepting responsibility coping partially mediated social support and depression in both groups. Low social support appears particularly detrimental in husbands of patients as it is associated with ineffective coping and depression. CONCLUSIONS: Findings suggest that among husbands of patients, social support relates to depression only through its relationship with coping, indicating healthcare providers should direct attention and intervention to the coping strategies employed by husbands with low social support.
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    Depressive rumination and cognitive processes associated with depression in breast cancer patients and their spouses
    (Families, Systems, & Health Journal, 2014) Steiner, Jennifer L.; Wagner, Christina D.; Bigatti, Silvia M.; Storniolo, Anna Maria
    Depression is common among patients with breast cancer (BC) and their spouses. The diagnosis of BC often results in negative cognitive processes, such as appraisals of harm/loss, intrusive thoughts, and depressive rumination, all of which contribute to the occurrence of depression in both the patient and spouse. The present research is a cross-sectional exploration of the mediating role of depressive rumination in the relationships of intrusive thoughts and appraisal of harm/loss with depression, in a sample of 56 BC patients and their partners. We hypothesized that depressive rumination would mediate the relationships between cognitive processes and depression in both BC patient and their partners. Participants completed self-report measures of depressive symptoms, depressive rumination, cognitive appraisals, and intrusive thoughts. Path analyses using hierarchical linear regression were conducted to assess the relationships among variables. Results indicated that for BC patients, harm/loss appraisals and intrusive thoughts had direct effects on depression; only harm/loss appraisals had indirect effects through depressive rumination. For partners, both harm/loss appraisal and intrusive thoughts had direct effects on depression, and both had indirect effects through depressive rumination. Dyadic analysis showed no relation of partner cognitive variables with patient depression or patient cognitive variables with partner depression. Findings show that the perseverative practice of dwelling on these negative thoughts of loss and harm relates to depressive symptoms. Rumination may act as 1 possible mechanism by which intrusive thoughts and harm/loss appraisals lead to depressive symptoms.
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    Dyadic influence of hope and optimism on patient marital satisfaction among couples with advanced breast cancer
    (Springer, 2014-09) Rock, Emily E.; Steiner, Jennifer L.; Rand, Kevin L.; Bigatti, Silvia M.; Department of Psychology, School of Science
    PURPOSE: An estimated 10-40 % of breast cancer (BC) patients report negative changes to their partnered relationships. Literature suggests that for these patients, marital satisfaction is related to depression and other quality of life factors which are associated with survivorship and treatment response. However, existing literature does not provide a clear explanation of the factors that strengthen vs. create strain in couples facing cancer. Given the benefits of a satisfying relationship to patient quality of life, it is important to better understand factors that put patients at greater risk for marital difficulties. This study examined the differential and combined roles of hope and optimism among BC patients and their partners on patient marital satisfaction. METHOD: Fifty-six breast cancer patient-partner dyads completed study questionnaires as part of a larger study. Regression analyses were used to examine the main and interaction effects of patient and partner hope and optimism on patient marital satisfaction. RESULTS AND CONCLUSION: Higher patient and partner hope predicted greater patient marital satisfaction, whereas optimism did not. These results are divergent from the literature on optimism and well-being, which shows the importance of studying these two traits concurrently. Interaction effects suggest certain combinations of patient and partner hope and optimism are more beneficial than others for patient marital satisfaction and suggest a dyadic approach is important for investigation of well-being in breast cancer.
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    Matched and Mismatched Cognitive Appraisals in Patients with Breast Cancer and their Partners: Implications for Psychological Distress
    (Wiley, 2011) Bigatti, Silvia M.; Steiner, Jennifer L.; Makinabakan, Nermin; Hernandez, Ann Marie; Johnston, Erica; Storniolo, Anna Maria
    The present study sought to identify couples’ cognitive appraisals of breast cancer and the extent to which matched or mismatched appraisals within a couple contribute to distress. Women with breast cancer (n = 57) and their partners completed the Cognitive Appraisals of Health Scale along with two self-report measures of distress, the Profile of Mood States and the Impact of Events Scale. Four groups were created based on their cognitive appraisals. Couples where both patient and partner scored highest on challenge or benign appraisals formed the positive outlook group (P+S+); when both scored highest on threat or harm/loss they formed the negative outlook group (P-S-). In the mismatched groups the patient had a positive outlook and their partner had a negative outlook (P+S-), or vice versa (P-S+). In general, lower distress was related to participants’ own positive outlook. Higher distress for patients was found in the matched group P-S-; for partners it was found in the mismatched group P+S-. These findings suggest partner effects for both patients and partners. When the patient had a negative outlook, a partner negative outlook was associated with the highest psychological distress. When the partner had a negative outlook, a patient positive outlook was associated with the highest psychological distress. There are several possible explanations for these findings, each with different implications for clinical practice. Future research with different groups of cancer patients and longitudinal, mixed methods designs may clarify their meaning.
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    Rates of Depression and Anxiety in Cancer Patients: A Review of Cross-National Findings
    (Pabst Publishers, 2012) Bigatti, Silvia M.; Steiner, Jennifer L.; Cronan, Terry A.
    Cancer is the leading cause of death worldwide. In this paper, we examine the similarities and differences between the United States (US) and the European Union (EU-27) in the incidences, deaths, types of screening, and screening rates for breast, cervical, colorectal, prostate, and lung cancers. We highlight the differences between the health care, economic, and sociopolitical systems in the US and EU-27 that result in different types of coverage, access to health care, and cancer screening. Finally, we discuss patient-directed, provider-directed, community-directed, and system-directed interventions and the outcomes of these approaches.
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    Trajectory of Change in Pain, Depression, and Physical Functioning after Physical Activity Adoption in Fibromyalgia
    (Sage, 2015) Steiner, Jennifer L.; Bigatti, Silvia M.; Ang, Dennis
    Fibromyalgia (FM) is associated with widespread pain, depression, and declines in physical functioning. The study purpose was to examine the trajectory of these symptoms over time related to physical activity adoption and maintenance via Motivational Interviewing versus Education, to increase physical activity. There were no treatment group differences, we divided the sample (n = 184) based on changes in physical activity. Repeated measures analyses demonstrated differential patterns in depression, pain, and physical functioning at 24 and 36 weeks. Findings suggest increased physical activity may serve as a multiple-target intervention that provides moderate to large, long-lasting benefits for individuals with FM.