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This paper addresses the question of the prevalence of self reported morbidity in the community and reports on results obtained using the Nottingham Health Profile in a population survey of morbidity. The variation between demographic and social groups and the relationship with GP are considered. The results show that certain aspects of morbidity vary according to social group more markedly than other aspects, and that some dimensions of self reported morbidity are predictive of recent consultation reported by the respondents. The interpretation of data of this sort for health planning purposes is considered. For example, the manual groups were particularly susceptible to tiredness and sleep disturbance, but these were not conditions associated with more frequent consultation. The manual groups also reported higher levels of pain and emotional distress, which were associated with propensity to consult. Other types of morbidity associated with consultation with the general practitioner were physical symptoms of pain and feelings of social isolation, but these did not show a strong class difference.
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PMID:Socio-demographic variation in perceived illness and the use of primary care: the value of community survey data for primary care service planning. 377 55

Visiting a physician for evaluation of a breast problem which could be cancer is often assumed to be a highly stressful experience. This study evaluates the degree of emotional distress in women about to undergo examination for signs or symptoms of breast disease. Three hundred twenty-two women who attended the Breast Problem Clinic of the Wisconsin Clinical Cancer Center were studied. Each patient completed standard self-administered psychologic tests to evaluate mood disturbance (Profile of Mood States [POMS]) and responsibility taken for overall health care (Health Locus of Control [HLCS]). Results of these tests were compared to control populations of normal college women and female psychiatric outpatients. The women seen in the Breast Problem Clinic were significantly less distressed on POMS subscales which measure depression, anger, fatigue, and confusion than both psychiatric outpatients and normal college women (P less than 0.001). A second group of 17 women who were seen in the hospital 24 to 48 hours before definitive breast cancer surgery were also studied. Women evaluated as inpatients before breast cancer surgery were more distressed than the women attending the outpatient clinic on most POMS subscales, but were not clearly different from normal college women. No differences between the groups were seen for the HLCS. These data indicate that emotional distress among women attending a breast problem clinic is not extraordinary, but that emotional distress heightens when the diagnosis of breast cancer is known.
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PMID:Psychological distress among women with breast problems. 394 21

Emotional reaction, health preoccupation and sexual adjustment two months after a first myocardial infarction (MI) were studied in relation to social, psychological and somatic factors prior to, during and after the MI in 201 consecutive male patients. Psychological and social data were covered by means of questionnaires and a brief interview and somatic data by a standardized medical examination. New concepts were introduced after factor analysis. The degree of preoccupation varied very much and was considered as a reaction to the diagnosis of MI. Seventy-nine percent of the patients complained about fatigue and 65% felt anxious and depressed. Fatigue and nervousness were regarded by the patients as more disabling than cardiac symptoms. Emotional distress was related to a previous history of emotional complaints and to psychological factors and self-reported coronary symptoms but was unrelated to severity of the infarction, medically rated cardiac symptoms, demographic and social data. Sexual maladjustment, mainly due to fear, was frequent and associated with both emotional and somatic variables. Emotional disturbance after MI is considerable and further measures ought to be taken in order to prevent future disability.
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PMID:Emotional reaction, health preoccupation and sexual activity two months after a myocardial infarction. 646 17

The purpose of this study was to determine the prevalence of perimenstrual symptoms (PMS) in a free-living population of US women and to determine if prevalence estimates varied with parity, contraceptive status, characteristics of the menstrual cycle, and selected demographic variables. We identified all households from a census listing for five southeastern city neighborhoods that offered variation in racial composition and socioeconomic status. We ascertained all households in which there was one nonpregnant woman between the ages of 18 and 35 years per household. Of the 241 eligible women, 179 (74 per cent) participated in the study. Trained interviewers administered the Moos Menstrual Distress Questionnaire (MDQ) and other demographic measures to women between March and July 1979. Symptoms with a prevalence greater than 30 per cent included weight gain, headache, skin disorders, cramps, anxiety, backache, fatigue, painful breasts, irritability, mood swings, depression, or tension. Only 2 to 8 per cent of women found most of these severe or disabling. The exceptions were severe cramps reported by 17 per cent of women and severe premenstrual and menstrual irritability by 12 per cent. Cramps, backaches, fatigue, and tension were most prevalent during the menstruum; weight gain, skin disorders, painful breasts, swelling, irritability, mood swings, and depression were more prevalent in the premenstruum. Parity, oral contraceptive use, age, employment, education, and income were negatively associated with selected PMS. Use of an IUD, having long menstrual cycles, long menstrual flow, or heavy menstrual flow, and being able to predict the next period were positively associated with selected PMS. Race had both positive and negative effects on PMS.
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PMID:Prevalene of perimenstrual symptoms. 688 17

Recent research findings contradict the notion that premenstrual and menstrual symptoms constitute two mutually exclusive categories of perimenstrual distress. The purposes of this study were to describe the prevalence of distress associated with menstruation in a community population and to determine whether perimenstrual distress could be regarded as a single construct. Nonpregnant women (N = 193) between 18 and 35 were selected from five neighborhoods in a southeastern city in a way that allowed for variability in race and income. The women were interviewed in their homes and 179 were asked to complete the Moos Menstrual Distress Questionnaire (MDQ). At least 30% of the women reported weight gain, skin disorders, backache, painful or tender breasts, irritability, depression, headache, cramps, fatigue, swelling, mood swings or tension in the perimenstruum. Cycle phase differences were not found for 31 MDQ symptoms, but were found for: weight gain, crying, lowered school or work performance, taking naps, headache, skin disorders, cramps, anxiety, backache, fatigue, painful or tender breasts, swelling, irritability, mood swings, depression, and tension. Although there were significant differences between the premenstrual and menstrual phases for certain symptoms, the magnitudes of the mean differences were small (less than .3) except for cramps, weight gain, and fatigue. Furthermore, premenstrual and menstrual reports of the same symptoms were highly correlated. Thus, it appears reasonable to study perimenstrual distress as a single construct.
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PMID:Toward a construct of perimenstrual distress. 692 41

Recent studies have demonstrated that patients receiving cancer chemotherapy are more likely to have a successful treatment outcome if they receive optimal doses of drug continually. The current study was designed as a first step toward discovering factors that are associated with emotional distress during treatment and subsequent decisions by patients to delay, reduce, or terminate treatment. Interviews were conducted with 61 patients receiving chemotherapy for malignant lymphoma. Patients reported on side effects of treatment and their efforts to control them, their knowledge and beliefs about their illness, their strategies for monitoring the effectiveness of treatment, and the extent to which they had been prepared for the experiences of chemotherapy. Ratings of emotional distress were obtained on an 11-point self-report scale, and information about treatment schedules was obtained from medical records. The number of side effects experienced, but not the duration or severity, was positively correlated with distress. Vague, diffuse side effects such as tiredness and pain were more likely to be associated with distress than were acute, specific side effects such as nausea and vomiting. Patients who reported either unsuccessful attempts to cope with side effects or no attempts at all had greater distress than those who were coping successfully. Patients who developed conditioned nausea during treatment reported higher distress than those who did not.
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PMID:Factors contributing to emotional distress during cancer chemotherapy. 709 22

Fatigue is the most frequently reported symptom of patients with cancer. The purpose of this study was to describe the experience of fatigue over time in patients with cancer receiving treatment with interferon alpha. Piper's Integrated Fatigue Model guided this study. A descriptive repeated-measures design was used. A convenience sample of 30 patients with malignant melanoma was drawn from a comprehensive cancer center in Southern California. Two instruments were used in data collection, the Symptom Distress Scale and the Piper Fatigue Scale. Study findings revealed descriptive data on patients' perceptions of the causes and remedies for fatigue while receiving active treatment for cancer. The pattern of fatigue was consistent over the five points of time during treatment, with the most extreme fatigue scores in the affective domain, followed by the sensory, temporal, total fatigue, and fatigue severity scores. The patterns and dimensions of fatigue provide implications for care of patients receiving interferon alpha, and for further investigation in the area of fatigue as a critical aspect of quality of life.
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PMID:Fatigue in patients with cancer receiving interferon alpha. 759 73

Melatonin (0.1-1.0 mg/kg) reduced isolation-induced distress vocalizations (DVs) in young domestic chickens in a dose-dependent manner. This effect was unaffected by the administration of d-amphetamine (1.0 mg/kg) suggesting that melatonin's effects were not merely due to fatigue. The melatonin reduction in DVs was not naloxone reversible, indicating an action independent of the endogenous opioid system. However, chronic pretreatment with naltrexone facilitated the melatonin effect, suggesting a complex relationship between melatonin and the endogenous opioids in regulating distress vocalizations. Chickens exhibited a marked reduction in DVs when isolation chambers were darkened, suggesting endogenous, as well as exogenous, melatonin mediation of isolation distress; however; pinealectomy only partially reversed the darkness effect. Pinealectomized animals, like control animals, exhibited a reduction in DVs following melatonin treatment; however, the melatonin effect was shorter lasting. The implications that these results may have for socialization and emotional distress are discussed.
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PMID:The effects of melatonin on isolation distress in chickens. 782 45

Suspected postprandial (reactive or idiopathic) hypoglycemia is characterized by predominantly adrenergic symptoms appearing after meals rich in carbohydrates and by their rare association with low blood glucose level (< 2.77 mmol/L). We studied heart rate, blood pressure, plasma insulin, C-peptide, and catecholamine responses during a 5-h oral glucose tolerance test in eight patients with suspected postprandial hypoglycemia and eight age-, sex-, and body mass index-matched healthy controls. We also evaluated beta-adrenergic sensitivity by using the isoproterenol sensitivity test. Psychological profile was assessed by the Symptom Checklist (SCL-90R) self-report symptom inventory. Patients with suspected postprandial hypoglycemia had higher beta-adrenergic sensitivity (defined as the dose of isoproterenol required to increase the resting heart rate by 25 beats/min) than controls (mean +/- SEM, 0.8 +/- 0.13 vs. 1.86 +/- 0.25 microgram isoproterenol; P = 0.002). After administration of glucose (75 g) blood glucose, plasma C-peptide, plasma epinephrine, and plasma norepinephrine responses were identical in the two groups, but plasma insulin was higher in the patients (group effect, P = 0.02; group by time interaction, P = 0.0001). Both heart rate and systolic blood pressure were significantly higher (but remained in the normal range) after glucose administration in patients with suspected postprandial hypoglycemia than in controls (group by time interactions, P = 0.004 and 0.0007, respectively). After glucose intake, seven patients had symptoms (palpitations, headache, tremor, generalized sweating, hunger, dizziness, sweating of the palms, flush, nausea, and fatigue), whereas in the control group, one subject reported flush and another palpitations, tremor, and hunger. Analysis of the SCL-90R questionnaire revealed that patients had emotional distress and significantly higher anxiety, somatization, depression, and obsessive-compulsive scores than controls. We may conclude that patients with suspected postprandial hypoglycemia have normal glucose tolerance, increased beta-adrenergic sensitivity, and emotional distress.
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PMID:Suspected postprandial hypoglycemia is associated with beta-adrenergic hypersensitivity and emotional distress. 796 39

The Memorial Symptom Assessment Scale (MSAS) is a new patient-rated instrument that was developed to provide multidimensional information about a diverse group of common symptoms. This study evaluated the reliability and validity of the MSAS in the cancer population. Randomly selected inpatients and outpatients (n = 246) with prostate, colon, breast or ovarian cancer were assessed using the MSAS and a battery of measures that independently evaluate phenomena related to quality of life. Symptom prevalence in the 218 evaluable patients ranged from 73.9% for lack of energy to 10.6% for difficulty swallowing. Based on a content analysis, three symptoms were deleted and two were added; the revised scale evaluates 32 physical and psychological symptoms. A factor analysis of variance yielded two factors that distinguished three major symptom groups and several subgroups. The major groups comprised psychological symptoms (PSYCH), high prevalence physical symptoms (PHYS H), and low prevalence physical symptoms (PHYS L). Internal consistency was high in the PHYS H and PSYCH groups (Cronback alpha coefficients of 0.88 and 0.83, respectively), and moderate in the PHYS L group (alpha = 0.58). Although the severity, frequency and distress dimensions were highly intercorrelated, canonical correlations and other analyses demonstrated that multidimensional assessment (frequency and distress) augments information about the impact of symptoms. High correlations with clinical status and quality of life measures support the validity of the MSAS and indicate the utility of several subscale scores, including PSYCH, PHYS, and a brief Global Distress Index. The MSAS is a reliable and valid instrument for the assessment of symptom prevalence, characteristics and distress. It provides a method for comprehensive symptom assessment that may be useful when information about symptoms is desirable, such as clinical trials that incorporate quality of life measures or studies of symptom epidemiology.
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PMID:The Memorial Symptom Assessment Scale: an instrument for the evaluation of symptom prevalence, characteristics and distress. 799 21


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