Dysfunctional Attitudes, Depression and Quality of Life in a Sample of Romanian Hungarian Cancer Patients
Kállay, Éva, Dégi, Csaba L., Vincze, Anna E., Journal of Cognitive and Behavioral Psychotherapies
The main objective of this was to investigate the relationship between depression, dysfunctional attitudes (DA), and their effect on quality of life (QoL) in a sample of Romanian Hungarian cancer patients. Our sample consisted of 376 patients hospitalized with different types and grades of cancer, and was assessed with the Beck Depression Inventory, the Dysfunctional Attitudes Scale, and the Functional Quality of Life Scale. We have found significant differences in depression only between age groups; significant differences in quality of life between age groups and different levels of education; significant differences of dysfunctional attitudes have been found between rural and urban patients. As our data have revealed, in the assessed population one of the most disturbing psychological changes that may accompany this life threatening illness consists in the heightened levels of depression. Taking into consideration the specificities of the traditional rural Romanian Hungarian culture, the reasons for these differences in depression and QoL may be induced or catalyzed by other mechanisms as well. The significant, though weak correlation between dysfunctional attitudes and depression supports this presumption. We suggest that cancer patients may need more individual-tailored and culture specific interventions.
Key words: psycho-oncology, depressive symptoms, dysfunctional attitudes, quality of life.
The diagnosis with cancer, its prolonged treatment and physical side effects can have a profound impact on the patient's life.
Approximately 25% of the patients diagnosed with cancer report considerable levels of distress around the event (McDaniel, Musselman, Porter, Reed, & Nemeroff, 1995). This first stage is characterized by intense symptoms of anxiety, depression, cognitive, and behavioral impairments in functioning. Usually, after approximately 2-3 weeks, the levels of distress seem to decrease (Chaturvedi & Maguire, 1998; Nordin & Glimelius, 1999), the person bouncing back to an acceptable level of functioning, while trying to incorporate the event in an accommodating way into his/her life narrative. Nevertheless, a significant part of research has not found any kind of decrease in the levels of distress (Omne- Ponten, Holmberg, & Sjoden, 1992; Vinokur, Threatt, Vinokur-Caplan, & Satariano, 1990), patients experiencing anxiety and depression even years after diagnosis and cessation of treatment.
As concerning the relationship between cancer and dysfunctional attitudes, long-term cancer survivors may have recurrent thoughts about the diagnosis and experience a greater sense of uncertainty about their health, about their future, and fears regarding the recurrence of the cancer (Tross & Holland, 1989).
Severe, life-threatening illness does not only affect a person's organism; it affects his/her entire life on all its dimensions, exerting physical, psychological, behavioral, social, and sexual changes. The study, diagnosis, and treatment of severe illness has until recently been interested mostly in length of survival, physical and psychological changes, taking little account of the way patients perceived themselves in the particular situation. Nevertheless, most recent approaches have taken seriously into consideration this aspect as well, within the concept of quality of life (QoL) after diagnosis and/or installation of illness. The issue of QoL becomes even more stringent in clinical oncology, where both diagnosis and treatment are severely debilitating (Fayers & Bottomley, 2002). In this specific situation where the changes produced by surgical and/or non-surgical interventions (radio-therapy, chemotherapy, etc.), the implications of the highly charged psychological nature of the diagnosis itself, become decisive factors that increasingly participate in treatment decisions. Consequently, the investigation of the factors implied in QoL along other parameters of the illness is strongly supported by the actual health policy targeting the prevention of premature mortality and morbidity, and simultaneously enhancing QoL itself (Pojoga, 2001). …