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Background: A burn event can elicit symptoms of posttraumatic stress disorder (PTSD) in survivors and their partners and may impact the way these couple members interact with each other. They may try to protect each other from further emotional distress by avoiding talking about the burn event, but they may also show concern towards each other. Objective: The aim of this study was to investigate bidirectional relationships between survivor’s and partner’s PTSD symptoms and two interpersonal processes: partner-oriented ‘self-regulation’, which is avoidance-oriented, and ‘expressed concern’, which is approach-oriented. Method: In this longitudinal multi-centre study, 119 burn survivors and their partners participated. Measures of PTSD symptoms, self-regulation, and expressed concern were administered in the acute phase following the burns, and follow-ups took place up to 18 months postburn. Intra- and interpersonal effects were examined in a random intercept cross-lagged panel model. Exploratory effects of burn severity were also investigated. Results: Within individuals, survivor’s expressed concern predicted later higher levels of survivor’s PTSD symptoms. In their partners, self-regulation and PTSD symptoms reinforced each other in the early phase postburn. Between the two couple members, partner’s expressed concern predicted later lower levels of survivor’s PTSD symptoms. Exploratory regression analyses showed that burn severity moderated the effect of survivor’s self-regulation on survivor’s PTSD symptoms, indicating that self-regulation was continuously related to higher levels of PTSD symptoms over time within more severely burned survivors, but not in less severely burned survivors. Conclusion: PTSD symptoms and self-regulation reinforced each other in partners and possibly also in more severely burned survivors. Partner’s expressed concern was related to lower levels of survivor’s PTSD symptoms, whereas survivor’s expressed concern was related to higher levels of survivor’s PTSD symptoms. These findings emphasize the importance of screening for and monitoring PTSD symptoms in burn survivors and their partner and of encouraging couple’s self-disclosure. PTSD symptoms in burn survivors and their partners are related to both avoidance- and approach-oriented interpersonal processes.In partners, higher levels of self-regulation were bidirectionally related to higher levels of posttraumatic stress symptoms.Concern expressed by partners may mitigate posttraumatic stress symptoms in burn survivors. PTSD symptoms in burn survivors and their partners are related to both avoidance- and approach-oriented interpersonal processes. In partners, higher levels of self-regulation were bidirectionally related to higher levels of posttraumatic stress symptoms. Concern expressed by partners may mitigate posttraumatic stress symptoms in burn survivors.

INTRODUCTION: Current grief research is dominated by cross-sectional studies assessing prolonged grief disorder (PGD) symptoms retrospectively. Examining grief in daily life, using Experience Sampling Methodology (ESM), may advance the field. Because of the lack of ESM-research on PGD, we evaluated the acceptability and feasibility of assessing PGD symptoms in daily life of bereaved people.MATERIALS AND METHODS: ESM-items assessing PGD symptoms were developed using cognitive interviewing with five ESM/grief experts. Eighty bereaved adults completed these ESM-items five times a day for two weeks. Before and after this ESM-phase, interviews were administered assessing PGD retrospectively (using the Traumatic Grief Inventory-Clinical Administered). t-tests were performed comparing symptom severity of aggregated moment-to-moment recall (using ESM-items) with retrospective recall (based on interviews) of PGD symptoms. Acceptability of participating in ESM-research (assessed with the Reactions to Research Participation Questionnaire) was examined using descriptive statistics. Feasibility was evaluated by reporting compliance and retention rates.RESULTS: Minor changes were made to the ESM-items based on expert interviews. Average levels of aggregated moment-to-moment recall of the symptoms "yearning" (d = -1.04), "preoccupation with the deceased" (d = -0.91), "marked sense of disbelief" (d = -0.43), and "intense loneliness" (d = -0.28) were lower compared with retrospective recalling these symptoms. On average, bereaved people were neutral about personal benefits gained through participation in this EMS-study. They indicated that participation did not raise emotional reactions. Compliance and retention rates were 60% and 65%, respectively.DISCUSSION: Our findings indicate that whereas compliance and retention is challenging, using ESM to study PGD symptoms in daily life might be useful. Nevertheless, more research is needed.

ObjectiveFatigue after burns is often attributed to the hyperinflammatory and hypermetabolic response, while it may be best understood from a bio-psychological perspective, also involving the neuro-endocrine system. This longitudinal multi-center study examined the course of fatigue up to 18 months postburn. The contribution of bio-psychological factors, including burn severity, pain, and acute PTSD symptoms, to the course and persistence of fatigue was studied in a multifactorial model.MethodsParticipants were 247 adult burn survivors. Fatigue symptoms were assessed with the Multidimensional Fatigue Inventory during the acute phase and subsequently at 3, 6, 12, and 18 months postburn, and were compared to population norms. Age, gender, burn severity, acute PTSD symptoms and pain were assessed as potential predictors of fatigue over time in a latent growth model.ResultsAt 18 months postburn, 46% of the burn survivors reported fatigue, including 18% with severe fatigue. In the acute phase, higher levels of fatigue were related to multiple surgeries, presence of pain, and higher levels of acute PTSD symptoms. Fatigue gradually decreased over time with minor individual differences in rate of decrease. At 18 months, pain and acute PTSD symptoms remained significant predictors of fatigue levels.ConclusionsProtracted fatigue after burns was found in almost one out of five burn survivors and was associated with both pain and acute PTSD symptoms. Early detection of PTSD symptoms and early psychological interventions aimed at reducing PTSD symptoms and pain may be warranted to reduce later fatigue symptoms.

Although the majority of the individuals confronted with involuntary job loss show stable levels of healthy functioning after job loss, a significant minority develops symptoms of job loss-related complicated grief (JLCG). Research on grief following bereavement loss showed that complicated grief symptoms include reactions like separation distress, yearning, preoccupation with the loss, anger, bitterness, and the feeling that life is meaningless, causing persistent suffering and impairments in daily life. It seemed conceivable that if JLCG symptoms are in some way similar to complicated grief symptoms following bereavement loss, they could not just negatively affect one’s psychological well-being, but could also form an obstacle to re-entering the labour market. Hence, the main research question of this dissertation was: ‘What are characteristics and correlates of complicated grief symptoms following job loss?’. This research question was addressed in eight chapters drawing on various samples, study designs and statistical techniques. The findings of these studies show that individuals can experience complicated grief symptoms after involuntary job loss. Factor and latent class analyses indicated that complicated grief symptoms differ from anxiety and depression symptoms after involuntary job loss. Avoidance strategies and negative cognitions related to the job loss were repeatedly associated with the intensity of JLCG symptoms. The results of diary study indicated that when someone perceives daily activities as more useful, one will experience more fulfilment of the basic needs (e.g., the need for affiliation or the need for time structure) and less emotional distress. Based on the findings in these empirical studies, a cognitive-behavioural framework was introduced to explain the underlying mechanisms of complicated grief symptoms after involuntary job loss. Three core processes play a central role, namely 1) negative cognitions related to the job loss, 2) anxious and depressive avoidance behaviour, and 3) insufficient integration of the loss in the autobiographical memory. These three core processes can be influenced by certain risk factors, such as circumstances surrounding the job loss, personality traits, and the social environment. JLCG symptoms can lead to an increase of psychological problems, emotional distress, reduced employability, depletion of resources, and a decreased chance of re-employment. In conclusion, the majority of individuals recover well after involuntary job loss, while a significant minority remains stranded and experiences high levels of emotional stress. The work within this dissertation shows that within this minority we should not only focus on symptoms of depression and anxiety, but also pay attention to the complicated grief symptoms in order to identify and treat vulnerable individuals in an early stage after involuntary job loss.

Objective Involuntary job loss can lead to symptoms of complicated grief (CG), depression, and anxiety. Information about the temporal linkage between these symptoms is limited and may have implications for the treatment of those suffering from mental health complaints after dismissal. The aim of this study was to explore the possible reciprocal relationships between symptoms of CG, depression, and anxiety following involuntary job loss. Method We recruited 128 Dutch workers who had lost their job within the past 12 months, including 72 males and 56 females with an average age of 49.8 (SD = 9.0) years. They completed questionnaires tapping CG, depression, and anxiety symptoms at baseline (Time 1) and a 6‐month follow‐up (Time 2). Several cross‐lagged panel models were compared. Results Our analyses indicated that CG symptom severity following job loss at Time 1 predicted depression at Time 2, but not vice versa. Similar results were found for job loss‐related CG and anxiety symptoms. Conclusions Symptom‐levels of CG following job loss predict later depression and anxiety symptoms more strongly than vice versa. This implies that screening and targeting job loss‐related CG symptoms with early interventions might protect individuals from developing depression or anxiety symptoms after their dismissal.

Purpose This study explored the individual trajectories of health-related quality of life (HRQL) compared to recalled pre-burn level of HRQL and investigated whether burn severity and post-traumatic stress disorder (PTSD) symptoms increase the risk of not returning to pre-burn level of HRQL. Methods Data were obtained from 309 adult patients with burns in a multicenter study. Patients completed the EQ-5D-3L questionnaire with a Cognition bolt-on shortly after hospital admission, which included a recalled pre-injury measure, and, again, at 3, 6, 12 and 18 months post-burn. Burn severity was indicated by the number of surgeries, and PTSD symptoms were assessed with the IES-R at three months post-burn. Pre- and post-injury HRQL were compared to norm populations. Results Recalled pre-injury HRQL was higher than population norms and HRQL at 18 months post-burn was comparable to population norms. Compared to the pre-injury level of functioning, four HRQL patterns of change over time were established: Stable, Recovery, Deterioration, and Growth. In each HRQL domain, a subset of patients did not return to their recalled pre-injury levels, especially with regard to Pain, Anxiety/Depression, and Cognition. Patients with more severe burns or PTSD symptoms were less likely to return to pre-injury level of functioning within 18 months post-burn. Conclusion This study identified four patterns of individual change. Patients with more severe injuries and PTSD symptoms were more at risk of not returning to their recalled pre-injury HRQL. This study supports the face validity of using a recalled pre-burn HRQL score as a reference point to monitor HRQL after burns.

OBJECTIVE: Scars resulting from burn injury can pose social and psychological problems that may affect body image and self-esteem. This study aimed to investigate whether burn severity, age and female gender are associated with body image dissatisfaction and self-esteem, through an association with perceived stigmatization and fear or negative evaluation. DESIGN & MAIN OUTCOME MEASURES: Burn survivors (N = 224) completed the Fear of Negative Evaluation scale (FNE) and the Perceived Stigmatization Questionnaire (PSQ) at 3 months post-burn, and the Rosenberg Self-Esteem scale (RSE) and the Satisfaction with Appearance scale (SWAP) at 6 months post-burn. Path analysis was used to test the relationships. RESULTS: Body image dissatisfaction and self-esteem were moderately associated. Burn severity was directly and indirectly associated with body image dissatisfaction through perceived stigmatization. Female gender and age were indirectly associated with body image dissatisfaction though fear of negative evaluation. Age was indirectly associated with both perceived stigmatization and fear of negative evaluation. Perceived stigmatization and fear of negative evaluation were associated with self-esteem through body image dissatisfaction, the first indirectly and the latter both directly and indirectly. CONCLUSIONS: Findings highlight that both burn-specific factors and psychological vulnerability should be taken into account to deal with social challenges that may affect body image and self-esteem after burns.

Verlies van werk heeft een grote impact op psychische welzijn van mensen, wat zelfs kan leiden tot klachten rouw, depressie en angst. Hoe meer het ontslag als onrechtvaardig en onverwacht wordt ervaren, hoe groter de kans is dat de persoon vastloopt in het rouwproces bij baanverlies. De strijd voor rechtvaardigheid gaat vaak hand in hand met letselschade. Deze strijd kan ertoe leiden tot de persoon langer blijft hangen in boosheid en meer gebruik maakt van onhandige copingstijlen, en dat kan een negatieve impact hebben om de mentale gezondheid en belemmerend werken in de zoektocht naar een andere baan. Tijdige herkenning van signalen dat de persoon vast dreigt te lopen, kan dan ook veel leed besparen.

Background Literature indicates that children from ethnic minorities are at increased risk of sustaining burns. Moreover, parents may experience more psychological distress but why this is the case is poorly investigated. Methods A prospective study including 120 mothers and 106 fathers of preschool children, of which 23 mothers and 24 fathers had an ethnic minority background, investigated levels of parental feelings of guilt, depressive and posttraumatic stress symptoms and compared Dutch parents with parents from different ethnic backgrounds on these outcomes. A qualitative study with 46 parents, 24 Dutch and 22 from different ethnic minority backgrounds, explored how they coped with the consequences of the burns. Results Results revealed more symptoms of posttraumatic stress and depression in ethnic minority parents. Ethnic minority fathers also had more guilt feelings. Lower social support, medical communication hampered by language barriers, lower health literacy and passive communication styles, (aspects of) religious coping and barriers to psychosocial care may partly explain the differences. Conclusions Parents with an ethnic minority background are at risk to experience increased distress after their child’s burn injury. By exploring the aforementioned factors, health care professionals may increase the family’s wellbeing. It may provide a starting point to offer tailored help.

Background: Research on grief, depression, and anxiety reactions following job loss is sparse. More insight in this matter could be important for the development of preventive and curative interventions targeting different manifestations of emotional distress following job loss, including grief reactions. Objective: The aim of this study was to examine job loss-related grief reactions in relation to depression and anxiety symptoms. Method: A sample of 525 Dutch workers (59.8% women, mean age of 50.6 years) who had lost their job was recruited. Latent class analysis was used to examine whether separate classes could be distinguished based on the endorsement of grief reactions and symptoms of depression of anxiety. We also examined factors associated with class membership. Results: Four classes were identified, including a so-called ‘mixed’, a ‘grieving’, a ‘depressed’, and a ‘resilient’ class. Job loss circumstances and coping strategies (but not socio-demographic and work characteristics) were associated with class membership. Conclusion: These results shed light on unique characteristics that might be targeted with specific clinical methods to increase mental health of different subgroups of individuals confronted with job loss. Research on grief, depression, and anxiety reactions following job loss is sparse.Latent class analysis revealed four distinct classes.Job loss circumstances and coping strategies (but not socio-demographic and work variables) were associated with class membership. Research on grief, depression, and anxiety reactions following job loss is sparse. Latent class analysis revealed four distinct classes. Job loss circumstances and coping strategies (but not socio-demographic and work variables) were associated with class membership.

Experts provide an alternative source of information to classical data collection methods such as surveys. They can provide additional insight into problems, supplement existing data, or provide insights when classical data collection is troublesome. In this paper, we explore the (dis)similarities between expert judgments and data collected by traditional data collection methods regarding the development of posttraumatic stress symptoms (PTSSs) in children with burn injuries. By means of an elicitation procedure, the experts' domain expertise is formalized and represented in the form of probability distributions. The method is used to obtain beliefs from 14 experts, including nurses and psychologists. Those beliefs are contrasted with questionnaire data collected on the same issue. The individual and aggregated expert judgments are contrasted with the questionnaire data by means of Kullback-Leibler divergences. The aggregated judgments of the group that mainly includes psychologists resemble the questionnaire data more than almost all of the individual expert judgments.

Objective This prospective study examined the course and potential predictors of parents' posttraumatic stress symptoms (PTSS) after burn injury in their child (Age 8 to 18 years). Method One hundred eleven mothers and 91 fathers, representing 118 children, participated in the study. Within the first month after the burn event and subsequently at 3, 12, and 18 months postburn, both parents completed the Impact of Event Scale (IES). Parental emotions related to the burn event and appraisal of threat to the child's life were assessed, which were investigated in a multilevel regression model. Results Within the first month postburn, 48% of the mothers and 26% of the fathers reported clinically significant PTSS (IES ≥26), which decreased to, respectively, 19% and 4% 18 months postburn. Symptoms of intrusion were mainly individually experienced, whereas parents within a couple were more similar in terms of their avoidance symptoms. The perceived life threat and feelings of guilt and anger linked to the burn event were significantly related to parental PTSS, especially in mothers. Conclusions The results indicate that a burn event to a child has a severe (acute) psychological impact on parents and that clinical levels of PTSS may persist in a subgroup of parents. The findings underline the need to incorporate parent support in burn care, especially for mothers with a strong emotional response during the first months after the burn event. (PsycINFO Database Record

Background: Research on complicated grief (CG) symptoms following job loss is surprisingly rare. Involuntary job loss can turn someone’s world upside down and can result in loss of identity, social contacts, and self-worth. In this study, we drew on the literature on major life events in conceptualizing involuntary job loss as a significant and potentially devastating life event. Objectives: The aim of this study was to develop and evaluate an instrument that measures job loss-related CG symptoms, the Job Loss Grief Scale (JLGS). The purpose of the JLGS is to foster systematic research on CG symptoms following job loss. Design: A cross-sectional study Methods: We recruited Dutch workers who had lost their job, 130 men and 158 women with an average age of 49.6 years. To examine the psychometric properties of the JLGS and its associations with other concepts we conducted correlational and confirmatory factor analyses. Results: CFA revealed that the JLGS was a one-dimensional instrument, and that CG symptoms were distinguishable from depression and anxiety symptoms. Conclusion: The JLGS is a reliable and valid instrument to measure job loss-related CG symptoms. The availability of the JLGS could stimulate systematic research on the antecedents and consequences of involuntary job loss.

OBJECTIVE: Nightmares are associated with psychopathology and daily distress. They are highly prevalent in a psychiatric population (30%). Currently, imagery rehearsal therapy (IRT) is the treatment of choice for nightmares. With IRT, the script of the nightmare is changed into a new dream, which is imagined during the day. However, the effects of IRT in a psychiatric population remain unknown. The aim of this study was to determine the effectiveness of IRT in a heterogeneous psychiatric population. METHOD: Between January 2006 and July 2010, 90 patients with psychiatric disorders (DSM-IV-TR) were randomized to IRT or treatment-as-usual conditions. IRT consisted of 6 individual sessions added to the treatment as usual. Nightmare frequency was assessed using daily nightmare logs and the Nightmare Frequency Questionnaire. Nightmare distress was assessed using the Nightmare Distress Questionnaire and the Nightmare Effects Survey. General psychiatric symptoms were assessed using the Symptom Checklist-90 and a PTSD symptom questionnaire. Assessments were administered at the start of the trial, after the IRT and at follow-up 3 months later. RESULTS: IRT showed a moderate effect (Cohen d = 0.5-0.7, P < .05) on nightmare frequency, nightmare distress, and psychopathology measures compared with treatment as usual. These effects were largely sustained at the 3-month follow-up (Cohen d = 0.4-0.6, P < .10). CONCLUSIONS: IRT is an effective treatment for nightmares among patients with comorbid psychiatric disorders and can be employed in addition to the on-going treatment. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT00291031.

OBJECTIVES: Rumination is a risk factor after bereavement, predicting higher concurrent and prospective symptom levels of complicated grief and depression in mourners. Research has shown that rumination may consist of adaptive and maladaptive subtypes, but there has been a paucity of research in this topic in the bereavement area. Therefore, we aimed to clarify whether functional and dysfunctional forms of rumination can be distinguished after loss. DESIGN: Two-hundred and forty-two adults, who lost a first-degree family member on average 10 months previously, filled out questionnaires at three time points with 6 months between each time point. METHODS: Multiple regression analyses, controlled for loss-related variables, neuroticism, and baseline symptoms, were run to examine associations of subtypes of depressive rumination (brooding, reflection) and grief rumination (rumination about injustice, meaning, reactions, relationships and counterfactual thinking) with concurrent and prospective symptom levels of complicated grief and depression. RESULTS: Overall, grief rumination explained more variance in symptom levels than depressive rumination. Other major findings were that grief rumination about injustice predicted higher concurrent and prospective symptom levels of complicated grief and higher prospective symptom levels of depression. In contrast, grief rumination about emotional reactions was related to prospective reductions in symptoms of complicated grief. Reflection was also associated with prospective reductions of complicated grief and depressive symptom levels. CONCLUSIONS: Results indicate that adaptive and maladaptive forms of ruminative thinking can be distinguished in bereaved individuals. Therapeutic interventions for complicated grief could potentially be improved by including techniques aimed at reducing maladaptive rumination and increasing adaptive rumination. PRACTITIONER POINTS: Clinical implications Adaptive and maladaptive components of rumination after loss can be distinguished. They are differentially associated with concurrent and prospective symptom levels of complicated grief and depression in mourners. Adaptive rumination after bereavement is characterized by repetitive, self-focused thinking aimed at understanding one's depressive and loss-related emotional reactions. Maladaptive rumination is characterized by repetitive, self-focused thinking about injustice to the self and making passive comparisons between the current situation (in which one has experienced a loss) and unrealized alternatives. Psychological interventions for complicated grief may be improved by adding therapeutic techniques aimed at reducing maladaptive rumination and increasing adaptive rumination. Cautions and limitations This investigation relied exclusively on self-report measures. Conjugally bereaved women were overrepresented in the current sample. Complicated grief and depression levels in the current sample ranged from non-clinical to clinical. Effects may be more pronounced in a clinical sample.

Pruritus is a frequently encountered symptom following burns. Higher intensity of itching has been associated with depth of the wounds and specific body locations but these differences are not well understood. Our aim was to investigate the intensity of post burn pruritus in grafted and non-grafted burns across anatomic areas and to report on itch-inducing factors and applied treatments. The study included 226 patients prospectively followed for 18 months. Results showed that grafted patients and non-grafted patients reported similar overall itch intensity in-hospital. At 3 months post burn, grafted patients had higher overall itch scores, a difference that was found robust across the study period. Grafted wounds were found to produce higher mean itch intensity at 3 months post burn but this difference disappeared at 12 months post burn. Differences in itch prevalence rates were found across anatomic areas, but only in non-grafted burns. The differences in itch intensity on patient level versus wound level suggest that on the longer run, peripheral mechanism do not explain the higher itch scores in grafted patients.

Een brandwondenongeval bij een kind treft niet alleen het kind, maar het hele gezin. Uit prospectief onderzoek in de drie Nederlandse en vier Belgische brandwondencentra bleken posttraumatische stressreacties vaak voor te komen bij moeders en vaders na een brandwondenongeval van hun jonge kind (0 tot 4 jaar). Emoties van ouders, zoals schuldgevoelens over het brandwondenongeval en vrees voor het leven van het kind, hadden een belangrijke voorspellende rol voor klachten op de langere termijn. Terwijl herbelevingen van het ongeval duidelijk individueel door ouders werden ervaren, bleken ouders binnen eenzelfde gezin vermijdingsreacties met elkaar te delen. Bij de kinderen werden door de ouders niet meer gedragsproblemen gezien dan in een normgroep van leeftijdgenootjes. Wel leefden er bij ouders zorgen over de ontwikkeling van de littekens en mogelijke (sociale) problemen in de toekomst. De stressreacties van ouders hingen samen met deze zorgen en met hun beoordeling van het gedrag van het kind. Deze studie laat zien dat zorgverleners oog moeten hebben voor het gehele gezin en de dynamieken tussen de gezinsleden om na het brandwondenongeval het kind en het gezin goed te ondersteunen.

Objective This study assessed the role of self-reported facial scar severity as a possible influencing factor on self-esteem and depressive symptoms in patients with facial burns. Method A prospective multicentre cohort study with a 6 months follow-up was conducted including 132 patients with facial burns. Patients completed the Patient and Observer Scar Assessment Scale, the Rosenberg Self-esteem Scale and the Hospital Anxiety and Depression Scale. Structural Equation Modeling was used to assess the relations between depressive symptoms, self-esteem and scar severity. Results The model showed that patient-rated facial scar severity was not predictive for self-esteem and depressive symptoms six months post-burn. There was, however, a significant relationship between early depressive symptoms and both patient-rated facial scar severity and subsequent self-esteem. The variables in the model accounted for 37% of the variance in depressive symptoms six months post-burn and the model provided a moderately well-fitting representation of the data. Conclusion The study suggests that self-esteem and depressive symptoms were not affected by self-reported facial scar severity but that earlier depressive symptoms were indicative for a more severe self-reported facial scar rating. Therefore, routine psychological screening during hospitalisation is recommended in order to identify patients at risk and to optimise their treatment.

Objective To examine whether GPs’ communication styles have changed since the introduction and implementation of clinical guidelines for psychosocial problems in Dutch general practice in the 1990s. Methods From a database of 5184 consultations videotaped between 1977 and 2008, 512 consultations assessed by GPs as ‘completely psychosocial’ were coded with RIAS (Roter Interaction Analysis System). The 121 consultations prior to and 391 consultations after implementation of guidelines were analyzed whether communication styles have changed over time. Results We found that GPs were more likely to consider consultations to be mainly (17%) or completely (12%) psychosocial after the implementation of guidelines. They gave more biomedical and psychosocial information and advice in the second period compared to the first period. We also found that empathy decreased over time (frequency of empathic statements by GPs changed from 2.9–3.2 to 1.4–1.6 between periods). Conclusion Communication in psychosocial consultations has changed; GPs have become more focused on task-oriented communication (asking questions, giving information and advice) and less on showing empathy. Practice implications GPs face the challenge of integrating an evidence-based approach of applying guidelines that promote active symptom exploration with understanding patients’ personal contexts and giving room to their emotions.

Background The face is central to our identity and provides our most expressive means of communication. Currently, the role of facial scarring in relation to self-esteem is unclear and the value of self-reported scar assessment is insufficiently understood. The aim of this study was twofold: (1) to assess the extent of agreement between patients’ ratings and observers’ ratings of facial scar characteristics; and (2) to examine if patients’ and observers’ scar characteristics ratings, or the differences, are associated with the patients’ self-esteem. Methods A prospective study was conducted including patients with facial burns. Patients completed the Patient and Observer Scar Assessment Scale (POSAS) and the Rosenberg Self-Esteem Scale 3 months post-burn. Results Ninety-four subjects were included, 76 (81%) men and mean percentage TBSA burned was 12.4 (SD 10.4; range 1–50). Subject's and observer's assessment were significantly positively correlated and were identical in 53% of the cases. Subjects’ assessments and discrepancy scores on the scar characteristic surface roughness were associated with self-esteem in multiple regression analysis. Conclusions The majority of the patients scored the quality of facial scars in a similar way as the professionals. Furthermore, facial scarring appeared only moderately associated with self-esteem. However, our study suggests that using both patients’ and professionals’ scar assessments provides more useful information regarding the patients’ well-being relative to focussing on the separate assessments only. In particular a discrepancy between the patients’ and professionals’ view on surface roughness might be an early indication of psychological difficulties and a call for further clinical attention.

ObjectivesThe Illness Invalidation Inventory (3*I) assesses patients’ perception of responses of others that are perceived as denying, lecturing, not supporting and not acknowledging the condition of the patient. It includes two factors: ‘discounting’ and ‘lack of understanding’. In order to use the 3*I to compare and pool scores across groups and countries, the questionnaire must have measurement invariance; that is, it should measure identical concepts with the same factor structure across groups. The aim of this study was to examine measurement invariance of the 3*I across rheumatic diseases, gender and languages.MethodsParticipants with rheumatic disease from various countries completed an online study using the 3*I, which was presented in Dutch, English, French, German, Portuguese and Spanish; 6057 people with rheumatic diseases participated. Single and multiple group confirmatory factor analyses were used to test the factorial structure and measurement invariance of the 3*I with Mplus.ResultsThe model with strong measurement invariance, that is, equal factor loadings and thresholds (distribution cut-points) across gender and rheumatic disease (fibromyalgia vs other rheumatic diseases) had the best fit estimates for the Dutch version, and good fit estimates across the six language versions.ConclusionsThe 3*I showed measurement invariance across gender, rheumatic disease and language. Therefore, it is appropriate to compare and pool scores of the 3*I across groups. Future research may use the questionnaire to examine antecedents and consequences of invalidation as well as the effect of treatments targeting invalidation.

IntroductionPlacebo effects (true biopsychological effects not attributable to the active ingredients of medical technical interventions) can be attributed to several mechanisms, such as expectancy manipulation and empathy manipulation elicited by a provider’s communication. So far, effects have primarily been shown in laboratory settings. The aim of this study is to determine the separate and combined effects of expectancy manipulation and empathy manipulation during preoperative and postoperative tonsillectomy analgesia care on clinical adult patients’ outcomes.Methods and analysisUsing a two-by-two randomised controlled trial, 128 adult tonsillectomy patients will be randomly assigned to one out of four conditions differing in the level of expectancy manipulation (standard vs enhanced) and empathy manipulation (standard vs enhanced). Day care ward nurses are trained to deliver the intervention, while patients are treated via the standard analgesia protocol and hospital routines. The primary outcome, perceived pain, is measured via hospital routine by a Numeric Rating Scale, and additional prehospitalisation, perihospitalisation and posthospitalisation questionnaires are completed (until day 3, ie, 2 days after the operation). The manipulation is checked using audio recordings of nurse–patient interactions.Ethics and disseminationAlthough communication is manipulated, the manipulations do not cross norms or values of acceptable behaviour. Standard medical care is provided. The ethical committee of the UMC Utrecht and the local OLVG hospital committee approved the study. Results will be published via (inter)national peer-reviewed journals and a lay publication.Trial registration numberNTR5994; Pre-results.

Contains fulltext : 171303.pdf (Publisher’s version ) (Open Access) A substantial proportion of patients with burn injury develop chronic itch, which can severely affect their quality of life. As found in research on chronic pain, different psychophysiological processes may also play a role in chronic itch, of which central sensitization, conditioned modulation, and attentional processes have been studied most frequently. This study aimed to explore psychophysiological processes of chronic post-burn itch by comparing 15 patients with long-term itch due to burn injury with 15 matched healthy controls. Exploratory results indicated tendencies for higher itch sensitivity in patients than in controls, for mechanical stimuli and histamine, but not for electrical stimulation. Results further suggest that the efficacy of itch modulation by an itch- or pain-conditioning stimulus or directing attention towards itch stimuli do not differ between these patients and controls. Further elucidation of the processes underlying post-burn itch may improve the early identification and treatment of burn patients developing chronic itch.

According to the Minority Stress Model, immigrants have an increased risk of mental health problems compared with the general population. Homosexual feelings can form an additional minority stress factor next to ethnic minority status, given the social disapproval of homosexuality within non-Western cultures, the open manifestations of homosexual behavior in the western society, and the influence of religion, such as the Islam. It is unknown whether Islamic homosexuals indeed have an increased risk of developing mental health problems as compared to the general population or indigenous homosexual people. The aim of this study is to obtain a first insight into mental health problems of Islamic men and women with homosexual feelings in order to tailor health care services to their possible needs. The Islamic sample consisted of 51 men and 6 women and was compared with the Dutch norm group (N=1009) and with a group of indigenous Dutch homosexuals (N=61). Indicators of mental health problems were the anxiety and depression subscales of the SCL-90. Both the Islamic and the indigenous homosexual group reported significantly more symptoms of anxiety and depression than the Dutch norm group. The Islamic homosexual group did not differ significantly from the indigenous homosexual group with regard to anxiety, but showed a trend for higher depression. Despite the limitations, this unique study has provided an important first insight into this complex to reach population, warranting more research. Potential consequences for prevention policy and clinical implications are discussed.

Increasing evidence shows that job loss can lead to symptoms of complicated grief (CG). However, little is known about which factors relate to the development and maintenance of CG symptoms following job loss. This study aimed to examine risk factors for the development and maintenance of job loss-related CG symptoms. For this study 485 Dutch workers who had lost their job were recruited (239 men and 246 women), with an average age of 50.2 years. A subsample of 128 participants also completed questionnaires at a six-month follow-up. We conducted correlational and multiple regression analyses (MRA) to examine the influence of the former work situation, coping strategies, and negative cognitions on job loss-related CG symptoms. MRA results showed that belief in an unjust world was related to job loss-related CG symptoms, cross-sectionally and longitudinally. Further, there was a significant relationship between CG symptoms following job loss and a preference for maladaptive coping over adaptive coping styles and a low level of self-esteem. This effect remained stable over time. These findings can inform the development of interventions for and early detection of job loss-related CG symptoms.

Background: Quality of life after bariatric surgery may, among other things, depend on patients' attachment representations such as anxiety about rejection and abandonment (attachment anxiety) and avoidance of intimacy and interdependence (attachment avoidance). The aim of this study was to examine whether attachment representations, independent of body mass index (BMI), are associated with the level and course of physical functioning and mental well-being after gastric bypass surgery.Method: A total of 131 patients applying for a Roux-en-Y gastric bypass operation agreed to participate in this longitudinal study. Patients' attachment representations (ECR-R) were measured before surgery, and quality of life dimensions (physical functioning and mental well-being, SF-36) were measured before surgery and 1, 3, 6, and 12 months following surgery. Linear mixed effect models were used in analyses.Results: Physical functioning (p Conclusions: Our study suggests that bariatric surgery leads to improvement in physical functioning but not mental well-being. Results highlight that patients with insecure attachment representations should be protected against unrealistic expectations regarding improvement of mental well-being after surgery.