Browsing by Author "Senra, Hugo Renato Carreira Gomes"
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- Beyond the body image: A qualitative study on how adults experience lower limb amputationPublication . Senra, Hugo Renato Carreira Gomes; Oliveira, Rui Aragão Gomes; Leal, Isabel Pereira; Vieira, CristinaObjective: To explore adults’ experiences of lower limb amputation, focusing on the changes in self-identity related to the impairment. Design: A cross-sectional and qualitative study, using semi-structured interviews. Interviews were transcribed, coded and analysed by two independent researchers. Setting: A rehabilitation medicine service from a general public hospital. Participants: A convenience sample of 42 patients with lower limb amputation performed after the age of 18 and followed up in the physical medicine and rehabilitation department of a general hospital. Main outcome measures: A semi-structured interview, addressing three core areas: the emotional impact of amputation; the adjustment process; and the relation with the external resources. Results: Eight themes emerged from interviews: reactions and feelings about becoming amputee; changes in own life; problems in well-being; relation with the prosthesis; self-perceptions; aims related to the rehabilitation and future plans; relation with the rehabilitation; and perceived social support. These results supported a theoretical model for the self-identity changes related to limb loss. Conclusions: The self-identity changes after a lower limb amputation appear beyond the patient’s body image and functioning, affecting the patient’s awareness of the impairment, biographical self and any future projections.
- Cross-cultural adaptation of the Operationalized Psychodynamic Diagnosis (OPD-2) in PortugalPublication . Vicente, Carla S.; Oliveira, Rui Aragão Gomes; Silva, Filipe; Ferrajão, Paulo; Augusto, Sara; Oliveira, Sandra; Senra, Hugo Renato Carreira Gomes; Oliveira, Raquel Lara Velez; Krieger, DanielaBackground: The Operationalized Psychodynamic Diagnosis (OPD-2) is internationally established as one of the major instruments available for clinical diagnosis and scientific research, being frequently used as an auxiliary tool in the selection of therapeutic interventions. Aims: 1) To describe the methodological aspects of the adaptation of the OPD-2 into Portuguese (Portugal and Brazil). 2) To assess inter-rater agreement for the different axes of the instrument when scoring clinical interviews. Method: The cross-cultural adaptation involved translation of the instrument by different independent translators, whose versions were compared in discussion groups in order to develop a final Portuguese version. In the presence of discrepancies regarding the translation of original concepts, the authors of the original instrument were contacted for clarification. Five interviews were used to assess inter-rater agreement. Each subject participated in two interviews, conducted by an experienced clinical psychologist. The interviews were recorded, transcribed and then analyzed by the principal investigator and by three independent examiners. Results: Axis IV (Structure) presented the highest inter-rater agreement (78%). Axes I (Experience of illness and prerequisites for treatment) and III (Conflict) showed the lowest inter-rater agreement results (66 and 57.7%, respectively). Conclusions: Our results point in the same direction as previous studies conducted in other countries. In our sample, the OPD-2 presented an acceptable inter-rater agreement; however, further studies are needed to assess the instrument’s reliability.
- Depression and experience of vision loss in group of adults in rehabilitation setting: Mixed-methods pilot studyPublication . Senra, Hugo Renato Carreira Gomes; Vieira, Cristina; Nicholls, Elizabeth G.; Leal, Isabel PereiraThere is a paucity of literature regarding the relationship between the experience of vision loss and depression. Therefore, the current pilot study aimed to explore whether significant differences existed in levels of depression between adults with different vision loss experiences. A group of adults aged between 20 and 65 yr old with irreversible vision loss in a rehabilitation setting was interviewed. Semistructured interviews were conducted in order to explore patients’ experience of vision loss. The Center for Epidemiologic Studies Depression Scale (CES-D) was used to assess depressive levels; 39.5% (n = 15) of patients met CES-D criteria for depression. In addition, higher levels of depression (p < 0.05) were identified in patients whose interviews revealed greater selfawareness of impairment, inadequate social support, and longer rehabilitation stay. Current findings draw attention to variables such as self-awareness of impairment and perceived social support and suggest that depression following vision loss may be related to patients’ emotional experiences of impairment and adjustment processes.
- Depression and self-awareness of impairment in a group of adults with sight lossPublication . Senra, Hugo Renato Carreira Gomes; Oliveira, Rui Aragão Gomes; Leal, Isabel PereiraBackground: Depression has been referred as a frequent problem in visually impaired adults. Recent studies have hypothesized depression as part of the adjustment process to vision loss. Studies with other physically impaired patients have associated depression with self-awareness of the impairment. Aim: Our study wants to know if self-awareness of the impairment is associated with depressive levels, putting depression as part of the adjustment process to vision loss. Methods: A naturalistic cross-sectional study, using both qualitative and quantitative instruments was adopted. Our sample was composed by a selected group of 40 adult patients at a rehabilitation setting, and who have lost their vision after age 18. Self-awareness of the impairment was collected through semi-structured interviews. Content analysis was performed using the Thematic and Categorical Analysis proposed by Bardin. Depressive levels were assessed using CES-D. Results: Qualitative data showed patients in with different emotional resonances of their impairment. A great portion of patients (40%) meet CES-D criteria for depression. Time between first diagnosis and vision loss (disease evolution) (.335; p=.035) and the rehabilitation time (.333; p=.036) were positively correlated with depressive levels. Patients who became impaired for longer (p=0.034), and those who verbalized more feelings and ideas about their impairment (p=0.039) showed higher depressive levels. Conclusions: Depression appeared associated with variables that reveal patients’ self-awareness of the impairment and its integration in the individual's self. Therefore, depression appeared as part of the adaptation to vision loss instead of being a signal of a pooradjustment. Keywords: Depression; vision loss; self-awareness; adaptation
- From injured body to changes in self-identity: A research on adults with acquired physical impairmentsPublication . Senra, Hugo Renato Carreira Gomes; Oliveira, Rui Aragão Gomes; Leal, Isabel PereiraBackground: The experience of becoming physically impaired, especially in lower limb adult amputees and in working-aged patients with vision loss, has deserved little attention by research in general. The weight of some variables associated with these experiences on depressive levels has been stressed by some studies. However, little is known about it. Aims: The current dissertation aimed at filing in the knowledge gap regarding these topics. We intended to explore the experience of acquired physical impairment, focusing on changes in self-identity, in two groups: working-aged adults with vision loss; and adults who suffered a lower limb amputation. In addition, we aimed at exploring a possible connection between the most relevant emerged variables of these experiences and the depressive levels: the self-awareness of impairment; and the selfidentifications with the impairment. Method: Two independent studies were performed, both was cross-sectional and using mixed-methods: study 1 was on the experiences of vision loss of 38 patients at rehabilitation setting (mean age of 42.7; SD=14.5); and study 2 was on the experiences of lower limb amputation in 42 patients (mean age of 61; SD=13.5) followed-up at a general hospital‟s rehabilitation medicine unit. Qualitative data on the experiences of impairment was collected by two semi-structured interviews for each patient. The interviews were performed by an independent and trained psychologist, under the supervision of a senior psychologist and psychotherapist. 80 interviews were conducted in study 1 and 84 interviews in study 2. Depressive levels were assessed using CES-D. The content analysis was performed using the Categorical and Coding analysis proposed by Bardin. Results: Qualitative data from the study 1, on the experiences of vision loss, retrieved seven themes, most of them focused on changes in self-identity. These results supported a new model for the adjustment process to vision loss, based on patients‟ self-awareness of impairment and self-identifications with the impairment. 39.5% (n=15) of patients met CES-D criteria for depression. Higher depressive levels (P<.05) were found in patients who: lost vision for longer; begun their rehabilitation later; were more aware of their impairment; and those who reported an inadequate social support (P<.01). A positive correlation was found between CES-D scores and vision loss evolution (.333; P=.036), and between CES-D scores and rehabilitation time (.335; P=.035). In study 2, eight themes emerged from the interviews. Qualitative results supported a theoretical model for the changes in self-identity related to lower limb loss beyond the body image. 31% (n=13) met CES-D criteria for Depression. Higher depressive levels (p<.05) were found in those who showed: greater self-awareness of impairment; lower identification with the impairment; and worse appraisals towards the prosthesis, social support and well-being. Conclusions: In both studies the changes in self-identity, especially in terms of selfawareness of impairment and self-identifications with the impairment, arose as core milestones of the adjustment process to the impairment. The relationship found between the variables related to the experience of impairment and depressive levels suggests two conclusions: the changes in self-identity caused by the impairment might be one of the important causes for the rising of depressive levels; the increase in depressive levels in these populations might be, at first, the reflex of the adjustment process to the many personal losses and therefore, do not necessarily reveal a bad adaptation to the impairment nor a mental health problem. ---------- RESUMO ----------Enquadramento: A experiência de amputação de membro inferior em adultos, e a experiência de perda irreversível de visão em adultos não idosos, são dois temas que têm tido pouca atenção por parte da investigação científica. O peso desta experiência ao nível da identidade dos sujeitos e a relação dessas variáveis com os níveis de depressividade são temas considerados relevantes, embora ainda pouco estudados. Objectivos: A presente dissertação veio no propósito de produzir alguma evidência acerca dos tópicos referidos. Com estes estudos pretendemos explorar as experiências incapacidade física adquirida e as suas implicações para a identidade dos sujeitos em dois grupos de sujeitos: adultos que tenham sofrido amputação de membro inferior; e adultos não idosos com perda irreversível e severa de visão. Outro dos objectivos destes estudos foi a investigação preliminar de potenciais relações entre variáveis como a autoconsciência de incapacidade e as auto-identificações com a incapacidade e os níveis de depressividade. Método: Para atingir os objectivos do nosso estudo, delineamos duas investigações independentes. Estudo 1: 38 sujeitos com perda irreversível de visão (média de idades de 42.7 anos; desvio padrão de 14.5), todos eles em fase de reabilitação. Estudo 2: 42 sujeitos amputados (média de idades de 61; desvio padrão de 15.6), todos eles em seguimento na consulta de medicina física e de reabilitação num hospital geral. Em ambos os estudos as experiências de incapacidade foram recolhidas através de uma metodologia qualitativa, com recurso a entrevistas semi-estruturadas realizadas individualmente a cada sujeito. Cada entrevista foi realizada por um investigador independente, formado em Psicologia e com experiencia clínica com este tipo de populações. As entrevistas foram supervisionadas por um Psicólogo e Psicoterapeuta Sénior. Os níveis de depressividade foram avaliados usando o CES-D. A análise do conteúdo das entrevistas foi realizada com base no método de codificação categorial não indutivo de Bardin. Resultados: Os resultados qualitativos do estudo 1 (perda de visão) revelaram sete temas, a maior parte dos quais acerca das alterações ao nível da própria identidade. Esses resultados suportaram um modelo compreensivo para o processo de ajustamento à perda de visão, com base na auto-consciência de incapacidade e nas auto-identificações à incapacidade dos sujeitos estudados. As pontuações no CES-D de 39.5% (n=15) dos sujeitos cumpriram os critérios para depressão clínica. Maiores níveis de depressão (P<.05) foram encontrados nos sujeitos que: tinham perdido a visão há mais tempo; começaram a reabilitação mais tardiamente; estavam mais conscientes a sua incapacidade; e percepcionaram um pior suporte social (P<.01). Foi encontrada uma correlação positiva entre as pontuações dos sujeitos no CES-D e duas variáveis: o tempo decorrido entre o primeiro diagnóstico da doença responsável pela perda de visão e o momento em que o sujeito ficou clinicamente com baixa visão ou cego (.333; P=.036); o tempo de reabilitação (.355; P=.035). No estudo 2 emergiram oito temas sobre a experiência de amputação. Esses resultados suportaram também um modelo teórico compreensivo para as alterações na identidade dos sujeitos, decorrentes da situação de amputação. 31% (n=13) dos sujeitos apresentaram pontuações no CES-D que cumpriram os critérios para depressão clínica. Maiores níveis de depressão (P<.05) foram encontrados nos sujeitos que apresentaram: maior auto-consciência de incapacidade; menor identificação à incapacidade; pior relação com a prótese; pior percepção do suporte social; e pior percepção do bem-estar. xii Conclusões: Nos dois estudos a auto-consciência de incapacidade e as autoidentificações com a incapacidade surgiram como duas variáveis chave do processo de ajustamento à incapacidade, demonstrando o potencial efeito transformador destas situações de incapacidade para identidade dos sujeitos. A associação encontrada entre as variáveis relativas à experiência de incapacidade e os níveis de depressividade parece sugerir duas conclusões: as alterações na identidade decorrentes da situação de incapacidade física adquirida poderão ser uma das importantes causas do aumento dos níveis de depressividade; o aumento dos níveis de depressividade poderão ser, num primeiro momento, reflexo do processo de ajustamento às perdas sofridas e não traduzir, necessariamente, uma má adaptação à situação de incapacidade, nem um problema de saúde mental.
- From self-awareness to self-identification with visual impairment: a qualitative study with working age adults at a rehabilitation settingPublication . Senra, Hugo Renato Carreira Gomes; Oliveira, Rui Aragão Gomes; Leal, Isabel PereiraObjective: To explore the experience of vision loss, focusing on working age patients’ self-awareness of impairment and self-identification with the impairment. Design: A cross-sectional and qualitative study, using semi-structured interviews. Setting: A specialized rehabilitation centre and a low vision unit at a public hospital. Participants: A convenience sample of 38 patients between the ages of 20 and 65, with sight loss caused by a serious ophthalmological condition acquired after the age of 18, and doing their rehabilitation. Main outcome measures: A semi-structured interview, addressing three core areas: the emotional impact of vision loss; adjustment; and social support. Interviews were transcribed, coded and analysed by two independent researchers. Results: Seven themes emerged from interviews. Changes in patients’ identity, achievement and future life projection arose as being the main transformations caused by vision loss. Self-awareness of impairment appeared associated with the patients’ first contact with their loss, while self-identification with the impairment arose connected with the later embodiment process of the vision loss. Conclusions: Patients’ self-awareness and self-perceptions of impairment appear to be two important milestones in the adjustment process to vision loss. Their assessment and monitoring over the rehabilitation period might help to promote impairment acceptance and rehabilitation outcomes.
- Psychologic adjustment to irreversible vision loss in adultsPublication . Senra, Hugo Renato Carreira Gomes; Barbosa, Fernando; Ferreira, Patrícia; Vieira, Cristina; Perrin, Paul B.; Rogers, Heather; Rivera, Diego; Leal, Isabel PereiraPurpose: To summarize relevant evidence investigating the psychologic adjustment to irreversible vision loss (IVL) in adults. Design: Irreversible vision loss entails a challenging medical condition in which rehabilitation outcomes are strongly dependent on the patient’s psychologic adjustment to illness and impairment. So far, no study has systematically reviewed the psychologic adjustment to IVL in adults. Methods: We reviewed all articles examining the psychologic adjustment to IVL in adults. We included articles published in English in peer-reviewed journals. We performed a keyword literature search using 4 databases (PubMed, EBSCO, Cochrane Library, and Science Direct) for all years through July 2014. We assessed risk of bias of selected studies using the RTI Item Bank for Assessing Risk of Bias and Confounding for Observational Studies of Interventions or Exposures and the Cochrane risk of bias tool for randomized controlled trials. Results: Of a total of 3948 citations retrieved, we selected 52 eligible studies published between 1946 and 2014. The majority of studies were observational and cross-sectional in nature. Our review suggests that high levels of depression occur during the adjustment to IVL. Better adjustment to IVL was associated with greater acceptance of vision loss and use of instrumental coping, good social support, positivity, and use of assistive aids. Conclusions: The overall findings indicate that IVL often has negative effects on patients’ quality of life and mental health and that such effects tend to remain over time. Specific factors and variables associated with the adjustment to IVL need to be clarified through further in-depth and longitudinal research.