Cognitive beliefs and affective responses to illness and treatment are known to independently predict health behaviours. The purpose of the current study is to assess the relative importance of four psychological domains – specifically, affective illness, cognitive illness, affective treatment and cognitive treatment – for predicting stroke and transient ischemic attack (TIA) survivors’ adherence to stroke prevention medications as well as their objective, categorised stroke risk. We assessed these domains among stroke/TIA survivors (n = 600), and conducted correlation and regression analyses with concurrent and prospective outcomes to determine the relative importance of each cognitive and affective domain for adherence and stroke risk. As hypothesised, patients’ affective treatment responses explained the greatest unique variance in baseline and six-month adherence reports (8 and 5%, respectively, of the variance in adherence, compared to 1–3% explained by other domains). Counter to hypotheses, patients’ cognitive illness beliefs explained the greatest unique variance in baseline and six-month objective categorised stroke risk (3 and 2%, respectively, compared to 0–1% explained by other domains). Results indicate that domain type (i.e. cognitive and affective) and domain referent (illness and treatment) may be differentially important for providers to assess when treating patients for stroke/TIA. More research is required to further distinguish between these domains and their relative importance for stroke prevention.
health beliefs; affective responses; cognitive beliefs; medication adherence; chronic illness
Amyotrophic lateral sclerosis (ALS) is a terminal neurological disease associated with progressive paralysis, loss of communicative ability, and functional decline. Expressive disclosure may help people with ALS, particularly those who are emotionally or socially inhibited, meet psychological challenges associated with the disease. People with ALS (N = 48) were randomised to expressive disclosure about their disease or no disclosure. Psychological well-being (affect, depression, quality of life) was assessed pre-intervention and 3 and 6 months after. Results of multi-level models indicated that the group that disclosed thoughts and feelings about ALS had higher well-being than the control group at 3 months post-intervention but not 6 months. Ambivalence over emotional expression (AEE) moderated 3-month post-intervention well-being. Those low in AEE had higher well-being than those high in AEE regardless of condition. Those high in AEE who disclosed had increased well-being from pre-intervention, whereas controls had decreased well-being from pre-intervention. Expressive disclosure may be helpful for people with ALS, but only those who have difficulty expressing emotions. In addition, the intervention had only temporary effects; the dynamic challenges of ALS progression may mean that the effect of processing thoughts and feelings about the disease in one stage may not generalize to later stages.
Amyotrophic Lateral Sclerosis; expressive disclosure; intervention; inhibition; emotional expression
This randomized controlled pilot trial tested a 6-week mindfulness-based intervention in a sample of pregnant women experiencing high levels of perceived stress and pregnancy anxiety. Forty-seven women enrolled between 10 and 25 weeks gestation were randomly assigned to either a series of weekly Mindful Awareness Practices (MAPS) classes (n = 24) with home practice or to a reading control condition (n = 23). Hierarchical linear models of between-group differences in change over time demonstrated that participants in the mindfulness intervention experienced larger decreases from pre-to post-intervention in pregnancy-specific anxiety and pregnancy-related anxiety than participants in the reading control condition. However, these effects were not sustained through follow-up at six weeks post-intervention. Participants in both groups experienced increased mindfulness, as well as decreased perceived stress and state anxiety over the course of the intervention and follow-up periods. This study is one of the first randomized controlled pilot trials of a mindfulness meditation intervention during pregnancy and provides some evidence that mindfulness training during pregnancy may effectively reduce pregnancy-related anxiety and worry. We discuss some of the dilemmas in pursuing this translational strategy and offer suggestions for researchers interested in conducting mind-body interventions during pregnancy.
Pregnancy; Meditation; Mindfulness; Prenatal Stress; Pregnancy Anxiety
It is important to identify predictors of psychological health among breast cancer patients that can be relatively easily identified by medical care providers. This article investigates the role of one class of such potential predictors: easily identified demographics that have potential social and/ or practical implications. Specifically, we examined whether income, marital status, presence of children in the home, education, travel distance, age and rurality interact with time to predict psychological health over the first year post diagnosis. Two hundred and twenty five breast cancer patients receiving radiation treatment completed four surveys over the course of 13 months that included measures of both their physical health and depressive symptoms. The results revealed that women who were not married had children living in the home or had to travel long distances to receive radiation treatment reported higher levels of depressive symptoms across the entire study. Women with lower incomes reported increased depressive symptoms, but only after the completion of treatment. Younger women reported elevated depressive symptoms during initial treatment, but this effect dissipated after the completion of treatment. The current results suggest that demographic patient characteristics may indeed be useful in identifying both when and for whom depressive symptoms are particularly likely to be problematic.
breast cancer; depression; income; marital status; distance; children
African-American women are significantly less likely to undergo postmastectomy breast reconstruction compared White women in the US. These observed differences have been interpreted as evidence of a healthcare disparity. The current study examines breast reconstruction decision-making among African-American women, locating reconstruction decisions in a context of culture, racial inequality, and biomedicalization. Semi-structured interviews were conducted with 27 African-American women who underwent mastectomy for breast cancer to add patient-centred perspectives to existing conceptualizations of racial/ethnic differences in reconstruction. Participants were socio-demographically diverse, and resided in the New York metropolitan area. Data analysis was informed by grounded theory. Spiritually and culturally-informed body ethics often guided surgery decisions. Participants expressed reservations about breast implants, preferring autologous procedures that use “what God has given.” For some, breast reconstruction restored a sense of normalcy after cancer; others challenged an imperative to reconstruct. Several participants redirected our focus on access to reconstruction toward access to alternatives, noting the low reimbursement for prostheses, or their unavailability in patients' skin tones. We suggest that a framework of “stratified biomedicalization” better addresses the complexities of race, class, and gender that inform preference, access, and recommendations for breast reconstruction, and focuses attention on access to high and lower-tech interventions.
breast cancer; reconstructive surgery; culture; qualitative methods; body image; health disparities
The objective of this study was to evaluate the efficacy of a couple-tailored print
intervention on colorectal cancer screening (CRCS), CRCS intentions and on knowledge and attitudes
among couples in which neither partner is on schedule with regard to CRCS. A total of 168 married
couples with both members non-adherent with CRCS were randomly assigned to receive either a
couple-tailored print (CTP) pamphlet accompanied by a generic print pamphlet or a generic print
pamphlet only (GP). Couples completed measures of CRCS, intentions, relational perspective on CRCS,
discussions about CRCS, spouse support for CRCS, spouse influence strategies, CRC knowledge,
perceived CRC risk, and CRCS benefits and barriers. Results indicated there was no significant
benefit of CTP versus GP on CRCS, but there was a significant increase in CRCS intentions in CTP
compared to GP. There was also a significant increase in relationship perspective on CRCS, a
significant increase in husbands’ support of their wives’ CRCS, and a significant
increase in CRCS benefits in CTP. In summary, CTP did not increase CRCS practices but increased
intentions and perceived benefits of CRCS as well as improving couples’ ability to view CRCS
as having benefit for the marital relationship.
colorectal cancer screening; behavioral interventions; couple focused interventions
Risk drinking, especially binge drinking, and unprotected sex may co-occur in college women and increase the risks of STI exposure and pregnancy, but the relationships among these behaviors are incompletely understood. A survey was administered to 2012 women of ages 18–24 enrolled in a public urban university. One-quarter of the college women (23%) drank eight or more drinks per week on average, and 63% binged in the past 90 days, with 64% meeting criteria for risk drinking. Nearly all sexually active women used some form of contraception (94%), but 18% used their method ineffectively and were potentially at risk for pregnancy. Forty-four percent were potentially at risk for STIs due to ineffective or absent condom usage. Ineffective contraception odds were increased by the use of barrier methods of contraception, reliance on a partner’s decision to use contraception, and risk drinking, but were decreased by the use of barrier with hormonal contraception, being White, and later age to initiate contraception. In contrast, ineffective condom use was increased by reliance on a partner’s decision to use condoms, the use of condoms for STI prevention only, and by risk drinking. Thirteen percent of university women were risk drinkers and using ineffective contraception, and 31% were risk drinkers and failing to use condoms consistently. Risk drinking is related to ineffective contraception and condom use. Colleges should promote effective contraception and condom use for STI prevention and consider coordinating their programs to reduce drinking with programs for reproductive health. Emphasizing the use of condoms for both pregnancy prevention and STI prevention may maximize women’s interest in using them.
Binge drinking; contraception; college; women’s health; pregnancy prevention
Chest pain can be a frightening experience that leads many to seek medical evaluation (American Heart Association, 2009). The symptom results in costly health care utilization (Kahn, 2000). Over half of patients referred for cardiac evaluations of chest pain do not obtain definitive medical explanations for their symptoms; these cases are described as non-cardiac chest pain (NCCP: Bass & Mayou, 1995). Some patients with NCCP are not reassured after being informed their chest pain is non-cardiac in origin and seek repeated medical evaluation (Tew et al., 1995). Co-morbid anxiety and mood disorders often co-exist with NCCP and are associated with health care utilization (White et al., 2008). The current study examined chest pain, general anxiety, interoceptive fear, and health care utilization in a sample of 196 chest pain patients near the time of cardiac evaluation (Time 1), and 70 of these patients one year later (Time 2). Results indicate that anxiety and interoceptive fear were significantly associated with health care utilization at Time 1, and only interoceptive fear (at Time 1) predicted health care utilization at Time 2. This study develops research in this area by examining the relation of anxiety and health care utilization longitudinally in patients with NCCP.
Non-cardiac chest pain; health care utilization; interoceptive fear; anxiety
The present study addresses gaps in the literature on affect-biased health perceptions by a) investigating health bias while considering both valence and arousal components of affect; b) establishing the presence of, and variability in, affective health bias at the daily level; and c) exploring daily health bias in a non-clinical, community sample of adults.
Participants were 477 adults (aged 33–80 years) who reported daily health events, health satisfaction, and affect for up to 56 days. Health bias was present when the effect of a given day’s health events on that day’s health satisfaction was significantly moderated by that day’s affect. Multilevel modeling was used to investigate fixed and random within-day effects.
Main Outcome Measure
Daily health satisfaction.
Significant interaction effects indicated the presence of health bias on the daily level: positively-valenced affect buffered the negative impact of health events on health satisfaction, whereas negatively-valenced affect exacerbated this association; additionally, valence emerged as the most salient characteristic of positive affect, whereas arousal was a differentiating factor for negative affect.
The results provide evidence that both valence and arousal components of affect are important to consider when investigating day-level health bias, and that these effects can be detected using a general population of adults.
Health Bias; Daily Diary; Positive Affect; Negative Affect; Health Satisfaction
Threats to external validity including pretest sensitization and the interaction of selection and an intervention are frequently overlooked by researchers despite their potential to significantly influence study outcomes. The purpose of this investigation was to conduct secondary data analyses to assess the presence of external validity threats in the setting of a randomized trial designed to promote mammography use in a high risk sample of women.
During the trial, recruitment and intervention implementation took place in three cohorts (with different ethnic composition), utilizing two different designs (pretest-posttest control group design; posttest only control group design).
Results reveal that the intervention produced different outcomes across cohorts, dependent upon the research design used and the characteristics of the sample.
These results illustrate the importance of weighing the pros and cons of potential research designs before making a selection and attending more closely to issues of external validity.
external validity; research design; methodology; cancer screening; randomized controlled trial
In a stepped-down approach, patients begin with a more intensive treatment and are stepped down to a less intensive treatment based on achieving treatment goals. This study compared a standard behavioural weight loss programme (BWLP) to a stepped-down approach to treatment.
Fifty-two overweight/obese adults (Age: M = 47 years, SD = 13.5; female = 67%) participated in an 18-week BWLP. Half of them were randomly assigned to be stepped down from weekly group meetings based on completion of weight loss goals (3%) every 6 weeks, while the other half remained in their groups regardless of weight loss.
There was a significant difference favouring the BWLP in the proportion of participants who met or exceeded their 3% weight loss goal during the first six weeks. While not statistically significant by the end of treatment, the BWLP participants lost nearly 3% more body weight than stepped-down participants (SC = 4.9% vs. BWLP = 7.8%; p = .10). Greater self-monitoring was associated with increased likelihood of stepped-care eligibility and higher percent weight loss at the end of treatment (p < .01).
There was little evidence to support the efficacy of the stepped-down approach for behavioural weight loss treatment employed in this investigation.
stepped-care; weight loss; obesity
Affective responses during exercise are often important determinants of exercise initiation and maintenance. Current physical activity may be one individual difference that is associated with the degree to which individuals have positive (or negative) affective experiences during exercise. The objective of this investigation was to explore physical and cognitive explanations of the relationship between current activity status (more versus less active) and affective response during a 30-minute bout of moderate-intensity exercise.
Participants reported their current level of physical activity, exercise self-efficacy, and affect during a 30-minute bout of moderate-intensity exercise.
More active individuals experienced higher levels of positive affect and tranquility and lower levels of negative affect and fatigue during exercise. Multivariate models for each affective state indicated separate processes through which physical activity may be associated with changes in affect during exercise.
These models indicate that affect experienced during physical activity is related to current activity level and these relationships can be partially explained by the physical and cognitive factors explored in this study. Recommendations for future research to elucidate whether positive affective response to physical activity improves as a function of becoming more active over time are discussed.
affect; exercise; transdisciplinary; physiological; self-efficacy
The current study examines the Theory of Planned Behavior’s (TPB) ability to predict marijuana use among young women who experienced a premarital pregnancy before age 18, using longitudinal data. The validity of the TPB assumption that all other variables work through TPB constructs is also tested. Indicators of four constructs that have been shown in the literature to be predictive of marijuana use -- persistent environmental adversity, emotional distress, adolescent marijuana use, drug use in the social network – were tested as predictors of attitudes, norms, and self-efficacy, in a structural equation modeling framework. All paths from distal predictors were through the mediating TPB constructs, in accordance with the tenets of the model. Implications of these findings for the TPB model and for understanding factors that lead to marijuana use are discussed.
Theory of Planned Behavior; adolescents; marijuana use; decision-making
We examined selected survivor characteristics to determine what factors might moderate the response to two psychosocial interventions.
Seventy-one prostate cancer survivors were randomly assigned to either a telephone-delivered health education (THE) intervention or a telephone-delivered interpersonal counseling (TIP-C) intervention.
Psychological QOL outcomes included depression, negative and positive affect, and perceived stress.
For three of the psychological outcomes (depression, negative affect and stress), there were distinct advantages from participating in THE. For example, more favorable depression outcomes occurred when men were older, had lower prostate specific functioning, were in active chemotherapy, had lower social support from friends and lower cancer knowledge. Participating in the TIP-C provided a more favorable outcome for positive affect when men had higher education, prostate specific functioning, social support from friends and cancer knowledge.
Unique survivor characteristics must be considered when recommending interventions that might improve psychological QOL in prostate cancer survivors. Future research must examine who benefits most and from what components of psychosocial interventions to enable clinicians to recommend appropriate psychosocial care.
psychosocial interventions; QOL; prostate cancer; psychological distress
The common-sense model posits that behavioural coping with illness is shaped by a complex combination of individuals’ abstract and concrete beliefs about their illness. We investigated this theoretical assumption in a study of 116 older adults diagnosed with type 2 diabetes who completed in-person interviews at baseline and six and twelve months later. Specifically, we examined 1) the interaction of patients’ abstract and concrete beliefs about the timeline of their diabetes as a predictor of change in adherence to a healthy diet and 2) whether these interactive effects differ among male and female patients. Abstract timeline beliefs were conceptualized as those pertaining to disease duration; concrete timeline beliefs were conceptualized as those pertaining to variability of disease symptoms (i.e., symptoms are stable versus fluctuating). As predicted, duration beliefs were positively associated with improvement in adherence among patients who viewed disease symptoms as stable, but not among those who viewed symptoms as variable. When gender was considered, these interactive effects were observed among male (but not female) patients. Findings revealed that the behavioural effects of men’s abstract knowledge about their diabetes were conditioned by their concrete representations of the disease, suggesting a bottom-up process of influence with implications for intervention.
illness beliefs; common-sense model; type 2 diabetes; adherence; gender
This study examined whether satisfaction from leisure activities moderates the relationship between caregiving demands (i.e., hours per day spent caring for a spouse with dementia) and resting levels of the catecholamines norepinephrine (NE) and epinephrine (EPI). Spousal caregivers (N=107; mean age 73.95±8.12 years) were assessed in home for plasma levels of NE and EPI, amount of care provided, and leisure satisfaction. Regression was used to determine whether leisure satisfaction moderated the relationship between hours providing care per day and catecholamine levels. A significant interaction was found between hours caregiving and leisure satisfaction for NE, but not for EPI. Post hoc regressions were conducted for both NE and EPI. At low leisure satisfaction, time spent caring for a spouse was positively associated with plasma NE (β = .41; p = .005) and EPI (β = .44; p = .003). In contrast, at high levels of satisfaction, time caregiving was not significantly associated with plasma NE (β = −.08; p = .57) or EPI (β = .23; p = .12). These findings suggest that leisure satisfaction may protect caregivers from increases in catecholamines, which have been implicated in cardiovascular risk. Further support for these findings may impact psychological treatments for distressed caregivers.
leisure satisfaction; leisure activities; catecholamine; dementia caregiving; cardiovascular disease
This study tested several relationships predicted by the Health Action Process Approach (HAPA) in a sample of 175 generally healthy, inactive, middle-aged women (40–65 yrs old) over a 12 week period. Participants’ physical activity, risk perceptions, outcome expectancies, action self-efficacy, and intentions were measured at baseline. Planning and maintenance self-efficacy were measured four weeks later. Physical activity behaviour was measured twelve weeks after baseline. The HAPA relationships were examined using a structural equation model. The data fit the model well and revealed several significant relationships. Action self-efficacy was the best predictor of intention. Maintenance self-efficacy was the best predictor of planning and behaviour. Contrary to the tenets of HAPA and to past research, planning did not predict behaviour. Overall, HAPA provides a useful framework for identifying determinants of physical activity intentions and behaviour within a group of inactive, middle-aged women.
Using multidimensional scaling analysis (MDS), this study examined how patient conceptualisations of treatment motivation compare with theoretically-based assumptions used in current assessment approaches. Patients undergoing antiretroviral therapy for HIV/AIDS (n = 39) rated for similarity all possible pairings of 23 treatment descriptions, including descriptors of intrinsic, extrinsic, approach, and avoidance motivation. MDS analyses revealed that patient perceptions of intrinsic and extrinsic motivation often differ from those based on definitions derived from common interpretations of self-determination theory. Findings also showed that patients reported motivation for avoiding treatment when they associated their medication regimens with side effects and other negatively-valenced outcomes. The study describes new applications of MDS in assessing how patients perceive the relationship between treatment behaviours and specific forms of motivation, such as intrinsic and extrinsic motivation. In addition, the study suggests how MDS may be used to develop behavioural strategies aimed at helping patients follow their regimens consistently by identifying treatment conceptualisations and contexts that facilitate or impede adherence.
HIV/AIDS; antiretroviral; adherence; motivation; psychometrics/statistics & numerical data
The pathways between parenting behaviours, personality and physical
health have all been separately studied. Prior research has paid little
attention to the indirect effects of personality in the path between parenting
behaviours and better health. The purpose of this study was to explore the
mediational effects of conscientiousness on the relationships between parental
socialisation of responsibility and self-rated health, and to examine potential
age differences in this mediational pathway. In total, 736 female and 749 male
members across Japan participated in this study. They were divided into three
groups by age category: younger-, middle-aged and older-aged. Conscientiousness
and health were concurrently rated, while parental socialisation of
responsibility was retrospectively assessed. Our analyses revealed that parental
socialisation of responsibility is positively associated with conscientiousness
and self-rated health, that conscientiousness is positively associated with
self-rated health, and that conscientiousness fully mediated the effect of
parental socialisation of responsibility on self-rated health. The mediational
links were consistent across younger, middle-aged and older-aged cohorts. Our
findings suggest that greater parental socialisation of responsibility relates
to higher conscientiousness, and consequently healthier adults. These findings
imply that parental behaviours could be a plausible target for intervention to
foster the development of conscientiousness and better health.
conscientiousness; parental socialisation of responsibility; self-rated health; moderated mediation
The purpose of this study was to investigate whether participants’ assessments of unfavourable health information are associated with individual differences in basal testosterone. Testosterone has previously been related to assessments of threat in social and other domains. Fifty-two undergraduate males were tested for a minor, fictitious medical condition (‘TAA deficiency’) in a paradigm that was developed to examine the thoughts and behaviours of individuals who have just received unfavourable medical news. In a variation on the classic paradigm, all participants were told that they had ‘TAA deficiency,’ after which they rated the seriousness and prevalence of that condition as well as 19 other actual conditions. Higher testosterone levels were significantly correlated with lower estimates of both the seriousness and prevalence of TAA deficiency as well as lower median seriousness and prevalence estimates of the 19 actual conditions. Findings are discussed in light of current research in the field of behavioural endocrinology. This study provides preliminary evidence that individual differences in assessments of threatening health information may be associated with neurobiological characteristics.
Health threat; testosterone; TAA deficiency paradigm
To test the relationships between worry and perceptions of likelihood and severity (two indicators of risk perception) across eight common diseases, and to examine contributions of individual and disease variability in worry and risk perceptions.
Participants were 294 people recruited through the Multiplex Initiative, in which a genetic susceptibility test for 8 common diseases was offered to healthy adults. Participants completed a baseline telephone survey and Web-based surveys measuring the variables for this ancillary study, without a commitment to be tested.
Between- and within-subjects analyses yielded the following findings: 1) worry is more related to likelihood perceptions than to severity perceptions; 2) severity perceptions add significantly to explained worry variances above and beyond likelihood perceptions; 3) the likelihood × severity perception does not add to explained variance in worry above its components; 4) risk perceptions and worries form two identifiable clusters: cancer diseases and cardiovascular-metabolic diseases; 5) there are significant differences in risk perceptions and worry among diseases; 6) there are significant gender differences in risk perceptions and worry about common diseases; 7) variance in risk perception and worry is explained by a combination of between- and within-subjects variances, with the latter being more powerful.
Risk perception research should pay attention to severity perceptions, within-subjects variability and inter-disease differences should not be ignored, gender perspectives on illness perceptions should be acknowledged, and health psychologists must prepare for considering groups of illnesses in addition to single diseases.
risk perception; worry; severity; likelihood; within-subjects
Understanding precursors to distress and emotional well-being (EWB) experienced in anticipation of radiotherapy would facilitate the ability to intervene with this emotional upset (i.e., higher distress, lower EWB). Thus the present study tested an expectancy-based model for explaining emotional upset in breast cancer patients prior to radiotherapy. Women affected by breast cancer (N=106) were recruited and participants completed questionnaires prior to commencing radiotherapy. Structural equation modeling was used test a cross-sectional model, which assessed the ability of dispositional optimism (Life Orientation Test-Revised - two factors), response expectancies (VAS items), medical (type of surgery, cancer stage, chemotherapy history) and demographic (age, race/ethnicity, education, marital status) variables to predict both EWB (Functional Assessment of Chronic Illness Therapy - Emotional Well-being Subscale) and distress (Profile of Mood States - Short Version). The model represented a good fit to the data accounting for 65% of the variance in EWB and 69% in Distress. Significant predictors of emotional upset were pessimism, response expectancies, Latina ethnicity, cancer stage, and having had a mastectomy. These variables explained a large portion of emotional upset experienced prior to radiotherapy for breast cancer and are important to consider when aiming to reduce distress and improve EWB in this context.
distress; quality of life; breast neoplasm; radiotherapy; optimism; response expectancies
This study examines perceived stress and its relationship to depressive symptoms, life changes and functional capacity in a large sample of individuals who are positive for the Huntington disease (HD) gene expansion but not yet diagnosed. Participants were classified by estimated proximity to HD diagnosis (far, mid, near) and compared with a non gene-expanded comparison group. Persons in the mid group had the highest stress scores. A significant interaction between age and time since HD genetic testing was also found. Secondary analyses using data from a different data collection point and including a diagnosed group showed the highest stress scores in the diagnosed group. Possible explanations and implications are discussed.
Huntington disease; perceived stress; depression