International Journal of Behavioral Medicine (Int J Behav Med)

Publications in this journal

• Article: Assessing the Stages of the Grieving Process in Chronic Obstructive Pulmonary Disease (COPD): Validation of the Acceptance of Disease and Impairments Questionnaire (ADIQ).

  Lonneke M Boer, Leonie Daudey, Jeannette B Peters, Johan Molema, Judith B Prins, Jan H Vercoulen
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  ABSTRACT: BACKGROUND: Patients with chronic obstructive pulmonary disease (COPD) encounter many (gradual) losses due to their disease, which trigger a grieving process. This process is characterized by stages of denial, resistance, sorrow, and acceptance. PURPOSE: This study examined whether these stages are conceptually distinct and whether the Acceptance of Disease and Impairments Questionnaire (ADIQ) can validly and reliably measure these stages in three samples of patients with COPD in the Netherlands. METHODS: Exploratory factor analysis (EFA) was performed on 145 outpatients with moderate to severe COPD. Confirmatory factor analyses were performed on 303 outpatients with mild to very severe COPD and 127 patients entering an inpatient pulmonary rehabilitation program. Furthermore, internal reliability, construct validity, sensitivity to change, and floor and ceiling effects were examined. RESULTS: EFA yielded a four-factor solution that explained 73.2 % of variance. Confirmatory factor analyses showed a good fit of the four-factor structure in all study samples. Cronbach's alpha reliability coefficients were .79 or higher. Subscales showed to be sensitive to change. CONCLUSIONS: Four distinct stages of grief are recognized in COPD. The ADIQ is a valid and reliable instrument to measure these stages: denial, resistance, sorrow, and acceptance. Measuring the stages of grieving is important for disease management: addressing patients with a specific therapeutic approach for the stage they are in could help to motivate patients to engage in self-management and change their lifestyle.
  International Journal of Behavioral Medicine 05/2013;
• Article: The Goose Is (Half) Cooked: a Consideration of the Mechanisms and Interpersonal Context Is Needed to Elucidate the Effects of Personal Financial Incentives on Health Behaviour.

  Martin S Hagger, David A Keatley, Derwin C K Chan, Nikos L D Chatzisarantis, James A Dimmock, Ben Jackson, Nikos Ntoumanis
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  ABSTRACT: While we agree that personal financial incentives (PFIs) may have some utility in public health interventions to motivate people in the uptake and persistence of health behaviour, we disagree with some of the sentiments outlined by Lynagh et al. (Int J Behav Med 20:114-120, 2012). Specifically, we feel that the article gives a much stronger impression that PFIs will likely lead to long-term behaviour change once the incentive has been removed than is warranted by current research. This claim has not received strong empirical support nor is it grounded in psychological theory on the role of incentives and motivation. We also feel that the presentation of some of the tenets of self-determination theory by the authors is misleading. Based on self-determination theory, we propose that PFIs, without sufficient consideration of the mechanisms by which external incentives affect motivation and the interpersonal context in which they are presented, are unlikely to lead to persistence in health behaviour once the incentive is removed. We argue that interventions that adopt PFIs as a strategy to promote health-behaviour change should incorporate strategies in the interpersonal context to minimise the undermining effect of the incentives on intrinsic motivation. Interventions should present incentives as informational regarding individuals' competence rather than as purely contingent on behavioural engagement and emphasise self-determined reasons for pursuing the behaviour.
  International Journal of Behavioral Medicine 04/2013;
• Article: Subjective Well-being in Heart Failure Patients: Influence of Coping and Depressive Symptoms.

  Ana M Pérez-García, Silvia Oliván, Ramón Bover
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  ABSTRACT: BACKGROUND: Psychological factors play a crucial role in the well-being of chronically ill patients. PURPOSE: This research examined coping, depressive symptoms and subjective well-being (SWB) in patients with heart failure (HF). The study also analysed whether depressive symptoms mediated the association between coping strategies and SWB. METHOD: Participants (N = 60, 68.3 % men, aged between 40 and 89 years old) diagnosed with HF were recruited from the cardiology service of a general hospital. Coping strategies were assessed with 16 items of the Brief COPE Scale. The items were organised, according to theoretical and empirical data, into four types of coping: task-focused, seeking social support, maladaptive emotion-focused and acceptance coping. Depressive symptoms were assessed with the corresponding subscale of the Hospital Anxiety and Depression Scale. SWB was assessed considering the Satisfaction with Life Scale and the Positive and Negative Affect Schedule. RESULTS: The multiple regression analyses carried out indicated that SWB was positively associated with task-focused coping and inversely related to maladaptive strategies and depressive symptoms. Gender was also a significant predictor of SWB, with male patients reporting higher well-being than female patients. The mediational analysis showed that depressive symptoms partially mediated the relationships between task-focused coping and SWB. CONCLUSION: Results were discussed in the light of the importance of gender, depression and coping in patients with HF since these factors may affect subjective well-being and contribute to severe physical impairment.
  International Journal of Behavioral Medicine 04/2013;
• Article: Insomnia Symptoms, Sleep Duration, and Disability Pensions: a Prospective Study of Swedish Workers.

  Catarina Canivet, Carin Staland-Nyman, Sara I Lindeberg, Robert Karasek, Mahnaz Moghaddassi, Per-Olof Ostergren
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  ABSTRACT: BACKGROUND: Previous studies have found insomnia and long sleep duration to be independently associated with subsequent disability pension (DP). However, the issue of a possible gender-based pattern in this context has received little attention. PURPOSE: This study aims to assess the impact of insomnia symptoms and sleep duration on the DP rates among Swedish women and men during a 12-year follow-up period. METHOD: The participants, from the general population of Malmö, Sweden, were enrolled from 1992 to 1994 (n = 4,319; participation rate 41 %), aged 45-64, healthy, and employed ≥30 h per week. Baseline inquiry data concerning psychosocial circumstances and self-reported sleep habits were compared with official register-based DP rates. RESULTS: Five hundred and nine persons were granted a DP. Insomnia symptoms, affirmed by 33 % of the men and 41 % of the women, were associated with receiving a DP; the hazard ratios in the fully adjusted model were 1.4 for both men [95 % confidence interval (CI) 1.1, 1.9] and women (95 % CI 1.1, 1.7). The fully adjusted hazard ratio for women sleeping ≥9 h was 7.8 (95 % CI 3.7, 16.6) for DP due to a mental disorder. In the age-adjusted analyses, the sub-domain "difficulties falling asleep" was related to DP due to mental disorders in men and DP due to cardiovascular diseases in women. CONCLUSION: The findings suggest that preventing and treating insomnia symptoms could reduce DP and that disease mechanisms linking sleep disturbances to DP may differ by gender.
  International Journal of Behavioral Medicine 04/2013;
• Article: Guest Editorial: Functional Somatic Syndromes.

  Urs M Nater
  International Journal of Behavioral Medicine 04/2013;
• Article: Unhealthy Behaviors in Adolescents: Multibehavioral Associations with Psychosocial Problems.

  Vincent Busch, Johannes Robertus Josephus De Leeuw
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  ABSTRACT: BACKGROUND: Several unhealthy behaviors are associated with psychosocial health in adolescents. Previous studies have shown that different adolescent health behaviors cluster, and, in order to understand these associations, it is important to investigate the relations between individual behaviors and psychosocial problems. PURPOSE: This study addressed the research question "Are adolescent health behaviors associated with psychosocial problems, and to what extent do certain health behaviors confound the relations between other health behaviors and psychosocial problems in adolescents?" METHODS: Self-reported questionnaire data on a broad range of health behaviors and demographics were collected from 2,690 high school students in the Netherlands in September 2012. RESULTS: After adjustment for demographic characteristics, nearly all unhealthy behaviors were found to be significantly associated with psychosocial problems. However, after correction for confounding by other behaviors, psychosocial problems were associated with fewer behaviors, namely compulsive internet use and videogame playing, smoking, cannabis use, and being bullied. These associations differed in boys and girls. CONCLUSIONS: In multibehavioral analyses adjusted for behavioral clustering, which can cause considerable interbehavioral confounding, several behaviors were associated with psychosocial problems in adolescents. This approach to behavior analysis provides a better insight into behaviors and psychosocial health, and the specific associations identified can be utilized when designing effective prevention programs, such as health-promoting school interventions.
  International Journal of Behavioral Medicine 04/2013;
• Article: Social Capital and Self-rated Health Amongst Older People in Western Finland and Northern Sweden: A Multi-level Analysis.

  Fredrica Nyqvist, Mikael Nygård, Wouter Steenbeek
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  ABSTRACT: BACKGROUND: Social capital can be conceptualised as an individual resource residing in relationships between individuals or as a collective resource produced through interactions in neighbourhoods, communities or societies. Previous studies suggest that social capital is, in general, good for health. However, there is a shortage of studies analysing the association between individual and collective social capital in relation to health amongst older people. PURPOSE: The purpose of this study was to assess the relationship between municipal- and individual-level social capital and self-rated health amongst older people in Western Finland and Northern Sweden. METHOD: Data were retrieved from a cross-sectional postal questionnaire survey conducted in 2010. The study included, in total, 6,838 people aged 65, 70, 75 and 80 years living in the two Bothnia regions, Västerbotten, Sweden and Pohjanmaa, Finland. The association between social capital and self-rated health was tested through multi-level logistic regression analyses with ecometric tests. Social capital was measured by two survey items: interpersonal trust and social participation. RESULTS: Individual-level social capital including social participation and trust was significantly associated with self-rated health. A negative association was found between municipal-level trust and health. However, almost all variation in self-rated health resided on the individual level. CONCLUSIONS: We conclude that contextual-level social capital on a municipal level is less important for understanding the influence of social capital on health in the Bothnia region of Finland and Sweden. On the other hand, our study shows that individual-level social participation and trust have a positive and significant association with self-rated health. We suggest that other ways of defining social capital at the collective level, such as the inclusion of neighbourhood social capital, could be one direction for future research.
  International Journal of Behavioral Medicine 04/2013;
• Article: Ethnicity Moderates the Relationship Between Perceived Stress and Benefit Finding in HIV+ Men Who Have Sex with Men (MSM).

  Julia S Seay, Erin M Fekete, Michael H Antoni, Gail Ironson, Maryann Fletcher, Neil Schneiderman
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  ABSTRACT: BACKGROUND: Numerous studies conducted within the USA demonstrate higher levels of benefit finding in ethnic minority individuals compared to nonminority individuals living with chronic disease. PURPOSE: As benefit finding may be a salient buffer for the effects of stress, the current study examined the association between perceived stress and benefit finding in human immunodeficiency virus (HIV)+ men who have sex with men (MSM) living in the southeast USA and investigated whether ethnicity was a moderator of this relationship. We hypothesized that benefit finding would be greater in ethnic minority MSM than in white MSM and that ethnic minority MSM with high levels of stress would experience greater benefit finding than their white MSM counterparts. METHOD: The current study utilized baseline (T1) and 3-month follow-up (T2) data drawn from a previous trial of a psychosocial intervention in HIV+ MSM. Participants were 130 HIV+ MSM; 52 % were white and 48 % belonged to minority ethnic groups (African-American, Caribbean-American, Hispanic). RESULTS: Analyses revealed that benefit finding was greater in ethnic minority MSM at baseline; however, this difference became nonsignificant when age, education level, highly active antiretroviral therapy adherence, and CD4 count were added to the model. Moderated regression analyses revealed a significant interaction between T1 perceived stress and ethnicity in predicting T2 benefit finding, such that higher levels of T1 perceived stress predicted lower levels of T2 benefit finding in ethnic minority MSM only. This association was independent of intervention group assignment. CONCLUSION: The current study's results highlight potential differences in the relationship between stress and benefit finding processes in white and ethnic minority HIV+ MSM.
  International Journal of Behavioral Medicine 04/2013;
• Article: Psychometric Properties of the Exercise Self-efficacy Scale in Dutch Primary Care Patients with Type 2 Diabetes Mellitus.

  M M P van der Heijden, F Pouwer, V J M Pop
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  ABSTRACT: BACKGROUND: Excercise self-efficacy is believed to influence physical activity bahavior. PURPOSE: The purpose of this study is to assess the psychometric aspects of the Exercise Self-efficacy Scale (ESS) in a type 2 diabetes Dutch Primary care sample. METHOD: Type 2 diabetes patients (n = 322; <80 years old) filled in the ESS and the short questionnaire to assess health enhancing physical activity (SQUASH). The structural validity of the ESS was assessed by means of principal axis factor analyses and confirmatory factor analysis. In addition, reliability and concurrent validity with the SQUASH outcomes "total" and "leisure time minutes/week of moderate to vigorous intensity physical activity" were evaluated. T tests and ANOVAs were used to examine ESS scores in subgroups. In addition, a 13-item version of the ESS was developed. RESULTS: Analyses were performed on complete cases (n = 255). Exploratory factor analysis suggested one underlying factor (total explained variance 54 %), with good internal consistency (α = 0.95). Confirmatory factor analysis showed a poor fit, as did a three-factor model suggested in an earlier research. Therefore, a 13-item ESS was developed with one underlying factor (total explained variance 59 %) and good internal consistency (α = 0.95). Both the 18-item and 13-item ESS correlated significantly with total and leisure time physical activity. ESS scores differed significantly between categories of education level and physical activity level. CONCLUSION: The 13-item ESS had sound psychometric properties in a large sample of primary care type 2 diabetes patients. The 13-item ESS could be useful in (intervention) research on physical activity in type 2 diabetes patients.
  International Journal of Behavioral Medicine 04/2013;
• Article: Examining the Associations Between Overeating, Disinhibition, and Hunger in a Nonclinical Sample of College Women.

  Geneviève Mailloux, Sophie Bergeron, Dominique Meilleur, Bianca D'Antono, Isabelle Dubé
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  ABSTRACT: BACKGROUND: Binge eating (BE) has long been identified as a correlate of overweight and obesity. However, less empirical attention has been given to overeating with and without loss of control (LOC) in nonclinical samples. PURPOSE: The goal of the present study was to examine the association of (1) established correlates of BE, namely, weight and shape concerns, dietary restraint, and negative affect, and (2) three additional correlates, disinhibition, hunger, and interoceptive awareness (IA), to overeating in a nonclinical sample of college women. METHOD: Female students (n = 1,447) aged 18 to 21 years recruited from colleges in three Canadian metropolitan areas completed self-report questionnaires in class to assess sociodemographic and anthropomorphic characteristics, overeating, LOC, dietary restraint, negative affect, weight and shape concerns, IA, disinhibition, and hunger. RESULTS: The established correlates of BE were significant correlates of all types of overeating and explained 33 % of the variance. Disinhibition was the most strongly associated correlate of overeating. CONCLUSIONS: Findings suggest that established correlates of BE are associated with other types of overeating such as objective overeating (OOE), as are disinhibition and hunger.
  International Journal of Behavioral Medicine 03/2013;
• Article: Everyday Physical Activity in Ambulatory Heart Transplant Candidates: the Role of Expected Health Benefits, Social Support, and Potential Barriers.

  Andreas Gerhardt, Gerdi Weidner, Mariel Grassmann, Heike Spaderna
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  ABSTRACT: BACKGROUND: Physical activity (PA) is recommended for stable patients with advanced heart failure (HF). PURPOSE: We evaluated expected health benefits of PA and social support as facilitators of PA, and physical symptom distress and psychological distress (depression, anxiety) as barriers to PA. Additionally, we investigated if facilitators of PA are of particular importance for patients who report barriers. METHOD: We analyzed data assessed at time of waitlisting in 231 ambulatory patients (53.4 ± 10.3 years, 18 % women) who were enrolled in the multisite Waiting for a New Heart Study in 1 Austrian and 16 German hospitals. Self-reported everyday PA scores (number of activities, duration of activities) was regressed on demographic characteristics and indicators of disease severity (ejection fraction, peak oxygen consumption), facilitators (expected health benefits of PA, perceived emotional support, perceived support for PA), and barriers to PA (physical symptom distress, psychological distress). Interaction terms of facilitators with barriers were also examined. RESULTS: PA was positively associated with higher peak oxygen consumption, validating self-reported PA. Regarding facilitators, expected health benefits of PA were independently associated with higher PA (p values < 0.001). There were no main effects for social support on PA. Regarding barriers, depression tended to be associated with fewer activities (p = 0.068). However, in the presence of barriers (depression, physical symptoms), feeling supported for being physically active was positively associated with PA (p values < 0.05). CONCLUSION: Interventions to improve PA may benefit from strengthening positive expectations of health outcomes associated with everyday PA and fostering PA-specific social support for those distressed by HF symptoms or depression.
  International Journal of Behavioral Medicine 03/2013;
• Article: Intimate Partner Violence and Symptoms of Sexually Transmitted Infections: Are the Women from Low Socio-economic Strata in Bangladesh at Increased Risk.

  Mosiur Rahman, Keiko Nakamura, Kaoruko Seino, Masashi Kizuki
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  ABSTRACT: BACKGROUND: There is little research on whether women who are either poor or illiterate and have experienced intimate partner violence (IPV) have a unique risk of sexually transmitted infections (STIs). Most such research concerns families displaced by wars and conflicts. PURPOSE: Therefore, we aimed to further this important area of inquiry by (1) addressing whether an association exists between experiences of physical and/or sexual IPV within the past year and symptoms of STI and (2) exploring the relationship between low socio-economic status and IPV and the relative roles they play as obstacles to reducing women's risk of STI in a nationally representative sample of Bangladesh. METHOD: This paper used data from the 2007 Bangladesh Demographic Health Survey. The analyses were based on the responses of 4,195 currently married women. Exposure was determined from women's experiences of physical and sexual IPV within the past year. Genital sores and genital discharge were used as proxy outcome variables of the symptoms of STI. Descriptive statistics and multivariate logistic regression analysis were used in the study. RESULTS: Experience of any physical and/or sexual IPV were associated with genital sores (adjusted odds ratio [AOR] = 1.79; 95 % confidence interval [CI], 1.28-2.51) and genital discharge (AOR 1.90, 95 % CI 1.42-2.53). Severity of physical IPV appeared to have more profound consequences on the outcome measured. Findings also demonstrated that for the risk of STI, women at the nexus of poverty or illiteracy and IPV were not more uniquely disadvantaged. CONCLUSIONS: The results suggest that for the risk of STI, the negative effect of having experienced IPV extends across all socio-economic backgrounds and is not limited to women at either at the nexus of poverty or illiteracy and IPV. Findings underscore the calls for protecting women from all forms of physical and sexual violence from their husbands as a part of interventions to reduce the risk of STI.
  International Journal of Behavioral Medicine 03/2013;
• Article: Conflicts Between Work and Family Life and Subsequent Sleep Problems Among Employees from Finland, Britain, and Japan.

  T Lallukka, J E Ferrie, M Kivimäki, M J Shipley, M Sekine, T Tatsuse, O Pietiläinen, O Rahkonen, M G Marmot, E Lahelma
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  ABSTRACT: PURPOSE: Research on the association between family-to-work and work-to-family conflicts and sleep problems is sparse and mostly cross-sectional. We examined these associations prospectively in three occupational cohorts. METHODS: Data were derived from the Finnish Helsinki Health Study (n = 3,881), the British Whitehall II Study (n = 3,998), and the Japanese Civil Servants Study (n = 1,834). Sleep problems were assessed using the Jenkins sleep questionnaire in the Finnish and British cohorts and the Pittsburgh Sleep Quality Index in the Japanese cohort. Family-to-work and work-to-family conflicts measured whether family life interfered with work or vice versa. Age, baseline sleep problems, job strain, and self-rated health were adjusted for in logistic regression analyses. RESULTS: Adjusted for age and baseline sleep, strong family-to-work conflicts were associated with subsequent sleep problems among Finnish women (OR, 1.33 (95 % CI, 1.02-1.73)) and Japanese employees of both sexes (OR, 7.61 (95 % CI, 1.01-57.2) for women; OR, 1.97 (95 % CI, 1.06-3.66) for men). Strong work-to-family conflicts were associated with subsequent sleep problems in British, Finnish, and Japanese women (OR, 2.36 (95 % CI, 1.42-3.93), 1.62 (95 % CI, 1.20-2.18), and 5.35 (95 % CI, 1.00-28.55), respectively) adjusted for age and baseline sleep problems. In men, this association was seen only in the British cohort (OR, 2.02 (95 % CI, 1.42-2.88)). Adjustments for job strain and self-rated health produced no significant attenuation of these associations. CONCLUSION: Family-to-work and work-to-family conflicts predicted subsequent sleep problems among the majority of employees in three occupational cohorts.
  International Journal of Behavioral Medicine 03/2013;
• Article: How Should Functional Somatic Syndromes Be Diagnosed?

  Samuel B Harvey, Simon Wessely
  International Journal of Behavioral Medicine 03/2013;
• Article: Decreased Physical Effort, Fatigue, and Mental Distress in Patients with Coronary Artery Disease: Importance of Personality-Related Differences.

  Adomas Bunevicius, Julija Brozaitiene, Margarita Staniute, Vaidute Gelziniene, Inga Duoneliene, Victor J M Pop, Robertas Bunevicius, Johan Denollet
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  ABSTRACT: BACKGROUND: Identification of cardio-toxic psychological symptoms in coronary artery disease (CAD) patients is important. PURPOSE: We examined the association of negative affectivity (NA), social inhibition (SI), and their combination in the distressed (Type D) personality with functional status, fatigue, and mental distress in CAD patients. METHOD: Following acute coronary syndrome, 690 consecutive CAD patients agreed to participate in this cross-sectional study and were evaluated for clinical characteristics, including left ventricular ejection fraction (LVEF), and for NA, SI, and Type D personality (i.e., NA and SI; DS14 scale) when they entered a cardiac rehabilitation program in Lithuania. Patient-centered outcomes included functional status (bicycle ergometer), symptoms of fatigue (Multidimensional Fatigue Inventory-20), and mental distress (Beck Depression Inventory-II and Hospital Anxiety and Depression Scale). RESULTS: The reference subgroup (neither NA nor SI) included 34 % of patients; 13 % had NA only, 19 % had SI only, and 34 % had Type D profile. Type D patients had worse functional status, and Type D patients and NA-only patients had higher symptom levels of fatigue and mental distress. In multivariate regression models that included LVEF, clinical characteristics, and depressive symptoms, Type D personality was an independent predictor of decreased exercise capacity (OR = 1.77, 95 % CI 1.06-2.95, p = .03) and decreased motivation for activity (OR = 3.14, 95 % CI 1.73-5.73, p < .001). Type D, NA, and SI were also independent predictors of mental distress. CONCLUSIONS: Type D personality traits independently predicted poor functional status and worse patient-centered outcomes independently from LVEF and depression. Further studies exploring personality-related differences in cardiovascular outcomes are needed.
  International Journal of Behavioral Medicine 02/2013;
• Article: The Impact of Lifestyle Factors on the Physical Health of People with a Mental Illness: a Brief Review.

  Susanne Stanley, Jonathan Laugharne
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  ABSTRACT: BACKGROUND: People with a mental illness are much more likely to experience poor physical health when compared to the general population, showing a higher propensity to develop the metabolic syndrome. Past focus has predominantly been upon individuals treated with antipsychotics, yet poor physical health is occurring across diagnoses. PURPOSE: The purpose of this paper is to draw attention to the major factors within the domain of lifestyle in order to support the need for more detailed and rigorous physical health assessment and ongoing monitoring for people with a mental illness. METHOD: This paper reviews existing evidence relating to lifestyle factors such as low exercise levels, poor diet and nutrition, high cholesterol levels, tobacco smoking and poor dental care, contributing to poor physical health such as a higher incidence of cardiovascular disease and type 2 diabetes. An integrative review was conducted from a multi-disciplinary search of online databases and journals, focusing upon mental illness and lifestyle issues predominant in the literature. RESULTS: The findings reviewed here suggest that greater attention should be paid to the physical health assessment and ongoing monitoring of all people with mental health disorders so that preventable illness does not result in higher levels of morbidity and mortality for this disadvantaged population. CONCLUSION: Early identification aids preventive interventions and assists clinicians and mental health staff to more effectively treat emergent physical health problems.
  International Journal of Behavioral Medicine 02/2013;