British Journal of Health Psychology

Published by Wiley
Print ISSN: 1359-107X
Publications
Despite the widely-held view that psychological stress is a major cause of poor health, few studies have examined the relationship between stressful life-events exposure and death. The present analyses examined the association between overall life-events stress load, health-related and health-unrelated stress, and subsequent all-cause mortality. This study employed a prospective longitudinal design incorporating time-varying covariates. Participants were 968 Scottish men and women who were 56 years old. Stressful life-events experience for the preceding 2 years was assessed at baseline, 8-9 years and 12-13 years later. Mortality was tracked for the subsequent 17 years during which time 266 participants had died. Cox's regression models with time-varying covariates were applied. We adjusted for sex, occupational status, smoking, BMI, and systolic blood pressure. Overall life-events numbers and their impact scores at the time of exposure and the time of assessment were associated with 17-year mortality. Health-related event numbers and impact scores were strongly predictive of mortality. This was not the case for health-unrelated events. The frequency of life-events and the stress load they imposed were associated with all-cause mortality. However, it was the experience and impact of health-related, not health-unrelated, events that proved predictive. This reinforces the need to disaggregate these two classes of exposures in studies of stress and health outcomes.
 
The objective was to investigate how childhood IQ related to all-cause mortality before and after age 65. The Midspan prospective cohort studies, followed-up for mortality for 25 years, were linked to individuals' childhood IQ from the Scottish Mental Survey 1932. The Midspan studies collected data on risk factors for cardiorespiratory disease from a questionnaire and at a screening examination, and were conducted on adults in Scotland in the 1970s. An age 11 IQ from the Scottish Mental Survey 1932, a cognitive ability test conducted on 1921-born children attending schools in Scotland, was found for 938 Midspan participants. The relationship between childhood IQ and mortality risk, adjusting for adulthood socio-economic confounders, was analysed. The effect of adjustment for childhood IQ on the relationship between established risk factors (blood pressure, smoking, height and respiratory function) and mortality was also investigated. For deaths occurring up to age 65, there was a 36% increased risk per standard deviation decrease (15 points) in childhood IQ which was reduced to 29% after adjusting for social class and deprivation category. There was no statistically significant relationship between childhood IQ and deaths occurring after the age of 65. Adjustment for childhood IQ attenuated the risk factor-mortality relationship in deaths occurring up to age 65, but had no effect in deaths occurring after age 65. Childhood IQ was significantly related to deaths occurring up to age 65, but not to deaths occurring after age 65.
 
To investigate the associations of childhood IQ and adult social factors, and smoking behaviour, lung function (forced expiratory volume in one second; FEV(1)), and smoking-related outcomes in adulthood. Retrospective cohort study. Participants were from the Midspan prospective studies conducted on Scottish adults in the 1970s. The sample consisted of 938 Midspan participants born in 1921 who were successfully matched with their cognitive ability test results on the Scottish Mental Survey 1932. Structural equation modelling showed that age 11 IQ was not directly associated with smoking consumption, but that IQ and adult social class had indirect effects on smoking consumption via deprivation category. The influence of IQ on FEV(1) was partly indirect via social class. Gender influenced smoking consumption and also IQ and social class. There was a 21% higher risk of having a smoking-related hospital admission, cancer, or death during 25 years of follow-up for each standard deviation disadvantage in IQ. Adjustment for adult social class, deprivation category, and smoking reduced the association to 10%. Childhood IQ was associated with social factors which influenced lung function in adulthood, but was not associated directly with smoking consumption. In future studies, it is important to consider other pathways which may account for variance in the link between childhood IQ and health in later life.
 
Cognitive epidemiology aims to explain health differentials in terms of cognitive functions, including intelligence. Kanazawa has proposed extending this to the explanation of health differences between nations. He concludes that 'wealthier and more egalitarian societies live longer and stay healthier ... because they are more intelligent'. The result does not apply to sub-Saharan Africa, but this exception is explained by reference to his theory of evolutionary psychology, 'The Savanna Principle'. We reanalyse the data, taking into account non-linearity in the relationship of GDP to life expectancy and find that the results no longer support his conclusions. We also argue that HIV prevalence rates are a more parsimonious explanation for differences between sub-Saharan Africa and elsewhere.
 
Kanazawa (2006) has put forward an evolutionarily grounded theory which claims that individuals in wealthier and more egalitarian societies live longer and stay healthier not because they are wealthier or more egalitarian but because they are more intelligent (2006: 637). The claim rests on an argument which asserts that general intelligence is a solution to evolutionarily novel problems and that most dangers to health in contemporary society are evolutionarily novel. Kanazawa also claims that this relationship does not hold in sub-Saharan Africa. These claims are based on a cross-national analysis which finds a positive correlation between 'national' IQ scores and mortality data. The implication is that intelligence is the principal factor determining longevity in the rest of the world, regardless of issues such as adequacy of diet and availability of health care. Kanazawa's theoretical claims about the evolution of general intelligence as a domain-specific adaptation are inconsistent with adaptationist analysis: natural selection does not solve general problems. The assumptions that sub-Saharan Africa is more representative of the evolutionary past than is the rest of the world, and that most hazards to health in contemporary society are evolutionarily novel, are implausible. The methods used are inadequate because Kanazawa argues for causation from correlation and fails to consider alternative explanations. The IQ data are flawed for reasons to do with sample size and sampling, extrapolation and inconsistency across measures. Nor are they temporally compatible with the economic and demographic data.
 
Objectives: Although ambiguous and uncertain situations, such as those dealing with the threat of widespread viral illness, may have pronounced psychological ramifications, there have been few studies that examined the factors that contributed to such outcomes. The purpose of the present investigation was to examine emotional reactions to a health threat. Design: A structural equation model examined the interplay between anxiety and intolerance of uncertainty, as sequentially mediated by appraisals and coping strategies. Methods: Adult participants over the age of 18 (N = 1,027) completed online self-report measures during the H1N1 pandemic in 2009. Results: Greater intolerance of uncertainty was related to lower appraisals of self- and other control, which predicted low levels of problem-focused coping and greater reports of H1N1-related anxiety. Additionally, individuals with a high intolerance of uncertainty were more likely to perceive the pandemic as threatening and also were more apt to use emotion-focused coping strategies, and both of these factors predicted elevated levels of anxiety. Conclusions: Together, these data indicate that threats, such as those related to a potential pandemic, not only have implications for physical health, but also for psychological distress, and that such outcomes vary with a constellation of appraisal and coping factors. Statement of contribution: What is already known on this subject? It has been established that the public is often confused by the threat that a potential pandemic virus poses and that they are unsure of what information related to the disease they can trust. Government health agencies often walk the line of minimizing the threat to prevent panic, but simultaneously emphasize the importance of action (vaccination) to prevent a worldwide pandemic. What does this study add? Beyond the physical threat of a pandemic, a significant psychological toll may occur for certain individuals. Anxiety regarding H1N1 is heightened amongst those who cannot tolerate uncertainty. Appraisals of threat, control, and the use of emotion-focused coping mediate the above relationship.
 
We aimed to describe the levels of anxiety and depression in patients during the 3 month period following the end of chemotherapy treatment and to identify factors that predict psychological morbidity. We performed a prospective study in women with ovarian cancer to determine the changes in psychological status in the 3 months following completion of chemotherapy. Sixty-three consecutive patients were assessed at the completion of chemotherapy (Time 1) and 57 at 3 months follow-up (Time 2). Relevant disease and patient characteristics were recorded and patients were assessed at Time 1 for anxiety, depression and their perception of emotional support, an index of their psychosocial environment. Anxiety and depression were re-assessed at Time 2. The results indicate significant initial psychological morbidity, with clinical caseness for anxiety (38%) and depression (33%) being common. Follow-up at Time 2 shows that patients undergo a significant reduction in cases (19%) and symptoms of depression but an increase in cases of anxiety (47%). The principal factors associated with symptoms of anxiety at Time 2 were poor perceived social support, increased intrusive thoughts and, to a lesser extent, younger age. Medical parameters, such as the stage of disease, response of the cancer to treatment, Ca125 (a tumour glycoprotein) and Karnofsky Performance status (a measure of how well the patients is) were not associated with worse psychological outcome. These data show for the first time that social support and intrusive thoughts, rather than physical parameters, are the principal determinants of psychological morbidity in patients with ovarian cancer.
 
Overview of the four groups; 1,351 study participants
The three clusters in the sample (N ¼ 1; 351): persistent sleep status
The purpose of this study was to examine whether arousal, distress and sleep-related beliefs are related to the maintenance of insomnia in old adults. From a randomly selected sample from the general population (N=3,600; 50-60 years old), 2,239 participants filled out a baseline and 1-year follow-up survey. Logistic regressions were used to investigate whether psychological mechanisms were related to sleep status (insomnia: N=230; poor sleep: N=210; normal sleep: N=658; good sleep: N=253) over one year. Cluster analysis was employed to assess whether it was possible to classify the participants based on their profiles of psychological functioning. The results showed that arousal, sleep-related beliefs about future consequences and anxiety were significantly related to the maintenance of insomnia (14-66% of the variance). Out of the individuals with persistent insomnia, 67% belonged to a cluster characterized by high scores on arousal, sleep-related beliefs and anxiety, 24% to a cluster defined by medium scores on the three mechanisms and 9% to a cluster characterized by low scores on the three mechanisms. This investigation shows not only that arousal, sleep-related beliefs and anxiety are associated with the maintenance of persistent insomnia, but also that these mechanisms often co-occur in individuals with persistent insomnia.
 
The purpose of this study was to examine the relation between self-reported psychological processes and changes in exercise behaviour in an 18-month longitudinal stage-based intervention trial in 115 initially sedentary women aged 40-65 years. A two-way factorial design was used. Participants were assigned randomly to either moderate or vigorous and either home or centre-based exercise. After six months, all participants exercised at home. Participants completed questionnaires at baseline, six, 12 and 18 months which assessed stage of exercise behaviour, self-efficacy, decisional balance and processes of change. 28 patterns of stage change were identified across the 18 months with 6.1% remaining sedentary and 45% demonstrating linear movement from contemplation to action to maintenance to continued maintenance. Two interpretable clusters were identified within both the contemplation (at baseline) and action (at six months) stages. Cluster membership, however, did not influence behaviour change. For participants demonstrating a linear pattern of change, self-efficacy for overcoming barriers and behavioural processes increased from contemplation to action. Self-efficacy for exercise competence increased from contemplation to action but was more pronounced for the vigorous exercise groups. Decisional balance showed a three-way interaction and there was no change for experimental processes. There was no change in any variable from action to maintenance. The intervention was seen to be effective regardless of location or intensity of exercise. The relevance of substages is questionable in stage-based interventions as women with a profile suggesting less readiness to change or sustain change were just as likely to adopt or maintain exercise.
 
Objective Type 2 diabetes disproportionately affects African American women, a population exposed to high levels of stress, including financial strain (Centers for Disease Control & Prevention, 2011, ). We tested a mediational model in which chronic financial strain among African American women contributes to elevated serum inflammation markers, which, in turn, lead to increased haemoglobin A1C (HbA1c) levels and risk for type 2 diabetes. Methods We assessed level of financial strain four times over a 10-year period and tested its effect on two serum inflammation markers, C-reactive protein (CRP) and soluble interleukin-6 receptor (sIL-6R) in year 11 of the study. We tested the inflammation markers as mediators in the association between chronic financial strain and HbA1c, an index of average blood glucose level over several months. DesignData were from 312 non-diabetic African American women from the Family and Community Health Study (FACHS; Cutrona etal., 2000, J. Pers. Soc. Psychol., 79, 1088). ResultsChronic financial strain predicted circulating sIL-6R after controlling for age, BMI, health behaviours, and physical health measures. In turn, sIL-6R significantly predicted HbA1c levels. The path between chronic financial strain and HbA1c was significantly mediated by sIL-6R. Contrary to prediction, CRP was not predicted by chronic financial strain. Conclusions Results support the role of inflammatory factors in mediating the effects of psychosocial stressors on risk for type 2 diabetes. Findings have implications for interventions that boost economic security and foster effective coping as well as medical interventions that reduce serum inflammation to prevent the onset of type 2 diabetes.
 
This study reports the perceptions of patients with a diagnosis of OAB and people with undiagnosed OAB symptoms about their health-related quality of life (HRQL) and psychological consequences. A qualitative study which employed a series of in-depth, semi-structured individual and group interviews using thematic and interpretive techniques of data analysis. A mixture of previously diagnosed patients and people bothered by OAB symptoms were recruited from three British cities. The interviews explored issues around HRQL. Data were transcribed verbatim and analysed thematically to draw out the context in which people experience OAB. The study design was reviewed by a Multi-Centre Research Ethics Committee and subjected to local research governance. OAB has devastating consequences for sufferers of both sexes which impact upon their HRQL, self-esteem and relationships. OAB without incontinence causes anxiety, fear of incontinence, a sense of depression and hopelessness all of which are worse for those with incontinence. Many sufferers feel too embarrassed to seek medical care. The psychological and HRQL consequences for OAB sufferers overlap with trajectories associated with chronic illness. However, because many sufferers avoid admitting to the condition and/or seeking treatment the psychological costs to them are even greater than with a diagnosed illness because the disruption remains unacknowledged and therefore unresolved.
 
Psychosocial factors have been examined in functional bowel disorders (FBD), including irritable bowel syndrome (IBS) and chronic idiopathic constipation (CIC). Abnormal illness behaviour (AIB) has been investigated in IBS patients as evidence of underlying psychological distress and as influencing health-care-seeking behaviour. Health locus of control may also contribute to health-care-seeking behaviour, as possession of an external locus of control places responsibility for health status onto professionals. Thus, external locus of control may also be more prominent in FBD patients. This study examined whether FBD patients displayed more AIB and an external health locus of control compared with organic disease and non-patient controls. A cross-sectional comparison group design was employed. Fifty-three CIC patients were compared with matched control groups of 50 IBS patients, 51 Crohn's disease patients and 53 non-patient participants. Questionnaire measures included the Illness Behaviour Questionnaire, the Multi-dimensional Health Locus of Control, the GHQ, and the SCL-90R. FBD patients did not differ from Crohn's disease patients on measures of AIB, but all three patient groups differed from non-patient participants. Crohn's disease patients possessed a higher external locus of control compared with FBD patients and non-patient controls. There was a general association between AIB and psychopathology. FBD patients did not report more AIB or a higher external locus of control regarding their health status, compared with organic disease controls, but did differ from non-patients. The presentation of AIB was related to increased psychopathology, suggesting that AIB may be related to psychological distress, irrespective of patient status.
 
Regression of emotion on demographic variables, disease severity and appraisals
Attendance at colposcopy following an abnormal cervical smear is potentially a highly distressing event. This study evaluates the role of cognitive appraisal components (Lazarus, 1991; Smith et al., 1993) in explaining emotional reactions to this event. We also compare the psychological sequelae of immediate treatment at first colposcopy (See and Treat, ST) vs. colposcopy with treatment deferred to a later date (Diagnose and Defer, DD). One thousand and eighty-five women referred for colposcopy completed a questionnaire assessing appraisal and emotion following their attendance. Clinical data were abstracted from medical records and social deprivation scores were estimated from postal code information based on normative data. Diagnosis and cognitive appraisals were each significantly associated with emotion, together accounting for between 3 and 15% of variance in different emotions. Specific patterns of appraisal explained specific emotions in line with theoretical predictions. Women with Cervical Intraepithelial Neoplasia (CIN) 2 or CIN 3 undergoing 'ST' were less anxious, less embarrassed and significantly more relieved compared with a matched sample of women undergoing 'DT', and perceived their first appointment as more motivationally congruent. Diagnosis, motivationally incongruent experiences and low emotion-focused coping potential are the most important determinants of anxiety after colposcopy. 'See and Treat' appears to have a positive psychological impact by increasing motivational congruence.
 
The aim was to examine the role of trait anxiety and diagnosis on depressive symptoms and fatigue in women with early stage breast cancer or benign breast problems. A prospective follow-up study was performed in order to find predictors of depressive symptoms and fatigue. From the 169 participating women, 81 patients had breast cancer and 88 benign breast problems. Questionnaires for depressive symptoms and fatigue were completed before diagnosis (T1) and 1 (T2), 3 (T3), and 6 (T4) months after diagnosis (benign patients) or surgical treatment (breast cancer patients). A trait anxiety questionnaire was only completed before diagnosis was known. Trait anxiety, assessed before diagnosis, was the only significant predictor of depressive symptoms at T4, even when depressive symptoms at baseline was included in the analysis. Fatigue at T4 was predicted by fatigue at baseline and trait anxiety. Demographic characteristics, diagnosis (benign or breast cancer) and adjuvant treatment (chemotherapy, radiotherapy, hormone therapy) did not play a role. Patients with breast cancer or benign breast problems scoring high on trait anxiety, scored higher on depressive symptoms and fatigue than the other patients, at all time points. Trait anxiety plays a role in experiencing depressive symptoms and fatigue over time.
 
The present research tested: (a) whether prototype perceptions and descriptive norms from the prototype/willingness model (PWM; Gibbons, Gerrard, Blanton, & Russell, 1998) enhance the prediction of adolescents' intentions to engage in health-protective and health-risk behaviours after variables from the theory of planned behaviour (TPB; Ajzen, 1991) and past behaviour have been taken into account and (b) whether images of the type of person who engages in a health behaviour (actor prototypes) and images of the type of person who does not engage in a health behaviour (abstainer prototypes) have equivalent predictive validity. An experimental design with a single between participants factor (actor versus abstainer prototype) was employed. Participants in this study were 247 school pupils who completed measures of TPB variables, PWM variables and past behaviour in relation to three health-protective and three health-risk behaviours. Findings indicated that PWM variables accounted for a significant proportion of the variance in behavioural intentions after TPB variables and past behaviour had been taken into account (Mean deltaR2=.05). Perceived similarity to prototypes was the most consistent additional predictor of intention. Actor and abstainer prototypes exhibited equivalent predictive validity. The present research suggests that variables from the PWM, especially prototype similarity, enhance the predictive validity of the TPB. The findings also provide new evidence that acquiring the characteristics of both health and risk images may be goals among adolescents and suggest that both healthy and risky prototypes constitute useful cognitive targets for interventions.
 
Regular exercise was experimentally reduced to determine its effects on positive feeling states. Using ecological momentary assessments, 40 participants maintained their regular exercise routine on 3 days and were deprived of their scheduled exercise on 3 other days. They recorded their feeling states, using the Exercise-Induced Feeling Inventory, four times daily as well as prior to and following exercise. Multi-level modelling analyses controlling for diurnal variations in feeling states revealed that positive feeling states were elevated on days when exercise deprivation occurred compared with non-exercise days and when no deprivation manipulation occurred. People with lower exercise dependence symptoms felt better on days when they were deprived from exercise compared with non-exercise days, whereas people with higher exercise dependence symptoms felt about the same when they were deprived from exercise compared with non-exercise days. These findings demonstrate that positive feeling states occur following an acute bout of exercise and that exercise deprivation had a positive impact on feeling states, with the level of exercise dependence symptoms moderating this effect.
 
Irritable bowel syndrome (IBS) presents in the absence of identifiable organic pathology. Clinical and research literature has suggested that both childhood abuse and anger are linked to functional gastrointestinal conditions including IBS. The present study tested the predictions that IBS patients, when compared to patients with an organic bowel disease (Crohn's disease), have higher levels of trait and suppressed anger, and that these mediate the link between abuse and IBS. The study was a cross-sectional multivariate comparison between groups of patients with IBS and Crohn's disease. Levels of self-reported trait and suppressed anger and recalled childhood abuse in patients with IBS (N=75) or Crohn's disease (N=76) were compared, using self-report questionnaires and controlling for other psychological characteristics (anxiety, depression, and dissociation). Trait and suppressed anger were greater in IBS patients, and differences in trait anger remained significant after controlling for other psychological variables. Childhood sexual abuse was more prevalent in IBS than Crohn's disease patients but was unrelated to trait anger. Higher levels of anger characterize IBS patients when compared to an organic bowel disease group, but do not explain the link between childhood abuse and IBS.
 
Objectives: Nonmedical prescription stimulant (NPS) use is an important problem among university students. The present studies applied the prototype-willingness model (Gibbons, Gerrard & Lane, 2003) to academic-based NPS use and examined the impact of academic versus health information on university students' NPS use cognitions. Design and methods: Study 1 used the prototype-willingness model to examine cognitions associated with academic-based willingness to use NPS. In Study 2, participants were randomly assigned to a control condition or to read information on the negative academic or negative health effects of NPS use. Beliefs, willingness, and expectation of engaging in future NPS use, prototypes of users, and perceived vulnerability were assessed. Results: Students without a prescription for stimulants or a diagnosis of attention deficit hyperactivity disorder (ADHD) participated in each study (Ns = 555; 166). Twenty to thirty per cent reported NPS use, primarily for academic reasons. Controlling for past NPS, alcohol, and marijuana use: friends' NPS use, prototypes, perceived vulnerability, and negative health and positive academic beliefs were associated with willingness to use NPS in Study 1. Study 2 demonstrated that participants in the academic-information condition reported the lowest willingness and expectations as well as the least favourable prototypes of NPS users. Participants in the health-information condition reported the highest perceived vulnerability. Conclusions: These studies highlight: the utility of using a health model framework to examine NPS cognitions, the importance of examining beliefs about the behaviour, and the potential for academic and health information to reduce risky NPS use cognitions.
 
A school-based vaccination programme to prevent infection with the human papillomavirus (HPV), the virus that causes cervical cancer, began in October 2008 in England. The present study evaluated the role of temporal perspective in the formation of attitudes and intentions towards the vaccine. A cross-sectional correlational survey of 245 parents of 11-12-year-old girls. Parents read a passage about the HPV vaccine containing information about benefits and concerns parents might have about the vaccine. They then completed a thought listing task and measures of attitude, vaccine efficacy, anticipated regret, intention, and consideration of future consequences. Parents with higher consideration of future consequences generated more positive relative to negative thoughts, held more positive attitudes, higher response efficacy, reported higher anticipated regret about not vaccinating their daughters and held more positive intentions. Mediation analyses suggested that the influence of thoughts generated on intention to vaccinate was partially mediated by attitude, perceived vaccine efficacy, and anticipated regret if the vaccine were not taken up. Messages emphasizing efficacy of vaccination and anticipated regret are likely to promote vaccination uptake.
 
The aims of this study were to examine the internal structure of the Spanish version of the Chronic Pain Acceptance Questionnaire and present new empirical evidence regarding its validity. A sample of 315 chronic pain patients attending a pain clinic completed a battery of instruments to assess pain acceptance, general psychological acceptance, depression, anxiety, pain intensity, functional impairment, and current functioning. Confirmatory factor analysis supported the validity of a 20-item version with two subscales corresponding to two independent factors: Activity Engagement and Pain Willingness. Structural Equation Modelling showed that the association between pain intensity and anxiety and depression was fully mediated by Activity Engagement which partially mediated the association between pain intensity and functioning. Pain Willingness partially mediated the influence of pain intensity on functional impairment. These findings indicate the differential influence of both components on adjustment to chronic pain.
 
The rights and needs of people with intellectual disabilities are being acknowledged within Department of Health policies. In spite of this, however, it is frequently cited that people with intellectual disabilities are vulnerable to many health problems but have poor access to health-related services. There are many factors that can act as barriers to people with intellectual disabilities enjoying good health and accessing services. These include: (a) a lack of clarity regarding responsibilities for ensuring that health policies are operationalized; (b) social and residential aspects of life being emphasized within the quality of life framework for evaluating services for people with intellectual disabilities, with health as an under-represented domain; (c) a lack of reliable and valid measures that can be used with carers and people with intellectual disabilities to explore health, particularly in comparison to literature on the general population; (d) potential communication difficulties (between the person with intellectual disabilities, their carers and health staff) that can impact on decision-making processes from early identification of health problems through to the stage of gaining appropriate treatment. These areas are discussed giving rise to questions and challenges for policy makers, researchers and clinicians.
 
In health education, the design of written materials is seldom subject to experimental tests. Using insights from cognitive-ergonomic literature on usability we tested a brochure against three stepwise improved versions. Effects were assessed of pictorials that flagged references in the brochure text, the use of tabs and colour coding of these pictorials and tabs, on finding information in the brochure. One hundred Dutch adults from the general population were videotaped while looking up search items. Dependent measures relating to search effectiveness, efficiency, satisfaction and learnability were extracted. Results showed a general inferiority of the original brochure. The presence of coloured tabs and pictorials contributed to a more usable brochure design, although errors were still made. It is concluded that this kind of research may provide valuable insights for more effective health education material design and thus contributes to the effectiveness of health education practice.
 
Attitudes may influence behaviour through both deliberative and automatic processes. To investigate the automatic influences of attitudes, this study explores the accessibility of modally salient beliefs about physical activity outcomes using response latency measures. Response latencies for modally salient beliefs for physically activity outcomes were compared with latencies for non-salient, hygiene outcomes. Possible relationships between self-report and response latency was assessed between- and within-subjects. Regularly active participants (N=148) completed a computer-based response latency task in which they indicated whether an outcome, for example more fit, was a likely or unlikely consequence of six different physical activities, for example go running. Self-reports of the likelihood of these outcomes, their importance, intentions to participate in the physical activities and frequency of participation were obtained. As expected, the physical activity outcomes were more accessible than control outcomes. In addition, the outcome strong heart was less accessible than the outcomes more fit and have fun. There was only weak evidence, however, of any relationship between self-reports and the accessibility of the physical activity outcomes. Response latency data may represent a source of between-subject variation that differs from self-report. Discussion focuses on the possible origins of such a discrepancy.
 
Objectives: The objective of this study was to determine the presence of possible bidirectional causal pathways between cigarette use and spinal pain in adolescents controlling for psychosocial functioning, using a prospective longitudinal research design. Design: The data for this study was collected from a cohort of Australian adolescents at 14 (n = 1596) and 17 (n = 1291) years of age. Methods: Multivariable logistic regression was used to assess i) if cigarette use at 14 predicted low back pain (LBP), mid back pain (MBP) or neck shoulder pain (NSP) at 17 in those adolescents without each condition at 14, and ii) if back pain only (BP), neck shoulder pain only (NSP) or comorbid BP and NSP at 14 predicted cigarette use at 17 in those adolescents who did not smoke at 14. Results: After controlling for psychosocial factors, cigarette use at 14 predicted MBP at 17 (OR = 3.05, p = 0.049, 95% CI [1.01-9.24]). BP only at 14 was a significant risk factor for smoking at 17 (OR = 1.84, p = 0.006, 95% CI [1.19-2.84]) after controlling for psychosocial factors. Conclusion: The findings indicate that there are bi-directional relationships between cigarette use and spinal pain and that these relationships vary with pain location.
 
Objectives: The diagnosis of fibromyalgia is based on self-report and indirect measures and thus is unavoidably influenced by patients' own understanding of their symptoms. In order to provide appropriate support for people with fibromyalgia, it is important to understand variation in patients' interpretations of their own symptoms. Methods: Twenty people with fibromyalgia participated in email interviews exploring their experiences, history and diagnosis. Respondents answered a series of questions in their own time. Rich accounts were elicited. A hermeneutic phenomenological approach linked two stages of analysis. In the first instance, an in-depth, inductive analysis was developed around a subset of eight transcripts, using interpretative phenomenological analysis. The outcomes of this work were then used to inform a template analysis, which was applied to the remaining 12 transcripts, in order to extend and check the credibility of the in-depth analysis. Results: Participants described enduring the course of a 'giant mess' of unpleasant symptoms, some of which were understood to be symptoms of fibromyalgia and some the interactive or parallel effects of comorbid illness. The respondents also demonstrated their considerable efforts at imposing order and sense on complexity and multiplicity, in terms of the instability of their symptoms. They expressed ambivalence towards diagnosis, doctors and medication, and we noted that each of the above areas appeared to come together to create a context of relational uncertainty, which undermined the security of connections to family, friends, colleagues and the workplace. Conclusions: Three key issues were discussed. First, there was not one overall symptom (e.g., pain) driving the unpleasantness of fibromyalgia; second, participants spent excessive time and energy trying to manage forces outside their control; third, because there is no definitive 'fibromyalgia experience', each diagnosis is unique, and our participants often appeared to be struggling to understand the course of their illness. Issues of stigma and legitimacy need to be considered carefully by health professionals in the context of the complex and uncertain experience of patients.
 
Hypotheses regarding the psychological factors implicated in the development and maintenance of acne first emerged in the middle of the eighteenth century. However, the psychodermatological literature from this date relating to acne has variously been described as confusing, overly prone to conjecture and, in particular, atheoretical. The current paper has two key objectives; first, to present a biopsychosocial model of acne development and maintenance and, secondly, to understand the psychosocial strain imposed by acne from an evolutionary perspective with a particular emphasis on body shame reactions. The psychodermatological literature relating to acne is reviewed with the data analysed for potential biopsychosocial interactions and shame eliciting responses. The review indicates that acne can be reconceptualized as a biopsychosocial phenomena which, in turn, provides the field with innovative hypotheses for empirical inquiry and the potential for expanding and evaluating treatment options. The evolutionary analysis illustrates that acne provides the potential for distressing body shame reactions due to the skin disease's potential for damaging self-other evaluations of attractiveness. Acne has tended to be viewed as a minor dermatological complaint which imposes minimal psychological distress upon sufferers. The paper concludes that acne has the ability to elicit in some sufferers significant mental health concerns due to a heightened sense of shame relating to appearance.
 
While mild to severe acne is a common problem in the teenage years, many adults also suffer from the condition. Although there is an appreciable body of dermatological literature on this issue, the psychosocial concomitants of severe, visible adult acne are little elaborated. The aim of this research is to detail the salient experiences of adults with severe visible acne, and to set out the implications of these experiences. A phenomenological qualitative approach was adopted to elicit detailed accounts of the impact of visible acne upon the lives of a small sample of sufferers. 11 adults suffering from severe visible acne took part in semi-structured interviews via e-mail, over an extended period of time. Transcripts of these interviews served as the data for an interpretative phenomenological analysis. Five themes emerged, detailing different aspects of respondents' personal and social lives in the context of their acne. These were: powerlessness and the variable nature of acne; comparisons, self-image and identity; the experience of general social interaction; relationships with family and friends; and gender, sexuality, and romantic relationships. These themes allowed a deeper understanding of issues reported in previous quantitative research in the area, as well as revealing findings that had not been previously reported in relation to the experience of adult acne and its impact upon personal and social relationships. With an acknowledgement of these experiences, personal and professional acquaintances have the potential to improve their interpersonal relationship with the person concerned, and encourage positive changes in their psychological health and social interaction.
 
To explore quality of life outcomes and the factors that influenced adjustment among individuals diagnosed with an acoustic neuroma. This qualitative study involved a focus group design. Twenty-one participants who had been diagnosed with and/or treated for an acoustic neuroma since 2000 attended one of four focus groups. Transcripts of the focus group discussions underwent thematic analysis to explore and describe the quality of life of participants and factors that impacted on their adjustment to the condition. Important themes that emerged were 'physical symptoms', 'psychological wellbeing', 'social wellbeing', 'functional status', and 'psychosocial factors that influenced adjustment'. Factors that influenced adjustment included severity of physical symptoms, co-morbid conditions, optimism, control, social comparison, and social support. Participants conveyed a diverse range of experiences in relation to quality of life. In addition to severity of physical symptoms, psychosocial factors also emerged as important influences on quality of life.
 
Past studies expected measures of obesity to be positively associated with positive affects. However, this hypothesis was not tested in reference to a specific positive affect. We tested the hypothesized unidirectional effects of measures of obesity on vigour, representing a positive affect, and of vigour on measures of obesity. We used a longitudinal design, separately for men and women. Participants were 1,876 and 931 healthy men and women, respectively, examined at Time 1 (T1) and Time 2 (T2), about 2 years apart. Measures of obesity included body mass index, waist circumference, and waist-to-hip ratio. Vigour was assessed by the Shirom-Melamed Vigour Measure. We used structural equation modelling to test our hypotheses. We found that for both genders, T1 measures of obesity did not predict either T1 or T2 vigour. Among both genders, we found support for the effects of T1 vigour on T1 but not on T2 measures of obesity. To the extent that the 'Jolly fat hypothesis' refers to the effects of measures of obesity on positive affects, we failed to support it for vigour as a positive affect. Vigour has contemporaneous but not longitudinal effects on body weight.
 
Objective: Research on health-related behaviour has typically adopted deliberative models of motivation and explicit measures. However, growing support for implicit processes in motivation and health-related behaviour has caused a shift towards developing models that incorporate implicit and explicit processes. Methods: The current research advances this area by comparing the predictive validity of a newly developed implicit measure of motivation from self-determination theory (SDT) with explicit measures of motivation for 20 health-related behaviours, in a sample of undergraduate students (N= 162). A dual systems model was developed to test whether implicit motivation provided unique prediction of behaviour. Results: Structural equation models for each behaviour indicated some support for the role of implicit measures; explicit measures and intention provided more consistent, significant prediction across most behaviours. Conclusions: This study provides some support for dual systems models, and offers an important contribution to understanding why some behaviours may be better predicted by either implicit or explicit measures. Future implications for implicit processes and SDT are outlined. Statement of contribution: WHAT IS ALREADY KNOWN ON THIS SUBJECT? : Previous research has highlighted the unique effects of implicit processes on goal-directed behaviour. Several studies have supported the role of implicit processes in motivation. WHAT DOES THIS STUDY ADD? : The current study adds to the previous literature by investigating the role of implicit processes and self-determination theory. Furthermore, the current study uses a relatively novel implicit measure across a wide range of behaviours. Finally, the current study incorporates a dual-systems model to provide a conceptual understanding of the findings.
 
The current paper examined the variability of predictors of changes in adolescent smoking across linear and nonlinear analytic models. Three analytic models typically used to model adolescent smoking behaviour were tested: one linear model of change (standard linear), one static linear model (pre-post linear) and one nonlinear model of change (cusp catastrophe). Variability in model composition was assessed by examining the pattern of variables achieving statistical significance and proportion of variance explained. Model testing was conducted on data from Australian adolescents successfully tracked through a 12-month longitudinal study of smoking (N = 779). The survey measured demographics, self-reported smoking, smoking among friends and family, self-esteem, neuroticism, coping, stress and risk taking. The results indicated that while predictors of change were invariant across analytic models explanatory power varied markedly. Models of change in smoking that included simple, interacted or polynomial forms of initial conditions (past behaviour) explained more than four times the variance of models without. These results justified confidence in the predictors of change in adolescent smoking across analytic models. A secondary implication was that more research into past behaviour's role in the context of dynamical models of adolescent smoking and other health behaviour is needed.
 
Using the transactional model of stress and coping, the present study investigated whether specific coping resources act as buffers of the relationship between perceived stress and psychological well-being among rheumatoid arthritis (RA) patients. A longitudinal observational study was carried out with assessments at baseline, 6 months and 1 year. Measures of perceived stress, coping resources (optimism/pessimism, social support and explicit active coping strategies) and psychological well-being (anxiety, depression and life satisfaction) were completed by 134 RA patients. Demographics, RA duration, pain, fatigue, functional disability, antidepressant use and physical comorbidities were recorded and statistically controlled for. Perceived stress had the strongest relationship with psychological well-being at baseline, and affected anxiety after 6 months. Optimism and pessimism predicted psychological well-being across 1 year. Active behavioural coping buffered an association of stress with depression at baseline, while baseline active cognitive coping buffered the effect of baseline stress on life satisfaction after 6 months. Patients with RA under greater perceived stress who do not use active coping strategies appear to be at risk of psychological comorbidity and may therefore benefit from interventions teaching specific active coping strategies. Larger observational studies and interventions are required to confirm and extend these findings.
 
Participant flow chart.
Simple mediation model in N = 193 university students. Note. *p < .05; **p < .01; men = 1, women = 2. Direct effect (c’ path) in parentheses. Control variables were baseline physical activity and sex.
Moderated mediation model for physical activity in N = 193 university students. Note. *p < .05; **p < .01; men = 1, women = 2. Direct effect (c’ path) in parentheses. Control variables were baseline physical activity and sex.
Interaction of self-efficacy and action control on physical activity. Note. Physical activity Time 3 is regressed on self-efficacy Time 2. The different regression lines demonstrate the effect on the level of the mean, 1 SD below and 1 SD above the mean of action control Time 2.
Experiencing positive consequences of one's physical activity is supposed to facilitate further activity. This motivational outcome might be generated by an increase in perceived self-efficacy. In addition to such a mediator effect, we examine whether this applies generally or only under conditions of volitional control. For this purpose, perceived action control was considered as a putative moderator. N = 193 students participated in a study with three measurement points in time. At baseline, positive experience with previous physical activity was measured as a predictor of physical activity. Two weeks later, self-efficacy and action control variables were assessed as putative mediator and moderator, respectively. After another 2 weeks, physical activity was measured as the outcome. A moderated mediation model was specified with baseline physical activity and sex as covariates. Self-efficacy was found to mediate between initial positive experience and later physical activity, and this mediation was moderated by action control. Participants’ perceptions of positive experience were associated with their subsequent self-efficacy fostering physical activity. However, persons with low levels of action control did not translate positive experience into physical activity via self-efficacy. What is already known on this subject? What does this study add?
 
In the action control framework, intention-behaviour discordance is studied around public health guidelines. Although this framework has been applied to physical activity behaviours, it has only seen very limited attention regarding fruit intake. The purpose of this study was therefore to investigate distributions and predictors of fruit intake intention-behaviour discordance. Prospective correlational design. Data were obtained from undergraduate students (n = 413) using validated questionnaires. Variables from the theory of planned behaviour, automaticity, and action planning were assessed at baseline, and fruit intake was assessed 2 weeks later. Data were analysed using discriminant function analyses and analyses of variance. The proportion of unsuccessful intenders ranged from 39.2% to 80.8%. There was a larger proportion of fruit intake intenders amongst those who reported strong automatic fruit intake. Action control was predicted by fruit intake automaticity and affective attitudes, but the strongest predictor was perceived behavioural control. No action planning items were related to fruit intake action control. There is considerable asymmetry in the intention-fruit intake relationship. An application of the action control framework may stimulate debate on the applicability of intention-based models at the public health level. What is already known on this subject? Intention is theorized to be a key construct in fruit intake. Studies in the physical activity domain indicate that nearly half of the people with positive intentions fail to subsequently act. What does this study add? The proportion of unsuccessful intenders ranged from 39.2% to 80.8%. Holding positive intentions is not sufficient to consume fruit at suggested public health guidelines. Perceived behavioural control is the most important predictor of fruit intake action control.
 
The aim of the present study was to test two brief planning interventions designed to encourage cardiac patients to engage in regular physical exercise following discharge from rehabilitation. The interventions comprised action plans on (a) when, where, and how to act, and (b) coping plans on how to deal with anticipated barriers. An experimental longitudinal trial was conducted to test two interventions that either focused on action planning alone, or on a combination of action planning and coping planning. A total of 211 participants completed assessments at baseline and 2 months after discharge. Participants were randomly assigned to either one of the intervention groups or a standard-care control group. Participants in the combined planning group did significantly more physical exercise 2 months post-discharge than those in the other groups. The theoretical distinction between action planning and coping planning as introduced in the present study has proven useful in explaining changes in health-related behaviour. The combined planning intervention can be applied in the context of cardiac rehabilitation programmes.
 
The identification of the determinants of physical activity (PA) among older adults is an important avenue of research. To date, although the health action process approach (HAPA) has proven to be a valid framework for the prediction of PA among heterogeneous sample of both middle-aged and older adults in rehabilitation and work settings, no studies have specifically considered its predictive value among older adults in their retirement years. Therefore, drawing upon the HAPA, the present study aimed to identify the social cognitive determinants of PA involvement among retired older adults. A 6-month prospective design was employed. Participants were retired older individuals (N= 120), members of a French university-based organization, aged from 53 to 83 years (Mean = 65.38 years; SD= 5.63). They were administrated measures of risk perception, action self-efficacy, outcome expectancies, and PA intention at baseline (T1) and of planning, coping self-efficacy, and PA behaviour 6 months later (T2). Path analyses revealed that, in the motivational phase, action self-efficacy and risk perception, but not outcome expectancies, were positively related to PA intention. In the volitional phase, PA intention and coping self-efficacy, but not planning, were positive predictors of PA behaviour. The present study contributes to existing knowledge as the first to apply the HAPA for the prediction of PA among retired older adults. It confirms that it provides a useful framework for the understanding of the social cognitive processes underlying this behaviour for this age group.
 
Literature search flow using QUOROM/PRISMA guidelines.
Studies employing the action control framework
Objectives: The physical activity (PA) intention-behaviour gap is a topic of considerable contemporary research, given that most of our models used to understand physical activity suggest that intention is the proximal antecedent of behavioural enactment. The purpose of this study was to quantify the intention-PA gap at public health guidelines with a meta-analysis of the action control framework. Design: Systematic review and meta-analysis. Methods: Literature searches were conducted in July 2012 among five key search engines. This search yielded a total of 2,865 potentially relevant records; of these, 10 studies fulfilled the full eligibility criteria (N = 3,899). Results: Random-effects meta-analysis procedures with correction for sampling bias were employed in the analysis for estimates of non-intenders who subsequently did not engage in physical activity (21%), non-intenders who subsequently performed physical activity (2%), intenders who were not successful at following through with their PA (36%), and successful intenders (42%). The overall intention-PA gap was 46%. Conclusion: These results emphasize the weakness in early intention models for understanding PA and suggest this would be a problem during intervention. Contemporary research that is validating and exploring additional constructs (e.g., self-regulation, automaticity) that augment intention or improving the measurement of motivation seems warranted. Statement of contribution: What is already known on this subject? Intention is considered the proximal antecedent of behaviour in many popular models. Intention is also an established correlate of physical activity behaviour, yet discordance is considerable in experimental research. What does this study add? This meta-analysis of studies that have assessed concordance/discordance of physical activity intention and behaviour at public health guidelines shows the intention-behaviour gap at 48% and the discordance is from intenders who do not act. The results demonstrate that discordance is not just from extreme levels of intention or behaviour (e.g., intend to exercise six times but only exercise five), but from levels that are relevant to health promotion.
 
Within health psychology, habit - the tendency to enact action automatically as a learned response to contextual cues - is most commonly quantified using the 'Self-Report Habit Index', which assesses behavioural automaticity, or measures combining self-reported behaviour frequency and context stability. Yet, the use of self-report to capture habit has proven controversial. This study used 'think-aloud' methods to investigate problems experienced when completing these two measures. Cross-sectional survey with think-aloud study. Twenty student participants narrated their thoughts while completing habit measures applied to four health-related behaviours (active commuting, unhealthy snacking, and one context-free and one context-specific variant of alcohol consumption). Data were coded using thematic analysis procedures. Problems were found in 10% of responses. Notable findings included participants lacking confidence in reporting automaticity, struggling to recall behaviour or cues, differing in interpretations of 'commuting', and misinterpreting items. While most responses were unproblematic, and further work is needed to investigate habit self-reports among larger and more diverse samples, findings nonetheless question the sensitivity of the measures, and the conceptualization of habit underpinning common applications of them. We offer suggestions to minimize these problems. What is already known on this subject? Habit is most commonly measured within health psychology via the Self-Report Habit Index, or a combination of self-reported behaviour frequency and contextual stability. The suitability of self-report for capturing automatic processes has been questioned. What does this study add? This is the first study of how people interpret and respond to self-report habit measures. Results show the potential for errors in recalling automaticity, cues, and behaviours. We discuss practical and theoretical challenges to assessing habit in health behaviours.
 
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Objectives This study investigates the joint role of coping planning and action control as volitional predictors of changes in the daily consumption of fruit and vegetables. DesignIn a longitudinal online survey, 203 participants completed assessments at baseline (Time 1), 1week (Time 2), and 2weeks later (Time 3). Methods Structural equation modelling was used to test a series of three nested models. In Model 1, only intention predicted behaviour; in Model 2, both coping planning and action control were tested as mediators between intention and behaviour; and Model 3 specified coping planning and action control as sequential mediators between intention and behaviour. ResultsModel 3 provided the best fit to the data. The mediating role of coping planning and action control between intention and fruit and vegetable intake was confirmed, whereby multiple mediation occurred in a sequential manner, with coping planning preceding action control. Conclusions For motivated individuals who are not yet following the recommendations for fruit and vegetable consumption, coping planning and action control reflect a psychological mechanism that operates in changes in fruit and vegetable consumption.
 
Repeated action can lead to the formation of habits and identification as 'the kind of person' that performs the behaviour. This has led to the suggestion that identity-relevance is a facet of habit. This study explores conceptual overlap between habit and identity, and examines where the two constructs fit into an extended Theory of Planned Behaviour (TPB) model of binge-drinking among university students. Prospective, questionnaire-based correlational design. A total of 167 UK university students completed baseline measures of past behaviour, self-identity, the Self-Report Habit Index (SRHI), and TPB constructs. One week later, 128 participants completed a follow-up behaviour measure. Factor analyses of the SRHI and four identity items revealed two correlated but distinct factors, relating to habit and identity, respectively. Hierarchical regression analyses of intention and behaviour showed that identity contributed over and above TPB constructs to the prediction of intention, whereas habit predicted behaviour directly, and interacted with intentions in predicting behaviour. Habits unexpectedly strengthened the intention-behaviour relation, such that strong intenders were more likely to binge-drink where they also had strong habits. Identity and habit are conceptually discrete and impact differently on binge-drinking. Findings have implications for habit theory and measurement. Recommendations for student alcohol consumption reduction initiatives are offered.
 
This study examined the effects of expressive narrative writing in 607 participants. Compared with a control group, the participants randomly assigned to write about their feelings and thoughts after the Madrid train attack on M11 report less negative emotions related to the recall of the collective trauma at a 2-month follow-up after the attacks. However, no effects were found on positive affect, probably because the study had only one writing session of brief duration. Stronger feelings of joy, use of positive words, and low use of negative words in the narratives predicted low emotional activation at follow-up.
 
The purpose of this persuasion research was to show that self-affirmation (SA) increases intentions in the advocated direction and that these intentions predict actual health behaviour change. That is, these intentions not only serve the function of short-term relief of the threat caused by the persuasive message. We proposed that the effect of SA depends on the level of value-involvement. Participants were randomly assigned to one of two conditions (no SA vs. SA) of a between-subjects design. After the SA manipulation, all participants read a threatening health text about the consequences of insufficient fruit and vegetable intake. At pre-test, value-involvement was determined. Participants included were undergraduate students. The SA manipulation consisted of a writing exercise. After reading the health message, participants reported their intention to eat sufficient fruit and vegetables (N= 537). After 1 week (N= 293) and 4 weeks (N= 261), participants completed self-reports of fruit and vegetable intake. No main effect was found for SA on any outcome measure. We did find that involvement moderated the effect of SA on cooked vegetables consumption. This effect was not present for raw vegetables/salad consumption or for fruit consumption. The moderated effect on cooked vegetable consumption was most evident after 1 week and the effect was mediated by the immediate intentions of participants. SA can lead to genuine intentions that predict actual behaviour, but the effect of SA depends on the type of behaviour and people's value-involvement.
 
Objectives: The current study examined the contribution of marital satisfaction to symptoms of depression among patients with acute coronary syndrome (ACS) and their partners. Method: The sample comprised of 91 ACS male patients and their female partners. Data were collected at the time of initial hospitalization and 6 months later. Patients' and partners' assessments of marital satisfaction were measured using the ENRICH scale. Symptoms of depression were measured using the Brief Symptoms Inventory (BSI). Dyadic analysis applying the Actor-Partner Inter-dependence Model (APIM) was used. Results: Different patterns emerged for the two phases. In the acute phase, only the Actor effect was significant: for both patients and partners, one's greater marital satisfaction was associated with one's lower levels of depression. In the chronic phase, both Actor and Partner effects were significant, while different trends were found for patients and partners. Partners' marital satisfaction was associated with their own and the patients' decreased depression symptoms, whereas among patients, higher levels of marital satisfaction were associated with elevated levels of depression both for themselves and for their partners. Conclusions: A dyadic perspective and phases of illness have to be taken into account in understanding adjustment and developing interventions following ACS. Statement of contribution: What is already known on this subject? The contribution of marital satisfaction to psychological adjustment following cardiac illness has been explored, but mainly from the perspective of one partner only. Different phases of an illness present different challenges for both patients and family members. What does this study add? A dyadic perspective on recovery from cardiac illness. The partner's contribution during the different phases of the illness.
 
Female cardiac patients' health-related quality of life (HRQoL) during the first year after an acute cardiac event was compared with age-weighted Australian population norms. The impact of age, event type and cardiac rehabilitation (CR) programme attendance on recovery was assessed. The short form 36-item health survey (SF-36) was administered to 229 women aged from 36 to 84 years consecutively admitted to 4 hospitals after acute myocardial infarction (AMI) or to undergo coronary artery bypass graft surgery (CABGS). Data were collected at 4 time points over 12 months. SF-36 subscale scores were compared with age-weighted norms for Australian women. Mplus was used to analyse growth trajectories for SF-36 subscales. Patients had impaired HRQoL at baseline (except in general health), with progressive improvement over time. Recovery to normative levels was fastest in the areas of bodily pain and mental health (by 2 months) and slowest in the area of physical functioning, and physical and emotional role limitations (by 12 months). By 4 months, general health scores had surpassed population norms. For all scales, most improvement occurred in the first 2 months, with little subsequent improvement. CABGS patients showed significantly more improvement than AMI patients in several areas, partly due to the poorer functioning of CABGS patients at baseline. Rate of improvement was not influenced by patients' age or frequency of CR attendance. Impairment of HRQoL in female cardiac patients is most pronounced at the time of the event, with most recovery occurring during early convalescence and full recovery in all domains by 12 months post-event.
 
Objectives: This study tested a recent theoretical development in stress research to see whether group membership influenced cardiovascular reactions following exposure to acute stress. Methods: Participants (N = 104) were exposed to a message in which a maths test was described as stressful or challenging by an ingroup member (a student) or outgroup member (a stress disorder sufferer). Systolic blood pressure and diastolic blood pressure(DBP) and heart rate (HR) were monitored throughout a standard reactivity study. Results: As expected, a significant interaction was found; relative to those who were told that the task was challenging, ingroup members reported more stress and had higher DBP and HR reactivity when told by an ingroup member that the maths task was stressful; task information did not have the same effect for outgroup members. Conclusion: These results indicate that informational support is not constant but varies as a function of group membership. Finally, this recent development in stress research may prove useful for those interested in investigating the interactions between social, psychological and physiological processes underlying health disparities. Statement of contribution: What is already known on this subject? Stress is a common risk factor for hypertension and coronary heart disease. Social support has been found to reduce cardiovascular reactions to acute psychological stress. The influence of social support on stress varies as a consequence of social identity. What does this study add? The social group that one belongs to influences how one appraises and responds to stress. Social identity provides a useful framework for understanding how social processes are associated with health disparities.
 
Objectives: Many previous investigations of the recovery of emotional well-being, particularly the resolution of depression, following an acute cardiac event assume that all patients follow a similar, linear trajectory. However, it is possible that there are different groups of patients who follow different trajectories. This study tested for multiple trajectories of anxiety and depression and identified the characteristics of patients most at risk for persistent or worsening anxiety and depression in the 12 months following their cardiac event. Method: A consecutive sample of 226 women was interviewed following either acute myocardial infarction (AMI) or coronary artery bypass graft surgery (CABGS). The Hospital Anxiety and Depression Scale were administered on four occasions over 12 months. Growth curve and growth mixture modelling were used to identify trajectories of change and univariate tests were employed to establish predictors of each trajectory. Results: Most women began with relatively low levels of anxiety and/or depression that improved over the 12 month period (84% women showed this trajectory for anxiety, 89% for depression). A smaller group began with relatively high levels of anxiety and/or depression that worsened over time (16% for anxiety, 11% for depression). Patients in the latter group were more likely to report high levels of loneliness, have a first language other than English, perceive their cardiac disease as more severe (anxiety group only) and have diabetes (depression group only). Trajectories were non-linear, with most change occurring in the initial 2-month period. Conclusion: Growth modelling techniques highlight that change in anxiety and depression following an acute event follows neither a single nor linear trajectory. Most women showed early resolution of anxiety and depression following their event, indicative of a normal bereavement or adjustment response. A minority of women reported worsening anxiety and/or depression in the year following their cardiac event, particularly those who lacked social support or were from non-English speaking backgrounds. Intervention studies to explore support options for these women are warranted, both prior to and following their event.
 
Objectives. Cardiac patients have been shown to have inaccurate understanding of their cardiovascular risk. The purpose of the study was to investigate whether a guideline-based risk assessment and management intervention could facilitate understanding of cadiovascular risk and appropriate illness perceptions in cardiac patients. Design. Randomized trial. Methods. A total of 106 patients with MI or unstable angina were randomized to receive standard care with or without a 30-min nurse-led computerized Predict CVD-Diabetes (where CVD is cardiovascular disease) session. Patients’ risk perceptions (using categorical and numerical measures), and perceptions of their heart condition were assessed at admission, discharge, and 3 months. Results. The intervention group rated the risk information as more easily understood than the control group. At discharge, they had increased perceptions of personal control, higher perceptions that a low-fat diet and regular exercise could help their condition, and believed their current illness would be shorter compared to the control group. At 3 months, no group differences were significant. The intervention had no effect on risk perceptions, which were high in both groups. Patients’ perceptions of ‘high’ risk corresponded to numerical estimates of over 50%, which differs from clinical guidelines (over 20%). Conclusions. A computerized cardiovascular risk assessment and management session can help acute coronary syndrome patients understand CVD risk information and improve perceptions of control in the short term, but not change risk perceptions. In-hospital risk factor assessment and management information may help patients understand the importance of key lifestyle changes.
 
Mean (6 SE) difference in pain tolerance (s) between two administrations of a cold pressor test (CPT) under three different conditions of attention focus in high-and low-anxiety participants (N = 72). PAIN = pain-focused attention, UNDIR = undirected attention, DISTR = distraction.
Summary of repeated-measure s ANOVA of difference scores for pain tolerance, systolic (SBP) and diastolic (DBP) blood pressure, heart rate (HR), and EMG (N = 72)
In light of inconsistencies in the reported effects of attention and anxiety on pain tolerance, this study examined the separate and combined effects of attention focus and trait anxiety on tolerance of acute experimental pain. Participants with 'high' and 'low' trait anxiety were assigned to three attention-focus conditions: pain-focused attention, 'undirected' (no experimenter-induced attempts to influence attention focus) and distraction. Several indices of autonomic arousal (systolic and diastolic blood pressure, heart rate and EMG) were measured before and during, and several self-report inventories were completed before and after, each of two administrations of the cold pressor test. In general, pain tolerance was greater when participants were distracted and in low- rather than high-anxiety participants. However, attention and anxiety interacted such that low-anxiety participants were most pain tolerant, and high-anxiety participants were least pain tolerant, in the undirected condition. The results are consistent with the notion that anxiety fosters attentiveness to possible environmental threats, and might have implications for the clinical management of acute pain.
 
Taylor's theory of cognitive adaptation proposes that adjustment depends on the ability to sustain and modify illusions (i.e. unrealistic optimism, exaggerated perceptions of control, and self-aggrandizement) that buffer against threats but also against possible future setbacks. Because the question of whether cancer patients show these illusions has received little attention, the present study compared patients' perceptions of optimism, control, and self-esteem at different stages of the cancer process with that of healthy references. The effects of these perceptions on psychological distress were also assessed. The present study has a longitudinal design. Including a group of healthy references enabled us to draw more firm conclusions about the effect of cancer upon cognitive perceptions. The participants were 67 cancer patients and 50 healthy references. Patients filled out questionnaires prior to their first radiotherapy (T1), at 2 weeks (T2), and at 3 months (T3) after completing radiotherapy. Healthy references were assessed at similar intervals. T tests revealed that patients experienced significantly higher levels of optimism and self-esteem than the healthy reference group. Concerning control, no group differences were found. Importantly, regression analyses showed that lower levels of optimism and control at T1 were predictive of feelings of anxiety at T3. Lower perceived control also predicted depressive symptoms. Results support the theory of cognitive adaptation in that patients are indeed able to respond to cancer with high levels of optimism and self-esteem and that lower levels of optimism and control are predictive of psychological distress.
 
OBJECTIVES: To determine the role of optimistic beliefs in adaptation processes of three chronic diseases different in controllability by self-care. It was expected that optimism towards the future would relate to adaptation independently of the controllability of disease. Optimism regarding one's coping ability should be beneficial in controllable diseases. Unrealistic optimism was expected to be beneficial in uncontrollable disease. DESIGN: The cross-sectional design involved 104 patients with type 1 diabetes, 95 patients with rheumatoid arthritis and 98 patients with multiple sclerosis, recruited via their physician at the out-patient department of five hospitals. METHOD: Confirmatory Factor Analysis (LISREL) was employed to confirm a three-dimensional approach of optimism: outcome expectancies, efficacy expectancies and unrealistic thinking. Multi-sample analysis by path modelling was used to examine whether the relationship of the three optimistic beliefs with coping (CISS-21), depression and anxiety (HADS), and physical functioning (SF-36) differs with the controllability based on the self-care options of chronic disease. RESULTS: These show that when chronic disease must be controlled by self-care, physical health depends more strongly on positive efficacy expectancies. In contrast, when self-care options for controlling chronic disease are limited, physical health depends more strongly on positive unrealistic thinking and relates negatively to positive efficacy expectancies. The impact of the three optimistic beliefs on mental health is independent of the controllability by self-care. CONCLUSION: Optimistic beliefs are differently beneficial for physical health dependent on the controllability of chronic disease. Unrealistic beliefs are helpful when patients are confronted with moderately to largely uncontrollable disease where self-care options are limited, in contrast to positive efficacy expectancies that are helpful when patients deal with largely controllable disease where self-care is required.
 
Top-cited authors
Susan Michie
  • University College London
David French
  • The University of Manchester
Mark T Conner
  • University of Leeds
Kristin E Heron
  • Pennsylvania State University
Paschal Sheeran
  • University of North Carolina at Chapel Hill