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The Differential Effects of Gratitude and Sleep on Psychological Distress in Patients with Chronic Pain.

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Abstract

This study aimed to examine the possible cross-sectional mediating role of sleep in the relationship of gratitude with depression and anxiety in patients with chronic pain. A total of 224 patients with chronic pain completed structured questionnaires assessing chronic pain, depression and anxiety symptoms, gratitude, and sleep disturbances. Results of multiple regression analyses yielded a modest mediating effect for sleep on the gratitude-depression link whereas a stronger mediating effect was found for sleep on the gratitude-anxiety link. These data show much of the effect of gratitude on depression was direct whereas sleep exerted a stronger mediating effect on the gratitude-anxiety link.

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... Smith, Perlis and Haythornthwaite found a greater risk of suicide in people suffering from chronic pain when the person's sleep was disrupted (Smith et al., 2004). Sleep disturbance is commonly associated with chronic pain, with one study showing that 76% of the participants with chronic pain had insomnia (Ng & Wong, 2013). ...
... Furthermore, while systematic reviews of RCTs and large controlled studies provide rigorous evidence for the effectiveness of interventions on health outcomes, including chronic pain, it is also useful to conduct cross-sectional studies that help to examine some of the links and mediating effects between dispositional traits and wellbeing. For example, a cross sectional study of 224 chronic pain patients found that dispositional gratitude was associated with lower depression and anxiety, in both cases partly mediated by sleep (Ng & Wong, 2013). In a more recent survey, the positive psychology variables being investigated (mindfulness, gratitude, satisfaction with life, optimism) explained 23% of the variance in pain intensity (Verhiel et al., 2019). ...
... At the level of individual positive psychology variables, the strongest contributor to both models was gratitude, uniquely accounting for 3.24% of the variance in depression scores and 12.25 % of the variance in satisfaction with life scores. This is consistent with the finding of Ng and Wong that gratitude was associated with depression and anxiety in people with chronic pain (Ng & Wong, 2013). It is particularly striking, however, that a far stronger association was found with satisfaction with life than with depression. ...
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Background: Chronic back pain is the leading cause of disability worldwide. Negative mental health outcomes, such as depression and anxiety, are common in those with chronic pain. Positive Psychology Variables (PPVs) including mindfulness, gratitude, pain self-efficacy and self-compassion have variously been found to be associated with the experience of pain itself, and with mental health in those with pain. Aims: The current study sought to assess the relationships of these variables to depression and satisfaction with life in people with chronic back pain. Method: This was an online cross-sectional survey with data from 211 adults with chronic back pain living in Ireland and the UK. Results: Controlling for demographic variables, personality, and level of pain, the four PPVs collectively explained 25.2% of variance in satisfaction with life scores, and 8.8% in depression scores. Gratitude was the strongest unique predictor. Discussion: Dispositional or trait gratitude was found to be an important predictor of satisfaction with life and in depression in people with chronic back pain. Conclusion: Positive psychology variables play an important role in pain-related outcomes. Future research should evaluate the role of gratitude interventions among people with chronic back pain. Keywords: chronic pain; back pain; wellbeing; depression; gratitude; mindfulness; self-compassion; selfefficacy; positive psychology
... Individuals high in trait gratitude value simple pleasures, appreciate how others invest in them, and experience a sense of abundance (Wood, Froh, & Geraghty, 2010); they view themselves as a recipient of gifts (Emmons & McCullough, 2003). Moreover, gratitude may represent an important source of resilience or contributor to quality of life (QoL) even in individuals struggling with adversity such as chronic illness (e.g., Ng & Wong, 2013;Otto, Szczesny, Soriano, Laurenceau, & Siegel, 2016). Individuals with multiple sclerosis (MS) in particular have endorsed lower QoL compared with healthy controls and people with other chronic conditions (Sprangers et al., 2000), yet relatively little research has examined strengths such as trait gratitude as a potential protective factor for QoL in MS. ...
... Studies have consistently linked gratitude to higher well-being in unselected samples (Emmons & McCullough, 2003;Wood et al., 2010), as well as in individuals experiencing chronic illnesses other than MS. For instance, in patients with chronic pain, gratitude was associated with higher sleep quality and lower depression and anxiety (Ng & Wong, 2013). Additionally, in women with breast cancer, gratitude predicted higher positive affect and hopeful thinking, as well as lower negative emotional symptoms, leading the authors to posit gratitude as a resilience factor (Ruini & Vescovelli, 2013). ...
... We acknowledge several limitations in the present study. First, although studies have detected effects of trait gratitude (Ng & Wong, 2013;Ruini & Vescovelli, 2013), gratitude inductions (e.g., Emmons & McCullough, 2003) are required to draw causal conclusions. Our correlational design precludes causal conclusion about the effects of gratitude on QoL in MS, although other studies have detected a range of experimental effects of gratitude (Wood et al., 2010). ...
Article
Purpose/objective: Individuals diagnosed with multiple sclerosis (MS) often experience decreased quality of life (QoL), in part attributable to fatigue, depression (Benedict et al., 2005), and cognitive dysfunction (Cutajar et al., 2000). Beyond these well-established predictors, the positive trait of gratitude-attentiveness to positive features in one's life-has predicted QoL in the context of other chronic illnesses. However, relatively little research has examined the relevance of gratitude as a contributor to QoL in MS. The purpose of the present study was (a) to test whether trait gratitude would predict QoL in MS, above and beyond known predictors (e.g., perceived and objectively assessed cognitive dysfunction, fatigue, and depression symptoms), and (b) to test whether gratitude would buffer (i.e., moderate) the effects of these predictors on QoL. Research Method/Design: This study employed a cross-sectional, single time-point design. Participants formally diagnosed with MS (N = 128) completed a short battery to assess cognitive function and self-report measures of depression, fatigue, perceived cognitive functioning, gratitude, and QoL. Results: Consistent with hypotheses, gratitude uniquely predicted higher QoL beyond other predictors. In addition, gratitude buffered the effect of objective cognitive performance on QoL as expected, but did not interact with other predictors. Conclusions/implications: These results suggest the need for further research into gratitude as a potential source of resilience for individuals with MS. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
... Gratitude. Gratitude has also been shown to protect against depression Lin, 2017;Ng & Wong, 2013) and anxiety (Ng & Wong, 2013;Petrocchi & Couyoumdjian, 2016) both cross-sectionally and longitudinally (Disabato, Kashdan, Short, & Jarden, 2017;Sirois & Wood, 2017;Southwell & Gould, 2017). It is worth mentioning that gratitude has been indirectly related to internalizing symptoms in past work (Disabato et al., 2017;Liang et al., 2018;Petrocchi & Couyoumdjian, 2016), perhaps due to its influence on self-compassionate thought processes (Petrocchi & Couyoumdjian, 2016) and because it promotes positive selfconcept , short-term positive life events (Disabato et al., 2017), and reduces rumination (Liang et al., 2018). ...
... Gratitude. Gratitude has also been shown to protect against depression Lin, 2017;Ng & Wong, 2013) and anxiety (Ng & Wong, 2013;Petrocchi & Couyoumdjian, 2016) both cross-sectionally and longitudinally (Disabato, Kashdan, Short, & Jarden, 2017;Sirois & Wood, 2017;Southwell & Gould, 2017). It is worth mentioning that gratitude has been indirectly related to internalizing symptoms in past work (Disabato et al., 2017;Liang et al., 2018;Petrocchi & Couyoumdjian, 2016), perhaps due to its influence on self-compassionate thought processes (Petrocchi & Couyoumdjian, 2016) and because it promotes positive selfconcept , short-term positive life events (Disabato et al., 2017), and reduces rumination (Liang et al., 2018). ...
... It is also worth noting that prosocial behavior and character strengths were not significantly associated with adolescents' experienced anxiety symptoms. These findings were inconsistent with studies on hope (DiPierro et al., 2018;Martins et al., 2018;Yeung et al., 2015) and gratitude (Ng & Wong, 2013;Petrocchi & Couyoumdjian, 2016;Southwell & Gould, 2017), but were consistent with a recent meta-analysis that reveals no link between prosocial behavior and anxiety (Memmott-Elison et al., 2019). It is possible that prosocial behavior does not protect against anxiety symptoms, but it is also possible that because the current sample is relatively well adjusted, anxiety levels were more indicative of healthy anxiety or normative stress rather than unhealthy anxiety (e.g., Damour, 2019). ...
Article
Introduction: Identifying protective factors against internalizing behaviors during adolescence is a public health priority, as rates of depression and anxiety are rising. As such, the purpose of this study was to examine whether prosocial engagement toward strangers and family members is protective against depressive and anxiety symptoms, and whether this link is mediated by character strengths (i.e., hope, persistence, gratitude, and self-esteem). Method: The sample consisted of 500 US adolescents (52% female; 66% European American; 33% from single-parent families). Data across three consecutive yearly waves were utilized in the current study (Mage Time 1 = 13.32). Results: Results of a longitudinal structural equation model revealed prosocial behavior toward strangers and family members were differentially related to character strengths, and that prosocial behavior toward strangers was indirectly associated with depressive symptoms via self-esteem. Conclusion: Taken together, findings extend the Developmental Cascades model and suggest that prosocial behavior and character strengths protect against depressive symptoms during the adolescent period. Findings are discussed in the context of relevant research and theory, and implications for future research and intervention programs are presented.
... The largest subset of gratitude and health research in this review involves mental health outcomes as re lated factors and, at times, mediators explaining the relationship between gratitude and physical health. A number of studies supported gratitude's relation ship with mental health in addition to physical health (Lambert D 'raven, Moliver, & Thompson, 2015;Ng & Wong, 2013). Yet, mental health is a large and var ied term. ...
... Sleep. Ng and Wong (2013) studied gratitude and sleep in 224 Chinese chronic pain patients. In this correlational and cross-sectional inquiry, insomnia correlated positively with chronic pain symptoms, and higher gratitude was associated with better sleep and lower depression. ...
Article
Gratitude is seen as a central component of Christian theology, and the extant literature suggests that there is an important relation between gratitude and physical health and well-being. In the current review, we summarize 42 studies published since 2009 that inform this relationship. Based on the theoretical framework by Hill, Allemand, and Roberts (2013), we organize our review in three sections that focus on how gratitude influences physical health through (a) mental health, (b) health behaviors, and (c) interpersonal variables. We discuss and integrate the findings from these studies into a theoretical model of gratitude and physical health. In addition to the three mechanisms in the Hill et al. model, we integrate variables from a previously conducted literature review of gratitude and well-being (Wood, Froh, & Geraghty, 2010), and we add personal factors, positive or adverse events, and explicit interventions as antecedents to gratitude in our model. We conclude by discussing future directions for gratitude and health research and its role within Christian psychology.
... Specifically examining psychiatric populations, a gratitude promotion program decreased depressive symptoms in patients with schizophrenia in South Korea (Jung & Han, 2017). Beyond this, few studies have examined gratitude among psychiatric inpatients, but numerous cross-sectional studies demonstrate the protective effects of gratitude against depressive and anxiety symptoms for potentially distressed samples, such as breast cancer patients in the U.S. (Ruini & Vescovelli, 2013), familial caregivers of persons with dementia in China (Lau & Cheng, 2017), trauma exposed college students in the U.S. (Van Dusen et al., 2015), and chronic pain patients in Hong Kong (Ng & Wong, 2012). Likewise, a growing number of studies have examined the protective effects of gratitude across time in distressed samples, such as with acute coronary syndrome patients (Millstein et al., 2016) and inflammatory bowel disease and arthritis patients (Sirois & Wood, 2017). ...
... Similarly, the sample had a higher proportion of White participants and lower proportion of Black participants compared to the typical private psychiatric inpatient hospital in the United States, so findings may be limited to predominately White/Caucasian populations. However, there is some evidence that these findings might persist in less or differently religious settings and across diverse cultures and ethnicities given the persistent association between gratitude and suicide risk in samples outside the U.S. (Jung & Han, 2017;Lau & Cheng, 2017;Li et al., 2012;Lin, 2015;Ng & Wong, 2012;Rey et al., 2019;Varaee et al., 2019). Though far less numerous, international studies on patience also suggest the moderation by life hardships patience replicate across cultures (Hashemi et al., 2018;Valikhani et al., 2017). ...
Article
Objective: Suicidal behavior is a leading cause of injury and death, so research identifying protective factors is essential. Research suggests gratitude and life hardships patience are character strengths that might protect against the deleterious association of struggles with ultimate meaning and suicide risk. However, no studies have evaluated their utility among people experiencing acute/severe mental health concerns. Method: We tested the protective function of gratitude and life hardships patience with cross-sectional data from adults (Mage = 31.83 years; SD = 14.84; range = 18-82) hospitalized in a Christian psychiatric inpatient facility (Mstay = 6.37 days, SD = 4.64). Results: Gratitude and life hardships patience moderated the positive relation between meaning struggles and suicide risk. Specifically, gratitude and life hardships patience protected against meaning struggles as a risk factor for suicide through mechanisms separate from ameliorating depressive symptoms. Conclusions: Findings provide initial support for gratitude and patience interventions as an adjunct to standard psychiatric treatment for minimizing suicide risk.
... Nonetheless, individuals faced with serious illness often express a heightened sense of gratitude or appreciation (Chun & Lee, 2013;Eakin et al., 2017). Among the few investigations that have examined relationships between gratitude and distress in medical samples, gratitude was tied to diminished depressive symptoms in cross-sectional studies of patients with chronic pain (Ng & Wong, 2013) and heart failure (Mills et al., 2015), and in longitudinal studies of individuals with acute coronary syndrome (Millstein et al., 2016), arthritis, and inflammatory bowel disease (Sirois & Wood, 2017). On the other hand, findings were more equivocal in a cross-sectional study with breast cancer survivors (Ruini & Vescovelli, 2013) and not supportive in a longitudinal study of heart failure patients (Sacco et al., 2014). ...
... The current findings built on a previous literature that focused on nonmedical samples (e.g., Disabato et al., 2017;Petrocchi & Couyoumdjian, 2016;Wood et al. 2008), and extend results from the few emerging investigations conducted in medical settings (Mills et al., 2015;Millstein et al., 2016;Ng & Wong, 2013;Sirois & Wood, 2017). They suggest that a generalized tendency to attend to and appreciate positive experiences may help diminish risks for depressive symptoms, despite the jarring disruptions associated with serious illness. ...
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Individuals with cystic fibrosis (CF) are confronted by a range of difficult physical and psychosocial sequelae. Gratitude has drawn growing attention as a psychosocial resource, but it has yet to be examined among adults with CF. The current investigation evaluated longitudinal associations between trait gratitude and subsequent outcomes from depression screening 12 months later, adjusting for disease severity (FEV1% predicted) and other significant clinical or demographic covariates. Participants were 69 adult CF patients recruited from a regional adult treatment center. They completed a validated measure of gratitude (Gratitude Questionnaire-6) at baseline and a screening measure of depression (Hospital Anxiety and Depression Scale) at 12-month follow-up. In a logistic regression analysis controlling for disease severity, higher levels of baseline gratitude were associated with reduced likelihood of depression caseness at 12 months (OR .83, 95% CI .73–.91, p = .001). Gratitude remained predictive after adjusting for other psychosocial resource variables (i.e., perceived social support and positive reframing coping). Findings offer an initial indication of the potential salutary role of dispositional gratitude in an understudied clinical population.
... Journal Pre-proof Clearly, these findings should be interpreted with caution due to several limitations. Despite these caveats, the suggestion that gratitude interventions may improve subjective sleep quality is consistent with cross-sectional gratitude research showing a strong relationship between gratitude and better sleep quality (45). Earlier studies suggest the relationship between gratitude and sleep quality may be mediated by more positive and less negative pre-sleep cognitions (49). ...
... Earlier studies suggest the relationship between gratitude and sleep quality may be mediated by more positive and less negative pre-sleep cognitions (49). In patients with chronic pain, sleep quality has been shown to mediate the relationship between gratitude and anxiety (45). This may imply that gratitude has a more immediate effect on pre-sleep cognitions, influencing sleep quality, and providing a possible explanation for the promising results reported for sleep quality over other physical health outcomes reviewed. ...
Article
Objective Gratitude interventions are easy-to-deliver, offering promise for use in clinical-care. Although gratitude interventions have consistently shown benefits to psychological wellbeing, the effects on physical health outcomes are mixed. This systematic review aims to synthesize gratitude intervention studies which assessed physical health and health behavior outcomes, as well as evaluate study quality, comment on their efficacy, and provide directions for future research. Methods Relevant studies were identified through searches conducted in PsycINFO, MedLine, Embase and Cochrane Library databases, up until August 2019. Only studies that evaluated a gratitude intervention, randomly assigned participants to gratitude and control conditions, and assessed objective and subjective measures of physical health and health behaviors were included. The Revised Cochrane risk-of-bias (RoB2) tool was used to assess risk of bias. Results Of the 1433 articles found, 19 were included in the review. Subjective sleep quality was improved in 5/8 studies. Improvements in blood pressure, glycemic control, asthma control and eating behavior were understudied yet demonstrated improvements (all 1/1). Other outcome categories remain understudied and mixed, such as inflammation markers (1/2) and self-reported physical symptoms (2/8). The majority of studies showed some risk of bias concerns. Conclusions Although it was suggested gratitude interventions may improve subjective sleep quality, more research is still needed to make firm conclusions on the efficacy of gratitude interventions on improving health outcomes. Further research focusing on gratitude's link with sleep and causal mechanisms is needed, especially in patient populations where more ‘clinically-usable’ psychosocial interventions are urgently needed.
... Given the above definition, gratitude can be conceptualized as one of many positive mental health indicators. Research has demonstrated that gratitude is positively associated with subjective wellbeing, negatively correlated with psychological distress, and positively associated with prosocial behavior (e.g., Krause, 2009;McCullough, Emmons, & Tsang, 2002;McCullough, Tsang, & Emmons, 2004;Ng & Wong, 2013;Park, Peterson, & Seligman, 2004;Renshaw & Steeves, 2016;Wood, Joseph, & Maltby, 2009). In their review of the empirical literature, Wood, Froh, and Geraghty (2010) concluded that "the size of the unique relationships between gratitude and subjective and eudemonic well-being appears substantial, suggesting that gratitude has a unique and distinct impact on well-being, and is a worthwhile subject for specific future research in the area" (p. ...
Article
Gratitude-based interventions have been shown to significantly improve positive indicators of mental health and reduce negative indicators of mental health. The present study used a randomized controlled trial design to test a brief grateful thinking-only exercise with a sample of college students (N = 97). Participants in the gratitude-based intervention condition (n = 54) were instructed to spend five minutes each day thinking about something they were grateful for, while participants in the activity-matched control condition (n = 43) were instructed to spend the same amount of time thinking about something they had learned recently. Descriptive results indicated that, compared to the control exercise, the grateful thinking-only exercise had greater therapeutic effects on happiness, life satisfaction, depression, stress, and negative affect. However, consideration of effect-size confidence intervals and associated inferential statistics suggested that we could not ultimately reject the null hypothesis. Overall, results suggest the need for including both activity-matched and passive control conditions within gratitude-based intervention research.
... Gratitude is an emotion in which individuals feel grateful for the favor or help that they receive and try to return (Ng and Wong, 2013;Proyer et al., 2013). Gratitude includes trait gratitude (ongoing emotion) and state gratitude (spontaneous emotion). ...
Article
This study investigated the relationship among emotional intelligence, gratitude, and subjective well-being in a sample of university students. A total of 365 undergraduates completed the emotional intelligence scale, the gratitude questionnaire, and the subjective well-being measures. The results of the structural equation model showed that emotional intelligence is positively associated with gratitude and subjective well-being, that gratitude is positively associated with subjective well-being, and that gratitude partially mediates the positive relationship between emotional intelligence and subjective well-being. Bootstrap test results also revealed that emotional intelligence has a significant indirect effect on subjective well-being through gratitude.
... Gratitude techniques have been utilised in a Japanese culture to reduce symptoms of anxiety. A study conducted by Ng and Wong (2013) investigated the differential effect of gratitude and sleep on psychological distress in patients with chronic pain. The study found that there was a direct impact of gratitude on depression. ...
... Gratitude for work appeared to predict well-being: a higher level of gratitude was associated with a lower risk of psychological distress and sleep problems, which is in line with precedent studies [97][98][99]. Researchers are currently developing various intervention programs to increase gratitude in the workplace [100,101], which could be a promising way to suppress the negative effects of CB and TB victimization on well-being. ...
Article
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Background The rapid introduction of teleworking due to the coronavirus disease 2019 pandemic has led to concerns about increases in cyberbullying (CB) worldwide. However, little is known about workplace CB in non-Western countries. The first objective was to clarify the prevalence and characteristics regarding workplace CB victimization in Japan. The second objective was to demonstrate the psychological outcomes of CB victimization in combination with traditional bullying (TB). Methods We conducted an anonymous, cross-sectional, Internet-based survey targeting regular employees in Japan ( N = 1200) in January 2021. We investigated CB victimization using the Inventory of Cyberbullying Acts at Work and TB victimization by using the Short Negative Act Questionnaire. Possible explanatory factors for TB/CB victimization were sociodemographic variables, personality trait, chronic occupational stress, organizational climate, and gratitude at work. We also measured psychological distress, insomnia, and loneliness to assess adverse effects of workplace bullying. Two-step cluster analysis was used in determining the patterns combined with TB and CB victimization. Hierarchical binomial logistic regression analysis was used. Results In total, 8.0% of employees reported experiencing CB on a weekly basis. CB victimization was associated with younger age, managerial position, higher qualitative workload, and active information dissemination via the Internet, and frequency of teleworking. Three clusters based on TB and CB victimization patterns were identified: those who belong to the first cluster suffered neither from TB and CB (81.0%), the second cluster suffered only from TB (14.3%), and the third cluster suffered from both TB and CB (4.8%). The third cluster exhibited higher odds ratios (ORs) and 95% confidence intervals (CIs) for psychological distress (OR = 12.63, 95% CI = 4.20–38.03), insomnia (OR = 6.26, 95% CI = 2.80–14.01), and loneliness (OR = 3.24, 95% CI = 1.74–6.04) compared to the first cluster. Conclusions These findings firstly clarify the prevalence and correlated factors of CB victimization among employees in Japan. Further, we showed that psychological wellbeing can be impaired by the coexistence of TB and CB. Our research could be the first step to develop the effective countermeasures against workplace CB.
... The relationship between gratitude and physical health in clinical populations has found similar findings. Ng and Wong (2013) for example, examined people with chronic musculoskeletal pain problems 76% of whom had insomnia and found that gratitude predicted significantly better sleep. Mills et al. (2015) examined the role of gratitude in patients with stage B asymptomatic heart failure. ...
Article
The empirical study of gratitude has experienced unprecedented growth in the past decade. As such there is now a growing body of research showing the emotional, social and psychological health benefits of being grateful. More recently, emerging research is indicating that being grateful may also positively impact physical health. However, the underlying mechanisms explaining this effect are yet to be fully explored. This research examines the relationship between dispositional gratitude and self-reported physical health symptoms, and explores whether this relationship occurs because grateful individuals have fewer experiences of loneliness. In a sample of 118 adults, gratitude significantly predicted fewer physical health symptoms (sleep disturbances, headaches, episodes of respiratory infections and gastrointestinal problems) and experiences of loneliness. Simple mediation analysis revealed that the positive effect of gratitude on self-reported physical health symptoms was significantly mediated by lower reported levels of loneliness. Therefore participants who reported higher levels of gratitude, also reported lower levels of loneliness, and this then predicted better self-reported physical health symptoms. As attention to the intervening mechanisms underlying the relationship between gratitude and physical health has only begun to be investigated, the study offers novel preliminary information regarding the psychosocial mediators accounting for this association.
... ej. Chan, 2010;Emmons & McCullough, 2003;Martínez-Martí, Avia & Hernández-Lloreda, 2010;Nelson, 2009;Ng & Wong, 2013;Rash, Matsuba & Prkachin, 2011). Lo anterior favorece su utilización en diversas intervenciones dirigidas a fomentar el bienestar y disminuir síntomas depresivos (p. ...
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El objetivo de esta investigación fue evaluar las propiedades psicométricas del Gratitude Questionnaire – 6 (McCullough y Emmons, 2002) en población chilena. En el estudio participaron 307 hombres y 295 mujeres de diferente grupo etario. En primer lugar, se estimó la confiabilidad y validez de constructo de la escala. En segundo lugar, se analizaron indicadores de validez basados en la convergencia y divergencia con los instrumentos: Cuestionario de los Cinco Grandes, Escala de Satisfacción Vital, Escala de Afectos Positivos y Negativos y el Test de Orientación Vital Revisado. Los resultados indican adecuación del cuestionario para su utilización en la evaluación de la gratitud en población chilena.
... Gratitude, defined as a felt sense of wonder, thankfulness, and appreciation for life (Emmons & Shelton, 2002), is a part of positive psychology. It was negatively associated with depression (Ng & Wong, 2013); it moderated associations between some risk factors (e.g., stress) and depression (Krause, 2009). Interventions can effectively enhance gratitude in some disease groups (e.g., neuromuscular disease) . ...
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HIV-positive men who have sex with men (HIVMSM) face severe stigma and high levels of stressors, and have high prevalence of mental health problems (e.g., depression and anxiety). Very few studies explored the role of positive psychological factors on mental health problems among HIVMSM. The present study investigated the prevalence of two mental health problems (anxiety and depression), and their associated protective (gratitude) and risk (enacted HIV-related stigma, and perceived stress) factors among HIVMSM in China. A cross-sectional survey was conducted among 321 HIVMSM in Chengdu, China, by using a structured questionnaire. Over half (55.8%) of the participants showed probable mild to severe depression (as assessed by the Center of Epidemiologic Studies Depression scale); 53.3% showed probable anxiety (as assessed by the General Anxiety Disorder scale). Adjusted logistic regression models revealed that gratitude (adjusted odds ratio (ORa = 0.90, 95% confidence intervals (95% CI) = 0.86-0.94) was found to be protective, whilst perceived stress (ORa = 1.17, 95% CI = 1.12-1.22) and enacted stigma (ORa = 7.72, 95% CI = 2.27-26.25) were risk factors of depression. Gratitude (ORa = 0.95, 95% CI = 0.91-0.99) was also found to be protective whilst perceived stress (ORa = 1.19, 95% CI = 1.14-1.24) was a risk factor of anxiety. Gratitude did not moderate the associations found between related factors and poor mental health. It is warranted to promote mental health among HIVMSM, as depression/anxiety was highly prevalent. Such interventions should consider enhancement of gratitude, reduction of stress, and removal of enacted stigma as potential strategies, as such factors were significantly associated with depression/anxiety among HIVMSM.
... Similarly, Krause and Bastida (2012) found that individuals who felt deeply connected to others were more likely to feel gratitude and this helped reduce feelings of death anxiety. This finding may be explained by the evidence that grateful people tend to adopt positive coping strategies, such as positive reframing (Ng & Wong, 2013). In this way, grateful people may be more likely to focus their appreciation on a life that has been lived, instead of on a life that has been lost. ...
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This study examined the combined influence of six positive psychology variables (optimism, hope, self-efficacy, grit, gratitude, and subjective life satisfaction), termed covitality, in relation to buffering individuals against anxiety symptoms. In addition, the influence of self-deception was examined to test whether this construct had an influence on the reporting of these positive psychology variables. A total of 268 individuals (203 females and 65 males) with a mean age of 22.2 years (SD = 7.4 years) from one Queensland university took part in the study. The participants completed an online questionnaire, which included a battery of positive psychological measures, plus a measure of anxiety and self-deception. The results indicated that the covitality constructs had a moderation effect on anxiety. In a regression analysis, the six covitality constructs explained an additional 24.5% of the variance in anxiety, after controlling for self-deception. Further analyses revealed that those higher in self-deception scored higher in self-efficacy and all positive covitality measures and lower in anxiety, than those lower in self-deception. These findings illustrate the importance of considering the role that self-deception might play in the reporting of positive psychology variables. see http://www.tandfonline.com/eprint/QpRZ6GGRZRgbRIZmaxby/full for access
... For example, exercises on gratitude-the gratitude letter and counting blessings-had high utility scores and were associated with substantial improvements in optimism. This finding is consistent with prior work that has linked gratitude to lower levels of depression, hopelessness and suicidal thoughts/attempts [13,[52][53][54][55][56], though is in some contrast to a study that found a gratitude letter to reduce depressive symptoms in mildly, but not more severely, depressed participants [57]. The exercise focusing on a personal strength was also associated with substantial improvements in this population and was perceived as easy to complete, consistent with prior work finding this exercise to be associated with prolonged improvement in depressive symptoms [19]. ...
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The objective was to assess the feasibility and acceptability of nine positive psychology exercises delivered to patients hospitalized for suicidal thoughts or behaviors, and to secondarily explore the relative impact of the exercises. Participants admitted to a psychiatric unit for suicidal ideation or behavior completed daily positive psychology exercises while hospitalized. Likert-scale ratings of efficacy (optimism, hopelessness, perceived utility) and ease of completion were consolidated and compared across exercises using mixed models accounting for age, missing data and exercise order. Overall effects of exercise on efficacy and ease were also examined using mixed models. Fifty-two (85.3%) of 61 participants completed at least one exercise, and 189/213 (88.7%) assigned exercises were completed. There were overall effects of exercise on efficacy (χ(2)=19.39; P=.013) but not ease of completion (χ(2)=11.64; P=.17), accounting for age, order and skipped exercises. Effect (Cohen's d) of exercise on both optimism and hopelessness was moderate for the majority of exercises. Exercises related to gratitude and personal strengths ranked highest. Both gratitude exercises had efficacy scores that were significantly (P=.001) greater than the lowest-ranked exercise (forgiveness). In this exploratory project, positive psychology exercises delivered to suicidal inpatients were feasible and associated with short-term gains in clinically relevant outcomes.
... Interventions that focus on gratitude increase positive affect and decrease negative affect (Emmons and McCullough, 2003;Sheldon and Lyubomirsky, 2006;Froh et al., 2008). Gratitude contributes to well-being (Wood et al., 2010), and there are positive impacts on both mental health (Lambert et al., 2012;Ng and Wong, 2013;Cheng et al., 2015;Mills et al., 2015;Van Dusen et al., 2015;Otto et al., 2016;Shao et al., 2016;Wong et al., 2016) and physical health (Jackowska et al., 2015;Redwine et al., 2016; but see Huffman et al., 2016). A recent review speculates that µ-opioids could be a potential mediator of these health effects (Henning et al., 2017). ...
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Gratitude is an emotion and a trait linked to well-being and better health, and welcoming benefits to oneself is instrumentally valuable. However, theoretical and empirical work highlights that gratitude is more fully understood as an intrinsically valuable moral emotion. To understand the role of neural reward systems in the association between gratitude and altruistic motivations we tested two hypotheses: First, whether self-reported propensity toward gratitude relates to fMRI-derived indicators of “pure altruism,” operationalized as the neural valuation of passive, private transfers to a charity versus to oneself. In young adult female participants, self-reported gratitude and altruism were associated with “neural pure altruism” in ventromedial prefrontal cortex (VMPFC) and nucleus accumbens. Second, whether neural pure altruism can be increased through practicing gratitude. In a double-blind study, we randomly assigned participants to either a gratitude-journal or active-neutral control journal group for 3 weeks. Relative to pre-test levels, gratitude journaling increased the neural pure altruism response in the VMPFC. We posit that as a context-dependent value-sensitive cortical region, the VMPFC supports change with gratitude practice, a change that is larger for benefits to others versus oneself.
... In two studies, Wood et al. (2008a, b) found that people with higher levels of dispositional gratitude appraised support received from others as more helpful than individuals with lower levels gratitude. Such changes in coping efforts may lead to better health behaviors such as improved sleep quality which may account for improved mental health (Ng and Wong 2013;Wood et al. 2009). ...
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The current study is a cross-sectional examination of the stress-buffering effects of gratitude. Specifically, the purpose of this study was to examine whether various aspect of gratitude—appreciation of others, simple appreciation, and sense of abundance—functioned equivalently as stress-buffers and alleviated negative psychological and physical reactions to life events. One-hundred eighty-one college students completed self-report, retrospective measures of dispositional gratitude, depressive symptoms, and physical symptoms, as well as the amount of stressful life events experienced. Data were analyzed using multiple hierarchical regression. The results of the analyses revealed significant statistical interactions between appreciation of others, stressful life events, and both depressive and physical symptoms. Specifically, participants reporting a greater sense of appreciation of others also reported lower levels of depressive and physical symptoms when experiencing stress. Our results are consistent with previous research that demonstrates the protective health benefits of gratitude but highlights the importance of considering the unique aspects of the different components of gratitude.
... Essas intervenções concluem com associações consistentes dessa emoção com o bem-estar subjetivo (Watkins, 2014b). Na literatura, encontramos evidências de que a Gratidão está relacionada com o aumento da liberação de oxitocina, "hormônio do bem-estar", no corpo (Algoe & Way, 2014), a melhora na qualidade de sono (Ng & Wong, 2013) e capacidades cognitivas (Kini, Wong, McInnis, Gabana & Brown, 2016), por aprimorar a atenção e memória. Em estudos com chineses com demência cognitiva, a Gratidão foi uma variável protetiva também para aspectos relacionados à presença de sintomas de depressão e ansiedade (Lau & Cheng, 2017). ...
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Resumo: O aumento do envelhecimento global tem despertado interesse em diversas áreas da saúde que almejam que essa etapa seja vivida de forma saudável e bem-sucedida. A gratidão vem se mostrado um constructo valioso para o desenvolvimento e fortalecimento das forças pessoais. Estudos da gratidão e outras emoções positivas relacionadas ao do envelhecimento se tornam importantes devido à contribuição na gerontologia para o desenvolvimento de estratégias que promovam qualidade de vida à população idosa. Este estudo consiste em uma revisão de literatura, cujo objetivo foi explorar na literatura existente evidências da gratidão relacionada ao envelhecimento bem sucedido. Nos resultados foi possível observar que estudos existentes apresentam a gratidão como uma emoção importante promotora de saúde mental. Algumas intervenções evidenciam as associações entre os níveis de gratidão com os de bem-estar subjetivo, redução de ansiedade e depressão e aumento da qualidade de vida. Palavras-chave: Gratidão; Envelhecimento Bem-Sucedido; Psicologia Positiva. Abstract: The global aging has provoked interest in several healthcare areas that aim for improving this stage of life, so that it can be lived in a healthy and successful way. Gratitude has proved to be a valuable construct for the development and strengthening of personal strengths. Studies of gratitude and other positive emotions related to aging become important due to the contribution in gerontology to the development of strategies that promote quality of life for the elderly population. This study consists of a review of literature, the goal was to explore in the existing literature evidence of gratitude related to successful aging. From the results, it was possible to observe that existing studies present gratitude as an important emotion that promotes mental health. Some interventions show the associations between levels of gratitude with subjective well-being, reduction of anxiety and depression, and increased quality of life.
... Essas intervenções concluem com associações consistentes dessa emoção com o bem-estar subjetivo (Watkins, 2014b). Na literatura, encontramos evidências de que a Gratidão está relacionada com o aumento da liberação de oxitocina, "hormônio do bem-estar", no corpo (Algoe & Way, 2014), a melhora na qualidade de sono (Ng & Wong, 2013) e capacidades cognitivas (Kini, Wong, McInnis, Gabana & Brown, 2016), por aprimorar a atenção e memória. Em estudos com chineses com demência cognitiva, a Gratidão foi uma variável protetiva também para aspectos relacionados à presença de sintomas de depressão e ansiedade (Lau & Cheng, 2017). ...
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Resumo: O aumento do envelhecimento global tem despertado interesse em diversas áreas da saúde que almejam que essa etapa seja vivida de forma saudável e bem-sucedida. A gratidão vem se mostrado um constructo valioso para o desenvolvimento e fortalecimento das forças pessoais. Estudos da gratidão e outras emoções positivas relacionadas ao do envelhecimento se tornam importantes devido à contribuição na gerontologia para o desenvolvimento de estratégias que promovam qualidade de vida à população idosa. Este estudo consiste em uma revisão de literatura, cujo objetivo foi explorar na literatura existente evidências da gratidão relacionada ao envelhecimento bem sucedido. Nos resultados foi possível observar que estudos existentes apresentam a gratidão como uma emoção importante promotora de saúde mental. Algumas intervenções evidenciam as associações entre os níveis de gratidão com os de bem-estar subjetivo, redução de ansiedade e depressão e aumento da qualidade de vida. Palavras-chave: Gratidão; Envelhecimento Bem-Sucedido; Psicologia Positiva. Abstract: The global aging has provoked interest in several healthcare areas that aim for improving this stage of life, so that it can be lived in a healthy and successful way. Gratitude has proved to be a valuable construct for the development and strengthening of personal strengths. Studies of gratitude and other positive emotions related to aging become important due to the contribution in gerontology to the development of strategies that promote quality of life for the elderly population. This study consists of a review of literature, the goal was to explore in the existing literature evidence of gratitude related to successful aging. From the results, it was possible to observe that existing studies present gratitude as an important emotion that promotes mental health. Some interventions show the associations between levels of gratitude with subjective well-being, reduction of anxiety and depression, and increased quality of life.
... Furthermore, there is a strong association between psychological pain and suicidal risk, regardless of depression (Ducasse et al., 2018a). Given the shared neurobiological pathways between psychological and physical pain (Eisenberger, 2012), it seems interesting to notice that positive psychology interventions based on gratitude have shown an impact in reducing physical pain (Ng & Wong, 2013). ...
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Background: The management of suicidal crisis remains a major issue for clinicians, driving the development of new strategies. Methods: We conducted a randomized controlled trial based on a 7-day add-on positive psychology program: gratitude diary (intervention) versus food diary (control) in adults hospitalized for current suicidal ideation or a suicide attempt. The primary effectiveness outcome was between-group differences for mean change of current psychological pain, between the beginning and the end of the 7-day intervention. We measured between-group differences for mean change of suicidal ideation, hopelessness and optimism, and depression and anxiety between inclusion and after the completion of the 7-day intervention. We compared mean change of current psychological pain, suicidal ideation, and hopelessness and optimism between immediate pre and post daily journal completion. Results: Two hundred and one participants were enrolled and randomized. Between pretherapy and posttherapy: There were no significant between-group differences for mean change of severity and intensity of suicidal ideation and current hopelessness. Between-group difference for mean change of current psychological pain was trending (P = 0.05). Mean change of depression, anxiety, and optimism was significantly higher in the intervention than in the control group. Between immediate pre and post daily journal completion: Between-group differences favored gratitude (vs. food) diary for all outcomes (psychological pain, suicidal ideation, and hopelessness and optimism; P < 10-3 ). Participants found the intervention to be more useful than the food diary. Conclusions: Through gratitude diary appears a very straightforward intervention that could be developed as an adjunctive strategy for suicidal patients.
... In recent years, a growing body of research has drawn attention to the benefits of gratitude for personal health and wellbeing (e.g., Lavelock et al. 2016, Yoshimura andBerzins 2017). Studies have shown that a grateful disposition offers some protection against depression and anxiety Tsang 2002, Petrocchi andCouyoumdjian 2016), improves sleep ( Alkozei et al. 2017, Emmons and McCullough 2003, Ng and Wong 2013, reduces stress, and buffers the effects of traumatic events (Vieselmeyer, Holguin, and Mezulis 2016, Wood, Joseph, andMaltby 2009). ...
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Gratitude has been heralded as important to emotional, social and societal wellbeing. A burgeoning body of recent research on the positive impact of gratitude in sport calls for an investigation into its relevance to the field of elite sport, particularly for building resilience and enhancing relationships. An interpretivist/constructivist research approach was adopted to explore the practices, outcomes and challenges of gratitude of 10 Australian elite athletes – Olympians and Para-Olympians – who participated in a workshop on gratitude. Sports represented in this cohort included cycling, sailing, track and field, beach volleyball and diving. Semi-structured interviews were used to generate data, which were explored using content analysis. Enhancement of gratitude with the elite athletes resulted in the adoption of more meaningful and authentic gratitude towards others. Positive impact of gratitude expressed in this way was reported in the areas of improved attitude; greater awareness; better capacity to deal with stress; increased confidence to express gratitude; and enhanced performance. The paper also discusses the perceived challenges of expressing gratitude within this context.
... High levels of trait gratitude (i.e., the disposition to experience gratitude more frequently) have been associated with a number of psychological and physical health benefits (see Alkozei et al. 2018 for a review). For example, correlational studies have shown that individuals who report high levels of trait gratitude report greater life satisfaction, happiness, and fewer symptoms of anxiety and depression, as well as better physical health (e.g., less pain) and better sleep quality (Hill et al. 2013;McCullough et al. 2004;Ng and Wong 2013). Longitudinal studies have also shown that higher levels of trait gratitude can predict greater future subjective wellbeing (SWB) in terms of lower depressive symptoms, lower perceived stress, and reduced risk for suicidality one to six months later (Kleiman et al. 2013a, b;Lambert et al. 2012;Wood et al. 2008). ...
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High levels of trait gratitude are associated with lower levels of depressive symptoms, but the potential mechanisms underlying this relationship have not been extensively studied. One potential explanation for this relationship is that individuals with higher levels of trait gratitude may have a more positive cognitive style, such that they interpret, attend to, and remember events in a more positive rather than negative manner. This study aimed to explore whether one aspect of a positive cognitive style, a positive interpretation bias, is a mediator in the relationship between trait gratitude and depressive symptoms. During a single visit to the lab, we asked eighty-eight individuals (41 females) to complete a measure of trait gratitude (the Gratitude Resentment and Appreciation Test [GRAT]), two measures of interpretation bias (the Sentence Completion Test for Depression [SCD], and the Ambiguous Scenarios Test for Depression [ASTD]), and a measure of depressive symptoms (the Beck Depression Inventory [BDI-II]). The results of the mediation analyses indicated that a positive interpretation bias partially explained the relationship between trait gratitude and depressive symptoms. These findings suggest that trait gratitude may reduce depressive symptoms in part through its effects on positive thinking patterns. Future longitudinal studies will be needed to elucidate the causal relationship between these variables in greater detail.
... 33 Evidence suggests that individuals with higher levels of gratitude adopt positive coping strategies (eg, reframing) and healthpromoting behaviors that boost personal resources to DovePress adapt to adversity. 59 In the context of pain, gratitude may prompt people to reinterpret pain as less aversive (ie, "I am glad/grateful for my cane/walker" and "I can keep going despite the pain"); in turn, this adaptive cognitive appraisal may lead to reductions in pain symptomatology. Discrete experiences of gratitude may also improve biological processes such as inflammation, 60 and increase parasympathetic heart rate variability, which have been associated with reduced pain sensitivity. ...
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Introduction: Racial minorities are disproportionally affected by pain. Compared to non-Hispanic Whites (NHWs), non-Hispanic Blacks (NHBs) report higher pain intensity, greater pain-related disability, and higher levels of mood disturbance. While risk factors contribute to these disparities, little is known regarding how sources of resilience influence these differences, despite the growing body of research supporting the protective role of resilience in pain and disability among older adults with chronic pain. The current study examined the association between psychological resilience and pain, and the moderating role of race across these relationships in older adults with chronic low back pain (cLBP). Methods: This is a secondary analysis of the Adaptability and Resilience in Aging Adults (ARIAA). Participants completed measures of resilience (ie, gratitude, trait resilience, emotional support), as well as a performance-based measure assessing lower-extremity function and movement-evoked pain. Results: There were 45 participants that identified as non-Hispanic White (NHW) and 15 participants that identified as non-Hispanic Black (NHB). Race was a significant correlate of pain outcomes with NHBs reporting greater movement-evoked pain (r = 0.27) than NHWs. After controlling for relevant sociodemographic characteristics, measures of movement-evoked pain were similar across both racial groups, F (1, 48) = 0.31, p = 0.57. Moderation analyses revealed that higher levels of gratitude (b = -1.23, p = 0.02) and trait resilience (b = -10.99, p = 0.02) were protective against movement-evoked pain in NHWs. In contrast, higher levels of gratitude were associated with lower functional performance in NHBs (b = -0.13, p =0.02). Discussion: These findings highlight racial differences in the relationship between resilience and pain-related outcomes among older adults with cLBP. Future studies should examine the potential benefits of targeted interventions that improve resilience and ameliorate pain disparities among racial minorities.
... Sleep quality is a significant section of health that has been found to be associated with many psychological factors (Baglioni et al., 2010;Casement, MD, 2012;Ng and Wong, 2012). Poor sleep quality has negatively influenced the activities Garms-Homolova et al., 2010) and even triggered many disorders (Mollaoglu, 2012). ...
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We examined the association of gratitude with perceived stress and burnout in firefighters. A total of 464 male firefighters completed a self-administered questionnaire including sociodemographic characteristics, the Korean version of the Gratitude Questionnaire (K-GQ-6), Perceived Stress Scale (PSS), Maslach Burnout Inventory-General Survey (MBI-GS), Big Five Inventory-10 (BFI-10), and the Hospital Anxiety and Depression Scale. The K-GQ-6 score was negatively correlated with the PSS and MBI-GS exhaustion and cynicism scores. The linear regression analysis revealed that gratitude was negatively associated with perceived stress and the exhaustion and cynicism burnout subscales after controlling for religiousness, personality variables, anxiety, and depression. These findings suggest that gratitude acts as an independent protective factor against stress and burnout. Gratitude should be incorporated into training and psychoeducation throughout the course of a firefighter's career.
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We examined sleep difficulties preceding death in a sample of adolescent suicide completers as compared with a matched sample of community control adolescents. Sleep disturbances were assessed in 140 adolescent suicide victims with a psychological autopsy protocol and in 131 controls with a similar semistructured psychiatric interview. Rates of sleep disturbances were compared between groups. Findings indicate suicide completers had higher rates of overall sleep disturbance, insomnia, and hypersomnia as compared with controls within both the last week and the current affective episode. Group differences in overall sleep disturbance (both within the last week and present episode), insomnia (last week), and hypersomnia (last week) remained significant after controlling for the differential rate of affective disorder between groups. Similarly, overall sleep disturbance (last week and present episode) and insomnia (last week) distinguished completers in analyses accounting for severity of depressive symptoms. Only a small percentage of the sample exhibited changes in sleep symptom severity in the week preceding completed suicide, but of these, a higher proportion were completers. These findings support a significant and temporal relationship between sleep problems and completed suicide in adolescents. Sleep difficulties should therefore be carefully considered in prevention and intervention efforts for adolescents at risk for suicide.
Article
The effect of a grateful outlook on psychological and physical well-being was examined. In Studies 1 and 2, participants were randomly assigned to 1 of 3 experimental conditions (hassles, gratitude listing, and either neutral life events or social comparison); they then kept weekly (Study 1) or daily (Study 2) records of their moods, coping behaviors, health behaviors, physical symptoms, and overall life appraisals. In a 3rd study, persons with neuromuscular disease were randomly assigned to either the gratitude condition or to a control condition. The gratitude-outlook groups exhibited heightened well-being across several, though not all, of the outcome measures across the 3 studies, relative to the comparison groups. The effect on positive affect appeared to be the most robust finding. Results suggest that a conscious focus on blessings may have emotional and interpersonal benefits.
Article
In four studies, the authors examined the correlates of the disposition toward gratitude. Study 1 revealed that self-ratings and observer ratings of the grateful disposition are associated with positive affect and well-being prosocial behaviors and traits, and religiousness/spirituality. Study 2 replicated these findings in a large nonstudent sample. Study 3 yielded similar results to Studies 1 and 2 and provided evidence that gratitude is negatively associated with envy and materialistic attitudes. Study 4 yielded evidence that these associations persist after controlling for Extraversion/positive affectivity, Neuroticism/negative affectivity, and Agreeableness. The development of the Gratitude Questionnaire, a unidimensional measure with good psychometric properties, is also described.
Article
Gratitude, like other positive emotions, has inspired many theological and philosophical writings, but it has inspired very little vigorous, empirical research. In an effort to remedy this oversight, this book brings together prominent scientists from various disciplines to examine what has become known as the most-neglected emotion. The volume begins with the historical, philosophical, and theoretical foundations of gratitude, and then presents the current research perspectives from social, personality, and developmental psychology, as well as from primatology, anthropology, and biology. The volume also includes a comprehensive, annotated bibliography of research on gratitude. This work contributes a great deal to the growing positive psychology initiative and to the scientific investigation of positive human emotions. It will be an invaluable resource for researchers and students in social, personality, developmental, clinical, and health psychology, as well as to sociologists and cultural anthropologists.
Article
Anxiety sensitivity (AS) is a construct that denotes an individual difference in fear of anxiety. Most research into the AS construct has focused on its association with panic attacks, panic disorder and several other psychiatric disorders. There has been growing interest recently in AS as an important factor in the maintenance and exacerbation of morbidity associated with some disabling chronic health conditions (e.g. gastrointestinal dysfunction, asthma, vestibular dysfunction and chronic pain). The purposes of this paper are (a) to provide a brief overview of the theoretical framework within which the AS and chronic health condition literature can be synthesized, (b) to review the existing literature regarding AS and chronic health conditions and (c) to offer recommendations for assessment and treatment. Theoretically and practically relevant directions for future investigation are provided throughout the review.
Article
We hypothesized that gratitude would be related to sense of coherence via positive reframing, which is a process by which negative events or circumstances are seen in a positive light. We tested this hypothesis in two studies. In Study 1 (N =166) we found a strong, robust relationship between trait gratitude and sense of coherence above and beyond life satisfaction, positive and negative affect, happiness, and social desirability. Study 2 (N =275) showed that gratitude at Time 1 predicted sense of coherence at Time 2, controlling for baseline scores. Positive reframing mediated the relationship between gratitude and SOC. Results are discussed in terms of their practical implications.
Article
Objective The aim of this study was to validate the Chinese-Cantonese version of the Hospital Anxiety and Depression Scale (HADS) and to compare it with the Hamilton Rating Scale of Depression (HRSD) as a screening tool for depressive disorders in general hospital in-patients.Method The Chinese-Cantonese version of the HADS was administered to general hospital in-patients seen on a consultation basis, and psychiatric diagnoses were made according to DSM-111-R. The subjects were further rated independently with the HRSD.ResultsThe Chinese-Cantonese version of the HADS was found to have good internal consistency and external validity, with favourable sensitivity and specificity for screening for psychiatric disorders. However, its performance was marginally inferior to that of the HRSD. The scale also performed poorly in identifying major depression.Conclusion The HADS has limitations with regard to identification of depressive disorders. However, despite its shortcomings, it remains one of the best paper-and-pencil tests for screening psychiatric disorders in the medically ill.
Article
ABSTRACT– A self-assessment scale has been developed and found to be a reliable instrument for detecting states of depression and anxiety in the setting of an hospital medical outpatient clinic. The anxiety and depressive subscales are also valid measures of severity of the emotional disorder. It is suggested that the introduction of the scales into general hospital practice would facilitate the large task of detection and management of emotional disorder in patients under investigation and treatment in medical and surgical departments.
Article
SYNOPSIS Recent epidemiologic studies have reported an association between migraine and major depression. Little is known about the mechanisms that link the two disorders, or the natural history of their co-occurrence. We examined the association between migraine and major depression in a sample of young adults, using longitudinal data. Method: A random sample of 1,007 young adults (21–30 years of age) members of a large HMO in Southeast Michigan was interviewed in 1989; 97% of the sample were reinter-viewed 3.5 years later, in 1992. A structured diagnostic interview was used to elicit information on DSM-III-R major depression and IHS migraine in lifetime (in the 1989 interview) and during the 3.5 year follow-up interval (in the 1992 interview). Using Cox-proportional hazards models with time-dependent covariates, we estimated the relative risk for major depression associated with prior migraine and the relative risk for migraine associated with prior major depression. Results: In this sample of young adults, the incidence of migraine per 1,000 person years, based on the prospectively gathered data, was 5.0 in males and 22.0 in females. The estimated relative risk for major depression associated with prior migraine, adjusted for sex and education, was 3.2 (95% CI 2.3–4.6). The adjusted relative risk for migraine associated with prior major depression was 3.1 (95% CI 2.0–5.0). Conclusions: The study provides the first body of evidence that the previously observed cross-sectional association between migraine and major depression can result from bidirectional influences, with each disorder increasing the risk for first onset of the other. The explanation that major depression in persons with migraine represents a psychologic response to migraine attacks would have been more plausible had we found an influence only from migraine to depression. By diminishing the plausibility of a simple causal explanation for the migraine-depression comorbidity, the findings favor the shared mechanisms explanation.
Article
Anxiety sensitivity (AS) is a construct that denotes an individual difference in fear of anxiety. Most research into the AS construct has focused on its association with panic attacks, panic disorder and several other psychiatric disorders. There has been growing interest recently in AS as an important factor in the maintenance and exacerbation of morbidity associated with some disabling chronic health conditions (e.g. gastrointestinal dysfunction, asthma, vestibular dysfunction and chronic pain). The purposes of this paper are (a) to provide a brief overview of the theoretical framework within which the AS and chronic health condition literature can be synthesized, (b) to review the existing literature regarding AS and chronic health conditions and (c) to offer recommendations for assessment and treatment. Theoretically and practically relevant directions for future investigation are provided throughout the review.
Article
In two longitudinal studies, the authors examined the direction of the relationships between trait gratitude, perceived social support, stress, and depression during a life transition. Both studies used a full cross-lagged panel design, with participants completing all measures at the start and end of their first semester at college. Structural equation modeling was used to compare models of direct, reverse, and reciprocal models of directionality. Both studies supported a direct model whereby gratitude led to higher levels of perceived social support, and lower levels of stress and depression. In contrast, no variable led to gratitude, and most models of mediation were discounted. Study 2 additionally showed that gratitude leads to the other variables independently of the Big Five factors of personality. Overall gratitude seems to directly foster social support, and to protect people from stress and depression, which has implications for clinical interventions.
Article
The objective of this study was to examine the associations between chronic pain and psychiatric morbidity using interview-based assessments of psychiatric symptomatology. We compared the prevalence of common mental disorder (CMD; consistent with neurotic and somatic symptoms, fatigue, and negative affect), depression, and anxiety disorder(s), and associated factors with these psychiatric illnesses among Chinese patients with chronic pain attending specialist orthopedics clinic and multidisciplinary pain clinic. A total of 370 patients with chronic pain were recruited from an Orthopedics Clinic (N=185) and a Pain Clinic (N=185) in Hong Kong. Psychiatric morbidity was assessed using the Revised Clinical Interview Schedule. Individual scores for neurotic symptoms and neurotic disorders (including depression and four types of anxiety disorders) were also calculated. The reported lifetime prevalence rates of CMD were 35.3% and 75.3% for the Orthopedics and Pain Clinic samples, respectively. Rates of depression and anxiety disorders in the Pain Clinic (57.1% and 23.2%, respectively) were significantly higher than those in the Orthopedics sample (20.2% and 5.9%, respectively) (all P<0.001). Pain characteristics including number of pain sites, pain duration, pain intensity, and pain interference were all significantly associated with psychiatric morbidity after controlling for sociodemographic factors. Pain duration and litigation/compensation status consistently predicted concurrent pain intensity and disability. Chronic pain is associated with psychiatric morbidity. The higher rate of depression than anxiety disorder(s) among patients with chronic pain is consistent with previous studies that have found depression to be highly prevalent in chronic pain.
Article
Gratitude was examined among 154 students to identify benefits from its experience and expression. Students completed measures of subjective well-being, social support, prosocial behavior, and physical symptoms. Positive associations were found between gratitude and positive affect, global and domain specific life satisfaction, optimism, social support, and prosocial behavior; most relations remained even after controlling for positive affect. Gratitude demonstrated a negative relation with physical symptoms, but not with negative affect. Relational fulfillment mediated the relation between gratitude and physical symptoms. Gratitude demonstrated strong relations with the following positive affects: proud, hopeful, inspired, forgiving, and excited. The relation between gratitude and family support was moderated by gender, indicating that boys, compared with girls, appear to derive more social benefits from gratitude. Strengths, limitations, and implications are discussed.
Article
Chronic pain status and health care utilization were assessed in a probability sample of 1016 adult HMO enrollees, and among 242 HMO enrollees seeking treatment for Temporomandibular Disorder (TMD) pain. Likelihood of health care contact for a painful symptom: Among persons reporting back pain, headache, chest pain, abdominal pain or temporomandibular pain in the prior six months, we evaluated whether (1) pain characteristics (severity, persistence, recency of onset), and (2) psychological distress were associated with the likelihood of recent use of health care for each pain symptom. Severity, persistence, and recency of onset of pain were generally associated with recent health care contact for a pain symptom. Females with a pain symptom were no more likely than males to report recent health care contact for the symptom after controlling for pain characteristics. The presence of psychological distress did not increase the likelihood of health care contact for individual pain symptoms. However, psychologically distressed persons were more likely to report pain at multiple anatomical sites and to report recent health care contact for one or more of the five pain symptoms (as a group). Chronic pain status and total use of ambulatory health care: Total number of health care visits (irrespective of reason for visit) was measured by automated data. Chronic pain status (summarized across all five anatomical sites) showed a modest correlation with the volume of health care use. Persons with recurrent pain and severe-persistent pain with no pain-related disability days used ambulatory care at rates close to population means. Persons with severe-persistent pain and seven or more pain related disability days used health care at rates substantially above population means. There was a statistically significant association between the volume of health care use and chronic pain after controlling for age, sex, self-rated health status, and psychological distress.
Article
In epidemiologic research on chronic pain, differentiation of recurrent, persistent and disabling pain states is critical in the investigation of burden, natural history, effective intervention and causal processes. We report population-based data concerning the development and evaluation of a graded classification of pain status. In a probability sample of 1016 health maintenance organization enrollees, recurrent or persistent pain was observed in 45%; severe and persistent pain in 8%; severe and persistent pain with 7 or more days of pain-related activity limitation in 2.7%; and severe, persistent pain with activity limitation and 3 or more indicators of pain dysfunction in 1.0% of the population sample. Graded chronic pain status was associated with psychological impairment, unfavorable appraisal of health status, and frequency of use of pain medications and health care. The presence of severe and persistent pain increased the likelihood of multiple indicators of pain dysfunction, but there was considerable heterogeneity in pain dysfunction among persons with comparable pain experience. Our data suggest grading chronic pain in terms of 3 axes: time (persistence); severity; and impact (disability and dysfunctional illness behaviors).
Article
There is considerable controversy in the literature regarding the extent to which chronic pain and depression are associated and the possible causal relationship of such an association. The present study examines these issues with a sample of 243 patients diagnosed with rheumatoid arthritis (RA) who were mailed questionnaires for six waves of data collection. The results indicated that RA patients experience higher levels of depressive symptomatology than community samples. Using a two-latent-variable, cross-lagged design, covariance structural modeling was conducted on self-report measures of pain and depression over 6-month intervals. Results most strongly supported a causal model in which pain predicts depression during the last 12 months of the study.
Article
Despite the prevalence of sleep complaints among psychiatric patients, few questionnaires have been specifically designed to measure sleep quality in clinical populations. The Pittsburgh Sleep Quality Index (PSQI) is a self-rated questionnaire which assesses sleep quality and disturbances over a 1-month time interval. Nineteen individual items generate seven "component" scores: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medication, and daytime dysfunction. The sum of scores for these seven components yields one global score. Clinical and clinimetric properties of the PSQI were assessed over an 18-month period with "good" sleepers (healthy subjects, n = 52) and "poor" sleepers (depressed patients, n = 54; sleep-disorder patients, n = 62). Acceptable measures of internal homogeneity, consistency (test-retest reliability), and validity were obtained. A global PSQI score greater than 5 yielded a diagnostic sensitivity of 89.6% and specificity of 86.5% (kappa = 0.75, p less than 0.001) in distinguishing good and poor sleepers. The clinimetric and clinical properties of the PSQI suggest its utility both in psychiatric clinical practice and research activities.
Article
Persistent mood alterations are evidently reflected in the sleep pattern, and in depression an abnormal REM sleep regulation is found fairly consistently. With additional knowledge diagnostic and therapeutic strategies can conceivably be based on the examination of the sleep pattern of psychiatric patients.
Article
The Johns Hopkins Precursors Study, a long-term prospective study, was used to study the relation between self-reported sleep disturbances and subsequent clinical depression and psychiatric distress. A total of 1,053 men provided information on sleep habits during medical school at The Johns Hopkins University (classes of 1948-1964) and have been followed since graduation. During a median follow-up period of 34 years (range 1-45), 101 men developed clinical depression (cumulative incidence at 40 years, 12.2%), including 13 suicides. In Cox proportional hazards analysis adjusted for age at graduation, class year, parental history of clinical depression, coffee drinking, and measures of temperament, the relative risk of clinical depression was greater in those who reported insomnia in medical school (relative risk (RR) 2.0, 95% confidence interval (CI) 1.2-3.3) compared with those who did not and greater in those with difficulty sleeping under stress in medical school (RR 1.8, 95% CI 1.2-2.7) compared with those who did not report difficulty. There were weaker associations for those who reported poor quality of sleep (RR 1.6, 95% CI 0.9-2.9) and sleep duration of 7 hours or less (RR 1.5, 95% CI 0.9-2.3) with development of clinical depression. Similar associations were observed between reports of sleep disturbances in medical school and psychiatric distress assessed in 1988 by the General Health Questionnaire. These findings suggest that insomnia in young men is indicative of a greater risk for subsequent clinical depression and psychiatric distress that persists for at least 30 years.
Article
Introduction: Chronic pain is in its nature multidimensional and is most successfully treated by a multidisciplinary approach. Some patients do not benefit from treatment, and psychological and socio-economic factors may play a major role. The present study investigated the ability of sociodemographic variables to predict the short-term effect of multidisciplinary treatment in patients with chronic pain who where referred consecutively to a Danish multidisciplinary pain centre. Method: Pain scores (VAS) and health-related quality of life (HRQL) were assessed. On entry and three and six months later HRQL was evaluated by medical outcome short form (SF-36) and the psychological general well-being scale (PGWB). Sociodemographic variables were: age, gender, educational level, civil status employment status, and disability pension (DP) status. Results: Of the sociodemographic variables evaluated, only the DP status seemed to be a significant outcome predictor. Patients applying for a DP do not improve. Patients receiving a DP and those who do not achieved moderate improvements, but these were significantly larger. The same pattern was seen for changes in psychological well-being and social functioning. The DP status predicted improvement in pain and social functioning. Discussion: The present study indicates that the multidimensional problems experienced by patients applying for a DP are dominated by sociodemographic factors. Focus on the solution of these socio-economic problems is important, if patients with chronic pain are to benefit from multidisciplinary pain treatment.
Article
This study reports on the influence of migraine and comorbid depression on health-related quality of life (HRQoL) in a population-based sample of subjects with migraine and nonmigraine controls. Two population-based studies of similar design were conducted in the United States and United Kingdom. A clinically validated, computer-assisted telephone interview was used to identify individuals with migraine, as defined by the International Headache Society, and a nonmigraine control group. During follow-up interviews, 389 migraine cases (246 US, 143 UK) and 379 nonmigraine controls (242 US, 137 UK) completed the Short Form (SF)-12, a generic HRQoL measure, and the Primary Care Evaluation of Mental Disorders, a mental health screening tool. The SF-12 measures HRQoL in two domains: a mental health component score (MCS-12) and a physical health component score (PCS-12). In the United States and United Kingdom, subjects with migraine had lower scores (p < 0.001) on both the MCS-12 and PCS-12 than their nonmigraine counterparts. Significant differences were maintained after controlling for gender, age, and education. Migraine and depression were highly comorbid (adjusted prevalence ratio 2.7, 95% CI 2.1 to 3. 5). After adjusting for gender, age, and education, both depression and migraine remained significantly and independently associated with decreased MCS-12 and PCS-12 scores. HRQoL was significantly associated with attack frequency (for MCS-12 and PCS-12) and disability (MCS-12). Subjects with migraine selected from the general population have lower HRQoL as measured by the SF-12 compared with nonmigraine controls. Further, migraine and depression are highly comorbid and each exerts a significant and independent influence on HRQoL.
Article
Disturbances of sleep are typical for most depressed patients and belong to the core symptoms of the disorder. Polysomnographic sleep research has demonstrated that besides disturbances of sleep continuity, in depression sleep is characterized by a reduction of slow wave sleep and a disinhibition of REM sleep, with a shortening of REM latency, a prolongation of the first REM period and increased REM density. These findings have stimulated many sleep studies in depressive patients and patients with other psychiatric disorders. In the meantime, several theoretical models, originating from basic research, have been developed to explain sleep abnormalities of depression, like the two-process-model of sleep and sleep regulation, the GRF/CRF imbalance model and the reciprocal interaction model of non-REM and REM sleep regulation. Interestingly, most of the effective antidepressant agents suppress REM sleep. Furthermore, manipulations of the sleep-wake cycle, like sleep deprivation or a phase advance of the sleep period, alleviate depressive symptoms. These data indicate a strong bi-directional relationship between sleep, sleep alterations and depression.
Article
To investigate current, 12-month, and lifetime prevalence rates, and associated psychosocial burden of psychiatric disorders in rehabilitation inpatients with musculoskeletal diseases. Two-stage epidemiologic survey. Four orthopedic rehabilitation inpatient clinics in southwest Germany. A total of 910 inpatients with different musculoskeletal diseases participated in the survey. According to their General Health Questionnaire-12 scores, 205 patients were selected randomly for standardized interviews. Not applicable. Psychosocial burden (Hospital Anxiety and Depression Scale, Lübeck Alcoholism Screening Test) and quality of life (Medical Outcomes Study 36-Item Short-Form Health Survey), assessment of diagnosis and somatic parameters through standardized medical records. Clinical interview (Munich Composite International Diagnostic Interview) in the second-stage examination to obtain Diagnostic and Statistical Manual of Mental Disorders (4th edition) diagnoses of psychiatric disorders. Prevalence rates of psychiatric disorders are 31.1% for the 4-week period, 47.1% for the 12-month period, and 64.6% for the lifetime period. The most prevalent current disorders are anxiety (15%), affective (10.7%), and substance-related disorders (9.2%). Half of the comorbid ill patients have 2 or more simultaneous psychiatric disorders and report elevated levels of psychosocial burden (eg, intense pain, low quality of life, more days of sick leave). Patients undergoing musculoskeletal rehabilitation should be assessed carefully for comorbid psychiatric illnesses. Further research should be undertaken to evaluate the effectiveness of psychosocial interventions for comorbid psychiatric disorders on life quality, therapeutic compliance, and outcome of rehabilitation treatment.
Article
A series of health surveys are conducted every sixth to seventh year in Denmark. In the most recent survey of 2000, a national random sample (>16 years) was drawn from the Danish Central Personal Register. Out of the original sample 12,333 (74%) were interviewed and of these 10,066 returned a completed questionnaire (SF-36). The present study includes only those who both took part in the interview and the postal questionnaire. Cancer patients were excluded. Persons suffering from chronic pain (PG) were identified through the question 'Do you have chronic/long lasting pain lasting 6 months or more'? An overall chronic pain prevalence of 19% was found -16% for men and 21% for women. Prevalence of chronic pain increased with increasing age. Persons >/=67 years had 3.9 higher odds of suffering from chronic pain than persons in the age group 16-24 years. Compared with married persons, divorced or separated persons had 1.5 higher odds of chronic pain. Odds for chronic pain were 1.9 higher among those with an education of less than 10 years compared with individuals with an education of 13 years or more. During a 14-day period reporters of chronic pain had an average of 0.8 days (range 0-10) lost due to illness compared with an average of 0.4 days (range 0-10) for the control group (CG) (Odds Ratio (OR)) 2.0). Persons with a job which required high physical strain were more likely to report chronic pain compared with those with a sedentary job (OR 2.2). The odds of quitting one's job because of ill health were seven times higher among people belonging to the PG. A strong association between chronic pain and poor self-rated health was also demonstrated. The PG had twice as many contacts with various health professionals compared with the CG, and the health care system was, on average, utilised 25% more (overall contacts) by the PG than by the general population. Among the persons in the PG, 33% were not satisfied with the examinations carried out in connection with their pain condition and 40% were not satisfied with the treatment offered. Nearly 130,000 adults, corresponding to 3% of the Danish population, use opioids on a regular basis. Opioids are used by 12% of the PG.
Article
The high prevalence of chronic pain (duration >3 months) reported from different populations indicates a public health problem. Knowledge of the long-term course of chronic non-malignant pain is incomplete and scarce. This paper describes a follow-up of a cohort recruited from a survey in the general population. The cohort (n=214) consisted initially of individuals with widespread or located (neck-shoulder) pain or without chronic pain. The individuals were initially examined and replied to questionnaires on pain, social factors, lifestyle, medication and health care after two and 12 years. The deaths during the period were obtained from the population register. Complete data exist for 77% of the eligible individuals. After 12 years one-third of the individuals initially without pain reported chronic pain, and among those with initial chronic pain 85% still reported chronic pain. The number of painful areas was the strongest predictor of chronic pain 12 years later (OR 15.8; >3 locations vs. 0) whereas a social factor (having a close friend) decreased the risk (OR 0.44). The onset of chronic pain during the same period was related to the physical workload (work with bent positions; OR 5.31; yes vs. no). Mortality was significantly higher in the group initially reporting widespread pain compared with the other groups. The chronicity of widespread chronic pain supports early and intense intervention among individuals with located pain. The association between chronic widespread pain and increased mortality needs further investigation but may deepen the view of chronic pain as a public health problem.
Article
Chronic pain and depression are two of the most common health problems that health professionals encounter, yet only a handful of epidemiological studies have investigated the relationship between these conditions in the general population. In the present study we examined the prevalence and correlates of major depression in persons with chronic back pain using data from the first cycle of Canadian Community Health Survey in a sample of 118,533 household residents. The prevalence of chronic back pain was estimated at 9% of persons 12 years and older. Rates of major depression, determined by the short-form of the Composite International Diagnostic Interview, were estimated at 5.9% for pain-free individuals and 19.8% for persons with chronic back pain. The rate of major depression increased in a linear fashion with greater pain severity. In logistic regression models, back pain emerged as the strongest predictor of major depression after adjusting for possible confounding factors such as demographics and medical co-morbidity. The combination of chronic back pain and major depression was associated with greater disability than either condition alone, although pain severity was found to be the strongest overall predictor of disability.
Article
The management of insomnia in patients experiencing chronic pain requires careful evaluation, good diagnostic skills, familiarity with cognitive-behavioural interventions and a sound knowledge of pharmacological treatments. Sleep disorders are characterised by a circular interrelationship with chronic pain such that pain leads to sleep disorders and sleep disorders increase the perception of pain. Sleep disorders in individuals with chronic pain remain under-reported, under-diagnosed and under-treated, which may lead--together with the individual's emotional, cognitive and behavioural maladaptive responses--to the frequent development of chronic sleep disorders. The moderately positive relationship between pain severity and sleep complaints, and the specificity of pain-related arousal and mediating variables such as depression, illustrate that insomnia in relation to chronic pain is multifaceted and poorly understood. This may explain the limited success of the available treatments. This article discusses the evaluation of patients with chronic pain and insomnia and the available pharmacological and nonpharmacological interventions to manage the sleep disorder. Non-pharmacological interventions should not be considered as single interventions, but in association with one another. Some non-pharmacological interventions especially the cognitive and behavioural approaches, can be easily implemented in general practice (e.g. stimulus control, sleep restriction, imagery training and progressive muscle relaxation). Hypnotics are routinely prescribed in the medically ill, regardless of their adverse effects; however, their long-term efficacy is not supported by robust evidence. Antidepressants provide an interesting alternative to hypnotics, since they can improve pain perception as well as sleep disorders in selected patients. Sedative antipsychotics can be considered for sleep disturbances in those patients exhibiting psychotic features, or for those with contraindications to benzodiazepines. Low doses of sedative antipsychotics may improve chronic insomnia in the elderly. However, no intervention is likely to be effective unless a good physician-patient relationship is developed.
Article
In Denmark, opioids have been used liberally for many years in the treatment of non-malignant pain, but long-term consequences as tolerance and influence on health related quality of life remain unknown. Adherence to medical treatment, opioid dose escalation, health related quality of life, anxiety, depression, coping strategies and health care utilization were evaluated in chronic pain patients 10 years after treatment in a multidisciplinary pain centre. Information was gathered from medical records, postal questionnaires and a central hospital register. Opioid dose escalation occurred in only a few patients. Increase and decrease in opioid dose were almost equally frequent. Sixty percent of those discharged on long acting opioids were still on that treatment at follow-up. Twenty-eight percent of the patients initiated opioid treatment after discharge from the pain centre. Occupational status was identified as a determining factor for future opioid use. Opioid users had a lower health related quality of life, higher occurrence of depression and more frequent use of coping strategies like 'Catastrophizing' and 'Hoping and Praying'. Adjuvant analgesics were highly discontinued. Multidisciplinary pain treatment reduced the number of hospital admissions and in-hospital days. We recommend that future research on opioid treatment does not only focus on biological issues. The effect of opioids needs to be viewed in a much more complex context where consequences like health related quality of life, depression and the role of various coping strategies are included.
Article
In order to effectively study the population experiencing insomnia, it is important to identify reliable and valid tools to measure sleep that can be administered in the home setting. The purpose of this study was to assess psychometric properties for the Chinese version of the Pittsburgh Sleep Quality Index (CPSQI) in community-dwelling adults with primary insomnia. The CPSQI had an overall reliability coefficient of 0.82 -0.83 for all subjects. "Subjective sleep quality" was the component most highly correlated with the global score. Overall, the CPSQI showed acceptable test-retest reliability over a 14- to 21-day interval with a coefficient of 0.85 for all subjects and 0.77 for primary insomniacs. The two contrasting groups had significantly different global and component scores. A CPSQI of greater than 5 yielded a sensitivity and specificity of 98 and 55% in primary insomniacs vs. controls. A CPSQI of greater than 6 resulted in a sensitivity and specificity of 90 and 67%. Results suggest that the CPSQI is a psychometrically sound measure of sleep quality and disturbance for patients with primary insomnia. It may not be an effective screening tool because of its low specificity, but it can be a sensitive, reliable, and valid outcome assessment tool for use in community-based studies of primary insomnia.
Article
Given the suggestion of a reciprocal relationship between sleep and pain and the recognition of sleep as an important parameter in determining quality of life, there is increasing research interest in sleep disturbance linked to chronic pain. The present study aimed to provide an estimate of the prevalence of 'clinical insomnia' in patients attending a specialist pain clinic and identify factors associated with it. Seventy chronic back pain patients and 70 gender- and age-matched pain-free controls completed a set of questionnaires measuring sleep (Insomnia Severity Index; ISI), pain (Short-Form McGill Pain Questionnaire) and a selection of general and specific psychological variables (Hospital Anxiety and Depression Scale, Short Health Anxiety Inventory). Scores suggestive of clinical insomnia (ISI > or = 15) were noted in 53% of chronic pain patients, when compared with only 3% in pain-free controls. Significant positive correlations with insomnia severity were detected for all six variables of interest (pain intensity, sensory pain ratings, affective pain ratings, general anxiety, general depression and health anxiety). Affective pain ratings and health anxiety were the best predictors of insomnia severity in this sample, accounting for 30% of the total variance, even when present pain intensity was controlled for. Affective pain remained as a significant predictor of insomnia severity when both the effect of pain intensity and the effects of anxiety and depression were controlled for. Future research should consider investigating the role of pain appraisal and health anxiety in the development and manifestation of insomnia concomitant to chronic pain.