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Posttraumatic stress disorder following asthma attack: the role of agency beliefs in mediating psychiatric morbidity
Journal of Mental Health
Abstract
Background: The link between serious illness and subsequent posttraumatic stress disorder (PTSD) and psychiatric comorbidity has been established. In populations with asthma, however, few studies have investigated this link, or what psychological mechanisms mediate it. Healthcare guidance for chronic conditions, and PTSD literature, highlight “agency beliefs” as a direction for investigation.
Aims: To determine the prevalence of PTSD following asthma attack, and investigate whether agency beliefs mediate PTSD and comorbid psychiatric symptoms in this population.
Method: We recruited 110 adults with asthma from online peer support forums. Participants completed the Asthma Symptom Checklist, PTSD Checklist, GHQ-28, General Self-Efficacy scale, and Multidimensional Health Locus of Control scale.
Results: 20% of our sample met criteria for PTSD. Regression results indicated that higher asthma severity significantly predicted PTSD and psychiatric co-morbidity. Lower self-efficacy significantly predicted PTSD symptoms while controlling for asthma severity, however Locus of Control (LoC) did not improve the model further. Self-efficacy, but not LoC, significantly partially mediated the effect of asthma severity on PTSD severity and psychiatric co-morbidity.
Conclusions: PTSD and other psychiatric symptoms in asthma populations are mediated in part by self-efficacy. Safeguarding and improving self-efficacy in this population is an important area for future research and intervention.
... The additive biological and psychological effects of PTSD and comorbid conditions may furthermore impact asthma morbidity and control [62]. Of note, individuals can also develop PTSD and associated comorbidity, secondary to experiencing an asthma attack and greater severity of asthma is associated with the risk of developing PTSD [77,78]. Although, comorbidity may explain some of the links between PTSD and asthma, we did not demonstrate an association between CMDs and asthma in PTSD patients in our sample. ...
Objective
Several studies suggest a relationship between atopy and psychiatric disorders, but few have investigated the association between atopic conditions and posttraumatic stress disorder (PTSD). We sought to compare the rates of atopy and allergies in a South African case-control study of 220 patients with PTSD (mean age 41.7 years. SD = 11.7) and 196 trauma exposed controls (TEC, mean age 45.4 years, SD = 14.7) conducted in Cape Town, South Africa from May 2014 to June 2017.
Methods
Self-reported atopic conditions and allergies were regressed on PTSD, as determined with the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5), in multivariate logistic regression models, controlling for age, gender, body mass index, physical activity, lifetime and childhood trauma, and time since index trauma.
Results
Rates of lifetime atopy (p = 0.03), current asthma (p = 0.04), lifetime allergic rhinitis (p = 0.002), and current allergic rhinitis (p = 0.004) were significantly higher in patients than TEC on bivariate analysis. On multivariate analysis, rates of current atopy (Cohen's d = 0.26, p = 0.04) and current allergic rhinitis (Cohen's d = 0.34, p = 0.012) were significantly higher in patients with PTSD than in TEC. Current eczema (p = 0.24), current asthma (p = 0.26), and allergies (p = 0.59) were not associated with PTSD.
Conclusions
Rates of atopy are higher in participants with PTSD than TEC, and this effect is related to higher rates of allergic rhinitis. Further studies are needed to elucidate the pathways linking allergic rhinitis and PTSD.
... Moreover, the physical symptoms of an unexpected asthma attack and PTSD bodily symptoms associated with intrusions and hyperarousal (e.g., shortness of breath) have a lot in common: they may bring about feelings of fear and helplessness enhancing loss of control by reducing self-efficacy in coping mechanism. In line, PTSD and other psychiatric symptoms in asthma populations are mediated in part by self-efficacy (Wagner et al., 2017). Common physiological symptoms in PTSD patients with asthma make it difficult to distinguish in highly distressing situations (such as in exposure-based interventions) between both which might have led to a decreased benefit from treatment. ...
Objective: The aims of this study were to determine the effectiveness of a routine clinical care treatment and to identify predictors of treatment outcome in PTSD inpatients. Methods: A routinely collected data set of 612 PTSD inpatients (M = 42.3 years [SD = 11.6], 75.7% female) having received trauma-focused psychotherapy was analyzed. Primary outcome was the clinical symptom severity change score, secondary outcomes were assessed using functional, anxiety, and depression change scores. Hedges g-corrected pre–post effect sizes (ES) were computed for all outcomes. Elastic net regulation as a data-driven, stability-based machine-learning approach was used to build stable clinical prediction models. Results: Hedges g ES indicated medium to large effects on all outcomes. The results of the predictor analyses suggested that a combined predictor model with sociodemographic, clinical, and psychometric variables contribute to predicting different treatment outcomes. Across the clinical and functional outcome, psychoticism, total number of diagnoses, and bronchial asthma consistently showed a stable negative predictive relationship to treatment outcome. Conclusion: Trauma-focused psychotherapy could effectively be implemented in a routine inpatient setting. Some important prognostic variables could be identified. If the proposed models of predictors are replicated, they may help personalize treatment for patients receiving routine clinical care.
... The Cronbach's alpha falls well within the high .80s and ranges between .76 to .94 across different sample nations and language versions (Juarez & Contreras, 2008;Schwarzer & Jerusalem, 1995;Wagner, Hoelterhoff, & Chung, 2017). ...
Objective: This study examined a work-related intervention designed to assist people with serious mental illness (SMI) in overcoming employment barriers. Methods: A pre-post-test experimental design was used to investigate the effects of a 10-session, prevocational seminar on self-efficacy and work motivation among adults with SMI residing in an inpatient psychiatric facility. Three one-way ANCOVAs were applied to analyze post-test results for the dependent measures. Findings: Although significant findings were not found regarding the effectiveness of the prevocational seminar on self-efficacy, other interesting discoveries were made. One noteworthy outcome was persons with SMI wanted to work but experienced barriers, including discrimination, decreased motivation, and work disincentives that impeded their return to employment. Conclusions and Implications for Practice: Vocational rehabilitation (VR) counselors continue to face challenges in their efforts to increase employment among persons with SMI. The results from the present study underscore the need for skills training and innovative VR strategies to mitigate barriers to employment among persons with SMI.
Lungenerkrankungen nehmen sowohl in der Todesursachenstatistik als auch in der Perspektive einer globalen Krankheitsbelastung Spitzenränge ein. Das Thema der affektiven Komorbidität wird für Asthma bronchiale, chronische obstruktive Lungenkrankheit, zystische Lungenfibrose, interstitielle Lungenerkrankung, pulmonale Hypertonie, obstruktive Schlafapnoe, Lungenkarzinom, akutes Lungenversagen dargestellt. Epidemiologisch sind erhöhte Prävalenzraten koexistenter affektiver und Stress-bezogener Störungen mit je signifikanten negativen Einflüssen auf die komplexe Dynamik des jeweiligen Krankheitsgeschehens im Verlauf nachgewiesen. Vorbestehende Depressionen, Ängste und posttraumatische Stressoren nehmen in der Entwicklung einzelner Lungenerkrankungen, insbesondere von Asthma bronchiale und COPD eine bedeutsame, wenngleich differentielle Rolle ein. Ein eventueller Risikostatus ist wiederum bei anderen Lungenkrankheiten schwieriger zu beurteilen. In einer ätiopathogenetischen Perspektive sind genetische, neuroendokrine, (auto-) immunologisch-inflammatorische und vor allem auch Einflüsse der autonom-nervösen Regulation der Atmung je speziell in der Zusammenschau zu analysieren. Es liegen ermutigende, aber nicht immer konsistente Resultate aus Studien zur Psychotherapie und Pharmakotherapie koexistenter affektiver und Stress-bezogener Störungen vor.
Objective:
The present meta-analysis consolidated research examining how positive expectancies (e.g., hope, self-efficacy, and optimism) may protect against the development of posttraumatic stress disorder (PTSD).
Method:
Articles were identified by searching PILOTS, PsycINFO, PubMed, and ProQuest Dissertations and Theses databases.
Results:
Aggregated results from 154 studies indicated that positive expectancies were associated with lower levels of PTSD symptoms. This relationship was stronger for coping-specific self-efficacy (k = 38, r = -.49; -.54 to -.43) and hope (k = 20, r = -.34; -.39 to -.28) compared with general self-efficacy (k = 45, r = -.25; -.30 to -.20) and optimism (k = 59, r = -.29; -.33 to -.25) when examining cross-sectional studies, and results were consistent in prospective studies. Age and gender did not moderate the cross-sectional relationships.
Conclusions:
These findings indicate that positive expectancies predict post-trauma resilience. Future research should identify moderators and examine positive expectancies as mechanisms of change in therapy.
Presents an integrative theoretical framework to explain and to predict psychological changes achieved by different modes of treatment. This theory states that psychological procedures, whatever their form, alter the level and strength of self-efficacy. It is hypothesized that expectations of personal efficacy determine whether coping behavior will be initiated, how much effort will be expended, and how long it will be sustained in the face of obstacles and aversive experiences. Persistence in activities that are subjectively threatening but in fact relatively safe produces, through experiences of mastery, further enhancement of self-efficacy and corresponding reductions in defensive behavior. In the proposed model, expectations of personal efficacy are derived from 4 principal sources of information: performance accomplishments, vicarious experience, verbal persuasion, and physiological states. Factors influencing the cognitive processing of efficacy information arise from enactive, vicarious, exhortative, and emotive sources. The differential power of diverse therapeutic procedures is analyzed in terms of the postulated cognitive mechanism of operation. Findings are reported from microanalyses of enactive, vicarious, and emotive modes of treatment that support the hypothesized relationship between perceived self-efficacy and behavioral changes. (21/2 p ref)
The most commonly used method to test an indirect effect is to divide the estimate of the indirect effect by its standard error and compare the resulting z statistic with a critical value from the standard normal distribution. Confidence limits for the indirect effect are also typically based on critical values from the standard normal distribution. This article uses a simulation study to demonstrate that confidence limits are imbalanced because the distribution of the indirect effect is normal only in special cases. Two alternatives for improving the performance of confidence limits for the indirect effect are evaluated: (a) a method based on the distribution of the product of two normal random variables, and (b) resampling methods. In Study 1, confidence limits based on the distribution of the product are more accurate than methods based on an assumed normal distribution but confidence limits are still imbalanced. Study 2 demonstrates that more accurate confidence limits are obtained using resampling methods, with the bias-corrected bootstrap the best method overall.
Key points:
Self-management education in asthma is not an optional extra. Healthcare professionals have a responsibility to ensure that everyone with asthma has personalised advice to enable them to optimise how they self-manage their condition.Overviews of the extensive evidence-base conclude that asthma self-management supported by regular professional review, improves asthma control, reduces exacerbations and admissions, and improves quality of life.Self-management education should be reinforced by a written personalised asthma action plan which provides a summary of the regular management strategy, how to recognise deterioration and the action to take.Successful implementation combines education for patients, skills training for professionals in the context of an organisation committed to both the concept and the practice of supported self-management.
Educational aims:
To summarise the evidence base underpinning supported self-management for asthmaTo provide clinicians with a practical approach to providing supported self-management for asthmaTo suggest an appropriate strategy for implementing supported self-management.
Summary:
The evidence in favour of supported self-management for asthma is overwhelming. Self-management including provision of a written asthma action plan and supported by regular medical review, almost halves the risk of hospitalisation, significantly reduces emergency department attendances and unscheduled consultations, and improves markers of asthma control and quality of life. Demographic and cultural tailoring enables effective programmes to be implemented in deprived and/or ethnic communities or within schools. A crucial component of effective asthma self-management interventions is the provision of an agreed, written personalised action plan which advises on using regular medication, recognising deterioration and appropriate action to take. Monitoring can be based on symptoms or on peak flows and should specify thresholds for action including increasing inhaled steroids, commencing oral steroids, and when (and how) to seek professional help. Plans should be personalised to reflect asthma severity and treatment regimes, avoidance of triggers, co-morbid rhinitis and the individual's preferences. Implementation is a challenge. Systematic review evidence suggests that it is possible to implement asthma self-management in routine care, but that to be effective this requires a whole systems approach which considers implementation from the perspective of patient education and resources, professional skills and motivation and organisation priorities and routines.
@PRISMS_project
NB.: THIS IS A VERY LARGE DOCUMENT. THE BEST WAY TO ACCESS IT IS FROM THE NIHR WEBSITE : http://www.journalslibrary.nihr.ac.uk/hsdr/volume-2/issue-53#hometab0
Abstract
Background
Despite robust evidence concerning self-management for some long-term conditions (LTCs), others lack research explicitly on self-management and, consequently, some patient groups may be overlooked.
Aim
To undertake a rapid, systematic overview of the evidence on self-management support for LTCs to inform health-care commissioners and providers about what works, for whom, and in what contexts.
Methods
Self-management is ‘the tasks . . . individuals must undertake to live with one or more chronic conditions . . . [including] . . . having the confidence to deal with medical management, role management and emotional management of their conditions’. We convened an expert workshop and identified characteristics of LTCs potentially of relevance to self-management and 14 diverse exemplar LTCs (stroke, asthma, type 2 diabetes mellitus, depression, chronic obstructive pulmonary disease, chronic kidney disease, dementia, epilepsy, hypertension, inflammatory arthropathies, irritable bowel syndrome, low back pain, progressive neurological disorders and type 1 diabetes mellitus). For each LTC we conducted systematic overviews of systematic reviews of randomised controlled trials (RCTs) of self-management support interventions (‘quantitative meta-reviews’); and systematic overviews of systematic reviews of qualitative studies of patients’ experiences relating to self-management (‘qualitative meta-reviews’). We also conducted an original systematic review of implementation studies of self-management support in the LTCs. We synthesised all our data considering the different characteristics of LTCs. In parallel, we developed a taxonomy of the potential components of self-management support.
Results
We included 30 qualitative systematic reviews (including 515 unique studies), 102 quantitative systematic reviews (including 969 RCTs), and 61 studies in the implementation systematic review. Effective self-management support interventions are multifaceted, should be tailored to the individual, their culture and beliefs, a specific LTC and position on the disease trajectory, and underpinned by a collaborative/communicative relationship between the patient and health-care professional (HCP) within the context of a health-care organisation that actively promotes self-management. Self-management support is a complex intervention and although many components were described and trialled in the studies no single component stood out as more important than any other. Core components include (1) provision of education about the LTC, recognising the importance of understanding patients’ pre-existing knowledge and beliefs about their LTC; (2) psychological strategies to support adjustment to life with a LTC; (3) strategies specifically to support adherence to treatments; (4) practical support tailored to the specific LTC, including support around activities of daily living for disabling conditions, action plans in conditions subject to marked exacerbations, intensive disease-specific training to enable self-management of specific clinical tasks; and (5) social support as appropriate. Implementation requires a whole-systems approach which intervenes at the level of the patient, the HCP and the organisation. The health-care organisation is responsible for providing the means (both training and time/material resources) to enable HCPs to implement, and patients to benefit from, self-management support, regularly evaluating self-management processes and clinical outcomes. More widely there is a societal need to address public understanding of LTCs. The lack of public story for many conditions impacted on patient help-seeking behaviour and public perceptions of need.
Conclusions
Supporting self-management is inseparable from the high-quality care for LTCs. Commissioners and health-care providers should promote a culture of actively supporting self-management as a normal, expected, monitored and rewarded aspect of care. Further research is needed to understand how health service managers and staff can achieve this culture change in their health-care organisations.
Study registration
This study is registered as PROSPERO CRD42012002898.
Funding
The National Institute for Health Research Health Services and Delivery Research programme.
General perceived self-efficacy pertains to optimistic beliefs about being able to cope with a large variety of stressors. It is measured with a ten-item scale that has proven useful in cross-cultural research. Previous findings suggest that the construct is universal and that it applies to the majority of cultures worldwide. The present investigation adds a new facet to it: can perceived self-efficacy be measured as part of an interactive computer session while surfing the Internet? A total of 1,437 computer users responded to a survey on the web, half of them young men and women below the age of 26. These data were compared to 290 Canadian university students, 274 teachers in Germany, and 3,077 high school students in Germany. It turned out that all psychometric characteristics were satisfactory. Some evidence for validity emerged. It is suggested that innovative methods of data collection be considered when developing a psychometric scale.
Background:
The goal of the current study was to investigate asthma and mental health among youth in the community, and to consider the role of asthma severity and persistence in this link. Method Data were drawn from the Raine Study, a population-based birth cohort study in Western Australia. Logistic regression models and generalized estimating equations were used to examine the relationship between asthma at age 5 years and the range of internalizing and externalizing mental health problems at ages 5-17 years. Analyses were stratified by asthma severity and persistence, and adjusted for a range of potential confounders.
Results:
More severe and persistent asthma at age 5 was associated with significantly increased odds of affective, anxiety, somatic, oppositional defiant and conduct problems at ages 5-17. Mild asthma and remitted asthma were not associated with heightened vulnerability to mental disorders.
Conclusions:
Our results suggest that youth with symptomatic asthma are more likely to suffer from a wide range of mental health problems, and that the likelihood of mental health problems appears to increase as a function of asthma severity. Youth with poorly controlled and/or more severe and persistent asthma may be considered a vulnerable group who might benefit from mental health screening in clinical, school and community settings.
Research involving perceived internal vs external control of reinforcement as a personality variable has been expanding at a rapid rate. It seems clear that for some investigators there are problems associated with understanding the conceptualization of this construct as well as understanding the nature and limitations of methods of measurement. This article discusses in detail (a) the place of this construct within the framework of social learning theory, (b) misconceptions and problems of a theoretical nature, and (c) misuses and limitations associated with measurement. Problems of generality-specificity and unidimensionality-multidimensionality are discussed as well as the logic of predictions from test scores. (35 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
In this article the construct of generalized expectancies for internal vs external control of reinforcement is used as a model to present a brief on the importance of broad theory and training in theory construction and evaluation in psychology. Specifically, the extraordinary heuristic value of this construct is attributed to 4 characteristics: the nature of the definition, the careful imbedding of the construct in a theoretical context, the use of a broad behavior theory in construction of a measure of individual differences, and the programmatic nature of the original research as well as the format of the early publications. Reevaluation of the characteristic criteria for publication of research studies and for the evaluation of promotion or advancement for psychologists involved in research activities is also discussed. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The articles included in the special series in this issue of
Developmental Psychology demonstrate that perceived self-efficacy for memory functioning is an important facet of metamemory. Self-beliefs of efficacy can enhance or impair performance through their effects on cognitive, affective, or motivational intervening processes. This commentary addresses a number of issues concerning the extension of self-efficacy theory to memory functioning. These include the following: the multidimensionality and measurement of perceived memory capabilities; the veridicality of memory self-appraisal; the efficacious exercise of personal control over memory functioning; the psychosocial processes by which people preserve a favorable sense of memory self-efficacy over the life span; and strategies for generalizing the impact of training in memory skills. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Key messages
Many people with long-term physical health conditions also have mental health problems. These can lead to significantly poorer health outcomes and reduced quality of life.
Costs to the health care system are also significant – by interacting with and exacerbating physical illness, co-morbid mental health problems raise total health care costs by at least 45 per cent for each person with a long-term condition and co-morbid mental health problem.
This suggests that between 12 per cent and 18 per cent of all NHS expenditure on long-term conditions is linked to poor mental health and wellbeing – between £8 billion and £13 billion in England each year. The more conservative of these figures equates to around £1 in every £8 spent on long-term conditions.
People with long-term conditions and co-morbid mental health problems disproportionately live in deprived areas and have access to fewer resources of all kinds. The interaction between co-morbidities and deprivation makes a significant contribution to generating and maintaining inequalities.
Care for large numbers of people with long-term conditions could be improved by better integrating mental health support with primary care and chronic disease management programmes, with closer working between mental health specialists and other professionals.
Collaborative care arrangements between primary care and mental health specialists can improve outcomes with no or limited additional net costs.
Innovative forms of liaison psychiatry demonstrate that providing better support for co-morbid mental health needs can reduce physical health care costs in acute hospitals.
Clinical commissioning groups should prioritise integrating mental and physical health care more closely as a key part of their strategies to improve quality and productivity in health care.
n Improved support for the emotional, behavioural and mental health aspects of physical illness could play an important role in helping the NHS to meet the Quality, Innovation, Productivity and Prevention (QIPP) challenge. This will require removal of policy barriers to integration, for example, through redesign of payment mechanisms.
Background: The General Health Questionnaire (GHQ) is a well known screening instrument, but little is known about its psychometric properties. Aims: The study aimed to evaluate the predictive power of GHQ-28 and compare alternative methods of enhancing its discriminatory power. We examined the detailed sensitivity and specificity of individual items of the GHQ-28 to understand its psychometric properties, and suggested the combination of items that best predict cases with high discriminatory power. Method: The data obtained in a study of non-psychotic psychiatric disorder in two-phase study of General Practice consulters was analysed. A total of 1670 consecutive patients aged 16 – 65 years were screened using the GHQ-28 and 336 were interviewed using the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID). Cases of non-psychotic psychiatric disorder were defined at interview using DSM-IV and Bedford College criteria. The diagnostic outcomes were dichotomized as cases and non-cases, and were combined with the GHQ data for the logistic regression. The regression was used to select individual GHQ items that exhibit high predictive power. Based on ROC analysis, the performance of the combination of the selected items with high predictive power was compared to the performance of the full 28-item version and the use of stratum-specific likelihood ratios (SSLR). Results: GHQ items reflecting depression have high specificity while items reflecting somatic symptoms that are non-specific to psychological problems, have high sensitivity. From the GHQ-28 items, eight items were selected using the logistic regression. Five items were selected because of their high sensitivity or specificity values. The remaining three items were selected because they enhance other significant items. Using an area under ROC curve to indicate the level of predictive power, the results showed that by removing the 20 insignificant individual items, the predictive power was increased slightly from 81.6% to 84.4%. When compared to SSLR, both tests seemed to perform better than SSLR. Conclusion: The study has shown an alternative analysis to evaluate the GHQ's validity. This approach to the GHQ psychometric properties may provide a simple way to enhance and preserve the high predictive power of GHQ. The computational scheme could be easily applied to other screening instruments to assess their validity.
Based on social-cognitive theory (Bandura, 1997), this paper examined whether perceived self-efficacy is a universal psychological construct that accounts for variance within various domains of human functioning. Perceived self-efficacy is not only of a task-specific nature, but it can also be identified at a more general level of functioning. General self-efficacy (GSE) is the belief in one’s competence to tackle novel tasks and to cope with adversity in a broad range of stressful or challenging encounters, as opposed to specific self-efficacy, which is constrained to a particular task at hand. The study aimed at exploring the relations between GSE and a variety of other psychological constructs across several countries. Relations between general self-efficacy and personality, well-being, stress appraisals, social relations, and achievements were examined among 8796 participants from Costa Rica, Germany, Poland, Turkey, and the USA. Across countries, the findings provide evidence for associations between perceived general self-efficacy and the selected variables. The highest positive associations were with optimism, self-regulation, and self-esteem, whereas the highest negative associations emerged with depression and anxiety. Academic performance is also associated with self-efficacy as hypothesized. The replication across languages or cultures adds significance to these findings. The relations between self-efficacy and other personality measures remained stable across cultures and samples. Thus, perceived general self-efficacy appears to be a universal construct that yields meaningful relations with other psychological constructs.
Perceived self-efficacy represents an optimistic sense of personal competence that seems to be a pervasive phenomenon accounting for motivation and accomplishments in human beings. The General Self-Efficacy scale, developed to measure this construct at the broadest level, has been adapted tomany languages. The psychometric properties of this instrument is examined among 19,120 participants from 25 countries. The main research question is whether the measure is configurally equivalent across cultures, that is, whether it corresponds to only one dimension. The findings confirm this assumption and suggest the globality of the underlying construct. They also point to a number of cross-cultural differences that merit further investigation.
Addresses the centrality of the self-efficacy mechanism (SEM) in human agency. SEM precepts influence thought patterns, actions, and emotional arousal. In causal tests, the higher the level of induced self-efficacy, the higher the performance accomplishments and the lower the emotional arousal. The different lines of research reviewed show that the SEM may have wide explanatory power. Perceived self-efficacy helps to account for such diverse phenomena as changes in coping behavior produced by different modes of influence, level of physiological stress reactions, self-regulation of refractory behavior, resignation and despondency to failure experiences, self-debilitating effects of proxy control and illusory inefficaciousness, achievement strivings, growth of intrinsic interest, and career pursuits. The influential role of perceived collective efficacy in social change and the social conditions conducive to development of collective inefficacy are analyzed. (21/2 p ref) (PsycINFO Database Record (c) 2006 APA, all rights reserved). © 1982 American Psychological Association.
This paper investigates the joint effects of academic self-efficacy and stress on the academic performance of 107 nontraditional, largely immigrant and minority, college freshmen at a large urban commuter institution. We developed a survey instrument to measure the level of academic self-efficacy and perceived stress associated with 27 college-related tasks. Both scales have high reliability, and they are moderately negatively correlated. We estimated structural equation models to assess the relative importance of stress and self-efficacy in predicting three academic performance outcomes: first-year college GPA, the number of accumulated credits, and college retention after the first year. The results suggest that academic self-efficacy is a more robust and consistent predictor than stress of academic success.
People with low back pain (LBP) with higher levels of external locus of control have a poorer prognosis and require greater improvements from active interventions in order to consider these interventions worthwhile. Whether locus of control levels differ between participants with LBP in a patient-health provider relationship and those waiting for treatment is unclear.
The aim was to investigate if differences in locus of control exist between participants with non-specific chronic LBP being treated (treatment group) and those waiting treatment (control group).
100 participants (50 per group) with low back symptoms for at least three months for the current episode of LBP and aged between 18 and 60 years were recruited. Multidimensional health locus of control questionnaire (MHLC) was used to collect their beliefs. Multiple linear regression adjusted for disability was used to compare health locus of control between both groups. Differences were described as mean differences and 95% confidence intervals.
Treatment group scored higher for external locus of control and lower for internal locus of control than control group. Mean differences (95% confidence intervals) were 2.7 points on possible 30-points difference (0.5 to 4.8) for external locus of control and -2.8 points (-5.4 to -0.1) for internal subscale.
Health locus of control was found to be different between treatment and control groups. Participants being treated had higher external locus of control and lower internal locus of control than control group.
Purpose
Chronic disorder can impose a significant negative mental health burden. This research was conducted to explore factors that may protect people from the adversity of chronic stuttering.
Method
The study employed a population group cohort design. Participants included 200 adults who have stuttered since childhood, and the sample was divided into those who were classified as resilient and nonresilient on the basis of their global psychopathology scores. Protective factor differences between the 2 groups were determined using multivariate analysis of variance and unique contributors to psychopathology were isolated using multiple regression.
Results
Factors that significantly distinguished between groups included superior levels of health status, social support, vitality and social functioning, fewer physical limitations, and a greater sense of self-efficacy. Three unique contributors to adaptive outcomes were found: self-efficacy, social support, and healthy social functioning.
Conclusions
A number of factors were isolated that potentially protect individuals with chronic stuttering from developing psychopathology. The findings provide a better understanding of how people cope with a chronic fluency disorder.
The Symptom Checklist 90 Revised (SCL-90-R) was used to assign participants to either a good adjustment group or a poor adjustment group. Group differences were analyzed with chi (2), t-tests and correlations on factors shown in previous research to be related to coping with spinal cord injury (SCI).
This study examines health locus of control (HLC) and attributions of cause and blame in relation to SCI. The replication of study findings in multiple settings is a cornerstone of the evidence base for developing interventions. Previous studies do not show a consensus on the role of attributions of cause and blame in persons with SCI. Similarly, their relationship to adjustment after SCI is unclear. Another attribution, HLC, is similarly analyzed in relation to adjustment.
Republic of Ireland.
Thirty people with SCI participated. They rated scales measuring psychological adjustment, locus of control (LOC) for health and attributions of cause and blame for the injury.
The well-adjusted group had a less external HLC. In addition, participants who were well adjusted endorsed the notion they could have avoided their accident significantly more than the poorly adjusted group. Similarly, they rated the belief that they could have caused the accident at a somewhat greater level. They did not, however, blame themselves any more or any less.
Results are consistent with general LOC theory, and suggest an adaptive or protective internal LOC for accepting responsibility for the injury.
Quisimos evaluar tanto la estructura factorial como la confiabilidad de la versión de 28 ítem del Cuestionario de Salud General (GHQ-28) en una muestra no-clínica en El Salvador. Aplicamos el GHQ-28 a una muestra de 714 de alumnos universitarios en El Salvador. Utilizamos un análisis de componentes principales y seleccionamos una solución de 4 factores. Reaplicamos la prueba a un grupo de los participantes después de un promedio de 3 meses, para evaluar la confiabilidad de ¿retest¿ del instrumento y calculamos la confiabilidad interna del GHQ-28 a través de la prueba alpha de Cronbach. Los resultados del análisis factorial correspondieron estrechamente con la estructura factorial antes identificada, aunque encontramos una correlación más alta entre las escalas, sobre todo entre Ansiedad e insomnio y Somatización. La fiabilidad test-retest y la consistencia interna alcanzaron valores de 0,70 o superiores. Los resultados del análisis factorial indican una gran coincidencia con las conclusiones de otros entornos culturales, lo que apoya la hipótesis de Goldberg de que hay una manera común de comunicar angustia psicológica en culturas distintas. Las escalas de Depresión severa y de Disfunción social parecen ser relativamente estables e independientes, mientras que las de Ansiedad e insomnio y de Somatización se correlacionan más. La fiabilidad del instrumento es satisfactoria.
We examined mediational models of panic-fear, panic disorder (PD), and asthma outcomes among adult asthma patients. PD was assessed by the Anxiety Disorders Interview Schedule. Twenty-one asthma-PD patients and 27 asthma-only patients completed spirometry and questionnaires. Asthma-PD patients reported greater illness-specific and generalized panic-fear than asthma-only patients, despite no differences in asthma severity or physical symptoms during asthma attacks. Illness-specific panic-fear mediated the relationship between PD and poorer health-related quality of life, including emotional disturbance due to asthma. Illness-specific panic-fear was associated with more primary care office visits for asthma. Asthma-PD patients reported greater irritability during asthma attacks than asthma-only patients. Generalized panic-fear was directly associated with restriction of activities due to asthma and use of rescue medication for asthma. Neither measure of panic-fear was associated with asthma severity. Panic-fear experienced during asthma attacks may be an important area to target for improving health-related quality of life among asthma-PD patients.
Reviews research on internal–external (I–E) locus of control expectancies and health attitudes and behaviors. The theoretical background of the I–E construct is described. Topics include I–E relation to health knowledge, precautionary health practices, reactions to physical disorders, psychological responding, psychological disturbances, and responses to psychological treatment. (5½ p ref)
The development of the Multidimensional Health Locus of Control scales is described. Scales have been developed to tap beliefs that the source of reinforcements for health-related behaviors is primarily internal, a matter of chance, or under the control of powerful others. These scales are based on earlier work with a general Health Locus of Control Scale, which, in turn, was developed from Rotter's social learning theory. Equivalent forms of the scales are presented along with initial internal consistency and validity data. Possible means of utilizing these scales are provided.
SYNOPSIS
Post-traumatic stress disorder (PTSD) was studied in the Piedmont region of North Carolina. Among 2985 subjects, the lifetime and six month prevalence figures for PTSD were 1·30 and 0·44 % respectively. In comparison to non-PTSD subjects, those with PTSD had significantly greater job instability, family history of psychiatric illness, parental poverty, child abuse, and separation or divorce of parents prior to age 10. PTSD was associated with greater psychiatric co-morbidity and attempted suicide, increased frequency of bronchial asthma, hypertension, peptic ulcer and with impaired social support. Differences were noted between chronic and acute PTSD on a number of measures, with chronic PTSD being accompanied by more frequent social phobia, reduced social support and greater avoidance symptoms.
Objective: To review psychological stress interventions employed to improve asthma outcomes.
In this article the construct of generalized expectancies for internal versus external control of reinforcement is used as a model to present a brief on the importance of broad theory and training in theory construction and evaluation in psychology. Specifically, the extraordinary heuristic value of this construct is attributed to four characteristics: the nature of the definition, the careful imbedding of the construct in a theoretical context, the use of a broad behavior theory in construction of a measure of individual differences, and the programmatic nature of the original research as well as the format of the early publications. Reevaluation of the characteristic criteria for publication of research studies and for the evaluation of promotion or advancement for psychologists involved in research activities is also discussed.
Asthma is a multifactorial chronic respiratory disease characterised by recurrent episodes of airway obstruction. The current management of asthma focuses principally on pharmacological treatments, which have a strong evidence base underlying their use. However, in clinical practice, poor symptom control remains a common problem for patients with asthma. Living with asthma has been linked with psychological co-morbidity including anxiety, depression, panic attacks and behavioural factors such as poor adherence and suboptimal self-management. Psychological disorders have a higher-than-expected prevalence in patients with difficult-to-control asthma. As psychological considerations play an important role in the management of people with asthma, it is not surprising that many psychological therapies have been applied in the management of asthma. There are case reports which support their use as an adjunct to pharmacological therapy in selected individuals, and in some clinical trials, benefit is demonstrated, but the evidence is not consistent. When findings are quantitatively synthesised in meta-analyses, no firm conclusions are able to be drawn and no guidelines recommend psychological interventions. These inconsistencies in findings may in part be due to poor study design, the combining of results of studies using different interventions and the diversity of ways patient benefit is assessed. Despite this weak evidence base, the rationale for psychological therapies is plausible, and this therapeutic modality is appealing to both patients and their clinicians as an adjunct to conventional pharmacological treatments. What are urgently required are rigorous evaluations of psychological therapies in asthma, on a par to the quality of pharmaceutical trials. From this evidence base, we can then determine which interventions are beneficial for our patients with asthma management and more specifically which psychological therapy is best suited for each patient.
Objectives: Asthma and allergy are stressful conditions that require coping strategies and social support to reduce stress and enhance health-promoting behavior. However, research is limited regarding coping and social support in asthma and allergy. The aim was to better understand use of different coping strategies and perceived social support in low and high severity (exacerbation frequency) of asthma and allergy. Methods: Population-based data were used to provide ratings of coping strategies (Study I) and social support (Study II) from 124 and 94 participants, respectively, with asthma and/or allergy, categorized as low or high in severity. Problem- and emotion-focused coping strategies were assessed as well as emotional, instrumental and informative social support from seven sources. Results: Study I showed that avoiding certain environments (problem-based coping) and trying to accept one’s situation (emotion-based) were the most commonly used coping strategies. These behaviors did not differ due to severity. Study II showed that more emotional than instrumental and informative support was perceived. The highest rated support sources were the partner, family members, and the healthcare system. More social support was reported in low compared to high asthma/allergy severity. Conclusion: The most commonly used coping strategies in the population of persons with these four types of asthma and allergy are avoiding certain environments and trying to accept one’s situation. More emotional support than instrumental and informative is perceived to be received, and most of the support is received from one’s partner and other family members, and least from authorities and patient associations/support groups.
This paper examines the psychometric properties of an existing measure of mental health, the GHQ-12, as revealed in three studies involving employees in an engineering firm (n = 659), recent school-leavers (n = 647), and unemployed men (n = 92). The measure was shown to be psychometrically sound in all cases, with a Likert scoring method providing a more acceptable distribution of scores than the more commonly deployed ‘ GHQ score ’ for use in parametric statistical analyses. Scores on GHQ-12 were found to be much higher (indicating lower mental health) for those who were unemployed, higher for women than for men in one sample, and unrelated to age, job level and marital status.
This article presents an agentic theory of human development, adaptation, and change. The evolutionary emergence of advanced symbolizing capacity enabled humans to transcend the dictates of their immediate environment and made them unique in their power to shape their life circumstances and the courses their lives take. In this conception, people are contributors to their life circumstances, not just products of them. Social cognitive theory rejects a duality between human agency and social structure. People create social systems, and these systems, in turn, organize and influence people's lives. This article discusses the core properties of human agency, the different forms it takes, its ontological and epistemological status, its development and role in causal structures, its growing primacy in the coevolution process, and its influential exercise at individual and collective levels across diverse spheres of life and cultural systems.
© 2006 Association for Psychological Science.
In this article, I review the diverse ways in which perceived self-efficacy contributes to cognitive development and functioning. Perceived self-efficacy exerts its influence through four major processes. They include cognitive, motivational, affective, and selection processes. There are three different levels at which perceived self-efficacy operates as an important contributor to academic development. Students' beliefs in their efficacy to regulate their own learning and to master academic activities determine their aspirations, level of motivation, and academic accomplishments. Teachers' beliefs in their personal efficacy to motivate and promote learning affect the types of learning environments they create and the level of academic progress their students achieve. Faculties' beliefs in their collective instructional efficacy contribute significantly to their schools' level of academic achievement. Student body characteristics influence school-level achievement more strongly by altering faculties' beliefs in their collective efficacy than through direct affects on school achievement.
In order to clarify the effects of health locus of control and value placed on participation in health protective behaviors, a questionnaire was formulated that included (a) a 20-item shortened version of the Lau and Ware multidimensional HLC Scale, (b) the 4-item health value index used by Seeman and Seeman, and (c) a 10-item index of health protective behaviors. Interviews were conducted with 213 undergraduate, college students. Results of a multiple regression are presented for the entire sample and separately for those low and high in health value. For the entire sample, health value is a stronger predictor than HLC of participation in HPBs. For the separate equations, a more internal HLC substantially increases participation in HPBs for those high in health value but not for those low in health value. Furthermore, respondents with high health value and internal HLC appear most likely to engage in HPBs.
This study examined the levels of posttraumatic stress disorder (PTSD) following asthma attack (post-asthma attack PTSD) and psychiatric co-morbidity among college students. It also investigated the association between these variables and alexithymia. One hundred and six college students participated in the study and completed an on-line survey comprising the Asthma Symptom Checklist, PTSD Checklist, General Health Questionnaire-28 and Toronto Alexithymia Scale. Ninety-one students without asthma and major illness formed the control group. 2 % met the diagnostic criteria for full-PTSD, while 42 and 56 % met the partial and no-PTSD criteria respectively. Compared with the control, the asthma group reported significantly more somatic problems, social dysfunction and depression and was five times more likely to have an elevated risk of developing a general psychiatric disorder. After adjusting age, marital status, asthma experience and symptoms, alexithymia did not predict PTSD, while difficulty identifying feelings predicted psychiatric co-morbidity. Mediational analyses showed that asthma symptoms partially mediated the link between difficulty identifying feelings and psychiatric co-morbidity. People can develop PTSD symptoms and other psychological difficulties following asthma attack. Alexithymia influenced general psychological difficulties independently of PTSD symptoms.
Social-cognitive theory and conservation-of-resources theory were utilized to understand individual differences in psychological response to natural disaster. Coping self-efficacy, lost resources, social support, and optimism were assessed along with demographic variables in predicting distress following Hurricane Opal. Participants included 67 residents of Okaloosa County, Florida. Multiple regression analyses indicated that coping self-efficacy was the strongest predictor of general distress and trauma-related distress. Loss of resources and gender were also important predictors of general distress. Path analyses demonstrated that lost resources directly influenced general distress, social support, optimism, and coping self-efficacy. These analyses also indicated that coping self-efficacy perceptions mediated the relationships between loss of resources and trauma-related distress, social support and both trauma and general distress, and optimism and both types of distress. Theoretical implications are discussed.
Variable- and person-focused approaches were applied to study the resilient outcomes of 326 Greek male and female 1st year
university students at a major educational transition point. Results indicated that resilience was related to both cognitive
and behavioural psychosocial resources in late adolescence. Locus of control emerged as an important resource which affected
adaptation in the face of difficulties. Active and avoidance coping strategies significantly influenced adaptation, as did
adversity. Under low adversity, avoidance coping was used; under high adversity, however, both active and avoidance coping
were used equally. Resilient and adapted young people utilised more resources than the maladaptive youths, and demonstrated
significantly higher levels of positive adaptation. Excelling-resilient adolescents utilised coping resources expertly.
This study investigated the prevalence of post-asthma attack posttraumatic stress disorder (PTSD) and the severity of psychiatric co-morbidity among a group of college students and whether alexithymia and coping strategies would relate to health outcomes. This is a cross-sectional study in which 156 college students who had previously experienced asthma attack were recruited. They completed a demographic page, Asthma Symptom Checklist, PTSD Checklist, General Health Questionnaire-28, Toronto Alexithymia Scale and the COPE. They were also matched with 141 students without asthma. The results showed that 3% met the criteria for full-PTSD, 44% for partial and 53% for no-PTSD. There were no significant differences between the asthma and control groups in severity of psychiatric co-morbid symptoms. Path analyses showed that asthma severity was significantly correlated with PTSD and psychiatric co-morbidity. It was also correlated with alexithymia which was in turn associated with psychiatric co-morbidity but not PTSD. Coping strategies were not correlated with health outcomes. To conclude, people can develop PTSD symptoms and degrees of psychiatric co-morbid symptoms after suffering asthma attack. The severity of these symptoms relates to people's perceptions of asthma severity and alexithymia.
Recommendations to improve self-management support and health outcomes for people with chronic conditions in primary care settings are provided on the basis of expert opinion supported by evidence for practices and processes. Practices and processes that could improve self-management support in primary care were identified through a nominal group process. In a targeted search strategy, reviews and meta-analyses were then identifed using terms from a wide range of chronic conditions and behavioral risk factors in combination with Self-Care, Self-Management, and Primary Care. On the basis of these reviews, evidence-based principles for self-management support were developed.
The evidence is organized within the framework of the Chronic Care Model. Evidence-based principles in 12 areas were associated with improved patient self-management and/or health outcomes: (1) brief targeted assessment, (2) evidence-based information to guide shared decision-making, (3) use of a nonjudgmental approach, (4) collaborative priority and goal setting, (5) collaborative problem solving, (6) self-management support by diverse providers, (7) self-management interventions delivered by diverse formats, (8) patient self-efficacy, (9) active followup, (10) guideline-based case management for selected patients, (11) linkages to evidence-based community programs, and (12) multifaceted interventions. A framework is provided for implementing these principles in three phases of the primary care visit: enhanced previsit assessment, a focused clinical encounter, and expanded postvisit options.
There is a growing evidence base for how self-management support for chronic conditions can be integrated into routine health care.
Post-traumatic stress disorder (PTSD) is one of the most prevalent long-term psychiatric diagnoses among survivors of severe acute respiratory syndrome (SARS).
The objective of this study was to identify the predictors of chronic PTSD in SARS survivors.
PTSD at 30 months after the SARS outbreak was assessed by the Structured Clinical Interview for the DSM-IV. Survivors' demographic data, medical information and psychosocial variables were collected for risk factor analysis.
Multivariate logistic regression analysis showed that female gender as well as the presence of chronic medical illnesses diagnosed before the onset of SARS and avascular necrosis were independent predictors of PTSD at 30 months post-SARS. Associated factors included higher-chance external locus of control, higher functional disability and higher average pain intensity.
The study of PTSD at 30 months post-SARS showed that the predictive value of acute medical variables may fade out. Our findings do not support some prior hypotheses that the use of high dose corticosteroids is protective against the development of PTSD. On the contrary, the adversity both before and after the SARS outbreak may be more important in hindering recovery from PTSD. The risk factor analysis can not only improve the detection of hidden psychiatric complications but also provide insight for the possible model of care delivery for the SARS survivors. With the complex interaction of the biopsychosocial challenges of SARS, an integrated multidisciplinary clinic setting may be a superior approach in the long-term management of complicated PTSD cases.
Sustained or spontaneous hyperventilation has been associated with a variety of physical symptoms and has been linked to a number of organic illnesses and mental disorders. Theories of panic disorder hold that hyperventilation either produces feared symptoms of hypocapnia or protects against feared suffocation symptoms of hypercapnia. Although the evidence for both theories is inconclusive, findings from observational, experimental, and therapeutic studies suggest an important role of low carbon dioxide (CO2) levels in this disorder. Similarly, hypocapnia and associated hyperpnia are linked to bronchoconstriction, symptom exacerbation, and lower quality of life in patients with asthma. Raising CO2 levels by means of therapeutic capnometry has proven beneficial effects in both disorders, and the reversing of hyperventilation has emerged as a potent mediator for reductions in panic symptom severity and treatment success.
A belief that doctors or family control one's health outcomes (external health locus of control), and a belief in one's own ability to achieve desired outcomes (general self-efficacy), may influence distress experienced in relation to a physical illness. This study examined the interaction between illness severity, external health locus of control and general self-efficacy in relation to distress. Illness severity was defined as acute or chronic illness, with the latter expected to be more stressful. Participants described a serious illness they experienced, and completed self-report scales in relation to it. Results confirmed that chronic illnesses were associated with more distress than acute illnesses across the sample. Hierarchical multiple regression analyses supported the predicted effects on distress of a three-way interaction involving external health locus of control, general self-efficacy and illness severity (acute vs. chronic). Analysis of these results may assist in explaining inconsistencies in previous research, and offer a model for understanding the role of person variables in emotional distress.
Quisimos evaluar tanto la estructura factorial como la confiabilidad de la
versión de 28 ítem del Cuestionario de Salud General (GHQ-28) en una muestra noclínica
en El Salvador. Aplicamos el GHQ-28 a una muestra de 714 de alumnos universitarios
en El Salvador. Utilizamos un análisis de componentes principales y seleccionamos
una solución de 4 factores. Reaplicamos la prueba a un grupo de los participantes
después de un promedio de 3 meses, para evaluar la confiabilidad de retest
del instrumento y calculamos la confiabilidad interna del GHQ-28 a través de la prueba
alfa de Cronbach. Los resultados del análisis factorial correspondieron estrechamente
con la estructura factorial antes identificada, aunque encontramos una correlación más
alta entre las escalas, sobre todo entre Ansiedad e insomnio y Somatización. La fiabilidad
test-retest y la consistencia interna alcanzaron valores de 0,70 o superiores. Los
resultados del análisis factorial indican una gran coincidencia con las conclusiones de
otros entornos culturales, lo que apoya la hipótesis de Goldberg de que hay una manera
común de comunicar angustia psicológica en culturas distintas. Las escalas de Depresión
severa y de Disfunción social parecen ser relativamente estables e independientes,
mientras que las de Ansiedad e insomnio y de Somatización se correlacionan más. La
fiabilidad del instrumento es satisfactoria.
In this study, the lifetime prevalence of stressful events and current posttraumatic stress disorder (PTSD) in the general adult population in the Netherlands were examined, and risk groups for PTSD were determined. A representative sample of 2,238 adults (>or=18 years) in the Netherlands completed digital questionnaires by computer-assisted self-interviewing. In total, 52.2% of the population reported at least one stressful event throughout their life. The estimated prevalence of current PTSD in the total population was 3.8%. Rape and physical assault were the stressful events most likely to be associated with PTSD, witness of injury the least likely. Stressful medical events were moderately associated with PTSD. Prevalence of PTSD was elevated among single women and middle-aged men.
Hypotheses involving mediation are common in the behavioral sciences. Mediation exists when a predictor affects a dependent variable indirectly through at least one intervening variable, or mediator. Methods to assess mediation involving multiple simultaneous mediators have received little attention in the methodological literature despite a clear need. We provide an overview of simple and multiple mediation and explore three approaches that can be used to investigate indirect processes, as well as methods for contrasting two or more mediators within a single model. We present an illustrative example, assessing and contrasting potential mediators of the relationship between the helpfulness of socialization agents and job satisfaction. We also provide SAS and SPSS macros, as well as Mplus and LISREL syntax, to facilitate the use of these methods in applications.
SYNOPSIS
This study reports the factor structure of the symptoms comprising the General Health Questionnaire when it is completed in a primary care setting. A shorter, 28-item GHQ is proposed consisting of 4 subscales: somatic symptoms, anxiety and insomnia, social dysfunction and severe depression. Preliminary data concerning the validity of these scales are presented, and the performance of the whole 28-item questionnaire as a screening test is evaluated. The factor structure of the symptomatology is found to be very similar for 3 independent sets of data.
The present article presents an integrative theoretical framework to explain and to predict psychological changes achieved by different modes of treatment. This theory states that psychological procedures, whatever their form, alter the level and strength of self-efficacy. It is hypothesized that expectations of per- sonal efficacy determine whether coping behavior will be initiated, how much effort will be expended, and how long it will be sustained in the face of ob- stacles and aversive experiences. Persistence in activities that are subjectively threatening but in fact relatively safe produces, through experiences of mastery, further enhancement of self-efficacy and corresponding reductions in defensive behavior. In the proposed model, expectations of personal efficacy are derived from four principal sources of information: performance accomplishments, vicarious experience, verbal persuasion, and physiological states. The more de- pendable the experiential sources, the greater are the changes in perceived self- efficacy. A number of factors are identified as influencing the cognitive processing of efficacy information arising from enactive, vicarious, exhortative, and emotive sources. The differential power of diverse therapeutic procedures is analyzed in terms of the postulated cognitive mechanism of operation. Findings are reported from microanalyses of enactive, vicarious, and emotive modes of treatment that support the hypothesized relationship between perceived self-efficacy and be- havioral changes. Possible directions for further research are discussed.
The routine use of screening instruments for psychiatric and cognitive impairment in hospital in-patients has been recommended in the United States. The validity of the scaled version of the General Health Questionnaire (GHQ-28) and the clinical utility of the Mini-Mental State Examination (MMSE) were therefore evaluated in a consecutive series of neurological in-patients (N = 102). Using Receiver Operating Characteristic (ROC) analysis, the discriminating power of the GHQ was very good, and best when using a threshold score of 11/12. The patient sample turned out not to contain any with generalised cortical damage, which casts some doubt on whether the MMSE should be used routinely in all neurological in-patients units in the UK.