parisis xpress stisimo.qxd - European Health Psychology Society

Transcription

European
Health
Psychology
Conference
17th
Kos, Greece
September 24-27
2003
Contents
Keynotes
2
Symposia and Round Tables
7
Oral presentations
43
Posters
73
1
Keynotes
DOES POSITIVE THINKING HELP OR HURT?
CRITICAL ISSUES IN UNDERSTANDING THE ROLE OF POSITIVE
BELIEFS AND EMOTIONS IN MANAGING ADVERSITY
Lisa G. Aspinwall, Ph.D.
Department of Psychology
University of Utah
It is a common finding that 30-90% of people experiencing serious illness and other forms of adversity report increased quality of life and other positive life changes following their experience, yet there
is still considerable disagreement among scientists and practitioners about whether such changes are
real or beneficial. This talk identifies several pervasive assumptions about positive emotions and
beliefs that may limit progress in understanding and promoting good mental and physical health outcomes among people with chronic illness, namely 1) that positive beliefs and emotions are, or should
be, absent among people facing adversity, and 2) that positive emotions and beliefs, when present
among people managing adversity, are ephemeral and trivial at best and delusional and dangerous at
worst, leading people to ignore or deny important aspects of their situation. Drawing on survey studies of people with such chronic illnesses as cancer and HIV infection, as well as on laboratory studies of the effects of positive beliefs, experiences, and expectations on attention to health risks and
other kinds of negative information, a review of evidence on each of these points suggests instead that
positive emotions and beliefs seem not only to be associated with good outcomes among people experiencing adversity, but also to play a role in realizing them. Specifically, optimism, positive affect,
self-affirmation, and expected positive mood seem to serve as psychological resources that allow people to attend to and use negative information useful in coping with problems and managing risks to
health.Implications for the study of positive beliefs, emotions, and life changes among people with
chronic illness and for understanding self-regulatory processes more generally are discussed, as are
potential cultural differences in the links between the experience and expression of positive beliefs
and coping outcomes.
CONTEXTUALIZING THE JOB STRESS-ILLNESS RELATIONSHIP:
THE ROLE OF FAMILY AND COMMUNITY FACTORS.
Rosalind Barnett, Ph.D.
Senior Scientist
Director of Community, Family & Work Program
Brandeis University, USA
Employees increasingly are in dual-earner couples, and we know that the stress experienced by one
member of a dyad affects the distress of the other member. Also, employees reside in communities in
which they may have access to resources (e.g., after-school programs, transportation
options) that have direct and indirect effects on health outcomes. Yet, the paradigms underlying
research into the job stress-illness relationship do not capture these sources of variance. In my talk, I
present a new research model that extends current models by incorporating family and community
factors.
2
Keynotes
SOCIAL SHARING OF EMOTION AND HEALTH PSYCHOLOGY
Professor Bernard Rimé
University of Louvain at Louvain-la-Neuve, Belgium
Data show that 80 to 95% of people who experienced an emotion or who came across an emotional
episode manifested afterwards a social sharing process. They talked about the experience or the
episode with selected members of their social environment. Such a process is initiated shortly after
the emotion, it is generally repetitive, and it is addressed most often to several target persons. Extent
of social sharing varies as a function of the intensity of the emotional experience: More upsetting
episodes are shared more repetitively, with a wider number of target persons, and for a longer period
after they occurred. When listening, social sharing targets generally experience emotional feelings
too, and therefore are motivated to later share what they heard with other people, thus undertaking a
secondary social sharing. In the case of high intensity emotional episodes, the emotional information
thus propagates in the community. As regards the effect of sharing an emotion, correlative and experimental studies failed to confirm the commonly held view that it simply involves relieving or cathartic effects. Once an emotional memory was reaccessed, its emotional impact was comparable whether
it had previously been shared or not. However, important cognitive and subjective benefits are generally reported by people after they shared an emotion. Data reveal that emotional experiences are at the
start of a process of sensemaking coupled with a process of seeking for social integration. Experiences
of illness and of medical intervention are most of the time eliciting intense emotions among patients
and are therefore particularly proper to activate in them a need to share. In the context of disease and
illnesses, sensemaking and social integration play a particularly critical role. At the same time, illnessrelated emotions are generally experienced as threatening by healthy people around patients, thus
opening to a communication dilemma.
3
Keynotes
SOCIOECONOMIC INEQUALITIES IN HEALTH IN EUROPE
Prof. Dr Johan P. Mackenbach
Department of Public Health
Erasmus MC
Erasmus University Medical Center
Rotterdam, the Netherlands
During the past decade, socioeconomic inequalities in health have increasingly become recognized as
an important public-health issue throughout Europe. In all countries with available data, persons with
a lower level of education, a lower occupational class and/or a lower income appear to have higher
rates of disease and premature death than their better-off counterparts. In my presentation I will give
an overview of these inequalities in different European countries, and of the factors that are likely to
be involved in their explanation.
There is considerable variation between European countries in both the size and the pattern of health
inequalities. Health interview survey data suggest that the risk of ill-health is between 1.5 and 2.5
times higher in lower than in higher socioeconomic groups, with substantial inequalities everywhere,
but particularly in the Nordic countries, despite their long histories of egalitarian policies. Mortality
data show that among middle-aged persons the risk of premature death is between 1.3 and 1.7 times
higher in the lower than in the higher socioeconomic groups. Analyses by cause of death reveal a
striking north-south pattern: in the Nordic countries and England and Wales, the socioeconomic gap
in total mortality is mainly due to an excess risk of cardiovascular disease in the lower socioeconomic
groups, but in southern European countries cancer and gastrointestinal diseases play a more important
role. This suggests that the explanation of health inequalities may at least be partly different between
countries.
Explanatory studies, particularly longitudinal studies conducted in a number of European countries,
have shed light on the factors involved in the explanation of health inequalities. ‘Causal’ effects of
low socioeconomic status on health are likely to be indirect, and to be mediated by material,
psychosocial and lifestyle factors that are unevenly distributed between socioeconomic groups, such
as unfavourable physical working conditions, psychosocial stressors, and smoking. In some analyses,
more than 50% of the excess risk of mortality in the lower socioeconomic groups can be explained
statistically by these specific factors, pointing towards opportunities for reducing inequalities in health
by reducing the exposure of lower socioeconomic groups. Based on the insights gained in these
explanatory studies, a search has begun for effective strategies to reduce health inequalities.
Nevertheless, important scientific questions are still open, and relate to the possible roles of the lifecourse, of biological factors, and of the macrosocial environment that need to be explored in future
multidisciplinary research.
4
Keynotes
MAKING SENSE OF ILLNESS AND TREATMENT:
A SELF–REGULATORY APPROACH.
Professor John Weinman,
Health Psychology Section,
Institute of Psychiatry,
King’s College,
University of London
Accumulating research evidence has revealed that there is an enormous variation in the ways patients
adjust to illness and that the nature of this adjustment is crucial in determining both psychological and
physical health outcomes. There is also consistent evidence that this variation is not primarily due to
medical factors such as illness severity but, until recently, little progress has been made in elucidating
the possible psychological determinants.
One approach, which does provide considerable potential for understanding the underlying psychological processes, is based on the study of patients’ perceptions of their illness. This paper will provide an overview of recent work in this area. It will begin with an outline of Leventhal’s self-regulatory model (SRM) and discuss the difficulties inherent in operationalising the model together with
some solutions developed by the author and colleagues.
The main part of the talk will focus on a number of empirical studies, which have investigated the predictive value of illness perceptions in explaining adjustment to chronic illness, and the potential,
which these findings have for developing new interventions to facilitate patient self-management.
There will also be consideration of other studies, which have sought to extend the SRM by examining patients’ beliefs about treatment, as a basis for explaining variation in levels of adherence to treatment and for developing new interventions.
The final part of the talk will focus on recent work attempting to deal with a number of unresolved
issues with the SRM. The latter includes the nature of the identity component of illness perception,
the possible role of illness coherence as an indicator of the appraisal process and the role of emotion
in illness adaptation and in response to psychological intervention.
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6
Symposia
and
Round tables
7
Symposium
Dyadic coping
and gender
SYMPOSIUM
DYADIC COPING AND GENDER
Content:
Many stressors in life are dealt with within intimate relationships. Put differently, dealing with stressors, such as illness, family conflicts, and problems in child rearing, is not an individual process, but a dyadic (interactive) affair. Such stressors affect both partners of a couple, Morever, individuals do not only have to deal with their own emotions (e.g. fear and anger) and concerns, they
also have to deal with their spouse’s emotions and problems. This symposium addresses several issues concerning dealing with
stress in intimate relationships, including:
(1) the level of psychological distress and the congruence in distress levels between partners in couples dealing with stress;
(2) the interactive stress process over time: interrelations between support, coping, well-being and marital adjustment within couples;
(3) Cognitions and behavior of one partner and and well-being of the other.
The role of gender in dyadic coping will be addressed in the presentations.
Convenor/chair: Mariët Hagedoorn
University of Groningen, Faculty of Medical Sciences
Public Health and Health Psychology, Northern Centre for Healthcare Research
Antonius Deusinglaan 1, 9713 AV Groningen, the Netherlands
DYADIC COPING AND QUALITY OF LIFE:
GENDER DIFFERENCES IN SPOUSAL SUPPORT AFTER SURGERY
Ute Schulz, Free University Berlin
The level of social support from spouses is regarded as a key indicator in the speed and quality of recovery from illness and adjustment after surgery. However, the availability and the effect of spousal support may differ for male or female patients since substantial gender differences have been reported in the literature on social support.
In this study, the question is raised whether men and women benefit in the same way from their intimate partners. The differential
gender effects of received social support on patients recovery are examined in a longitudinal design with 108 cancer patients who
underwent tumor-related surgery, and their spouses. Two kinds of dyads, male patient female partner and female patient male partner, were used to disentangle role (patient/spouse) and gender effects in the analysis, which was performed in a time-lagged fashion. Spouses’ resources, as well as support provision measured one month after the patients’ surgery, served as predictors for
patients’ quality of life five months after release from health care facilities. Path models test direct and mediated effects of spousal
support on patients’ coping strategies and health.
Results provide evidence for a direct path from partner support to coping but rather weak associations with health outcomes.
However, these effects vary for the two subgroups of patient-partner dyads. Findings highlight the importance of differential analyses and will be discussed with regard to gender differences in couples coping with stress.
STRESS, COPING, AND SOCIAL SUPPORT IN COUPLES LIVING IN STEP-FAMILIES
A LONGITUDINAL STUDY
Anita DeLongis, Susan Holtzman, & Dayna Lee-Baggley
University of British Columbia, Department of Psychology,
2136 West Mall, Vancouver, British Columbia, Canada V6T 1Z4.
Stepfamilies are an increasingly common family form, and step-parents are faced with a set of unique challenges and stressors. How
they cope with these stressors can have important implications not only for their own well-being, but also for that of their spouse,
children, and step-children. The few studies that have been done in this field suggest that cognitive appraisal and support processes within the married couple may be critical determinants of long-term family functioning.
The present study sought to examine these issues by following 150 couples in step-families across a 12-year period. Initial interviews were completed with each member of the couple regarding their sources of family and marital stress, ways of coping, appraisal processes, and family relationships. Daily diary data regarding stress, coping, and support processes were collected following the
initial interview. At two-year follow-up, each member of the couple was again interviewed. At twelve years, the couples marital
status was re-assessed to allow an examination of predictors of divorce in this at-risk group.
Predictors of dyadic adjustment included the couple’s perceived coping efficacy, stress appraisals and support from the spouse. In
particular, the extent to which spouses reported communicating clearly regarding the stressor, and the extent to which they felt they
could both get help from their partners and give help to them was significantly associated with marital adjustment. Gender differences surfaced in the types of problems reported by husbands and wives with wives more concerned about step parenting issues
and more threatened and ruminative about family problems.
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COUPLE SIMILARITY FOR PATTERNS OF DISTRESS:
A COMPARISON OF PATIENTS AND HEALTHY CONTROLS
Jolanda Tuinstra, Ans Smink, Adelita V. Ranchor, Robbert Sanderman
University of Groningen, Faculty of Medical Sciences,
Public Health and Health Psychology, Groningen, the Netherlands
A review of the literature on couples dealing with cancer shows inconclusive answers on congruence between patient’s and spouse’s
distress. We consider similar levels of distress within a couple as an indicator of congruence. Our study examines patterns of psychological distress one year after diagnosis in patient couples and matched control couples. These patterns concern both congruence within couples and changes in congruence over time. The present paper addresses the following questions:
Do patients report similar psychological distress as their spouses three months and nine months after diagnosis?
Do patient couples have different patterns of psychological distress than control couples?
This study included 80 newly diagnosed breast cancer patients and their spouses. Control couples (n=60) followed the same longitudinal study design as patient couples (9 assessments in total). For the present study data from two assessment points are used, i.e.
3 months (T1) and 9 months (T2) after diagnosis. Psychological distress was measured with the Hospital Anxiety and Depression
Scale. Absolute difference scores were assessed as an indicator of congruence.
At T1 and T2 no significant correlations were found for psychological distress in patient couples, in contrast to control couples.
Patient couples and control couples showed different patterns of congruence: In patient couples highest levels of congruence were
found in the lowest and highest quartiles of patient’s distress scores. Congruence in control couples was mainly found in the two
lowest quartiles of distress. Couple characteristics as marital satisfaction and equity will be discussed with regard to different patterns in couple adjustment.
PATIENT AND SPOUSAL ATTITUDES IN COUPLES
LIVING WITH CHRONIC HEART FAILURE
James C. Coyne, Nili R. Benazon, Michael J. Rohrbaugh, Varda Shoham
University of Pennsylvania Health System, Department of Psychiatry, Philadelphia, USA
Expressed emotion (EE) is a term applied to the emotional climate of the family as measured by semi-structured interview or ratings of speech samples of the family members. Although high EE is associated with poorer prognosis in a variety of psychiatric
conditions, results for physical health conditions are more equivocal. The aim of this paper was to investigate levels and effects of
EE in couples coping with chronic heart failure (CHF). One important feature is that patient EE was assessed in addition to what
was obtained from speech samples of spouses.
The present study utilized Five Minute Speech Samples (FMSS) obtained from 106 couples in which one partner had a diagnosis
of CHF. Additional clinical self-report and mortality data were available.
Compared to psychiatric samples, levels of EE from both patients and spouses were quite low, with patient and spouse EE unrelated. The strongest findings were that patients whose spouses were high on EE reported more distress and less self-efficacy. This
effect seemed to be due to the effects of emotional overinvolvement. Spouse EE was also related to lower marital quality. Gender
differences emerged in that the wives of male patients were more likely to report high EE than the husbands of female patients, and
female patients were also more likely than male patients to report high EE.
Strikingly low rates of EE observed in these couples suggest that a life-threatening illness may dampen hostile critical exchanges.
The effects of spousal EE need to be interpreted with caution. Given they are largely due to emotional overinvolvement, the effects
may be largely a matter of patient difficulties eliciting higher spouse involvement rather than spouses undermining patients.
Comparisons between psychiatric and medical samples need to pay attention to important differences in mean levels of expressed
emotion as well as their correlates.
REPRESENTATIONS OF TYPE 2 DIABETES:
AN EXAMINATION OF PARTNERS BELIEFS
AND THEIR INFLUENCE ON PATIENTS WELL-BEING.
Aidan Searle, Paul Norman & Kav Vedhara.
MRC Health Services Research Collaboration, Department of Social Medicine, University of Bristol,. UK.
Aims
This research aimed to elucidate the health beliefs of individuals with a partner with type 2 diabetes. As part of this, we will examine whether health beliefs of the partner vary according to the partner’s gender; and the extent to which partners representations
influence patients’ emotional well-being (anxiety and depression) and dyadic adjustment.
Method
The Revised Illness Perception Questionnaire (IPQ-R) was utilised to assess the representations of partners’ beliefs about type 2
diabetes (N=164). The emotional well-being of patients was assessed with the Hospital Anxiety and Depression Scale and dyadic
adjustment was assessed with the Dyadic Adjustment Scale (DAS).
Results
Analyses will be conducted to (1) examine if gender differences exist for partners representations of type 2 diabetes and (2) explore
whether the relationships between partner health beliefs and patients’ emotional well-being and dyadic adjustment are influenced
by the gender of the partner.
Conclusion
The results of these analyses will be discussed in the symposium in the context of dyadic relationships and emotional well-being
with chronic disease.
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PREDICTING DISTRESS IN STROKE PATIENTS AND CARERS:
DYADIC BELIEFS AND DISCREPANCIES
Val Morrison
School of Psychology, University of Wales Bangor, Wales, UK
OBJECTIVES: This paper addresses the question of early discrepancies in illness cognitions and mood between 72 stroke patients
and their informal carers, and examines whether discrepancies are predictive longitudinally of patient or carer mood.
METHODS: 72 couples who acted as controls in a randomised controlled trial of a stroke workbook-based intervention (Johnston
et al, 2002) were assessed approx 3 weeks post-discharge (T1), 7 weeks later (T2), and finally 5 months thereafter (approx 190 days
post discharge, T3). Participants were assessed in terms of mood (HADS); perceived control over recovery (RLOC), recovery confidence, and perceived patient disability. Discrepant responses were calculated by subtracting carer scores from patient scores.
RESULTS: Descriptive results show that at T1, carers perceive patients to be more disabled than they perceive themselves to be,
carers are more anxious and less depressed than patients, and patients have greater recovery confidence. Perceived control did not
differ between groups. Discrepancies in T1 anxiety are associated with higher subsequent anxiety and observed disability in
patients, and less carer anxiety. Discrepancies in T1 depression is associated with higher subsequent patient depression but less carer
depression. Initial discrepancies in perceived disability or perceived control over recovery are not predictive of emotional outcome
for either patients or carers.
CONCLUSION: Differences within married couples in emotions following stroke, or in recovery beliefs, have differential effects.
It is proposed that dyadic or individual coping, and premorbid marital interaction may mediate potential negative effects of discrepant responses to acute stroke.
Symposium
Cognitive and
emotional processes
in clinical health
psycology
SYMPOSIUM
COGNITIVE AND EMOTIONAL PROCESSES IN CLINICAL HEALTH PSYCHOLOGY:
DEVELOPMENTS AND APPLICATIONS
Under the auspices of the Division of Clinical Psychology of the Hellenic Psychological Society
and the Department of Psychology of the University of Athens
THE IMPACT OF AN EXAMINATION PERIOD AS A RECURRENT ACUTE STRESSOR
ON PSYCHOLOGICAL HEALTH, AND THE ROLE OF APPRAISAL AND COPING
Evangelos C. Karademas, Anastasia Kalantzi-Azizi
Department of Psychology, University of Athens, Greece
In this study the effects of the stress process after a commor recurrent stressful encounter, that is an examination period, on university students’ psychological health, as well as certain factors that play a significant role in this relationship are being examined. Two
hundred and ninety-one (291) students at the University of Athens participated in our study. They completed a series of questionnaires concerning (a) psychological symptoms, (b) self-efficacy expectations, (c) threat, challenge and stakes, (d) coping strategies,
and (e) a cognitive self-schema concerning personal examination abilities. The questionnaires were completed in three phases: three
months and one week before an examination period, and one week after completion of this period. According to the findings, psychological health is negatively and significantly infected by the stressful encounter, especially between females. Psychological
symptoms are predicted by prior health level, appraisal variables (threat and self-efficacy expectations), and certain coping strategies (tension reduction, social support, and positive approach). Self-efficacy expectations play a significant role in shaping threat,
challenge, and stakes. These appraisal categories in turn exert influence upon psychological health, even after controlling for prior
psychological health and coping strategies. A path analysis showed that self-efficacy serves as a key variable in the appraisal
process, as well as a mediator between inner cognitive structures and stress outcomes.
POSITIVE EMOTIONS IN GROUP EFFECTIVENESS
M. Galanakis, A. Stalikas
Panteion University, Athens
Studies of positive traits and positive emotions, or positive psychology, are accelerating due to a growing recognition that these can
lead to adaptive and healthful results concerning the human mind and the human soul. The major target of the speech is to present
the most important aspects of a new theory, in the field of positive psychology, the Theory of Positive Emotions (Fredrickson B.
1998), in order to enlighten possible positive outcomes for human health in general. The theory of Positive Emotions states that
feeling certain emotions, such as joy, love, contentment. pride and happiness can lead through different complex mechanisms
(“broadening”, “Upward Spiral”) to numerous positive outcomes (increase of all kinds psychological resources, increase of the level
of personal well being e.t.c) concerning the individual’s mental and psychological health as it can also prevent the manifestation of
negative emotions and their deleterious effects (“Antidote Hypothesis”). The analysis of Fredrickson’s Theory can lead to the construction of better psychological health prevention techniques and strategies in different levels and settings. In particular this speech
will examine the possible positive effects of Fredrickson’s Theory in the organization and in various occupational settings.
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PSYCHOSOCIAL FACTORS THAT PREDICT ACTUAL AND PERCEIVED BREAST CANCER RISK
VLAVIANOU MIRANDA, ANAGNOSTOPOULOS FOTIOS, KARADIMAS EVANGELOS, KALANTZI-AZIZI ANASTASIA
ATHENS UNIVERSITY AND PANTEION UNIVERSITY, Dept. of Psychology, 7 PTOLEMAION STREET, Athens 11635
Research has shown that the difference between actual and perceived breast cancer risk affects screening behavior (eg. mammograms) (Skinner,1998). Moreover, a number of research has indicated a correlation of breast cancer risk with factors, such as age,
family history, smoking (Black,1995; Drossaert,1996) and with psychological factors, such as monitoring and blunting
(Miller,1996).
The aim of this research was to examine the psychological factors that influence the difference between actual and perceived breast
cancer risk in healthy women. The sample consisted of 162 healthy women who visited a Breast Clinic of a public oncology hospital in Athens for breast screening. The median value of the womens’ age was 55 years, the majority of them (67,7%) were married and their educational level was that of high school in the largest percent (45,1%). The women were administrated a General
Information Questionnaire and the Monitoring and Blunting Questionnaire.
Multiple regression, using as dependent variable the difference between actual and perceived breast cancer risk and as independent
variables age, family history and monitoring-blunting, revealed that women who concentrate on their health problem (monitoring)
have an increased perceived risk. Comparison of mean values revealed that women slightly overestimate risk for other women their
age both for a five-year-period as well as for lifetime.
Given that monitors have an increased perception of breast cancer risk, this finding can help us plan interventions. These interventions will aim at the reduction of the difference between actual and perceived breast cancer risk, which will lead to the increase of
preventive behavior (eg. regular mammography utilization) and to the possibility of breast cancer diagnosis in time.
LONELINESS AND DEPRESSIVE SYMPTOMATOLOGY IN PARENTS OF DISABLED CHILDREN
KLEFTARAS GEORGE and GRIGORIOU FOTINI
UNIVERSITY OF THESSALY
The quality of life and the psychological health of parents with disabled children depend largely on the social and interpersonal
support they receive. In Greece this support is minimal and parents face many psychological, social and financial difficulties with
side effects on their self-esteem, interpersonal relationships and feelings of loneliness. Loneliness has been defined as the psychological state resulting from a discrepancy between ideal and perceived personal relationships. As such it is a state of dissatisfaction regarding one’s quality and quantity of interpersonal relationships and it is probably related to emotional maladjustment and
psychopathology more specifically depression.
Based on the above reasoning the relationship between loneliness and depressive symptomatology in parents with disabled children is investigated. Eighty parents with disabled children who present physical or intellectual disabilities participated in this
study and were administered: a) Pichot’s Depressive Symptomatology Questionnaire b) UCLA Loneliness Scale and c) Weiss’
loneliness Scales of social and emotional isolation. The study is currently at the stage of data analysis. However, the analysis of
the pilot study data seems to confirm the initial hypotheses and as expected significant correlations were found between depressive symptoms and type of loneliness such as a) loneliness of social isolation (lack of social support) and b) loneliness of emotional isolation (loss of a specific relationship partner). The co relational nature of the present findings as well as their implications for counseling, assessment and treatment of depressive symptomatology in these parents are discussed.
DRUG – RELATED PRECAUTIONARY BEHAVIOURS INSIDE PRISON
George Koulierakis
Scientific Collaborator, Shool of Public Health, Athens
A representative sample of male population of the judicial prison of Korydallos (N = 242) participated in a study on HIV/AIDS risk
behaviours. Inmates completed a set of self-report questionnaires referring to precautionary behaviours, before incarceration, inside
prison and (intentions) after release; demographics; Health Belief Model, Health Locus of Control, Health Value and Theory of
Planned Behaviour. Results indicated that 103 inmates (42.6%) reported that they had sometime in their lives injected drugs. Use
of new syringes was the precaution of preference before incarceration (87%) and intended to be also after release (93.7%). During
imprisonment, use of sterilised works was the mostly reported precaution (47.1%). Regression analyses showed that inmates who
believed they had control over avoiding injecting inside were more prone to stop sharing by 17% [OR=1.17 (95% CI: 1.02-1.34)].
Inmates who reported having stopped sharing before incarceration were at about 6 times more likely to do the same inside [OR=5.70
(95% CI: 1.02-35.20)]. Concerning precautions when released, inmates who thought themselves as susceptible to AIDS were 5
times more prone to use new syringes [OR=5.23 (95% CI: 1.89-14.48)]; for every increasing unit in the Health Value scale, the possibility of using new syringes increased by more than 100% [OR=1.26 (95% CI: 1.06-1.50)]; for every extra month in prison, the
possibility of using new syringes decreased by about 6% [OR=0.94 (95% CI: 0.89-0.98)]. Finally, inmates who reported that they
had stopped sharing before incarceration were at about 7 times more likely to use new syringes when released [OR=6.64 (95% CI:
1.06-41.48)]. Concluding, it was shown that past behaviour and components of some SCMs could be used as explanatory variables
of Greek inmates’ injecting and precautionary behaviours.
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Symposium
Work, Stress &
Health
SYMPOSIUM
WORK, STRESS & HEALTH: THE IMPACT OF CROSSOVER OF STRESS AND STRAIN
Chair: Dr. Anthony Montgomery
Discussant: Prof. Rosalind Barnett
THE IMPACT OF VACATION ON THE CROSSOVER OF BURNOUT
BETWEEN SPOUSES: A LONGITUDINAL STUDY
Dalia Etzion & Mina Westman
Tel Aviv University
The goal of the present study was to examine the influence of vacation from work on the crossover of burnout between spouses, in
order to determine whether levels of stress influence the intensity of the crossover process. In the present study we assessed the
crossover of burnout, before and after a vacation, and during a regular work period in 149 couples, while controlling for their job
stress. The sample comprised administrative personnel at an academic institution in the center of Israel and their spouses.
Participants were assessed on three separate occasions: first, at the end of the academic year; second, immediately after their return
from a nine-day Succoth holiday vacation, and third, three weeks later.
The main hypothesis concerning crossover of burnout was confirmed. The results show a significant bi-directional crossover
between spouses on all three occasions. They also strengthen earlier preliminary findings pertaining to the correspondence between
the intensity of crossover and the pressure or tranquility encountered by the spouses at each occasion.
The ameliorating effect of vacation on stress is demonstrated in that job stress was higher before the vacation than after it. No such
effect was found for burnout. A number of explanations for these results are offered in the discussion, relating, inter alia, to the limitations of the measurement tools.
THE TOLL OF UNEMPLOYMENT DOES NOT STOP WITH THE UNEMPLOYED:
CROSSOVER OF ANXIETY BETWEEN SPOUSES
Mina Westman & Dalia Etzion
Tel Aviv University
Crossover is the process that occurs when a psychological strain experienced by one person affects the level of strain of another
person in the same social environment. The study focuses on the crossover of state anxiety that couples undergo when one of them
faces unemployment. We hypothesize that (1) Financial hardship increases the state anxiety of both spouses; (2) Social support
decreases the state anxiety of both spouses; and (3) There is a bi-directional crossover of state anxiety between husband and wife
when one of them is unemployed.
Participants were 150 unemployed people who came to the Academics Employment Exchange to apply for the “unemployment
grant”. They and their employed spouses completed questionnaires at the beginning and end of the period of two months for which
they were entitled to the unemployment grant.
Findings demonstrate that at both occasions, the economic hardship was a positive predictor of state anxiety for both the unemployed and their spouses and that social support was inversely related to their anxiety. Furthermore, there was a significant bidirectional crossover effect of anxiety from the unemployed to the spouse and from the spouse to the unemployed. The crossover
of anxiety at Time 2, after two months of unemployment, tended to be more intense than at Time 1. Planners of prevention programs dealing with the unemployed should be aware of the crossover process and incorporate actions for both spouses in their programs to eliminate it.
CROSSOVER AND WORK-HOME INTERFERENCE
A.J. Montgomery, M.C.W. Peeters, E. Panagopoulou, W.B. Schaufeli
Utrecht University, The Netherlands and The Medical School of Thessaloniki, Greece
In the present study, we examine crossover - the transmission of stress and strain from one spouse to another - in a sample of 78
information technology (IT) professionals and their working spouses. Results of hierarchical regression analysis indicated the following: (H1) For IT professionals, work-home interference (WHI) was directly linked to work-related outcomes (i.e., burnout,
turnover intention); (H2) Crossover effects were found between the home-work interference (HWI) of the IT professional and the
exhaustion and turnover intentions of their spouse. For IT professionals, negative affectivity (NA) was a significant predictor of all
outcomes, whereas for the spouse NA was only a predictor for exhaustion and psychosomatic health. The relevance of these findings to crossover research is discussed.
THE ROLE OF EMPATHY AND COPING IN BURNOUT
Eleni Mouzoura
Aristotle University of Thessaloniki, Greece
Burnout is a work related stress syndrome characterize by three main symptoms: emotional exhaustion, depersonalization and lack
of personal accomplishment (Maslach & Jackson, 1981). This syndrome is often observed in helping professions, and in particular
among teachers (Schaufeli & Enzmann, 1990). Indeed, Schaufeli and Enzmann, in a review of 73 US studies, found that emotional exhaustion was clearly highest among the teaching profession.
12
Research findings indicate that empathy has an important influence on teachers in their professional life (Klis, 1997), as the way that
teachers cope with difficult situations in their profession (i.e., problem focused – emotion focused coping) is influenced by the emotional labour or empathy involved in teaching. According to the Conservation of Resources theory (Hobfoll & Freedy, 1993), burnout
can be characterized as resource depletion and is more likely to occur when resources are depleted. For example, for teachers, negative interactions with pupils, parents and administrators prompt teachers to use coping skills to regain or prevent resource depletion. Therefore, burnout-the depletion of emotional resources-can be considered the price for a teachers attempt to regain or prevent
the loss of resources.
The present study investigated the relationship between the teacher’s burnout syndrome, empathy and coping among 363 secondary
school teachers from Greece. The results of the study indicate that each of the dimensions of burnout syndrome can be influenced
(positively or negatively) by the empathy factors and coping (problem focused – emotion focused coping). Results are discussed
from the perspective of potential burnout prevention strategies for teachers.
SYMPOSIUM
INTERNATIONAL RESEARCH ON THE SELF-REGULATION MODEL
IN HEATH AND ILLNESS
I: RECENT THEORETICAL ADVANCES
Martin Hagger
Department of Psychology, University of Essex
Discussant: Prof. John Weinman (KCL)
Symposium
International
Research on the
Self-Regulation
Model I
The number of studies adopting Leventhal et al.’s (1980) self-regulation model and illness representations is steadily increasing. This symposium aims to assemble interna
tional researchers who have made pivotal contributions to this area in the past alongside researchers who have made recent theoretical
advances or empirical data to support revisions to the model. It is anticipated that this symposium will provide a showcase for current
European and international research using the self-regulation model.
TREATMENT PERCEPTIONS AND SELF-REGULATION
Rob Horne
Centre for Health Care Research (CHCR), University of Brighton
This paper will consider the role of treatment beliefs in the self-regulation of illness. It will argue that a better understanding of how
people perceive treatments could improve our ability to operationalise theories of social cognition and self-regulation and enhance
their power to explain variations in treatment-related behaviour such as treatment choice and adherence and so guide the development of interventions to optimise the use of health care resources. Using prescribed medication as an example, this paper will present a simple necessity-concerns framework for conceptualising the specific treatment beliefs that may be particularly salient to adherence,. Drawing on empirical studies spanning a range of illness conditions such as asthma, HIV, cardiovascular and renal disease it
will examine the utility of the framework for explaining adherence.
The paper will present an extended-common-sense model (e-CSM) in which ‘common-sense’ representations of treatment (e.g.
necessity-concerns) as well representations of illness are specified. In the e-CSM illness and treatment representations are related as
the individual strives to attain common-sense coherence between their perceptions of the illness and treatment. In common with illness perceptions, treatment representations are processed at a cognitive and emotional level and inform the selection and appraisal
of coping procedures. Moreover, for treatments such as medication or surgery that are perceived to carry risks or costs, these are balanced against perceived need. The paper will present a framework for understanding the contextual factors influencing these such as
‘prototypic’ beliefs about classes of treatments (eg medication vs homeopathy), past experiences of ourselves and others, social and
cultural norms, the information we receive from various sources and satisfaction with care.
ILLNESS REPRESENTATIONS: WHERE TO FROM HERE?
Rona Moss-Morris1 and Trudie Chalder 2
1University of Auckland, New Zealand 2Department of Psychological Medicine and Department of Health Services Research,
Guy’s, King’s & St Thomas School of Medicine, UK
The Illness Perception Questionnaire (IPQ) was developed to provide a quantitative assessment of the five components of the illness
representation - identity, consequences, timeline, control/cure and cause in Leventhal’s Self-Regulatory Model (SRM). The publication of the IPQ in 1996 sparked off a series of publications investigating the role of patients’ cognitive representations of illness
and how these may affect adaptation to illness. However, there are a number of other aspects of Leventhal’s SRM which have
received relatively little attention from researchers. These include patients’ abstract and emotional representations of their illness and
their coping behaviours. Although some studies have investigated coping in relation to illness representations they have relied on
generic measures of coping strategies rather than looking at specific behavioral or cognitive responses, which is how coping is conceptualised in the SRM. The aim of this paper is to facilitate research in these areas by presenting preliminary data on a new measure designed to address some of these gaps in the research. The measure, the Symptom Interpretation and Responses Questionnaire,
focuses on both the concrete and abstract emotional representations of symptoms and patients’ behavioural and cognitive coping
responses to these symptoms. It consists of two sections. The first measures symptom representations including labeling of symptoms as either illness, stress or behaviorally related, catastrophising about symptoms, fear avoidance beliefs in relation to symptoms and embarrassment about symptoms. The second section measures the way in which patients may cope with symptoms including symptom focusing, avoiding activity, and a “crash and burn” response to symptoms.
13
VALIDATION OF THE IPQ-R IN A LARGE, REPRESENTATIVE DUTCH SAMPLE
Monique Heijmans & Mieke Rijken
Netherlands Institute of Health Services Research (NIVEL)
This paper presents a validation study of the revised version of the Illness Perception Questionnaire (IPQ-R) in a large representative Dutch sample of 4000 chronic disease patients. All patients took part in a longitudinal study, called Panel of Patients with
Chronic Diseases, which is conducted by NIVEL.
The IPQ is a widely used quantitative measure of the five components of illness representations in Leventhal’s self-regulatory
model. Compared to the IPQ, the IPQ-R has some additional subscales making it a more comprehensive assessment of the key components of patients’ perceptions of illness.
We verified the factor structure of the IPQ-R in 10 different chronic illness groups and looked at the internal reliability and testretest reliability in subsamples of patients. The results showed high reliability and good predictive and discriminant validity. Besides
these positive findings, we also encountered some practical problems in using the IPQ-R, especially in patients who suffered from
comorbidity. And we found that some subscales were less applicable in certain patient groups. The implications of these findings
will be discussed and some practical suggestions for use of the IPQ-R in research will be given.
INTEGRATING THEORETICAL MODELS OF HEALTH BEHAVIOUR
Sheina Orbell and Martin Hagger
Department of Psychology, University of Essex, UK
Relatively few studies have attempted to compare or integrate different theoretical approaches. Such an approach may lead to greater
parsimony in our theorising and, importantly, may provide clearer implications for practice. We examined the value of a multi-model
approach to explaining health behaviour in the context of a prospective study of womens’ clinic attendance. Specifically , we examine the role of four theoretical accounts of attendance/non-attendance: a) an avoidant reponse to emotional distress, b) a reasoned
action (Fishbein, 1975), c) a planned behaviour (Ajzen, 1985) and d) a coping response to illness threat (Leventhal et al, 1980).
Women were recruited to the study at their first colposcopy clinic appointment. Women who were required to re-attend for treatment and follow-up were sent a questionnaire booklet containing variables specified by the four models three weeks prior to their
second attendance. The response rate was 52% (N = 600). Subsequent behaviour was determined objectively from clinic records.
Dicriminant function analysis discriminated between three different behavioural groups; those who kept all of their appointments
as scheduled, those who attended after receiving further reminders and those who stopped attending even when reminded. Variables
from each of the theoretical models were correlated with the discriminant functions. However, importantly, whilst self-regulation
theory offered
A REVIEW OF THE SELF-REGULATION MODEL
Martin Hagger and Sheina Orbell
Department of Psychology, University of Essex
This paper serves to introduce the current state of quantitative investigations into illness representations using the self-regulation
model (SRM; Leventhal, Meyer and Nerenz’s (1980). An electronic and manual literature search yielded 45 studies that satisfied
the inclusion criteria. Relationships among illness representations, coping procedures and illness outcomes were corrected for sampling and measurement error and averaged across studies using Hunter and Schmidt’s (1990) meta-analytic techniques.
The average corrected intercorrelation matrix for the sample of studies showed that the CSM illness cognition dimensions of consequences, control/cure, identity and timeline followed a logical pattern supporting their construct and discriminant validity across
illness types. A content analysis identified seven distinctive coping strategies and six separate health outcomes. Examining the average corrected correlation coefficients across the studies revealed that perceptions of a strong illness identity were significantly and
positively related to the use of coping strategies of avoidance and emotion expression. In addition, perceived controllability of the
illness was significantly associated with cognitive reappraisal, expressing emotions and problem-focused coping strategies.
Perceptions of the illness as highly symptomatic, having a chronic timeline and serious consequences was significantly correlated
with avoidance and expressing emotions coping strategies. Further, perceptions that the illness was curable/controllable was significantly and positively related to the adaptive outcomes of psychological wellbeing, social functioning and vitality and negatively
related to psychological distress and disease state. Conversely, illness consequences, timeline and identity exhibited significant, negative relationships with psychological well being, role and social functioning and vitality.
The analyses provide evidence for theoretically predictable relations between illness cognitions, coping and outcomes across studies.
14
SYMPOSIUM
PSYCHONEUROIMMUNOLOGY:
CAN PSYCHOLOGICAL FACTORS MODULATE DISEASE PROCESSES?
Symposium
Psychoneuroimmunology
Symposium Convenor:
Dr Kavita Vedhara
MRC Health Services Research Collaboration,
University of Bristol
This symposium will examine whether psychological factors can exert clinically-relevant effects on disease processes. This will be
explored with presentations concerned with four different diseases: Diabetes, Rheumatoid Arthritis, Infectious Diseases and Chronic
Fatigue Syndrome. Through a mixture of observation and intervention research, the symposium will consider whether there is evidence that psychological factors can influence a diverse range of clinically-relevant outcomes such as wound healing, disease activity, responses to vaccination and hormonal activity.
PSYCHOLOGICAL DETERMINANTS OF WOUND HEALING
IN DIABETIC PATIENTS WITH FOOT ULCERATION
*K.Vedhara, *D. Tallon, *L. Gale, E. Dougan, A. Strode, L. Mudge, J. Weinman,
UNIVERSITY OF BRISTOL, MRC HEALTH SERVICES RESEARCH COLLABORATION,
Aims: There is considerable evidence that psychological distress can influence the healing rates of artificial wounds in ‘healthy’
populations. The current study was designed to extend this work by examining the role of psychological distress in the healing of
diabetic foot ulcers
Methods: Prospective study involving patients with type II diabetes presenting with foot ulceration. Baseline assessments are
undertaken of ulcer size (i.e., length, width and depth of ulcer) and psychological distress (i.e., stress, anxiety and depression) and
repeated at 6, 12 and 24 weeks.
Results: Data from the first 22 patients recruited into the study (14 men, 8 women; mean age 65 years) revealed considerable heterogeneity in ulcer size at baseline: length=2-50mm; width=1-40mm and depth=1-17mm. Patients were distinguished into those
reporting low and high levels of stress, anxiety and depression (based on a median split) and ANOVAs conducted to explore the
relationship between baseline levels on these measures and ulcer size at 12 weeks. For all analyses ulcer size was greater in patients
reporting greater, stress, anxiety or depression, indicating poorer healing in these patients. For example, ulcer depth in patients
reporting low anxiety was 0.95mm, compared with 3.12mm for those reporting high anxiety; for those reporting low depression =
1.5mm vs. 3.1mm (high depression) and for those reporting low stress = 0.85 vs. 3.27mm (high stress).
Conclusions: These preliminary results suggest that healing of diabetic foot ulcers may be influenced by psychological stress.
THE EFFECTS OF EMOTIONAL DISCLOSURE ON PSYCHOSOCIAL AND PHYSIOLOGICAL
OUTCOMES IN PATIENTS WITH RHEUMATOID ARTHRITIS
Mark A Wetherell*, Lucie MT Byrne-Davis*, Sara Brookes*, Margaret Byron*,Paul Dieppe*,
Jenny Donovan*, Rob Horne, John Weinman & Kav Vedhara*
UNIVERSITY OF BRISTOL, MRC HEALTH SERVICES RESEARCH COLLABORATION, CANYNGE HALL,
WHITELADIES ROAD, CLIFTON, BRISTOL, BS8 2PR, United Kingdom
Aims: The current study explores the effects of emotional disclosure on a variety of psychosocial and physiological outcomes in
rheumatoid arthritis (RA) patients with varying disease severity.
Methods: Thirty-five RA patients were recruited and assessed at baseline, 1, 6 and 10 weeks post-intervention. At each session
clinical and psychosocial data were collected including, disease activity, CRP and ESR (markers for inflammation) and measures
of emotional well-being. Patients were randomly assigned to either the disclosure group or an episodic recall control group . The
intervention comprised an established disclosure paradigm adapted specifically for RA patients whereby, in their own homes,
patients were asked to write or talk into a recorder for a 20 minute period on 4 consecutive days. Following each disclosure session
all patients completed questionnaires regarding how stressful or arousing they found the session. (add
Results: Results from the first 10 patients to undergo the disclosure intervention demonstrated increases in disease activity, CRP
and ESR at 1 week post-intervention. Fluctuations in mood were also evident with decreases in positive affect and increases in
negative affect. However, at 10 weeks disclosure patients demonstrated improvements in disease activity, CRP, ESR and emotional well-being compared to control patients.
Conclusions: The Results indicate that the disclosure intervention improves a variety of outcomes in RA patients. Results from
all 35 patients will be discussed and potential psychological and physiological mediators of this process will be proposed.
15
THE INFLUENCE OF LONELINESS ON NEUROENDOCRINE,
CARDIOVASCULAR AND IMMUNE PROCESSES
Andrew Steptoe, Sabine Kunz-Ebrecht, and Lena Brydon
University College London, UK
Loneliness is a psychological experience related to social isolation and perceived lack of companionship, and may be relevant to
health risk. Research relating loneliness with biological responses related to disease risk has been limited. The revised UCLA loneliness scale was completed by 240 working men and women aged 47-59 years, and related to affective state, cortisol responses over
the working day, and to cardiovascular and inflammatory responses to standardised mental stress tests. Loneliness scores were lower
in married than single or divorced participants, but did not differ with gender, age or socioeconomic position. Loneliness was positively related to social isolation, low emotional support, ratings of depression and low self-esteem, and to reported sleep problems.
Subjective stress responses to mental stress tests did not vary with loneliness, and there were no differences in task appraisal related to loneliness. However, loneliness scores were associated with greater fibrinogen and natural killer cell responses to acute mental stress, independently of gender, age, socioeconomic position, smoking status, and change in haematocrit. Diastolic blood pressure reactions were also positively correlated with loneliness in women but not men, independently of covariates. The cortisol awakening response (increase between waking and 30 minutes later) was positively associated with loneliness after adjusting for waking
cortisol value, sex, socioeconomic position, smoking, time of waking, and body mass. These data suggest that loneliness is a psychological experience with potentially adverse effects on biological stress processes that may be relevant to health.
COGNITIVE BEHAVIORAL STRESS MANAGEMENT INTERVENTION
EFFECTS ON PSYCHOLOGICAL AND PHYSIOLOGICAL FUNCTIONING
IN BREAST CANCER PATIENTS RECOVERING FROM SURGERY
M. H. Antoni
Department of Psychology and Center for Psycho-Oncology Research,
University of Miami, Coral Gables, FL
Aims: We tested the effects of a 10-week Cognitive Behavioral Stress Management (CBSM) intervention on cognitive and emotional processing and cortisol and immunologic functioning among 99 women diagnosed with early-stage breast cancer who were
recovering from surgery.
Methods: This intervention provides training in relaxation techniques, coping skills, and other stress management techniques, in a
supportive group. Approximately 4 - 8 weeks after surgery women were randomized to CBSM or a 10-wk wait-list control (followed by a 1-day CBSM seminar). We measured psychological functioning (depression, optimism, emotional processing and benefit finding) and from a subset of the sample, collected blood samples just prior to (T1) and after (T2) the CBSM intervention program or wait-list control period and at 3-month (T3) and 9 month (T4) follow-ups.
Results: The intervention reduced the prevalence of moderate depression and maintained these changes out to T4. The intervention
also increased participants’ reports of optimism, emotional processing and benefit finding over this period. Benefit fining effects
remained significantly elevated at the T3 and T4 follow-ups, all p’s < .01. At T2 intervention participants revealed lower serum cortisol levels and also showed increased lymphocyte proliferation at T3. Increases in emotional processing during the intervention
were associated with greater increases in benefit finding. Increases in benefit finding were associated with both reductions in serum
cortisol levels during the 10-week intervention and increases in lymphocyte proliferation over a 3-month follow-up. Conclusions:
Improving emotional processing and benefit finding during CBSM may also affect physiological functioning in women with breast
cancer.
Symposium
International
Research on the
Self-Regulation
Model I
SYMPOSIUM
INTERNATIONAL RESEARCH ON THE SELF-REGULATION MODEL IN HEATH AND ILLNESS
II: ADVANCED APPLICATIONS OF THE SELF-REGULATION
MODEL TO CLINICAL POPULATIONS
Martin Hagger
Discussant: Prof. John Weinman (KCL)
Recent reviews have indicated consistency in the relationships among the self-regulation model (SRM) constructs across a number
of illnesses (Hagger and Orbell, 2003). This symposium aims to provide a forum for diverse applications of the self-regulation theory toward the understanding of chronic illnesses. Each presenter will provide evidence that lends empirical support for the SRM
in a clinical population and provide initial evidence for the modification and augmentation of the model. The presentations will indicate how such data drives modifications to the theory and can assist clinical practioners involved with assisting patients to cope with
chronic illness.
16
THE IMPACT OF PARTNERS’ ILLNESS PERCEPTIONS
ON THE WELL-BEING OF HD PATIENTS
D.I. Helder1; A.A. Kaptein1; G.M.J. van Kempen1; J. Weinman2; J.C. van Houwelingen3; R.A.C. Roos4
1Unit of Psychology, Department of Psychiatry, Leiden University Medical Centre (LUMC), the Netherlands, 2Unit of Psychology,
Division of Psychiatry and Psychology, Guy’s, King’s and St Thomas’ School of Medicine, United Kingdom, 3 Department of
Medical Statistics, LUMC, the Netherlands, 4 Department of Neurology, LUMC, the Netherlands
Recent findings suggest that differences exist between the way chronically ill patients and their partners perceive and cope with illness, and that these differences have an impact on patients’ well-being. Few studies have however focused on the impact of the illness perceptions of healthy spouses on patients’ well-being. In this study we will focus on Huntington’s disease (HD), an inherited
neurodegenerative disorder, characterized by involuntary movements and hypokinesia, dementia, and personality changes.
Aims: 1. to investigate whether the illness perceptions and coping mechanisms of HD patients differ from their partner’s;
2. to assess whether these differences influence the well-being of HD patients. Fifty-one HD patients and their partners from the
Outpatient Department of Neurology of the LUMC and from the Dutch Huntington Association were interviewed at their homes by
means of the Illness Perception Questionnaire (IPQ), the COPE, and the Medical Outcome Study 36-item Short Form (MOS SF36). The duration and severity of the motor and cognitive symptoms of HD was also assessed.
Results indicated that HD patients and their respective partner differed significantly on their scores on the “Identity”,
“Consequences”, and “Control” dimensions of the IPQ. Compared to HD patients, partners maximized the seriousness and consequences of HD, and minimized their ability to control the disease process. These differences were significantly negatively related
to patients’ vitality and mental health as assessed by means of the MOS SF-36. Thus, in clinical practice, minimizing the differences between the illness perceptions of patients and their partners could be beneficial to patients’ well-being.
ADAPTATION FOLLOWING A FIRST-TIME MYOCARDIAL INFARCTION:
THE ROLE OF ILLNESS PERCEPTIONS
Natasha Mitchell and Paul Norman
Department of Psychology, University of Sheffield, UK
This paper considers the role of illness perceptions in relation to adaptation following a first-time myocardial infarction (MI).
According to Leventhal’s Self-Regulation Model, individuals form an illness representation when faced with a disease threat that is
structured around five dimensions: (i) disease identity, (ii) causes, (iii) consequences, (iv) time-line, and (v) cure/control. The illness representation is then used to guide coping efforts, and thereby drives adaptation to the illness.
First-time MI patients completed questionnaires (i) whilst in-patients (< five days post-MI) (n=124), (ii) at three weeks post-discharge (n=92), and (iii) at three months post-discharge (n=78). The questionnaires included measures of illness representations
(IPQ), anxiety and depression (HADS), and various health behaviours.Hierarchical regression analyses were conducted in which
baseline measures of the dependent variables were entered at a first step followed by baseline IPQ measures. Baseline illness perceptions were able to explain additional variance in time 2 anxiety (∆R2=.12, ∆F=2.54, p<.01) and depression
(∆R2=.19, ∆F=3.48, p<.001), with the perceived consequences dimension emerging as an important predictor.
Baseline illness perceptions were unable to explain an additional variance in time 3 anxiety (∆R2=.09, ∆F=1.06, ns)
and depression (∆R2=.18, ∆F=1.63, ns). Considering changes in heath behaviour, baseline illness perceptions were
only able to explain additional variance in time 2 vigorous exercise (∆R2=.20, ∆F=1.95, p<.05) and time 3 alcohol
consumption (∆R2=.13, ∆F=2.98, p<.001), with the control/cure dimension emerging as an important predictor.The
present results provide only limited support for the Self-Regulation Model. Suggestions for modifications to the model and its operationalisation are discussed.
A COMPARISON OF ILLNESS REPRESENTATIONS AND
SPECIFIC EMOTIONAL RESPONSES IN
CANCER SCREENING PATIENTS: RESULTS FROM CERVICAL
AND COLORECTAL SCREENING PROGRAMMES
Martin Hagger, Sheina Orbell and Ian O’Sullivan
There may be similar psychological determinants of emotional responses to attending at colposcopy and colonoscopy after receiving a positive screening test. The present study adopted self-regulation theory (SRT; Leventhal et al., 1980) as a framework to examine the influence of cognitive and emotional representations of illness on the emotional responses of patients undergoing cervical
and colorectal cancer screening.
Participants were 600 women who attended colopscopy after receiving an abnormal cervical smear test and 701 people who attended for colonoscopy following receipt of an abnormal FOBt result. Participants completed postal questionnaires containing measures
of illness representations (Moss-Morris et al., 2002) and anxiety and anger (Spielberger et al., 1978). Participants attending for coloposcopy also completed measures of anger (Smith et al., 1993) and participants attending for colonoscopy completed a further measure of anxiety (Zigmond and Snaith, 1983).
After controlling for demographic variables, similar patterns of predictions emerged in the prediction of anxiety from the illness representations for the colposcopy and colorectal participants. Emotional representations, serious consequences and identity were significantly related to anxiety in both sets of patients. However, controlling for emotional representations attenuated the impact of
serious consequences and identity. The pattern of relationships for anger was different. Anger in colorectal patients was a function
of illness coherence and emotional representations, whilst anger in the colposcopy patients was predicted by identity, psychological and uncontrollable causes and emotional representations.
Results indicate that there is some congruence in the relationships between illness representations of an emotionally salient event
17
and anxiety in patients from the two cancer screening programmes, supporting cumulative reviews of SRT (Hagger and Orbell,
2003).
ILLNESS REPRESENTATION, COPING AND OUTCOME
IN IRRITABLE BOWEL SYNDROME
Claire Rutter1 and Derek Rutter2
1Department of General Practice and Primary Care, Guy’s, King’s and St Thomas’ School of
Medicine King’s College London 2Department of Psychology,
University of Kent at Canterbury, UK
The majority of research using the illness representation model has focused upon observable, organic illness; little research has been
directed at invisible, functional illness, even though a clear understanding of the cognitive mechanisms in functional illness is warranted. Four studies were conducted to explore the illness representation of different populations of irritable bowel syndrome (IBS)
sufferers over time, to examine whether these cognitions can predict simultaneous and subsequent outcome, and to determine if coping mediates the link between illness representation and outcome. Three of the four studies compared the responses of IBS patients
to those of people with inflammatory bowel disease (IBD) (an organic illness). Six hundred and sixty-five participants were recruited from three different populations: self-help groups (N=557), primary care (N=61) and secondary care (N=47). All four studies
confirmed that the illness representation of IBS sufferers does predict outcome - notably the level of anxiety twelve months later.
All four studies demonstrated the stability of the representation pattern over time and the importance of the serious consequence
component as a predictor of poor outcome. Avoidant coping was found to partially mediate the link between illness representation
and outcome, but was found not to contribute significantly to the illness representation itself. The predictive strength of the illness
representation was stronger in IBS sufferers than IBD sufferers. We hypothesise that the strong influence of the representation is
attributable to the functional status of the illness, but we cannot be sure until the work is repeated with other non-bowel functional
illnesses.
ILLNESS PERCEPTIONS, NEGATIVE AFFECTIVITY AND QUALITY OF LIFE
IN PATIENTS WITH COPD
AND PATIENTS WITH HEAD AND NECK CANCER
Scharloo M1, Kaptein AA1, Schlosser M2, Baatenburg de Jong RJ3,
Langeveld APM3, Bel EHD4, Rabe KFG4, Wouters EFM5
1Medical Psychology, LUMC; 2Dept. of Cure and Care, De Zorgboog, Helmond;
3Department of Otolaryngology and Head and Neck Surgery, LUMC;
4Department of Pulmonology, LUMC; 5Department of Pulmonology, AZM.
The aim of this paper is to explore the possible role of a personality variable (negative affectivity) in influencing relationships
between illness perceptions and functioning in patients with chronic obstructive pulmonary disease (COPD) and patients with head
& neck cancer. Literature suggests that people who have a high level of negative affectivity are also likely to have exaggerated perceptions of symptoms and interpret illness as more threatening. Also personality factors may play an important role in determining
scores on self-reported quality of life outcome.
107 COPD patients were examined on two occasions, 1 year apart. Data from 50 patients with head and neck cancer have been collected shortly after diagnosis. Patients from both groups completed questionnaires measuring illness perceptions (Illness Perception
Questionnaire-R), quality of life (COPD: RAND MOS-SF36, Quality of Life for Respiratory Illness Questionnaire; Cancer: EORTC
QLQ-C30, and QLQ-Head & Neck module-35), and negative affectivity (Dutch Personality Questionnaire-NPV).
Illness perceptions scores of patients with high/ low scores on negative affectivity will be compared. Preliminary analyses suggest
that perception scores (identity and consequences and emotional representations) are significantly different for patients with high vs
low scores on negative affectivity. The relative contribution of negative affectivity and illness perceptions in determining quality of
life scores will be examined.
Implications of the results for future studies examining illness perceptions and intervention studies in this area will be discussed.
Symposium
Perspectives
on Infertility
SYMPOSIUM
PERSPECTIVES ON INFERTILITY
Irina Todorova
Health Psychology Research Center
Sofia Bulgaria
The symposium “Perspectives on Infertility” with gather presentations on psychosocial aspects of infertility from diverse cultures
in Europe, the US and India. It aims to present different approaches to the study of the experience and treatment of infertility, including quantitative and qualitative methods. In the first presentation Yael Benyamini and co-authors will discuss the links between religious beliefs and social attitudes toward infertility, as well as differences in distress and coping among traditional, religious and secular women in Israel. Frank van Balen will illustrate how the decision to undergo treatment for infertility is connected to the experience of anxiety in medical settings for women in The Netherlands. Adriana Baban will explore the phenomenology of experiences
of Romanian women who are childless and situate them in the context of women’s social roles. Penelopi Sintrivani will present a
cross-cultural study, which includes Greek and English women undergoing In Vitro Fertilization, and will interpret the findings in
light of local norms and beliefs about parenthood and patterns of social relations. Catherine Kohler Riessman will discuss the role
of reflexivity in understanding the experience of infertility and the stigma associated with it, based on ethnographic research in
India.
18
THE ROLE OF RELIGIOUSNESS IN APPRAISAL
AND COPING WITH INFERTILITY AND ITS TREATMENTS
Benyamini, Y.1, Barkay, T. 2, Gozlan, M. 3, Shiloh, S.2, & Kokia, E. 3
of Psychology Tel Aviv University, 3Maccabi Health Services
2Dept.
Infertility involves substantial emotional difficulties and is generally perceived as highly stressful. Yet, there is considerable variability in reactions to infertility and its treatment, which may in part be due to the social-cultural-religious context. In the pronatalist Jewish-Israeli society, religion and fertility issues are intimately linked, so that infertile religious and traditional women may face
more social pressure than secular women. At the same time, religious women may benefit from stronger faith and support from their
Rabbi.
The present research hypothesized that secular, traditional and religious women will show different patterns of appraisal and coping when faced with infertility. Specifically, traditional women were expected to perceive the problem in a more pessimistic way,
to use less adaptive coping strategies and to suffer from higher levels of distress compared to the secular and religious women. These
hypotheses were examined on two different samples: 149 women at their first visit to the clinic and 257 women at various stages
of treatment.
Findings showed that traditional women, compared with the secular and the religious, perceived the problem in a more pessimistic
way, were more likely to use maladaptive coping strategies, and reported greater distress, as predicted, in the sample of women
already in treatment, but not in the sample of women at their first visit. Possible explanations for the differences between the two
samples will be discussed. The findings suggest that awareness of religious background may be important for health psychologists
and physicians treating fertility patients.
ANXIETY FOR INFERTILITY TREATMENT:
THE INFLUENCE OF MEDICAL ANXIETY ON THE CHOICE FOR INFERTILITY TREATMENT,
THE REJECTION OF TREATMENT, AND THE CHOICE OF ALTERNATIVES TO TREATMENT.
Van Balen Frank
University of Amsterdam, Faculty of Social and Behavioral Sciences
Infertility is generally regarded as a condition for which medical treatment is optional. It is also possible no to have treatment or
choose the alternative of adoption. The decision about undergoing infertility treatment, may be influenced by the general medical
anxiety of the patient concerned. An instrument was developed to measure general medical anxiety (GMA-index). This instrument covers the aspects uneasiness and anxiety about medical settings, about medical examinations and treatments, and about
physical discomfort and pain. The GMA-index was applied among women who experienced infertility and had the possibility and
the availability of treatment: 75 women aged between 25 and 49 answered the questionnaire.
The results showed that women who chose alternatives (e.g., adoption) for treatment, or who rejected infertility treatment after considering it, showed a higher score on the GMA-index compared to women who chose infertility treatment. It is concluded that medical anxiety is an important factor in explaining why some women do not have medical treatment for infertility, and chose to stay
childless or adopt a child. Finally medical anxiety is discussed in the light of other reasons for not having treatment.
A PHENOMENOLOGICAL STUDY OF INFERTILITY
IN THE ROMANIAN CONTEXT
Baban Adriana
Babes-Bolyai University, Department of Psychology
Historically, feminine identity and women’s social roles have been constructed around motherhood. Pregnancy and birth are widely regarded as peak experiences in a woman’s life. In Romania, approximately, one in five women of reproductive age is infertile.
Infertility is more than a medical condition. Previous research indicates that infertility brings a “crisis” in women and couple life.
The purpose of this study was to explore women’s experience, feelings and reactions related to infertility. Using the method of eidetic (descriptive) phenomenology, in depth interviews were conducted with 15 women. Women’s accounts make it clear that infertility is a multi-faceted and dynamic state, and that their reactions vary considerably. While women find infertility a painful and damaging experience, they also try to find ways of coping with it, and making sense of their infertility.
CULTURAL VARIATIONS IN MOTIVES FOR PARENTHOOD
AND PSYCHOSOCIAL RESPONSES TO IVF
Penelopi Sintrivani
The ability to procreate is considered a cultural demand worldwide. Infertility is viewed as a neglected area of study and most of
the information regarding psychosocial responses of infertile patients is derived through individuals who seek treatment. A survey
design study was carried out in order to determine cultural variations of motives for parenthood and psychosocial responses between
English (N=31), and Greek women (N=29) undergoing in vitro fertilization (IVF) treatment. IVF patients were recruited from two
IVF clinics. Four semi structured questionnaires were used (Parenthood Motivation List, Cope Scale, Social Support Questionnaire,
and General Health Questionnaire), in order to collect the data. In addition, open ended questions were used for examining emotional, social, and stressful aspects of IVF.
Findings showed significant differences between IVF groups demonstrating an intense desire for parenthood. In general, it appeared
that Greek norms and beliefs influenced the attitudes of Greek IVF patients more strongly. Results are discussed in terms of individualistic (England) and collectivistic (Greece) patterns. Finally, demographic characteristics (age and duration of treatment), are
also considered for a further interpretation of the outcomes.
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REFLEXIVITY, EMOTIONS, AND THE STIGMATIZED WOMAN
Kohler Riessman Catherine
Boston College, Dept. of Sociology, Chestnut Hill, MA , USA 02467
The paper looks back on research I conducted in Kerala, South India in 1993-4, supported by a Fulbright award. The aim of the
study was to examine the meaning and management of infertility by women and families. Methods included participant observation
in an infertility clinic of a government hospital, lengthy narrative interviews with childless women in the clinic, similar women in
towns and villages, and on-going relationships with several South Indian families. I published a series of scholarly papers on the
research. Now, after almost 10 years, I look back on the emotions of the women I studied to explore how I came to understand them
through fieldwork. I raise questions about the medicalization of emotions in infertility research, where they are typically seen as
“symptoms.” I describe how and why I abandoned a medicalized view of infertility, and adopted a social view: the women were
childless. My data for the current paper are the extensive field notes I constructed in 1993-4 but never examined in detail until now;
among many things, they describe the stigma I faced (because of marital status) and how such experiences lead me to new understandings of the stigma women face when they are childless My difficult emotions as an ethnographer far from home (and my children) provided a way into interpretation of the lives of my subjects, whose situations were very different than my own. When investigators can build research relationships across the divides of difference, reflexivity about those relationships can become an important source of knowledge.
Symposium
Ageing, health, and
quality of life
SYMPOSIUM
AGEING, HEALTH, AND QUALITY OF LIFE: CHALLENGES AND OPPORTUNITIES
Convenors:
Dr Kevin J McKee
Sheffield Institute for Studies on Ageing
University of Sheffield
Professor Hannah McGee
Director, Health Services Research Centre
Royal College of Surgeons in Ireland
Chair
Prof Marie Johnstone
University of St Andrews
A LONGITUDINAL STUDY OF QUALITY OF LIFE (QOL) IN CHRONIC ILLNESS.
Bridget Dibb, Lucy Yardley
Department of Psychology, University of Southampton
Aims: To assess adjustment over time, as measured by change in QOL and response shift, and to determine the factors predicting
change in QoL.
Method: At baseline and 10 month follow-up 301 people with Meniere’s Disease who were members of a self-help group (SHG)
completed questionnaires assessing functional QoL (using the SF-36) and goal-oriented QoL (using the newly developed GOQOL).
Baseline predictors comprised social comparison (the Identification/Contrast scale and items assessing social comparison through
use of the SHG), self-esteem (Rosenberg scale), perceived control (IPQ-R scale), optimism (LOT), disease severity scales, and
demographic information. At follow-up the Thentest was used to measure response shift.
Results: Self-esteem positively predicted change in functional and goal oriented QoL over time, and in addition social comparison
occurring through use of the SHG negatively predicted functional QoL. QoL scores significantly improved on the GOQOL but not
on the SF-36, whereas response shift occurred on most scales of the SF-36 but not on the GOQOL.
Conclusion: Despite no change in functional status on the SF36 between baseline and follow-up, response shift occurred as assessed
by the Thentest. This was apparently mediated by a change in perceptions of movement towards goals (as assessed by the GOQOL).
This change in QoL may be promoted by high self-esteem. Persistent social comparison with others with chronic illness may lead
to a reduction in QoL, perhaps due to excessive preoccupation with illness and possible negative futures.
SELECTION, OPTIMISATION AND COMPENSATION (SOC): DEVELOPING A HEALTH-RELATED
MEASURE OF SOC TO STUDY THE CHALLENGES OF ILL-HEALTH AND AGEING
Hannah McGee, Ann O’Hanlon, Maja Barker, Anne Hickey & Ciaran O’Boyle on behalf of the SAGE Study Group
Health Services Research Centre, Department of Psychology, Royal College of Surgeons in Dublin , Ireland
Most ‘health’ research focuses on single diseases and the more generic aspects of ageing are often ignored. This reflects a general
perception of ageing as a collection of independent deficits rather than as part of the development of the person across the lifecycle. Ageing must instead be understood as a psychological and social process. Baltes & Baltes (1990) developed a model of successful ageing emphasising lifespan development in which individuals engage in a dynamic process of growth, maintenance and
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regulation of loss through selection, optimisation and compensation (SOC) strategies. In older age, with the onset of many more
losses, SOC proposes that individuals shift personal resources towards maintaining functioning and regulating loss, rather than
towards growth. Successful ageing occurs when individuals engage in SOC processes to maximise gains and minimise losses. More
specifically, individuals may be more selective in their personal goals (selection), use their resources to optimise their functioning
in these selected goal areas (optimisation), and compensate for their losses with available resources (compensation). This project
aims to operationalise the SOC model from a health perspective. The objective is to develop a measure which will permit a more
individualized and meaningful dialogue between an individual health service user and service providers about that individual’s SOC
preferences, needs and possibilities in a challenging health situation. For instance, what options are possible, preferred and supportable for a person with significant limitation of movement following stroke? The development of the measure is described in this
presentation.
PERSPECTIVES ON ONE’S OWN AGEING: CROSS-SECTIONAL COMPARISON OF UK AND US POPULATIONS
Ann O’Hanlon & Peter Coleman
University of Southampton, UK & Royal College of Surgeons in Ireland, Dublin, Ireland
Objectives: This cross-cultural study sought to examine adults’ attitudes towards their own ageing and future old age in the UK
and the US. This research also sought to examine the role of specific concerns (across physical, social & psychological domains)
in contributing to general evaluations about own future old age.
Method: Adults of all ages (n = 325) were recruited in the same way from high streets in two cities in the US (Washington, D. C.
and New York) and the UK (Southampton and Sheffield). A wide range of measures were used, including scales specifically developed from earlier exploratory data.
Results: Across both cultures, results indicate 1) that the new scales did have good psychometric properties, 2) that perceived problems across physical, social & psychological domains contributed similarly to general attitudes about own ageing and future old
age, and 3) that concerns about own future old age better predicted general attitudes than did evaluations about possible positive
experiences in later life. Results also indicated that the attitudes of participants in both countries were often similar, although the
US respondents had some more negative attitudes than their UK-based counterparts.
Conclusion: To bring quality of life and health to increased longevity, more research is needed exploring attitudes to own old age.
The role of society and culture needs to be considered in such research. The current presentation offers new measures and insights
which can facilitate further work in this area.
IS LIVING IN THE PAST GOOD FOR YOUR PRESENT?
REMINISCENCE AND WELL-BEING IN FRAIL OLDER PEOPLE
Kevin J McKee Fiona Wilson, Helen Elford, Gillie Bolton, Man Cheung Chung,
Fiona Goudie, Sharron Hinchliff, Cindy Mitchell
Sheffield Institute for Studies on Ageing, University of Sheffield
There is much anecdotal evidence that reminiscing – thinking or talking about one’s past – improves well-being in older people.
However, there is a lack of good evaluative studies. This presentation will describe the results of a reminiscence intervention study
involving 142 older people living in residential settings. Over a four-week period, participants received weekly reminiscence-based
activities. The study examines the influence of activity context (group or one-to-one) and form (talking or writing) on psychosocial
outcomes. Activities varied in their structure and content (i.e., the extent to which the activity took on the nature of a ‘life review’)
or focused on the past or the present (i.e., reminiscence vs. disclosure). Results indicate that one month after intervention, intervention participants had reduced negative affect and psychological morbidity and in comparison to a non-intervention control group
had higher morale and reduced morbidity and better positive affect and less negative affect. How activities were carried out made
no significant difference to outcomes - i.e., whether disclosure, reminiscence or life review; whether in groups or in on-to-one contexts; and whether talking or writing. The study’s findings will be discussed in relation to the developmental theories of Erikson ,
and in terms of social care policy.
PREDICTING POSITIVE AND NEGATIVE PSYCHOLOGICAL OUTCOMES
IN WORKING FEMALE CARERS: A LONGITUDINAL ANALYSIS
Clare Lyonette , Lucy Yardley
Dept. of Psychology, University of Southampton
Aims/problems to be addressed: To identify those factors which predict positive and negative psychological outcomes in working
female carers over time.
Methods: 203 working women caring for an elderly person responded to a questionnaire pack which included measures of workrelated factors (autonomy/control, work demand, peer support, work satisfaction and stress), care-related factors (relationship to
elder, resident status, length of time caring, help with caring) and personal factors (quality of relationship with the elder and motivations involved in elder caring). The psychological outcome measures were the GHQ-12 and the positive affect subscale of the
PANAS. Follow-up questionnaire packs were sent out after one year.
Results: A combination of high work demand, work stress and carer stress predicted GHQ scores at Time 1. High work stress also
predicted change in GHQ scores over time. Lower external pressures to care, better carer health and higher work satisfaction predicted positive affect at Time 1. Lower work stress and lower age of the carer predicted change in positive affect over time.
Conclusions: Combining higher-intensity caring and work roles leads to negative psychological outcomes for working carers.
Higher levels of psychological distress may feed back into higher perceived work demand, work stress and carer stress, creating a
negative cycle. In the same way, higher positive affect may feed back into better perceptions of health, satisfaction with work and
lower perceived pressures to care, creating a positive cycle.
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Symposium
Social Support and
Gender Differences
SYMPOSIUM
SOCIAL SUPPORT AND GENDER DIFFERENCES:
IMPLICATIONS FOR HEALTH
CHAIRS: ESTHER GREENGLASS AND HELENA SEK
This symposium examines the role of gender in the relationship between coping, health and social support. It consists of 5 empirically-based papers from 4 countries. In one paper, the role of gender is examined in social support and coping with life stress in 3
groups of young adults. Results showed that females were higher than males in social support mobilization Results showing interactive effects are discussed in light of matching social support with individual coping strategies and with support expectancies in
men and women. Another paper investigates gender differences in reports of social support in hospital patients undergoing rehabilitation therapy. Results show that relationships between social support and outcomes vary with gender. A third paper investigates
gender differences in social support and their effects on adherence to treatment in patients with liver disease. Results are discussed
with reference to applicability of gender and social support to adherence to treatment. In another study of employees, results showed
an interaction between sex and age in social support. The older they were, the less support women received from their spouses.
Another study investigates the contribution of social support to coping strategies in men and women experiencing job stress. Results
indicate that social support is a contributor to coping, and that this effect is moderated by gender. The papers in this symposium
indicate that gender is a significant factor to consider when studying the relationship between social support, coping and health..
GENDER DIFFERENCES, SOCIAL SUPPORT AND FUNCTIONAL
DISABILITY IN REHABILITATION PATIENTS
Sandra Marques, Melanie de Ridder, Supriya Behl & Rachel Horton
York University
Social support may influence health by affecting health behaviors. Social support may be associated with positive affective states
and increased control. In addition to emotional resources, social support may also be a source of practical and informational
resources. In general, research findings show that social support is associated with less functional disability during rehabilitation
therapy. Other research reports that women seek and report more social support than men and that women, more than men, utilize
social support in coping with stress. Close relationships may help individuals cope with stress where they can disclose and discuss
problems, share concerns, and receive advice keyed to their needs.
The present study extends previous research by examining gender differences in the relationship between social support and selfreported functional disability in hospital patients undergoing physical rehabilitation. Results show that women reported receiving
significantly more social support than their male counterparts. A model is presented whereby social support predicts to functional
disability and this relationship is mediated by feelings of vigor.
The data support the model only in women patients. Thus, to the extent that women reported receiving support, they reported higher vigor. Higher vigor and social support were associated with lower disability. These results suggest that social support contributes
to better, more positive affect and to greater functional ability in women. The findings parallel previous results showing a stronger
relationship between social support and coping strategies in women than in men. Gender role implications for health promotion are
discussed.
GENDER DIFFERENCES IN SOCIAL SUPPORT:
IMPLICATIONS FOR ADHERENCE TO DISEASE REGIMENS
Viorel Mih1, Dan L. Dumitrascu2
1Babes-Bolyai University, Cluj-Napoca, Romania;
2University of Medicine and Pharmacy, Cluj-Napoca, Romania
There has been much research carried out on the relationship between social support and health, with general agreement that individuals having high levels of social support are more likely to have better mental and physical adjustment. However, the mechanism by which social support protects against ill health is unclear. At the same time, patients’ non-adherence to medical treatment
is a serious problem for health care.This paper will present the results of a study aimed at identifying the independent and interactive effects of social support on adherence to treatment. The study also focuses on identifying gender differences on perceived
social support and its effect on adherence.The sample consists of 120 patients with chronic digestive disease (60 women and 60
men) who completed a battery of assessment tools focusing on self-efficacy, social support, illness cognition, health locus of control and compliance with medical treatment and advice. Data analyses focus on the relationship between gender, social support,
self and illness cognition, as well as adherence to treatment. Results will be discussed with reference to their applicability to
explain adherence to disease regimens and, in relation to practical strategies that can be employed to increase medication adherence. Additionally, the paper will reflect upon the necessity for gender aware interventions.
DIFFERENTIAL ASSESSMENT OF RECEIVED SUPPORT:
THE ROLE OF GENDER AND PROVIDER SOURCE
Benicio Gutirrez Dopa
Universidad Estatal a Distancia, Costa Rica
The present paper examines types and sources of received support in a sample of 902 Costa Rican men and women employees. Sex
and age differences were considered as well as associations with health and emotions. Using 16 Spanish items from the UCLASocial Support Inventory, advice giving, assistance, reassurance, and emphatic listening were measured as received from four
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sources: friends, relatives, partner, and groups/organizations.
Results showed that support types were not very distinct, suggesting that sum scores across these variables could be aggregated. In
contrast, sources were discriminant and had to be studied separately. Gender differences emerged for spousal support only.
Moreover, an interaction between sex and age pointed to a larger discrepancy of social support in older men and women. The older
they were, the less support women received from their spouses. In addition to these mean level differences in gender, further sex
differences emerged for spousal support when correlating received support with emotions, depression, and quality of life half a year
later. Implications of gender and age for received social support are discussed.
A HELPING HAND: HOW SOCIAL SUPPORT CONTRIBUTES TO COPING
STRATEGIES IN WORKING MEN AND WOMEN
Fiksenbaum Lisa
York University
Work-related stress is increasingly recognized as one of the most serious occupational health hazards, often resulting in lower productivity, employee dissatisfaction, absenteeism, and turnover. Research suggests that social support and coping can moderate the
effects of job stress. In the past, research on coping and social support has tended to be conceptually and empirically separate.
Recently, however, researchers have linked coping and social support, in order to evolve an interpersonal theory of coping with
stress.
This study investigates the contribution of social support to coping strategies used by 198 men and women when experiencing job
stress. Instrumental and palliative coping were assessed, as was social support from supervisors, co-workers, and family and friends.
Level of cynical distrust was also measured and related to coping. Gender differences in social support and coping were examined.
Results indicated that social support is a major contributor to coping, and that this effect is moderated by gender. Specifically, coworker support contributed positively to instrumental coping, internal control, and preventive coping in women. In men, co-worker support did not predict significantly to instrumental coping but family and friend support predicted positively to preventive coping. Additional results demonstrated that cynical distrust did not contribute significantly to women’s coping; however, in men, cynical distrust contributed positively to palliative coping, wishful thinking and self-blame, and contributed negatively to preventive
coping. Taken together, these findings suggest that social resources play a different role in contributing to the coping strategies used
by working women and men.
PERCEIVED, USED AND MOBILIZED SOCIAL SUPPORT
IN COPING WITH LIFE STRESS AMONG YOUNG MEN AND WOMEN
Helena Sek
Adam Mickiewicz University, Poland
The aim of the study is to investigate gender differences in the functions of social support in coping with life stress in young adults.
The role of gender differences was examined in the perception of social support and the use of different sources and types of support. Gender differences in social support mobilization were also examined. Three different patterns of stressors were examined and
compared in three different groups: Coping with the transition to parenthood, coping with work stress and coping with stressful life
events.
The sample consisted of three subgroups of young adults (ages 22-35) (N=390): 30 couples (30 pregnant women and their male
partners), 44 young adults and 317 students. Transition to parenthood was examined in the first group, coping with work stress in
the second, and coping with stressful life events in the third. Measures include: The Life Events Scale; the ISSB (received support) (Polish version), two self-rating scales of perceived support and support sources, and a short scale measuring social support
mobilization.
Results showed that gender differences were observed only in social support mobilization; females were higher than males. The role
of gender in social support functions depended on the mode of stress and type of support. In the couples, mutual support giving
and receiving were observed. The results showing interactive effects are discussed in the light of matching social support with individual coping strategies and with support expectancies in men and women.
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Symposium
Applying
Psychological
Theory to Medical
Testing and
Treatment
SYMPOSIUM
APPLYING PSYCHOLOGICAL THEORY TO MEDICAL
TESTING AND TREATMENT.
Symposium organiser:
Professor Lucy Yardley
Department of Psychology,
University of Southampton
Medical testing and treatment has been conventionally regarded within the health care system as the exclusive domain of medically trained personnel. However, the process and outcome of medical testing and treatment can be profoundly influenced by the beliefs
and behaviour of patients. It is for this reason that psychological theory may provide valuable insights into the processes and outcomes of medical testing and treatment.
This symposium brings together five papers that draw on well-established psychological theories (e.g. Illness Representations
Theory, Social Cognition Theory, Theory of Planned Behaviour) to demonstrate different ways in which such theory can be used to
better understand various aspects of medical management. Each paper also illustrates the implications of this understanding for optimising patient care.
The first two papers analyse the beliefs of patients undergoing screening tests, and highlight the importance of eliciting and changing erroneous beliefs in order to ensure that patients’ responses to test outcomes are appropriate. The following paper considers how
patients’ attitudes may be changed by their experiences of medical care, and the implications this has for maximising adherence to
treatment. The penultimate paper describes how psychological theory can be used to design an intervention to maximise adherence,
while the final paper applies psychological theory to understand the behaviour of the medical practitioners themselves. A discussion will then be led by Professor Marie Johnston.
BELIEFS ABOUT DIABETES AND PSYCHOLOGICAL RISK FACTORS
IN A DIABETES SCREENING PROGRAMME
Skinner, T.C.(1), Daavies, M.J. (1), Jarvis, J. (1), Khunti, K. (2) Farooqui, A (2)
University Hospitals of Leicester, Department of Diabetes & Endocrinology,
Leicester Royal Infirmary, Leicester, LEI 5WW, UK
Aims:- Explore beliefs about diabetes, and the psychological predictors of and outcome of a diabetes screening test.
Method:- Whilst undertaking an oral glucose tolerance test (as part a diabetes screening study), 200 participants completed a booklet containing the Spielberger State Anxiety Scale, Revised Diabetes Illness Representations Questionnaire, the Centre for
Epidemiological Studies Depression scale and the Big Five 44 Personality questionnaire.
Results: - 64% agreed type 2 diabetes is a chronic condition, 74% agreed that it was
a serious condition. Factor analysis indicated three causal models; biomedical (diet, genes, own behaviour), mental (stress, state of
mind) and alternative (pollution, other people, poor medical care, virus, chance). Participants subscribing to the alternative causal
model were less likely to agree that diabetes is a chronic illness (r = -.40; p<0.001) and were more extroverted (r = - .25; p <0.005).
Participants with either impaired glucose tolerance or diabetes were less conscientious ( t= -1.73; df = 95; p <0.05), reported more
depressive symptomology (t =1.81; df = 101; p <0.05) and were more anxious during screening ( t =2.07; df = 82 ; p <0.05).
Conclusions: - A significant proportion of those at risk for diabetes do not believe diabetes is caused by lifestyle, that it is a permanent or serious condition. Results support suggestions that depression is a risk factor for type 2 diabetes.
PREDICTIVE GENETIC TESTING:
THE APPLICATION OF SELF-REGULATION THEORY
Susan Michie, University College London
Jonathan Smith, Birkbeck College London
Victoria Senior, University of Surrey
Theresa Marteau, Kings College London
Aims : This study aimed to investigate perceptions of risk, illness and tests in those receiving negative results following predictive
genetic testing.
Problems addressed: A proportion of those receiving negative results following predictive genetic testing desire future clinical
screening, despite it being clinically unnecessary and experienced as aversive.
Methods: Interviews with nine people receiving negative genetic test results for familial adenomatous polyposis (FAP) were
analysed using the qualitative method, Interpretative Phenomenological Analysis (IPA).
Results: Those not reassured by their results perceived a continuing risk to themselves and their children. Explanatory themes that
emerged concerned perceptions of the cause of the condition and perceptions of the test:
Perceptions of the cause of the condition. The condition was seen as caused by other factors as well as genes, so that information
about only one risk factor could not be reassuring. Although the condition was perceived to be genetic, genetic status was seen as
transient, so a result today could not predict the future.
Perceptions of tests. There was a lack of conviction in the genetic test, which reflected two sets of representations: (a) The representation of a blood test for genes and (b) The fit between the representation of the test and that condition.
Conclusions: Self- regulation theory provides a coherent explanatory framework for these findings. It may be that eliciting and
changing people’s representations prior to testing may enable those receiving negative results to be more reassured about their risk.
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UTILITY OF THE THEORY OF PLANNED BEHAVIOUR
FOR PREDICTING ADHERENCE TO TREATMENT FOR DIZZINESS IN PRIMARY CARE.
Lucy Yardley and Margaret Donovan-Hall,
University of Southampton, UK
Aims: To examine the longitudinal relationship between attitudes and adherence to a clinical intervention in primary care, using the
Theory of Planned Behaviour (TPB).
Hypotheses 1. Attitudes to a clinical intervention will be changed by experience of the intervention.
2. Adherence will be predicted by attitudes pre and post experience of the intervention, but the latter will be the stronger predictors.
Methods: 120 people participated in a randomised controlled trial of balance retraining exercises for dizziness, delivered by nurses in a primary care setting. This paper reports data from 64 who completed treatment and 56 controls. TPB variables (attitudes,
subjective norms, perceived behavioural control and intention) were elicited in structured interviews before randomisation and at 3
month follow-up. Adherence was also assessed at 3 months in the treatment group.
Results: GLM and test-retest reliability calculations both indicated much greater change in TPB variables in the treatment than in
the control group. Multiple regression analyses confirmed an association between reported adherence at 3 months and all TPB variables prior to experience of treatment, but a much closer association between adherence and TPB variables at the 3 month followup.
Conclusions: Attitudes to a treatment that has not previously been experienced may change considerably following experience of
the treatment, and so pre-treatment attitudes may not be powerful predictors of adherence. This suggests that it is important to focus
on the experiences that shape attitudes during treatment in order to maximise adherence.
USING THE SELF-REGULATION MODEL TO DEVELOP AND EVALUATE
AN INTERVENTION FOR STROKE PATIENTS
Sara Joice and Marie Johnston
University of St Andrews, St Andrews, UK. KY16 9JU
Background and Aims: This programme of research illustrates the stages of implementing a theory-based (Leventhal’s SelfRegulation model, SRM) intervention for stroke patients, from gathering initial data to assess the applicability of the theory, achieving a method of delivery compatible with theoretical constructs, creating a message that elaborates the mechanisms of the theory
and evaluating the effectiveness of the intervention in changing mechanisms proposed by the theory. The final stage is to assess the
effectiveness of the intervention in achieving health outcomes. This paper describes the stages of data gathering, intervention design
and evaluation development.
Methods: a) A cohort of 37 patients completed the IPQ-R and the HADS two weeks after discharge from Hospital to examine the
relationships between illness representations and distress. b) An SRM- based intervention was designed to visually and verbally represent illness representations compatible with adherence and to be delivered as a letter. c) An intervention evaluation, based on the
theoretical mechanisms proposed by the SRM was also designed.
Results and Conclusions: Emotional distress was related to three illness representations: consequences, coherence and timeline (all
p<. 05). These representations were addressed in the intervention design. The next stage, intervention evaluation, has been instigated in a further RCT, examining the effects on illness representations (IPQ -R), theoretical mechanisms and adherence to the intervention (using tailored assessments of behaviour and intervention familiarity) in a cohort of 100 stroke patients.
WHICH FACTORS DO PREDICT THE INTENTION OF THE GENERAL PRACTITIONER
TO INFORM HIS PATIENTS ABOUT THE DISADVANTAGES OF BENZODIAZEPINE USE?
Ten Wolde, G.B.1, Dijkstra, A. 2, Knuistingh Neven, A. 3, Zitman, F2. & Maes, S1.
of Clinical and Health Psychology, Leiden University, 2Department of Social
and Organizational Psychology Groningen University 3, Department of Psychiatry Leiden University Medical Center 3,
Department of General Practitioners Medicine Leiden University Medical Center, The Netherlands.
1 Department
Aims and problem: Benzodiazepines (BZD) are the most prescribed psychotropic drugs in the Netherlands. 10-15% of the population uses BZD on a regular basis and 3% uses it chronically. Because of the problems of abuse, dependence, associated withdrawal and the lack of adequate treatments of the underlying conditions there is an urge to prevent and reduce chronic BZD use.
To be able to develop an intervention aimed at preventing and reducing chronic use, the role of the general practitioner (GP) as an
intermediary is essential. Therefore, insight into the GP’s behaviours such as prescribing BZDs and educating patients about
BZDs is needed.
Method: To map the psychology of these behaviours the Adherence Model was used. This model combines determinants of the
Theory of Planned Behaviour, the Social Cognitive Theory, and the Self-Regulatory Model. The main determinants are attitude,
response-efficacy, social norm en self-efficacy. We expect that these psychological factors are related to the intention of the GP to
educate his patients about the drawbacks of benzodiazepine use. A questionnaire was developed and sent out to 949 GPs in The
Netherlands of which 339 were returned (response rate 36%).
Results: Linear multiple regression analysis was used to test which psychological factors do predict the intention of the GP to
educate his patients. The results show that all four psychological factors significantly predict intention to educate patients who
were already taking BZD for a long time, whereas only attitude en social norm are significant predictors of intention to educate
patients who were going to use BZD for the first time.
Conclusions: Implications for the GP as an intermediary in preventing chronic benzodiazepine use will be discussed.
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Symposium
Self-Efficacy,
Self-Regulation,
and Health
Behavior
SYMPOSIUM
SELF-EFFICACY, SELF-REGULATION, AND HEALTH
BEHAVIOR: RECENT THEORY AND RESEARCH
Co-Chairs: Anastasia Kitsantas, and James E. Maddux
George Mason University, USA
Discussant: Arie Dijkstra, Leiden University, Netherlands
This symposium brings together a group of scholars to discuss their research on the role of self-efficacy beliefs and self-regulation
on health. Self-efficacy refers to the degree to which one feels competent to complete a give task (Bandura, 1986) whereas self-regulation is a broader construct that refers to the organized network of personal processes and actions that people use to direct their
own behavior toward desired goals (e.g., preventing disease, enhancing health, controlling addictive behaviors (Zimmerman, 1994).
Self-efficacy beliefs are an important component of self-regulation.
The symposium will feature five presentations on self-efficacy, self-regulation, and health behaviors. Kitsantas and Trice will
examine the validity of two new scales, designed to assess children’s and parents’ health enhancing knowledge, self-regulated strategies, and the self-efficacy to implement these strategies in health promoting behaviors. Lyszczynska looks at the influence of socialcognitive variables such as phase-specific self-efficacy and adolescents’ own planning in the context of nicotine abstinence and regular seat belt use. Maddux will discuss the role of emotion in self-regulation and will review the research on the relationship between
emotion and health related cognitions such as self-efficacy beliefs. Schwarzer and Ziegelmann will report on recent research on
physical exercise changes of orthopedic patients trained in developing self-regulated strategies to deal with setbacks and barriers to
exercise. Finally, Trice will present a study that compares children’s beliefs about control over health, wealth, longevity and careers
across three countries.
The Discussant will offer evaluative and integrative comments and will discuss the implications of the studies for research and
health practice. Finally, the symposium members and the audience will be invited to participate with suggestions and comments.
DEVELOPMENT OF THE GENERAL HEALTH ENHANCING
BEHAVIOR SCALES (GHEBS) FOR ADULTS AND CHILDREN:
PRELIMINARY FINDINGS
Anastasia Kitsantas, George Mason University, USA
Ashton Trice, James Madison University USA
This paper reports two new scales, the General Health Enhancing Behaviors Scales (GHEBS), one for children and one for adults.
Each scale assesses an individual’s health enhancing knowledge, self-regulated strategies, and the self-efficacy to implement these
strategies in health promoting behaviors. These scales were developed based on the social cognitive perspective of self-regulation.
Three studies to establish the reliability and validity of both child and adult versions were conducted. The first study established the
internal consistency, test-retest reliability, and concurrent validity of the adult scale; the second the reliability and validity of the
child scale; and the third the parent and child scores of health knowledge, self-regulation and self-efficacy are correlated. Analyses
revealed that these instruments showed good reliability; construct validity, and criterion validity. In addition, significant positive
correlations were found between parent and child scores on health knowledge, self-regulation and self-efficacy. Recommendations
for using these scales are provided.
THE ROLE OF PHASE-SPECIFIC SELF-EFFICACY IN MAINTENANCE
OF HEALTH BEHAVIORS AND RELAPSE MANAGEMENT
Aleksandra Luszczynska,
Warsaw University
Most adolescents find it difficult to initiate health behaviors after they formed an intention. Further problems arise when an individual tries to maintain an initiated health behavior or to get back on track after lapses. These problems might result from self-regulatory deficits. The role of social-cognitive variables, such as phase-specific self-efficacy and subjects’ own planning were analyzed
in the context of nicotine abstinence and regular seat belt use. Five hundred students (55.4% men), aged 16 to 21, participated in
the study, at three points in time. Outcome expectancies, self-efficacy specific for the motivation phase (i.e., preaction self-efficacy), the intention to quit smoking, and the intention to use seat belt were assessed at Wave 1. Half a year later, subjects’ own planning and optimistic self-beliefs specific for the postintentional phase (i.e., maintenance self-efficacy and recovery self-efficacy)
were assessed. One month later, all respondents answered the questions designed to assess recovery self-efficacy. Smoking and seat
belt use were measured at all waves. The results of structural equation modeling with latent variables revealed that preaction selfefficacy is a crucial predictor of the intention, regarding both nicotine abstinence among smokers and regular seat belt use. The
recovery after lapses and maintenance of behaviors were related to optimistic self-beliefs specific for the postintentional phase.
Recovery self-efficacy was found to be the best predictor of lower number of lapses. Maintenance self-efficacy predicted longer
nicotine abstinence. The results show the influential role of self-regulatory cognitions in postintentional processes.
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THE ROLE OF EMOTION IN THE SELF-REGULATION
OF HEALTH-RELEVANT BEHAVIOR
James E. Maddux
George Mason University Fairfax, VA, USA
The importance of emotion or affect in the self-regulation of behavior has become increasingly recognized over the past decade or
so. Recent social cognitive models of self-regulation now view emotional reactions during self-regulation as having a powerful
influence over the traditional cognitive and behavioral aspects of self-regulation. Although emotional experiences during self-regulation are largely the result of the person’s cognitive evaluations of his or her performance, these reactions also influence these
cognitive evaluations and self-regulatory behavior. This presentation will review the role of emotion in self-regulation, focusing
on the relationship between emotions and health-relevant cognitions such as self-efficacy beliefs and behavior-outcome expectancies. In particular, it will discuss research on the causal relationship between induced emotions and health-relevant cognitions.
SELF-EFFICACY AND POSTINTENTIONAL
PROCESSES IN PHYSICAL EXERCISE
Ralf Schwarzer & Jochen Ziegelmann
Freie Universitet Berlin
Changing health-related behaviors requires two separate processes that involve motivation and volition, respectively. First, an intention to change is developed, in part on the basis of self-beliefs. Second, the change must be planned, initiated, and maintained, and
relapses must be managed; self-regulation plays a critical role in these processes. Social-cognition models of health behavior change
address these two processes. One such model, the health action process aproach, is explicitly based on the assumption that two distinct phases need to be studied longitudinally, one phase that leads to a behavioral intention and another that leads to the actual
behavior. Particular social-cognitive variables may play different roles at the two stages. Evidence emerged that self-beliefs in the
motivation phase can be distinguished from self-beliefs in the motivation phase. Examples are chosen from research on physical
exercise changes of about 300 orthopedic patients who were studied during and after a medical rehabilitation period with followups up to a half a year later. One question aimed at the identification of motivational stages and the movement from one stage to
the next. Another question aimed at the effects of a brief planning intervention that was administered at the end of rehabilitation.
The intervention was designed both to elicit detailed plans regarding up to three physical activities and to develop self-regulatory
strategies in coping with barriers and setbacks. In the first intervention group, plans were elicited by interview whereas in the second group the intervention consisted of a self-administered planning sheet. The age range from 18 to 80 years allows taking a life
span view on the adoption and maintenance of physical exercise and on the effectiveness of the intervention.
CHILDREN’S BELIEFS ABOUT CONTROL OVER HEALTH, WEALTH, LONGEVITY,
AND CAREERS: A CROSS-NATIONAL STUDY.
Aishton Trice
James Madison University, USA
We interviewed children (30 boys and 30 girls in America, Italy and Bulgaria) about the future predictions about longevity, health,
financial opportunities, and career options and their personal control over them. There was a semi-structured interview conducted
by native graduate students, followed by ITEMS from Wallston’s Health Locus of Control and Crandall’s Intellectual Achievement
Responsibility scale. Children’s beliefs about their futures and their control over them varied considerably with country, and in the
US by sex. American girls has high expectations for longevity and positive beliefs about control over careers and health. American
boys had lower beliefs of control over health and careers than American girls, but higher expectations about wealth. They had much
lower beliefs about longevity than any other group in the study. Bulgarian children had low expectations about wealth, but high
expectations about health and longevity and high control orientations. They had little expectations about personal control over career
choices. Italian children had relatively high expectations about all aspects of their lives and high control orientations, expect about
wealth. These results suggest that there is not a generalized control orientation that affects all aspects of children’s future expectations, and that children learn many aspects of their expectations from aspects of their culture.
Emotional expression, health and disease
INVITED SYMPOSIUM
EMOTIONAL IMPACT AND EMOTIONAL EXPRESSION IN HEALTH PSYCHOLOGY
Symposium convened by
Bernard Rimé
Research Unit “Emotion, Cognition, and Health”,
University of Louvain at Louvain-la-Neuve, Belgium.
Invited Symposium
Emotional Impact
and emotional
expression in health
psychology
The range of perspectives under which emotion and emotional expression are investigated in health psychology is now very broad.
This symposium is intended to illustrate both the variety and the interest of these approaches. The first contribution will show how
new medical practices such as genetic tests open new avenues in the study of the emotional impact of a medical diagnosis. Healthy
individuals were screened for their risk of developing an inherited disease and then informed of the positive or negative outcome of
the test. The two groups were followed up and compared for the emotional impact of the test. The second contribution will describe
an in-depth study of the consequences of a major life stress. Based on longitudinal data collected before and after the death, the
27
study investigated the emotional impact and the health consequences of the death of the spouse for the surviving member of the couple. A special accent was borne on the various factors that increase the risk of a poor outcome following loss. The third and fourth
contributions will examine and discuss the interpersonal consequences of expressing and communicating distress about one’s disease. The reported studies focussed in particular on the conditions under which emotional expression by seriously ill patients will
or will not elicit support and prosocial behavior from the social environment. The fifth contribution will test a number of hypothesis on the role played by emotional disclosure in the recovery process among patients who faced a major health problem. Using a
longitudinal design, the study observed the evolution of emotional disclosure after myocardial infarction and investigated the conditions under which it contributed to meaning making, to recovery, and to psychosocial adjustment.
EMOTIONAL IMPACT OF GENETIC TESTING
Pio Enrico Ricci Bitti, Elisabetta Razzaboni, and Paola Gremigni
Department of Psychology, University of Bologna
This study investigates the emotional impact of screening for inherited thrombophilia (IT). A repeated measure design with control
group was used to examine the emotional effects of IT screening. Subjects who received a positive result for presence of at least
one thrombophylic alteration were compared with subjects who resulted negative by using ANOVA for repeated measures. Thirtythree adults receiving positive result and 104 receiving negative result following IT screening completed a questionnaire assessing
emotional state and perceived well-being before testing an after receiving communication of result. No significant harmful emotional effects of IT screening were detectable. Twenty days after receiving the results, both positive and negative groups increased their
perceived health status and well-being, and decreased their sanitary fears and perceived life stress, whereas only positive group
decreased anxiety. In the short period, IT screening seems to be well accepted and should not be discouraged based on potential
adverse emotional effects. However, emotional impact of testing at longer term should be studied to confirm our findings. Further
longitudinal studies are needed to evaluate the influence of emotional impact on both quality of life and adoption of preventive
behaviours and the role of genetic counselling.
THE EMOTIONAL IMPACT OF THE DEATH OF A SPOUSE
Camille B. Wortman
State University of New York at Stony Brook
Following the death of a spouse, people are expected to show intense distress which improves over time. However, this reaction is
by no means universal. Some people show little distress at any point following the loss, while others appear to experience prolonged
or chronic grief. At this point, we know little about the prevalence of these and other patterns of grieving. We also know very little
about the antecedents of such patterns. For example, is failure to show distress indicative of lack of attachment to the partner or
resilience in the face of loss? In the first part of this talk, I draw from a prospective, longitudinal study of bereavement to address
these questions. Elderly respondents were interviewed an average of 3 years prior to the death of their spouse and at 6 and 18 months
after the death. The most prevalent pattern, evidenced by nearly half of the sample, was one of consistently low depression. About
10% of the respondents actually showed an improvement in depression following their spouse’s death. There was no evidence to
suggest that those failing to evidence depression were not attached to their spouse or were shallow, superficial people. In the second part of the talk, I discuss additional factors that increase the risk of a poor outcome following loss of a spouse. These include
how the death occurred, whether it was timely or untimely, and whether the bereaved was faced with additional stressors such as
poor health. I place particular emphasis on gender, since there is clear evidence that men show greater mortality and morbidity following widowhood than do women. Reasons for this disparity are discussed, including the fact that the marital role is more beneficial to men than to women, and that women typically take greater responsibility for the spouse’s health care, diet, nutrition, and
exercise than do men. Elucidating the reasons behind these gender differences helps to illuminate the mechanisms linking stressful
life events and health.
CHRONIC ILLNESS AND THE RESPONSE OF OTHERS: EMOTIONAL,
COGNITIVE AND SOCIAL ASPECTS
Gwénola Herbette
U. F. R. de Psychologie, Université de Lille 3, France
Studies on the social sharing of emotions showed that people share their emotions to a very large extent and that they believe that it
is beneficial for them. They are also eager to listen to other people’s emotional experiences. Yet, life event victims are often exposed
to negative reactions of their social environment when they want to share their problem-related thoughts and emotions. Two studies
examined this paradoxical attitude towards victims, and more specifically, towards ill people. A first study examined the characteristics of seriously the social sharing of emotions by patients suffering from severe illness. A second study investigated how healthy
perceivers responded to an ill person as a function of the latter’s characteristics for severity of the disease and quality of coping. It
was observed that people who need support the most (i.e., those with a high severity disease and a poor coping) are those who are
the most likely to be derogated. Furthermore, we examined how far the results held independently of the intimacy bonds between the
sufferer and the person exposed to him/her. Finally, all results will be discussed in relation to the dilemma of emotional disclosure to
which stigmatized individuals, such as seriously ill persons, are faced with: On the one hand, they may receive little social support
if they do not share their emotions with others. On the other hand, they run a high risk to become derogated if they do so.
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WHEN SERIOUSLY ILL PERSONS COMMUNICATE DISTRESS: SOCIAL SUPPORT VERSUS
SOCIAL STIGMA
Arjan E. R. Bos, Open University, The Netherlands, and Anton J. Dijker,
Maastricht University, The Netherlands
Seriously ill persons face a self-presentational dilemma. On the one hand, they have to convey distress to motivate others to give
social support. On the other hand, ill persons may receive negative emotional and stigmatising reactions when they confront others
with their suffering. This paper reports three studies on the interpersonal consequences of communicating distress about one’s disease. Study 1 examined what coping strategies of persons with HIV or cancer are preferred by healthy perceivers. In general, healthy
perceivers seem to reject self-pity and negative mood states of seriously ill persons. However, women reported a significant stronger
preference for patients’ communication about the disease than men. In Study 2, conveying distress of persons with HIV was experimentally manipulated by means of vignettes. Men and women reacted differently when persons with HIV conveyed distress:
women reported stronger feelings of pity, whereas men reported stronger feelings of anger. Study 3 replicated this study in a realistic experimental setting with additional behavioural measures. Similarly, women reported stronger pro-social behaviour than men,
when confronted with a target with HIV who conveyed distress. In sum, the results of the present studies show that seriously ill persons should be careful with confronting relative strangers with their suffering. Displaying large amounts of distress may result in
negative emotional reactions and stigmatisation from others. However, communicating a moderate amount of distress may result in
positive emotions and pro-social behaviour in women, but not in men.
WHY DO PATIENTS DISCLOSE THEIR EMOTIONS? EMOTIONAL DISCLOSURE,
MEANING MAKING, AND PSYCHOSOCIAL ADJUSTMENT AFTER MYOCARDIAL INFARCTION.
Efharis Panagopoulou and Alexis Benos
Medical School
Aristotle University of Thessaloniki, Greece
The present paper is part of a longitudinal study investigating the relationships between emotional disclosure, meaning making, recovery,
and psychosocial adjustment, one week, one month, two months, and six months after myocardial infarction. The paper advances upon
previous work showing that emotional disclosure in cardiac patients was positively related to appraisals of threat, and the perception of an
internal need to disclose emotions (Panagopoulou, & Maes, in press). This paper tests two sets of hypotheses: The first one concerns general disclosure in relation to meaning-making, and the second concerns specific disclosure in relation to patient’s spouse. The first hypothesis predicts that patients are more likely to disclose their emotions when they are trying to construct the meaning of their experience (linear negative association). An alternative hypothesis predicts that the direction of the association will reverse if disclosure fails to provide
meaning (culvinear association). The second hypothesis predicts that patients are more likely to disclose their feelings to their spouse in
an attempt to construct compatible meanings (linear negative association). Alternatively the direction of the association will reverse if disclosure does not provide compatibility in meanings (culvinear association). Based on previous conceptualizations, meaning is conceptualized as comprehensibility, and as significance (Affleck & Tennen, 1996; Davis, Nolen Hoeksema, & Larson, 1998). For the purposes of
the study a third conceptualization, self-continuity, based on self-identification theory, was added (Schlenker, & Weingold, 1990). Utilizing
a mixed-methods approach all three conceptualizations are measured both with a quantitative and a qualitative measure. Emotional disclosure is assessed using a self-report instrument based on previous studies (Rimé, 1995). Objective and subjective indicators of cardiac condition, demographic characteristics, and marital relationship are measured as control variables. All consecutive patients receiving pharmacological treatment for myocardial infarction in two large city-hospitals in Greece, and their spouses are included in the study.
SYMPOSIUM
ELICITING AND CHANGING BELIEFS ABOUT CORONARY HEART DISEASE
THE IMPACT OF LEARNING OF A GENETIC VULNERABILITY
TO THE ADVERSE EFFECTS OF SMOKING ON THE HEART: AN ANALOGUE STUDY
Symposium
Eliciting and
Changing Beliefs
about Coronary
Heart Disease
AJ Wright, J Weinman & TM Marteau
King’s College London
Background: There is growing evidence of a genetic vulnerability to the adverse effects of smoking on the heart. Informing smokers that they have such a vulnerability may motivate smoking cessation. Protection Motivation Theory (PMT) and the Extended
Parallel Processing Model (EPPM) make competing predictions regarding when health risk information will motivate behaviour
change, which were examined in this study. The EPPM predicts a threat x efficacy interaction, such that risk information will only
have a positive impact on behaviour change when individuals perceive themselves both to be at risk and to have high efficacy. PMT
predicts main effects of threat and efficacy in addition to an interaction. Participants receiving positive genetic test results, who perceive high efficacy, were predicted to have the greatest motivation to quit.
Methods: 197 smokers read one of six vignettes, in a 3(risk status: gene positive, gene negative or standard smoking risk advice)
x 2(high or low efficacy) design. Key outcomes were intention to quit, intention to attend an information session, and attitudes
towards quitting. Analyses used a 3x2 ANOVA, with planned contrasts to examine whether the pattern of results better fit PMT’s
or the EPPM’s predictions.
Findings: Participants in the gene positive, high efficacy condition had the greatest motivation for smoking cessation. There were
significant risk x efficacy interactions for intention to attend an information session and attitudes towards quitting, F(2,195)=3.194
and F(2,195)=3.407, respectively. These interactions better fit the EPPM’s predictions than PMT’s. For intention to quit, the pat-
29
Symposium
Eliciting and
Changing Beliefs
about Coronary
Heart Disease
tern of means best fit PMT’s predictions.
Discussion: While high efficacy individuals with gene positive test results had the greatest motivation to quit, low efficacy individuals who received positive results had decreased motivation. Presenting genetic risk information without taking account of perceived efficacy is unlikely to result in increased motivation for behaviour change.
CAUSAL BELIEFS FOR MYOCARDIAL INFARCTION:
AN INTERPRETIVE PHENOMENOLOGICAL ANALYSIS
David P French, Esther Maissi & Theresa M Marteau
University of Cambridge & GKT School of Medicine, Kings College London
Eliciting and changing beliefs about coronary heart disease
Aims Patient beliefs concerning the causes of their illness are theoretically core to a number of psychological models. The current study aims to explore the themes that emerge from patients’ accounts of the causes of their first myocardial infarction.
Methods Semi-structured interviews were conducted with 13 people in hospital within a week of their first myocardial infarction
(MI). Transcripts were analysed using Interpretive Phenomenological Analysis. Three researchers noted themes that emerged from
each interview, then common themes were selected and refined on the basis of an aggregation of interviews.
Results Respondents reported actively searching for explanations for their MI. A key process appeared to be attempting to avoid
blame for their current illness, whilst seeking to assert control over future recurrence. Three major themes emerged. Stress was the
most common attribution: this may be due to the flexibility of the stress concept as both an uncontrollable demand, whilst also a
controllable and avoidable response. Whilst many respondents had complex models of what caused their MI, containing several
causes, they also tended to emphasise the importance of a single cause, which often related to their symptoms. Several respondents
also interpreted “cause” in terms of both underlying pathology and as acute trigger of MI.
Conclusions Patient responses appear to be concerned with making sense of their symptoms while avoiding self-blame; researchers
should be careful to distinguish between attributions of cause and attributions of blame.
HEALTH BEHAVIOUR CHANGE AND ADAPTATION AFTER
CARDIAC REHABILITATION: A SELF-REGULATORY APPROACH
Falko F. Sniehotta & Urte Scholz
Free University Berlin
Background: CHD patients usually need to change health-related habits such as physical activity to reduce their cardiac risk status. After discharge many patients fail to adapt to the necessary behavioural changes. Furthermore, depression and problems with
re-adaptation are a major problem in such patients.
Aims: To investigate the role of personality, motivational and self-regulatory processes that underlie long-term health behaviour
change and influence well-being after rehab. A special focus of this research is on the mediation of the intention-behaviour relation
by self-regulatory processes.
Sample: 500 German CHD in-patients of cardiac rehabilitation clinics with a mean age of 58,5 years (range 31-86 years).
Method: Experimental and longitudinal multi-center study with two experimental groups and a control group. Participants of the
experimental groups undergo different 30-minutes interventions in the hospital focussing on planning of physical activity after discharge. Four waves of measurement are assessed: Pre-test measures in the hospital prior to the intervention, and follow-up measures two, four and twelve months after discharge. Included Variables: Physical activity, depression, well-being, personality measures, HAPA-measures, planning, self-regulation and self efficacy.
Results: The present research underlines the important role of self-regulatory competences for long-term behavioural changes and
well-being. Most Patients are highly motivated. Especially the planning interventions significantly foster the uptake of physical
activities after discharge. Post-intentional constructs such as planning, self-efficacy and self-regulation successfully mediate the
relationship between intention and behaviour.
Conclusion: Psychological interventions in cardiac rehabilitation should especially enhance self-regulatory competences such as
planning instead of solely focussing on motivational processes e.g. risk information.
AN INTERVENTION TO IMPROVE ATTENDANCE AT
AN OUT-PATIENT CARDIAC REHABILITATION COURSE.
ALETHEA COOPER1,2, JOHN WEINMAN3, GRAHAM JACKSON2, ROB HORNE 1.
1CENTRE FOR HEALTHCARE RESEARCH, UNIVERSITY OF BRIGHTON.
2CARDIOTHORACIC
3UNIT
CENTRE, GUY’S & ST THOMAS’ HOSPITAL, LONDON.
OF PSYCHOLOGY, GKT MEDICAL SCHOOL, LONDON.
Background: Cardiac rehabilitation courses (CR) are offered to patients who have suffered myocardial infarction (MI). Many
patients fail to attend and illness perceptions have been shown to significantly influence this.
Aim: To assess the impact of a single-session intervention aimed at altering unhelpful illness and treatment beliefs that may be associated with failure to attend CR.
Method: 81 post MI patients were recruited (79% men, 21% women) mean age 57.6 years (SD 9.48). Patients were randomised into
an intervention group (in-hospital single session cognitive-based intervention) or control group (usual care). Patients were followed
up at three and six months.
Result: Overall cardiac rehabilitation attendance was approximately 64%, however there was no statistically significant difference
in attendance between the two groups. Illness perceptions did not differ between the intervention and control groups at three
30
months. However, the intervention did impact on specific treatment beliefs, i.e. at three months, those patients in the intervention
group were less likely to endorse the view that cardiac rehabilitation was suitable for young, previously active patients than those
in the control group (t-test p=0.025). Patients in the intervention group were also less likely to report shortness of breath.
Conclusion: It would appear that a single session intervention is not effective at increasing attendance at cardiac rehabilitation or
changing illness perceptions. However, certain treatment beliefs may be changed. Suggestions for future interventions will be discussed along with the role of illness perceptions and treatment beliefs in predicting attendance at cardiac rehabilitation.
GENDER AND COGNITIVE REPRESENTATIONS AS PREDICTORS OF PSYCHOSOCIAL
ADJUSTMENT FOLLOWING AN MI IN PORTUGUESE PATIENTS
McIntyre, T.*, Pereira, G., Soares, V, Gouveia, J., Trovisqueira, A.,
Figueiredo, M., Bastos, L., Figueiras, M.J., Johnston, M.,
Univ. of Minho, Braga, Portugal; Hospital of S. Marcos, Braga, Portugal;
Instituto Piaget, Almada, Portugal; Univ. St. Andrews, Scotland
This paper reports on a study which aims at comparing differential patterns of psychosocial outcomes of women and men following myocardial infarction in Portugal. This report examines the role of gender and illness representations as predictors of psychosocial outcomes in Portuguese MI patients (anxiety, depression and functional status). The subjects are 64 men and 38 women inpatients in the cardiology units of central hospitals. Evaluations were conducted at five moments post-MI: 3 days after admission, at
discharge, 2 weeks, 3 months, and 6 months after discharge. The instruments used are: The Sickness Impact Profile (Bergner et
al., 1981), the Hospital Anxiety and Depression Scale (Zigmond & Snaith, 1983), the Illness Perception Questionnaire - Revised
(Weinman & Petrie, 1996), and a social and clinical demographic form constructed for this study. Preliminary analyses show a less
favorable psychosocial profile for women post-MI regarding anxiety, depression and illness representations. The final results will
be interpreted in terms of the determination of the relative role of gender, time and illness representations as predictors of outcome
following MI. Several implications are formulated regarding the provision of cardiac rehabilitation services in Portugal, which take
into consideration gender variations and the role of illness cognitions as mediating factors in adjustment.
SYMPOSIUM
MEDICALLY UNEXPLAINED SYMPTOMS AND SYNDROMES:
MECHANISMS AND INTERVENTIONS
Convenor: Dr Rona Moss-Morris
ADULT ATTACHMENT, REASSURANCE SEEKING AND HYPOCHONDRIASIS
Symposium
Medically
Unexplained
Symptoms and
Syndromes
Alison Wearden, Katherine Perryman, Victoria Ward.
University of Manchester
Aims An individual’s attachment style can be conceptualised as a working model for interactions with others, developed as result
of experiences with childhood caregivers. People with hypochondriacal tendencies are both preoccupied with thoughts of having an
illness and resistant to medical reassurance. Using Bartholomew and Horowitz’s (1991) four-category attachment style model, we
hypothesised that people with anxious-preoccupied attachment would score highly on a measure of hypochondriasis, and investigated whether the association would be explained by the tendency to seek reassurance in relationships.
Methods 117 undergraduate students (99 female; mean (s.d.) age = 20.0 (2.35) years) completed questionnaires measuring attachment style (RQ, Bartholomew & Horowitz, 1991); negative affectivity (PANAS, Watson, Clark & Tellegen, 1988); reassurance
seeking in relationships (DIRI, Joiner & Metalksy, 2001) and hypochondriasis (Whitely Index, Pilowsky, 1967).
Results 55 participants were classified as having a secure attachment style, 17 avoidant-dismissive, 17 anxious-preoccupied, and
28 avoidant-fearful. Participants with the anxious-preoccupied attachment style had significantly higher hypochondriasis scores
than those with other styles. Negative affectivity (r=.471, p<.001) and reassurance seeking (r=.444, p<.001) were correlated with
hypochondriasis. In multiple regression analysis, attachment style explained an additional 2.8% of the variance after negative affectivity and reassurance seeking had been taken into account. With attachment style variables forced into the equation, negative affectivity, reassurance seeking and attachment style accounted for 30% of the variance in hypochondriasis (adjusted R2=.299,
F[5,111]=10.919, p<.001).
Conclusions The association between the anxious-preoccupied attachment style and hypochondriasis was mostly mediated by a tendency to reassurance-seeking and by negative affectivity.
THE IMPORTANCE OF CATASTROPHIC THINKING
IN SOMATIC COMPLAINTS.
Gert Crombez
Ghent University
Catastrophic thinking about pain has emerged as one of the most important psychosocial variables in predicting pain intensity, distress and disability in both prospective and cross-sectional studies. We review (1) the validity of the Pain Catastrophizing Scale to
assess catastrophizing in adults and children, and describe its subcomponents (rumination, magnification and helplessness), (2)
explore its role in explaining pain and disability in adults and children with pain, (3) explore differences and similarities with traitlike concepts such as negative affectivity and neuroticism, (4) apply the construct of catastrophizing upon other somatic complains
like chronic fatigue and tinnitus, and demonstrate its potential importance in these areas, and, finally, (5) provide a theoretical model
31
(Aldrich e.a., 2000) in which the process of catastrophizing is conceived of as a particular instantiation of worry and rumination
about a highly threatening pain experience. In normal situations these processes of worry and rumination facilitate avoidance and
escape from pain. However, in situations where pain is chronic and insoluble, catastrophic thinking may become a perseverative and
ineffective problem-solving strategy that fuels distress and hypervigilance to pain (Eccleston & Crombez, 1999).
SENSITIZATION, SOMATIZATION AND SUBJECTIVE
HEALTH COMPLAINTS
Hege R. Eriksen and Holger Ursin
University of Bergen
“Subjective health complaints” are common in the general population, and are complaints without any verifiable organic disease,
or the complaints are stronger than one would expect from the organic findings. The most common complaints are musculoskeletal pain, gastrointestinal complaints and “pseudoneurology” (tiredness, sleep problems, fatigue, and mood changes). These complaints are common in the general population, but for some these complaints reach a level that requires care and assistance. We suggest that these complaints are based on sensations from what in most people are normal physiological processes. In some individuals these sensations become intolerable. In some cases it may signal somatic disease, in most cases not. Cases without somatic disease, or with minimal somatic findings, occur under diagnoses like burnout, epidemic fatigue, multiple chemical sensitivity, chronic musculoskeletal pain, chronic low back pain, chronic fatigue syndrome, and fibromyalgia. These complaints are particularly common in individuals with low coping and high levels of helplessness and hopelessness. The psychobiological mechanisms for this is
suggested to be sensitization in neural loops maintained by sustained attention and arousal.
“ALL OR NOTHING” BEHAVIOUR AS A RISK FACTOR FOR ONGOING MEDICALLY
UNEXPLAINED SYMPTOMS FOLLOWING ACUTE INFECTION.
Meagan Spence, Rona Moss-Morris, Susan Taylor
The University of Auckland and Diagnostic Med Lab, Auckland
Cognitive theorists have proposed that behaviour in the acute stage of illness may contribute to the development of ongoing medically unexplained syndromes. However, there is little empirical evidence to support these theories. The aim of this study was to
design a self-report measure of behaviour during the acute phase of an illness and to assess if these behaviours predicted the onset
of a functional somatic syndrome. A conceptually derived scale was piloted on 312 university students. Principal components analysis of the items yielded a four factor solution, labelled “all or nothing” behaviour, avoidant behaviour, emotional support seeking
and practical support seeking. The scale was further validated on 746 patients with a recent episode of Campylobacter gastroenteritis. The factor structure was confirmed, and Cronbach’s alphas for the subscales ranged from .81 to .89. Three months after their
initial infection, patients were sent a second questionnaire assessing their ongoing bowel symptoms. Patients who engaged in more
“all or nothing” behaviour were significantly more likely to experience ongoing bowel symptoms and to meet diagnostic criteria for
irritable bowel syndrome than those who did not. The results suggest that the measure is a useful indicator of illness behaviour relevant to delayed recovery. Overdoing things at the time of infection and then needing to rest up for prolonged periods, appears to
be a particular risk factor for the development of a somatic syndrome. Early interventions for patients who engage in “all or nothing” behaviours may prevent delayed recovery from infection.
COGNITIVE BEHAVIOURAL THERAPY AND ANTISPASMODIC THERAPY
FOR IRRITABLE BOWEL SYNDROME IN PRIMARY CARE:
A RANDOMISED CONTROLLED TRIAL
Trudie Chalder1 Simon Darnley2 Tom Kennedy2 Simon Wessely1 Roger Jones, 2.
Academic Department of Psychological Medicine and Department of Health Services Research, Guy’s, King’s
& St Thomas School of Medicine, 2. Department of General Practice and Primary Care,
Guy’s King’s and St Thomas’ School of Medicine,
5 Lambeth Walk. London SE5 8QS
Irritable Bowel Syndrome (IBS) is a common gastrointestinal disorder that accounts for significant morbidity and health care expenditure. Mebeverine hydrochloride has been shown to be an effective therapy for IBS and hospital based studies have shown psychological therapies such as cognitive behavioural therapy (CBT) to be of use. There is insufficient evidence that either are beneficial
for those patients attending a general practitioner (GP).
The aim of this study was to establish in a randomised controlled trial whether early intervention with CBT was advantageous over
mebeverine hydrochloride alone in patients identified as having IBS by a GP.
Patients with IBS aged 17-50 were recruited from 12 general practices. After two weeks those with moderate or severe IBS (determined by the validated Symptom Severity Score Questionnaire (SSS)) were prescribed 275mg of mebeverine hydrochloride three
times a day. After a further four weeks patients who continued to score as moderate or severe on the SSS were randomised to either
continue on medication alone or have 6 additional sessions of CBT. The CBT focused on identifying and challenging the patient’s
behaviours and beliefs associated with IBS. We trained four practice nurses to deliver the therapy in the general practices. Symptom
Severity, global satisfaction, work and social adjustment, depression and anxiety were measured before randomisation, after treatment and at 3 and 6 months post treatment.
Of 334 patients initially referred, 145 were randomised; 74 to drug alone and 71 to drug and CBT. At follow up those who received
the combined treatment were less symptomatic than those who received drug alone.
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SOCIAL SUPPORT AND THE PERSISTENCE OF COMPLAINTS
IN CHRONIC FATIGUE SYNDROME
Judith Prins, Liesbeth Bos, Petra Servaes, Jos van der Meer, Maja Stulemeijer, Gijs Bleijenberg.
Netherlands Fatigue Research Group, University Medical Centre Nijmegen, the Netherlands
Several studies suggested that the surroundings of CFS patients are of importance in the persistence of complaints. Contrary to
expected, participation in support groups has not led to clinical improvement. Purpose of the present study was to describe social
support in CFS patients as compared to other groups. Further, changes in social support and the influence of social support on the
course of CFS over a period of more than one year were studied in patients with and without treatment
Baseline data were assessed in 270 CFS patients, 150 disease-free breast cancer patients and 108 healthy subjects using the Social
Support List. CFS patients were followed in cognitive behaviour therapy (CBT), guided support groups and natural course at 8 and
14 months.
CFS patients reported more negative interactions and insufficiency of supporting interactions than cancer patients and healthy controls. Negative interactions decreased significantly after treatment with CBT, but did not change in support groups or natural course.
In the natural course, higher fatigue severity at 8 months was predicted by more negative interactions at baseline.
In CFS patients social support is worse than in disease-free cancer patients and healthy controls. Lack of social support was identified as a new factor in the model of perpetuating factors of fatigue severity and functional impairment in CFS.
INVITED SYMPOSIUM
PSYCHOSOCIAL RISK FACTORS OF HEART DISEASES:
GENDER AND CROSS-CULTURAL PERSPECTIVE
Co-Chairs
C. David Jenkins
K.Wrzesniewski*
Invited
Symposium
Psychosocial Risk
Factors of Heart
Diseases
THE HIDDEN PLAGUE: INFLAMMATORY AND PULMONARY HEART DISEASES
CULTURE AND GENDER DIFFERENCES
C. David Jenkins
Departments of Psychiatry and Epidemiology, University of North Carolina
Department of Preventive Medicine, University of Texas Medical Branch
Public attention to cardiovascular diseases has focused on ischemic and coronary heart disease (CHD), despite the fact that in many
countries inflammatory and pulmonary heart diseases kill more young adults. World health statistics from 15 nations show that,
despite death rates being low for ages 25 – 34 years, women have more I&P HD than CHD in 14 of 15 nations. For women ages
35 – 44 years, I&P HD death rates still exceed CHD deaths in 6 of the 15. In all these nations men’s death rates exceed women’s
for both categories in all ages from 25 - 64 years.
Another data set from the America’s (13 nations) shows a strong inverse correlation between CHD and I&P HD, with I&P HD
occurring mostly in poorer nations (and disadvantaged sections of all nations), whereas CHD dominates in wealthier areas.
Health psychologists are the best equipped profession to plan and conduct primary and secondary prevention of this “hidden
plague.” Risk factors for the inflammatory HDs include: repeated viral or bacterial infections, alcohol abuse, nutritional deficiency,
and failure to treat certain blood parasites.
Pulmonary HD (affecting the right side of the heart) can be caused by any of 37 factors; most commonly, severe hypertension and
chronic obstructive lung disease. Risks include: untreated hypertension, tobacco smoke, industrial air pollution (particulate or caustic), tuberculosis, parasites in the lungs, and sickle cell disease. Behavioral and social changes can reduce these diseases.
GENDER, SOCIOECONOMIC AND PSYCHOSOCIAL RISK FACTORS
AND MIDDLE-AGED CARDIOVASCULAR MORTALITY DIFFERENCES
1Maria Kopp, M.D., Ph.D. 2Árpád Skrabski, Ph.D.
1Institute of Behavioural Sciences, Semmelweis University, 2Apor Vilmos College
Objectives: There are considerable differences in middle aged cardiovascular mortality among 20 Hungarian counties. In an ecological, cross-sectional study we examined the relationships between psychosocial and socioeconomic risk factors and male/female
middle-aged cardiovascular mortality differences.
Methods: 12,570 people were interviewed in Hungarostudy 2002 survey, representing the Hungarian population according to sex,
age and county. Socioeconomic and psychosocial factors were education, income, income inequality, depression and social capital,
ie. lack of social trust, reciprocity and participation in civic organisations. Gender-specific cardiovascular mortality rates were calculated for the middle-aged population (30-64 years) in the 20 counties of Hungary.
Results: Among men 52,2 % of cardiovascular mortality differences could be explained by education, depression and income
inequality. Among women education, depression and social distrust were the significant predictors of cardiovascular mortality differences, these factors explained 36,7 % of variance.
Conclusion: Socioeconomic and psychosocial factors are important determinants of premature cardiovascular mortality differences
among the Hungarian regions. There are gender differences in the relation of cardiovascular mortality rates and socioeconomic and
psychosocial variables in the middle aged population. Male mortality is more closely connected with socioeconomic factors and
depression while female mortality is more closely connected with low social capital.
33
GENDER, AGE AND AGRESSIVENESS DIFFERENCES AT TYPE
A BEHAVIOR PERSONS FROM THREE COUNTRIES
K.Wrzesniewski*, D.K.Forgays**, P.Bonaiuto*** and A.M.Giannini***
*Warsaw University and Warsaw Medical School,Poland,**Western Washington University,USA,
***First University of Roma, Italy
Many recent studies show that aggressiveness is the most “toxic” compononent of the Type Behavior Pattern (TABP).
The aim of this study is to examine the relationships between gender, age glotbal TABP and agressiveness in three countries.
We obtained TABP and its components from 2520 subjects from the US, Italy and Poland The participants compriesed 18 groups
with 140 subjects in each, to represent each country, and gender, as well as three age groups: middle adolescence, young adult, and
middle-aged adult. TABP was determined on a self-report measure the Adolescent/Adult Type A Behavior Scale (AATABS-3).
The findings suggest that, despite similar galobal TABP scores, considerable differenes may be found in the TABP component,
aggressiveness, as a function of country, age and gender.
DO OPTIMISM AND GENDER PREDICT QUALITY OF LIFE AFTER
CORONARY ARTERY BYPASS GRAFT SURGERY
J.Julkunen*, O.Jarvinen**,T.Saarinen***, M.R.Tarkka**
University of Helsinki,**Tampere University Hospital,***Rehabilitation Foundation, Helsinki
The aim of this study was to investigate how optimism and gender associate with changes in health related quality of life (HQL
after coronary artery bypass graft surgery (CABG).The main hypothes is was that optimism and male gender would predict better
HQL.
The sample consisted of 508 patients (17.3 % women) who underwent CABG.The RAND-36 Health Survey was used as an indicator of HQL. Optimism was assessed with the LOT-R scale. All assessments were made preoperatively and repeated 12 months
later.
As expected, optimistic patients and male patients consistently reported higher levels of HQL. However,only one sub-scale revealed
significant change x gender interaction indicating a parallel trend of improvement for both genders.Optimism x change interactions
were significant for the psycho-social sub-scales showing greatest improvement for the most pessimistic patients. Most of the HQL
scales showed significant optimism x gender x change interactions indicating that largest improvements in HQL could be observed
in pessimistic women and in optimistic men. These results suggest that despite of different levels of HQL, men and women benefit equally from CABG. Optimistic patients report consistently higher levels of HQL. They do not, however, improve more than
pessimistic patients. On the contrary, the benefits in psycho-social functioning are greater for pessimists. Finally, the results strongly suggest that optimism works in different ways for men as compared to women.
Symposium
The Role of Health
Psychology in
Rehabilition
SYMPOSIUM
THE ROLE OF HEALTH PSYCHOLOGY
IN REHABILITATION
Chair: Ladislav Valach
It has been recognized that, due to the increase of chronic illness, rehabilitation with its high proportion of non medical professions
needs substantial strengthening to effectively implement existing knowledge in improving the functions, actions, and participation
of patients in their everyday life.
The primary task of psychologists is to provide and disseminate their professional knowledge and skills within rehabilitation and
then support the specialized disciplines such as rehabilitation psychology, neuropsychology, and clinical psychology. Health psychology provides the optimal basis in which the various types of psychological contribution to rehabilitation processes, including
primary, secondary and tertiary prevention, postvention as well as health promotion could be anchored. In addition, health psychology points to psychological avenues and mediators of the process of rehabilitation that will contribute in a positive way to the
achievement of treatment goals.
This symposium will give voice to some of the innovative ideas and research as articulated by health psychologists conducting
research on rehabilitation in various parts of the world.
Esther Greenglass, York University, Toronto, Canada, will report on her research in a rehabilitation setting consequently applying
a proactive approach to the process of rehabilitation developed in cooperation with her co-workers within health psychology.
E. Ricci-Bitti and his team, University of Bologna, Italy, are concerned with cardiac rehabilitation underlying the comprehensive
role health psychologists can assume in the area of rehabilitation.
Shulamith Kreitler, Tel Aviv University in Israel, will report on her work and research in rehabilitation.
M. Sommaruga and P. Gremigni from the University of Bologna will present a paper on Italian guidelines for psychological intervention in cardiac rehabilitation, thus providing an example of how health psychologists apply the principles of heath psychology to cardiac rehabilitation.
L. Valach from the University of Zurich will provide a comprehensive conceptual framework for rehabilitation based on psychological theories which could help psychologists integrate the conceptualization of other professions active in rehabilitation such as
occupational therapists, physical therapists, nursing as well as rehabilitation medicine and administration.
The implications of the research presented here for the rehabilitation process are discussed as is the integral relationship between
theory and empirical work in health psychology and rehabilitation.
34
PROACTIVE COPING AND POSITIVE AFFECT:
IMPLICATIONS FOR REHABILITATION OUTCOMES
Esther R. Greenglass, Sandra Marques, Melanie de Ridder, Supriya Behl & Rachel Horton
York University, Toronto, Canada
Physical rehabilitation represents a physical and emotional challenge to individuals recovering from physical injury and/or surgery.
This paper examines the relationship between coping styles, intentions, motivation, affect and outcomes in a sample of rehabilitation hospital in-patients, all of whom have had surgery either for joint replacement or for injuries sustained in motor vehicle accidents.
According to proactive coping theory, individuals have the potential to envision success, to plan to work towards their goals, and to
believe they can achieve them. Proactive coping integrates planning and preventive strategies with proactive self-regulatory goal
attainment. It was hypothesized that proactive cognitions would contribute positively to positive affect and motivation as well as
better rehabilitation outcomes.
Data were collected using a self-report questionnaire administered during patients’ stay in a rehabilitation hospital. Proactive coping was assessed using the proactive coping subscale of the Proactive Coping Inventory; vigor was assessed with the POMS, motivation relating to intentions to return to work and to get on with life was measured using scales designed for this study and outcomes included an independence functioning measure and walking tests. Data analyses showed positive relationships between psychological variables and outcomes. The data suggest that proactive cognitions contribute in a positive way to affect, including vigor,
as well as to intentions to get on with life, and that these, in turn contribute to positive outcomes. Implications of the results are that
the rehabilitation experience is more likely to meet with success when patients use proactive coping in dealing with the challenges
of rehabilitation.
ANXIETY AND DEPRESSION
IN CARDIAC REHABILITATION
Ricci Bitti P.E., Gremigni P., Bettinardi O.°, Manno F.°, Giacani M.° & D’Cruz S.°
Department of Psychology, University of Bologna;°S. Giacomo Hospital, Department of Psychology
and Department of Cardiac Rehabilitation, Pontedall’Olio, PC, Italy
BACKGROUND: Anxiety and depression are significant factors associated with the perceived quality of life after a major cardiac
event. Accordingly, it is critical to include specific psychological intervention to reduce the level of distress, in addition to conventional cardiac rehabilitation (CR).
OBJECTIVE: This study investigated the association of three different types of psychological treatment, within an in-hospital CR,
with the reduction of anxiety and depression. The link between anxiety, depression and perceived quality of life at six month follow up was also investigated.
METHOD: 713 in-patients, after CAGB, were assigned to three different types of psychological treatment within the in-hospital
CR. Among them, 203 received a minimum intervention (A) consisting of 1-2 educational sessions form a counsellor, 396 received
(B) up to 4 additional sessions including individual counselling and relaxation, 114 received more than 6 sessions (C) including individual psychotherapy. Anxiety and depression were assessed before and at the end of CR, while quality of life was assessed (SF36) at 45 days and 6 months after discharge from hospital.
RESULTS: 47,83% of patients reduced both anxiety and depression at the end of CR, while only 19,58% maintained the same level
or enhanced it. Reduction was associated to type of psychological treatment: Patients in the type C treatment showed the best results,
while those in the type A treatment showed the weakest reduction. Reduction of anxiety and reduction of depression were also related to each other. Moreover, low level of anxiety and depression and high number of encounters with the psychologist predicted the
quality of life at both follow ups.
CONCLUSION: results of the present study encourage the use of specific psychological treatments, in addition to conventional
CR, targeted at the reduction of both anxiety and depression, including at least three individual counselling session.
PSYCHOONCOLOGY:
REHABILITATION OF CANCER PATIENTS
Professor Shulamith Kreitler
Department of Psychology, Tel-Aviv University, and Head of Psychooncology
Unit, Tel-Aviv Medical Center, Israel
The main difficulties facing cancer patients are related to the diagnosis, the treatments, the chronicity, the recurrence and the threat
of death characterizing the disease. These difficulties necessitate coping on the part of the patients and their families and generate
a great deal of psychological distress. Health psychological attempts of rehabilitation are particularly important in view of the serious physical and psychological ordeals of the patients. The talk will focus on two major themes. The first theme is quality of life
(QOL) as a measure of adaptation and rehabilitation - its nature, assessment, and determinants. A study on QOL in cancer patients
(n=230) will be reported. QOL profiles in patients with different diagnoses and in different disease stages will be reported, as well
as interrelations between QOL and coping mechanisms applied by the patients. The second theme is quantity of life (i.e., degree of
recurrence of disease and survival). The results of previous findings in regard to psychological effects on survival in cancer patients
have been controversial. A study will be reported in which the psychological factors were conceptualized in terms of the cognitive
orientation theory (beliefs about goals, norms, self and reality) and the beneficial effects on survival were shown in a follow-up up
to 12 years. The number of participants was 120. The first part of the study was retrospective, the second prospective.
35
GUIDELINES ON PSYCHOLOGICAL INTERVENTION IN CARDIAC
REHABILITATION - METHODOLOGICAL APPROACH
M. Sommaruga, P. Gremigni, R. Tramarin on behalf of Working Group on Psychological Intervention in Cardiac
Rehabilitation of GICR - Gruppo Italiano di Cardiologia Riabilitativa e Preventiva
(Italian Working Group on Cardiac Rehabilitation and Prevention), Italy
Purpose: The need to define the standards of the psychological intervention in cardiac rehabilitation programs on the basis of scientific evidence, encouraged the Board of the Italian Group of Cardiac Rehabilitation and Prevention to set up a working group
(WG) of psychologists with the task of defining the state-of-the-art of the psychological intervention in cardiac rehabilitation.
Methods: The methodology adopted by the WG was in line with the recommendations of the National Guidelines Program of the
Italian Ministry of Health; the WG decided, in addition, to exploit a detailed critical review of clinical psychology practice in order
to provide systematic evidence for recommendations and clinical approaches at present supported only by expert opinion.
Results: The main body of the document is structured on the basis of the steps that characterize the interactions between the patient
suffering from heart disease and the psychologist, through a qualitative analysis of the intervention provided by the psychologist.
The phases of this process have been organized as follows: selection, entry, evaluation, intervention, follow-up. For each of these
phases, the evidence is given in support of the evaluation and therapeutic tools at the psychologist’s disposition in the context of
cardiac rehabilitation. The recommendations contained in the document elaborated by the WG were formulated on the basis of a
systematic review of the evidence available in the international literature, by means of the consultation of Cochrane Library,
Medline, PsychINFO (1985-2002).
Conclusions: The rationale and the methodological approach of the ongoing process for production of Italian Guidelines on psychological intervention in cardiac rehabilitation will be reported.
AN AGENTIC CONCEPTION OF REHABILITATION
Valach, L., Young, R. A., Wald, J., Cox Steck G.
Neurosciences, philosophy, psychology, nursing, rehabilitation, psychiatry and other disciplines call for integrative models of cognition, emotion, motivation and motor behaviour. This call can be answered by health psychologists with a conceptualisation
informed by an action theoretical view.
It is proposed that rehabilitation can be best anchored in psychological conceptualisation of goal directed processes in actions, project and career. This allows health psychologists to claim a position in rehabilitation beyond psychotherapy.
We distinguish between the system of ‘rehabilitation actions’, representing patients exercises with others to improve their actions,
the system of ‘rehabilitation processes’, best characterized by setting the rehabilitation goals and their evaluation, and the system of
‘learning organisation’ suggesting goal directed processes of the development of the organisation carrying out the rehabilitation
tasks. All three systems are processed in individual and joint actions, projects and career.
The recent rapid development of neuropsychology leads to strengthening of an action theoretical conceptualisation in rehabilitation
as this requires executing and monitoring of ongoing processes in which emotion, cognition, motivation and motor behaviour are
integrated. The consequent introduction of goal directed organization of rehabilitation processes calls for their psychological conceptualisation which would integrate individual and group processes. Finally, the agentic organizational development of rehabilitation is best seen in terms of goal directed systems which originate in psychological thinking.
It is shown that a rehabilitation centre which, reorganizing itself at these three levels, reaches good rehabilitation results while utilizing less resources.
The comparison of the entry-discharge measures of vascular brain damaged patients at the beginning of this organisational process
with some recent data supports thisstatement.
Symposium
Emotional
Disclosure Processes
Symposium
EMOTIONAL DISCLOSURE PROCESSES: MECHANISMS BEHIND THE BENEFITS
OF EMOTIONAL DISCLOSURE IN CLINICAL AND NON-CLINICAL GROUPS
Symposium Convenor:
Mrs Lucie Byrne-Davis
MRC Health Services Research Collaboration,
University of Bristol
Symposium Discussant:
Professor Rob Horne
Centre for Health Care Research
University of Brighton
This symposium will propose and examine some ways in which the popular emotional disclosure paradigm may bring
about positive changes in the health of clinical and non-clinical groups. This will be explored in qualitative and quantitative studies with people suffering from stress (ambulance workers), people who currently have or who have had
serious ill health conditions (Myocardial Infarction and Rheumatoid Arthritis), young people and people who are
well. The symposium will draw on current literature and studies to explore the mechanisms that are proposed to contribute to the myriad of benefits reported in emotional disclosure studies.
36
MECHANISMS UNDERLYING EMOTIONAL DISCLOSURE: DATA
FROM A MIXED METHODS PILOT RANDOMISED CONTROLLED TRIAL
Lucie MT Byrne-Davis*+, Mark A Wetherell*, Sara Brookes*, Margaret Byron*,
Paul Dieppe*, Jenny Donovan*, Rob Horne, John Weinman & Kav Vedhara*
*MRC Health Services Research Collaboration, University of Bristol, UK
Emotional disclosure is a technique in which people are required to discuss, usually by writing, a traumatic or upsetting experience.
It has been associate with positive emotional and health benefits. There are a number of mechanisms proposed by which disclosure
is said to improve emotional well-being, including fostering a problem-solving approach through which people actively improve
their lives. Other mechanisms include cognitive restructuring, in which the stress of having unresolved trauma is reduced or
removed by altering cognitive schema through disclosure.
This paper presents a pilot randomised controlled study (n = 36) of emotional disclosure in people with rheumatoid arthritis. A variety of psychological, clinical and biological measures were used to measure outcome. In addition, a purposive sampled group of the
participants were interviewed about whether they thought the experience had been positive or negative and the process they thought
brought about these effects. Combined with the quantitative data, these qualitative data provide further indications of the mechanisms of emotional disclosure and we suggest quantitative measures that could be used in future studies to further elucidate these
mechanisms.
STRUCTURED WRITING TASKS: AN ASSESSMENT OF THE MECHANISMS
OF CHANGE AS INDICATED BY COGNITIVE-BEHAVIOURAL MODELS OF TRAUMA.
Guastella, A. & Dadds, M.
Psychology Department, Griffith University, Qld, Australia
This paper reviews cognitive-behavioural models of trauma and proposes three mechanisms that may lead to future health benefits
in the writing paradigm. These include exposure to the trauma memory, cognitive devaluation of the upsetting stimulus, and the
development of positive meaning. Manualised instructions developed to influence engagement with each of these processes whilst
writing are discussed. Individual differences are also discussed in relation to patient matching to these processes.
College students from Griffith University were assigned to one of five conditions (standard, control, exposure, devaluation, and benefit-finding). Manipulation checks and outcome assessments at 2 and 6-month follow-up are presented. Results indicate that patient
matching variables and the type of writing task significantly influenced health benefits. These results are discussed in relation to the
identified processes of change.
THE USE OF STRESS DIARIES IN AN OCCUPATIONAL SETTING
Paul Bennett* & Karen Lewis+
*Universities of Plymouth and Exeter +University of Cardiff
This paper reports the outcome of a pilot study evaluating the uptake, usage, and benefits of a one-month programme involving the
use of daily stress diaries in a large organisation. Thirty participants who were involved in potentially stressful encounters with the
public on a regular basis were asked to attend a focus group before the programme began, in which they described the sources of
stress associated with their work and the coping strategies they used. They were then asked to complete daily stress diaries using a
modification of the Pennebaker model of emotional disclosure. Participants completed weekly reports of their use of the diary, its
perceived value, and any comments on its use. Finally, participants attended a focus group at the end of the month which allowed
them to discuss their use of the diaries, factors that had promoted or inhibited their use, and the perceived costs and benefits of the
diary use.
About one-third of the original cohort completed the month of diary keeping and found it useful in reducing their stress levels, onethird failed to complete the first week of diary keeping, while a third kept a diary for a period between these two extremes. Most of
those who continued to use the diary found it helpful, and intended to carry on using it in the future, although not perhaps every
day. Of those that stopped using the diary early, four found the experience extremely valuable and had used it to problem-solve a
number of work issues. Once this was completed, they saw no further use for the diary. Most participants considered diary keeping
to have some value: failures to use the method were more a result of pragmatic factors such as lack of time than a rejection of its
underlying value.
EXPRESSIVE WRITING AS AN INTERRUPTION
OF DYSFUNCTIONAL EMOTION REGULATION
Horn, A.B., Pössel, P. & Hautzinger, M.
University of Tuebingen, Germany
Expressive writing, as introduced by Pennebaker, has proven its beneficial effects in many studies with different populations. There
are several mediating factors that are discussed. Thought suppression as an intent to regulate mood by suppressing mostly negative
thoughts is known to have several negative effects like a loss of mental control and superficial information processing. Another
intent to regulate emotion is the suppression of emotional expression. Expressive writing could be seen as an interruption of these
two inhibitive intents to regulate emotions and their negative effects. People habitually engaging in suppression of thoughts and
emotional suppression should therefore benefit more by the writing task than those who do not.
In this study expressive writing was applied within an adolescent sample (N=190) which was compared to a non-treated control
group (N=150). Chronic thought suppression and ambivalence over emotional expression was measured as individual variables and
extreme groups identified by a median split. Dependent variables were negative affect and negative automatic thoughts.
37
Analyses reveal the expected difference between the writing and the control group regarding negative affect and automatic thoughts.
Adolescents highly engaging in habitual thought suppression seem to benefit more than those without this tendency. Regarding the
interaction between high and low ambivalence over emotional expression and writing vs. control condition there is a gender difference observable.
This study gives indications that the interruption of the suppression of thoughts and emotional expression might be involved in the
mechanisms underlying the effects of emotional disclosure through writing.
COGNITIVE EMOTION REGULATION IN PEOPLE WITH INFERTILITY
Vivian Kraaij1, Nadia Garnefski1, Anne Vlietstra, & Kosse Jonker2
1 Leiden University, Division of Clinical and Health Psychology, The Netherlands
2 Psycho Medical Center Parnassia, The Netherlands
Aim. About 10% of couples who want to start a family, have problems getting pregnant. After examination and treatment, about
3% to 5% of the couples with a wish to get a child, remain childless. People with infertility report lower levels of well being compared to people without this problem. In general, cognitive emotion regulation is assumed to be an important factor in determining
well being and successful functioning. Whether specific cognitive emotion regulation strategies are related to well being in people
with infertility is not known. If we gain insight into which cognitive emotion regulation strategies are adaptive or maladaptive in
response to infertility, we could integrate these findings into programs which focus on teaching people how to cope with their infertility and unfulfilled child wish.
The present study will examine which cognitive emotion regulation strategies people use in response to infertility. Also, the relationship between these cognitive emotion regulation strategies and well being will be studied.
Method. Respondents were approached using various sources, such as placement of announcements in newspapers and self-help
groups on the internet.
Respondents received a mailed questionnaire including the Symptom Check List (SCL-90) and the Cognitive Emotion Regulation
Questionnaire (CERQ). The data collection is still in process. An estimated 100 people will be included in the study.
Results. Findings will be presented and discussed.
Symposium
Culture, Context
and Health
SYMPOSIUM
“CULTURE, CONTEXT AND HEALTH: EXAMINING EUROPEAN PERSPECTIVES
WITH INTERPRETATIVE PHENOMENOLOGICAL ANALYSIS”
Convened and chaired by Jonathan A Smith
This symposium presents a collection of studies using interpretative phenomenological analysis to examine how culture and context impact on patients’ response to health conditions and decisions in a range of settings across Europe. The symposium offers a
series of detailed case studies of these processes at work in specific geographical sites.
The papers illustrate culture and context operating at a number of levels from the more micro-level of the family, through cultural
group membership, to the higher level of societal forces.
The first two papers are concerned primarily with how individuals decide whether to take a medical test. In the first paper Jonathan
Smith et al. examine how the family provides a pervasive contextual backdrop to the decision-making process in candidates for the
genetic test for Huntington’s disease in England. In the second paper, Paul Flowers explores cultural factors associated with the gay
community in Scotland as they impact on decisions around the test for HIV. In the third paper, an even higher level lens operates as
Irina Todorova and Tatyana Kotzeva discuss how socio-economic changes in Bulgaria can be seen to affect how women deal with
issues of fertility and reproduction. In the final paper Elizabeth Dunne considers how Irish women with iatrogenic Hepatitis C navigate through the complex arena of social stigma and political action. The discussant will be Susan Michie.
“HE’S LEFT US SOMETHING TO THINK ABOUT”:
The family as crucible for patient risk perception and decision-making: an interpretative
phenomenological analysis of candidates for genetic testing in England
Jonathan A Smith; Susan Michie; Oliver Quarrell
Birkbeck University of London, UK; University College London, UK;
University of Sheffield, UK
Aims This study is concerned with examining how candidates for pre-symptomatic genetic-testing for Huntington’s Disease represent their risk status and how they describe the process involved in their deciding whether or not to take the test.
Method Transcripts of semi-structured interviews with five women offered testing were analysed by interpretative phenomenological analysis (IPA). The participants were attending a regional genetics centre in the north of England.
Results The women find it difficult to conceptualize their current risk, and present complex and sometimes contradictory accounts
based on, for example, number of previous family members affected or pre-selection of a likely recipient of the genetic mutation.
The paper then illustrates how the family (either manifestly or symbolically) can be seen as a key influence on the decision process
of whether or not to take the genetic test.
Conclusions The study has implications both for psychological models of decision-making and lay representations and for the practice of genetic counselling. It offers an idiographic level analysis of the complex nature of risk perception and decision-making and
points to the family as a significant presence in the process.
38
CULTURE, CONTEXT AND DECISION-MAKING: EXPLORING THE COSTS AND BENEFITS
OF HIV ANTIBODY TESTING AMONGST GAY MEN IN SCOTLAND
Paul Flowers
Glasgow Caledonian University
Aims This paper explores contemporary understandings of the psychosocial and sociocultural costs and benefits associated with
learning one’s HIV status within a purposive sample of Scottish gay men. It seeks to provide insight into the factors associated with
decision-making processes relating to the HIV antibody test.
Method Transcripts of one-to-one interviews (n=19) and four focus groups (n=18) were analysed using interpretative phenomenological analysis (IPA). Participants had varied HIV testing histories, and the sample included men who identified their HIV status
as positive, men who identified it as negative, and men who did not know.
Results The HIV test could resolve doubt and anxiety for some men, but only when ‘not knowing’ was experienced as less tolerable than an imagined positive result. Many participants were deterred from seeking an HIV test because of their fears of the implications of a positive result (which strongly related to the local context of the commercial gay scene and the relative small size of
local gay communities). The decision to take an HIV test could be understood as a choice between living with uncertainty and the
perceived impact of ascertaining HIV status.
Conclusions For the participants in this study, the decision to test or not involved many complex medical, psychological, social and
cultural factors. It is argued that the development of HIV testing policy must start with a perspective grounded in an understanding
and appreciation of these complexities.
WOMEN CONSTRUCTING IDENTITIES IN RELATION TO MOTHERHOOD:
THE CONTEXT IN BULGARIA
Irina Todorova; Tatyana Kotzeva
Health Psychology Research Center; Bulgarian Academy of Sciences
Aims The paper will present a study on the meanings that the expected transition to motherhood holds for Bulgarian women.
Currently, in conjunction with the political, economic and social dimensions of change in Eastern Europe, transformations have been
taking place in women’s roles and identities, in relation to gender, health, and reproduction.
Method Interviews were conducted with 20 women in Bulgaria, who were facing primary or secondary infertility. They were
undergoing treatment to stimulate conception in medical centers in Sofia. The interviews were analyzed through the method of
interpretative phenomenological analysis (IPA).
Results Through the analysis we identify the meanings that the expected, but elusive pregnancy holds for the women. We can
identify the multiplicity and contradictory nature of meanings of infertility and pregnancy, including the absent conception as disruption, as emptiness, as defectiveness, and as purposeful. We will focus on their constructions of an identity as agents relative to
stigma and blame, and particularly the shifts from relational to individualistic conceptualizations of the self in their narratives.
Conclusion The discussion will focus on the women’s constructions of identity in relation to pregnancy and motherhood, and
their implications for decisions to continue or discontinue infertility treatment. We will discuss how these processes can be interpreted by situating them in the local cultural meanings of womanhood.
SEEKING REDRESS AND SUFFERING STIGMA:
AN INTERPRETATIVE PHENOMENOLOGICAL ANALYSIS OF TENSIONS ARISING
IN ATTEMPTS TO DEAL WITH IATROGENIC HEPATITIS C IN A GROUP
OF WOMEN IN IRELAND
Elizabeth Dunne
National University of Ireland
Aims The paper examines the response to an iatrogenic infection of a group of Irish women who are members of a mutual help
group, formed by them after the route of infection became known.
Method Accounts of the impact of Hepatitis C on the lives of 32 members of the mutual help group were gathered through focus
groups. Groups were held at 5 centres in Ireland. Numbers of participants ranged from 3 -9 with and average of 6. Accounts were
analysed using interpretative phenomenological analysis, (IPA).
Results The women’s roles of spouse, mother, home-maker and house-keeper were severely curtailed or demolished by their illness. This impacted on their sense of identity. Coping with the stigma attached to Hepatitis C while seeking redress for its iatrogenic origin was a source of significant stress for the women. Their involvement with the mutual help and advocacy group, Positive
Action, proved a major resource in their coping with this and with their changed health status generally. It also reflected a significant shift in their self-perception of themselves as women in the Irish context.
Conclusions The usefulness of IPA in capturing the complexity of the women’s experience is discussed.
The women’s experiences and responses were often apparently simultaneously contradictory as when they sought redress from the
state for the harm done them, through political action while at the same time not disclosing their serostatus to neighbours.
IPA was able to contain these data thus giving an enriched account of the reality of the women’s experience.
39
PATIENTS’ EXPERIENCE OF THE DIAGNOSIS AND TREATMENT OF SKIN CANCER.
Anna Winterbottom & Diana Harcourt
MRC Health Services Research Collaboration, Dept of Social Medicine,
Canynge Hall, Whiteladies Road, Bristol BS8 2PR
Despite the number of newly diagnosed cases of skin cancer increasing each year, the psychological impact of receiving a diagnosis of skin cancer has received little attention. This research aims to examine the experience of being diagnosed with skin cancer
from the perspective of the patient.
Sixteen patients who had attended the outpatient dermatology clinic at the Bristol Royal Infirmary were interviewed regarding their
experiences of being diagnosed with one of three diagnoses of skin cancer. Employing Interpretative Phenomenological Analysis
the data were analysed for emergent themes.
Similar themes for both the basal cell carcinoma and squameous cell carcinoma patients emerged from the data. Information and
knowledge of skin cancer appeared as a key theme, and influenced the patients’ experiences in a variety of different ways. When
there was insufficient information patients experienced anxiety and actively sought information in an effort to cope. Attributing a
cause was also important in terms of making sense of the illness. The malignant melanoma group utilized a wider variety of strategies in order to cope with the diagnosis, and these varied depending on the stage of the illness. Satisfaction with the healthcare
received by each of the three groups of patients, played a crucial role in minimizing the psychological consequences of the disease.
Within this group of patients there are a number of diagnoses which differ in their prognosis, and so may result in a variety of different consequences and thus experiences, for the patient. The study therefore has implications for the provision of care in the early
stages of a skin cancer diagnosis and treatment, through increasing the awareness of the disease from the patients’ perspective.
Symposium
Postintentional
Processes in
Health Behaviour
Change
SYMPOSIUM
Postintentional processes in health behaviour change: The role of planning
Symposium Convenor: Aleksandra Luszczynska
Symposium Discussant: Stephen Sutton
Facilitating intended health behaviour change:
The role of planning, phase-specific self-efficacy and self-regulation
Urte Scholz & Falko F. Sniehotta
Objectives: The intention-behaviour gap is mainly due to persons who intent to act but fail to translate their intentions into behaviour (Orbell & Sheeran, 1998). The aim of the present study was twofold: first, to identify the underlying processes that are helpful
to successfully change the behaviour and second to test whether the intention-behaviour relation is mediated by such processes.
Method: The design of the study is experimental and longitudinal. 300 cardiac rehabilitation patients (mean age 59 ) answered questionnaires during rehab as well as two and four months after discharge. Participants were randomly assigned to either a control or
one of two planning intervention groups. Such interventions lasted up to 30 minutes and were realised in the rehab-clinic. Measures
included intentions, implementation and coping planning, phase-specific self-efficacy and other measures of self-regulation such as
self-monitoring and intention-stability.
Results: Most patients were found to be highly motivated to engage in physical activities after discharge although the majority was
completely inactive prior to their acute treatment.
In these post-intentional patients the self-regulatory measures added substantially to the explanation of physical activities beyond
the effect of intentions. Furthermore the intention-behaviour-relation was mediated by these measures. The planning interventions
enhanced physical activities of patients after discharge.
Conclusions: Interventions to change health behaviours in a highly motivated sample should focus on self-regulatory processes.
Planning interventions as implemented in the present study can foster the uptake and maintenance of health behaviour even on the
background of the comprehensive treatment patients undergo in the rehabilitation.
PLANNING AS A PREDICTOR OF NUTRITION
AND PHYSICAL ACTIVITY IN PORTUGUESE ADOLESCENTS
Vera Araújo-Soaresa, Teresa McIntyrea, & Falko F. Sniehottab
a University of Minho, b Free University Berlin
Objectives: Portuguese epidemiological data have indicated important health habit concerns among adolescents in nutrition and
physical activity (Matos et al., 2000). To address this problem, in collaboration with the Regional Health Administration, a developmentally-based integrated prevention program was developed to target multiple risk factors at an early age (McIntyre & Soares,
2002). The theoretical foundations of the program were HAPA and TPB models. The aim of the study was to investigate the potential mediating role of “planning” in the relationship between intention and behaviour, concerning nutrition and physical activity.
Also the effect of the prevention program in enhancing “planning” in the experimental group, in comparison to a control condition,
will be investigated.
Sample: 500 young adolescents of both sexes attending 6-7th grades, ages 11-15.
Method: Experimental and longitudinal, with two experimental groups and a control condition. Experimental group A undergoes
10 intervention sessions (two hours each), targeting nutrition behaviours, physical activity, substance use, sexual risk behaviours,
and self affirmation. Experimental group B undergoes 2 intervention sessions, targeting nutrition behaviours and physical activity.
Five measurements are taken: pre-test, two process measures (nutrition & physical activity), post-test and 9 month follow-up (fol-
40
low-up data will not be presented). Instruments used: Health habits and health risk behaviours (Wardle & Steptoe, 1991; adaptation,
McIntyre & Araújo-Soares, 1996) and Health Behaviour Change Assessment that includes a stage assessment, HAPA, TPB and
planning measures.
Results: Data will be analysed in terms of determining the predictive value of planning in fostering behavioural changes in nutrition and physical activity.
ATTAINING HEALTH RELATED GOALS THROUGH PLANNING: A LIFE SPAN PERSPECTIVE
Jochen P. Ziegelmann a, Sonia Lippkea, & Ralf Schwarzer a
a Free University Berlin
Objectives: To investigate the role of post-intentional processes in the adoption and maintenance of physical activity with a specific emphasis on a life-span perspective. The study draws on a sample of orthopaedic rehabilitation patients who are post-intentional
with regard to the health behaviour of physical activity.
Method: N=300 young, middle-aged, and older orthopaedic rehabilitation patients were enrolled in a longitudinal intervention
study. Detailed questionnaire assessments were administered at the beginning and at the end of a three-week stay at an ambulatory
rehabilitation clinic. A volitional planning intervention to enhance the adoption and maintenance of a physically active lifestyle took
place before the second assessment. In addition, there were three follow-up measurement points after discharge: after two and four
weeks, and after six months. The intervention consisted of the following components: 1) Specification of up to three kinds of physical activity to be performed post-rehabilitation. 2) Elaboration of action plans that serve as a prompt for action initiation. 3)
Development of coping plans to overcome barriers, which might hinder the patients to engage in the selected physical activities.
Results: Findings show that the volitional planning intervention enhances the amount of physical activity performed at follow-up.
Those patients who formulate more elaborate and more complete action plans engage in a more active life-style at follow-up.
Conclusion: Results indicate that a short volitional planning intervention can have additional effects above and beyond a three-week
orthopaedic rehabilitation treatment regarding the extent of physical activity performed after the rehabilitation.
CAN IMPLEMENTATION INTENTIONS OVERCOME UNWANTED HABITUAL BEHAVIOUR?
Thomas L. Webb & Paschal Sheeran
Objectives: Many behaviours that are detrimental to our health form part of our habitual routines and are therefore difficult to overcome. For example, when we consistently and frequently eat fast food for lunch, willpower alone may not be sufficient to attenuate the association between lunch and fast food. The present research employed naturally occurring semantic associations between
words (e.g., bread and butter) to investigate whether implementation intentions have the potential to break habitually formed associations.
Methods: Participants (N = 33) completed two ostensibly unrelated tasks. In the first task, half the participants formed an implementation intention to distract themselves whenever they thought about bread and half did not. Next, after a short filler task, participants completed a lexical decision task in which target words (strong versus weak semantic associates of bread) were preceded by
subliminally presented primes (“bread” or a neutral word). The dependent variable was response latencies to the target words.
Results: ANOVA revealed a main effect of word type only for participants who had formed an implementation intention, F(3, 45)
= 11.48, p < .001. As expected, participants responded slower to weakly associated target words following the bread prime (M =
808.86) than following a neutral prime, (M = 624.74). However, participants did not respond slower to the strongly associated target (“butter”) following the bread prime (M = 603.96).
Conclusion: The present study suggests that implementation intentions cannot break strong habitual associations. Although, an
implementation intention attenuated a weak semantic association, the strong semantic association prevailed.
THE ROLE OF PLANNING IN QUITTING SMOKING
Aleksandra Luszczynskaa & Ibrahim Ouedraogo b
a University of Warsaw, b Free University Berlin
Objectives: Smoking is the result of conditioning trials (e.g., a person who smokes 40 cigarettes daily, have 1200 conditioning trials during one month), learned in multiple contexts. The lapse after quitting, paradoxically introduces additional contextual cues
that further trap the person into his/her old behaviour. Implementation intentions are expected to block habitual response. The present study investigates the role of planning in the context of habit strength (nicotine dependence) and previous failures in attempts
to change one’s behaviour (relapse).
Method: Of 352 students, 119 (33.8%) were smoking cigarettes daily. Nicotine dependence, previous quitting attempts, and intentions to reduce or quit smoking were measured at Wave 1. Six months later, smoking, subjects own plans, and attempts to quit smoking during months between Wave 1 and Wave 2, were assessed. After Wave 2, individuals were randomly assigned to control or
intervention (planning) group. One month later, smoking and quitting attempts were measured.
Results: Most of the participants (65.8%) had at least one unsuccessful quitting attempt prior to the study, 34.4% tried to quit smoking during the month previous to Wave 1 of data collection. The results revealed that plans facilitate behaviour change in participants with the lowest number of lapses and lowest nicotine dependence. No effects of simple plans were observed among persons
with strong nicotine dependence and those who had multiple relapses.
Conclusions: The results of the present study suggest that simple plans facilitate behaviour change, however the effects of plans
are limited and depend on the strength of the habit.
41
Round Table
A Cross Cultural
Approach to
Stress and Coping
in Women
ROUND TABLE
A CROSS-CULTURAL APPROACH
TO STRESS AND COPING IN WOMEN: RESEARCH PERSPECTIVES
Irina L.G. Todorova (Co-Chair)
Health Psychology Research Center, Sofia, Bulgaria
This roundtable focuses on theoretical and empirical issues relating to cross cultural research collaboration on stress, coping and
well-being in women. One paper addresses the major considerations in this research including cultural meanings of stress and coping, and how a research program can take these into account. Illustrations are cited from studies on women’s well-being in
Bulgaria. In another submission, implications of work for women’s psychological health and particularly their occupational wellbeing are examined. Data indicate greater deleterious health effects of role conflict in women than in men. How women deal with
role conflict and job burnout is discussed here. Another submission applies the gender paradigm to a consideration of the different
stages of the stress process: Exposure to stressful life events, appraisal, personal resources and coping strategies. Empirical data on
Romanian women highlight the cultural stereotypes of men as rational ! and women as emotional. A fourth paper examines factors
that influence women’s decision-making to undergo a major treatment for their health problem. Data indicate that, in addition to illness-related factors such as severity of health problems, their responsibilities and social roles play a significant role in their decision regarding chosen treatment. A qualitative study with women who have undergone a hysterectomy is discussed. Taken together, this roundtable illustrates how psychological research into women’s health can benefit from cross-cultural collaboration.
CROSS-CULTURAL RESEARCH AND WELL-BEING IN WOMEN
Todorova Irina
Tatyana Kotzeva
Health Psychology Research Center, Sofia, Bulgaria
This paper introduces the major considerations that a cross-cultural research collaboration on the topics of well-being, stress and
coping in women would need to address. It will discuss the importance of local constructions of femininity and women’s roles as
they contribute to health and stress. It will also bring forth cultural meanings and perceptions of stress, of appropriate coping strategies, and how a research program can take these areas into account. As illustrations, studies on women’s well-being conducted in
Bulgaria will be discussed.
STRESS AND COPING IN WOMEN:
IMPLICATIONS OF THE GENDER PARADIGM
Adriana Baban
Babes-Bolyai University
The paper will debate various proposed explanations for gender differences in stress and coping. The arguments will address the
gender paradigm, taking into consideration the different stages of the stress process such as, the exposure to stressful life events,
appraisal, personal resources and coping strategies. Empirical data gathered on Romanian women samples are reported to highlight the cultural stereotypes that include “portraits” of men as rational problem solvers and women as emotional, dependent and
helpless. Implications of these findings for stress and coping in women are explored.
ROLE CONFLICT, BURNOUT AND SOCIAL
SUPPORT: IMPLICATIONS FOR WOMEN’S HEALTH
Esther Greenglass
York University
This paper will examine the implications of social roles for women’s occupational well-being. Considerable research indicates that
multiple roles can have positive effects on women’s well-being. Data indicate psychological consequences and deleterious health
effects of role conflict are greater in women than in men. At the same time, the experience of burnout differs in men and women
with men experiencing greater depersonalization and women reporting more emotional exhaustion. The role of social support in
relation to role conflict and burnout in women are examined in this context. Implications of research findings for women’s occupational well-being and their health in general are examined
PSYCHOLOGICAL FACTORS, MEDICAL PROBLEMS
AND DECISION-MAKING IN WOMEN
Ayse K. Uskul
York University
This paper will examine the factors that influence women’s decision-making to undergo a major treatment for their health problem.
Data indicate that, in addition to illness-related factors such as, the severity of the health problem women are suffering from or the
evaluation of perceived consequences of the treatment on physical health, the responsibilities and social roles women have to fulfill also play a significant role in decision-making for the kind of treatment chosen and when it should be implemented. Medical
decisions seem not to be based only on physical considerations, but are also influenced by individual and social factors.
A qualitative study conducted with women who have undergone a hysterectomy will provide the basis for discussion
42
Oral
Presentations
43
Oral
CROSS NATIONAL COMPARISON OF SMOKING AMONG
MALE AND FEMALE STUDENTS. CAN POLICY MAKE A
DIFFERENCE?
PERCEIVED RISK OF SMOKING AND INTENTION TO
STOP SMOKING IN A NATIONAL SAMPLE OF
NORWEGAIN SMOKERS
Holger Schmid
Jostein Rise & Stephen Sutton
Swiss Institute for the Prevention of Alcohol and Drug Problems - SIPA
J.Rise: Norwegain Institute for Alcohol and Drug Research, Oslo, Norway.
S.Sutton: Institute of Public Health, University of Cambridge, UK
Objective. Recent findings from school surveys in different countries have
shown an increase in smoking among youth. Gender and geographical differences in rates of smoking by young people in Europe exist. The present study
attempts to explain smoking behaviour patterns among male and female students by different national characteristics including policy measures.
Method. Data on smoking were taken from the 1998 World Health
Organization (WHO) collaborative, cross-national survey on Health Behaviour
of School-aged Children (HBSC). The multi-national representative sample
consisted of 23’965 male and 24’903 female students aged 15 years from 24
countries. Country characteristics included tobacco control initiatives such as
advertising bans, information campaigns, smoking restrictions, as well as pricing and affordability of cigarettes. Hierarchical Linear Modelling (HLM) was
used to analyse the effects of country characteristics on individual smoking.
Results. The rate of at least weekly smoking is 24% over all countries with
slightly higher rates for female students. However, there are important differences in the smoking behaviour among young people between the 24 different
countries. Contrary to the negative correlation between pricing as well as
affordability and smoking prevalence in the adult population, in young people
pricing and affordability is not linked to reduced smoking.
Conclusion. Despite the potential influence of tobacco control initiatives on
young peoples smoking, no preventive effect of the measures was found. It is
questionable, if policy measures are enough to initiate a complex behaviour
change without considering the functionality this behaviour has for young people.
The purpose of this report was to predict the intention to quit smoking in 6
months in a national sample of daily smokers in Norway (N=322). The data
was collected through an interview survey and are supposed to be representative of Norwegian daily smokers. We established a predictive model in which
the desire to quit smoking is hypothesised to mediate the effect of perceived
risk, perceived confidence of quitting, and previous quit attempts on intention
to quit smoking. The empirical data partly supported this model in that the
effects of cognitive risk (perceived risk if continue smoking - perceived risk if
quitting) and previous attempts was fully mediated by quitting desire, while
affective risk (worry about dying from own smoking), and confidence was partly mediated by desire. In addition there was an interaction between confidence,
desire and intention in that the relation between desire and intention was
strongest when the level of confidence was high. The full model accounted for
50% of the variance in quitting intentions. Furthermore, affective risk was a
stronger determinant than cognitive risk of both desire and intentions. This distinction parallels the distinction between affective and instrumental attitudes as
predictors of behavioural intention. The theoretical and practical implications
of the results will be discussed.
ATTITUDES TOWARDS SMOKING AMONG BOYS AND
GIRLS IN LITHUANIA
USING INDIVIDUALLY TAILORED FEEDBACK REPORTS
TO CHANGE SMOKING BEHAVIOUR
Antanas Gostautas, Ina Pilkauskiene, Kristina Zardeckaite-Matulaitiene
Habil.Dr., Prof., Chief of Department; Dr., Associated Prof.;MA, doctoral student
Vytautas Magnus University, Lithuania
Hazel M. Gilbert
Health Behavour Unit, Department of Epidemiology and Public Health,
University College London
While there are many self-help materials available offering help to the intending
quitter, these are mainly of the generic ‘one-size-fits-all’ variety. However,
smokers are not a homogeneous group. They smoke for different reasons, hold
different attitudes and beliefs about smoking, and have different levels of
dependence. In recent years computer technology has enabled the development
of printed self-help materials, highly tailored for the individual, derived from an
individual assessment. This study aimed to examine the influence of these
materials in producing cognitive and behavioural change for smoking cessation
in a randomised controlled trial where personalised feedback reports were added
to a standard information pack and brief telephone counselling protocol.
Smoking and drinking habits of adults differ significantly among males and
females in Lithuania. Still there is no proper explanation for these differences.
The aim of this study was to analyse the prevalence and attitudes towards
smoking among boys and girls from 7 through 9 grade trying to find starting
point for the tobacco use differences in adulthood.
The investigation was carried out in the frame of GYTS-2001 in Lithuania with
consequent investigation in Kaunas city and Kaunas region in 2002.
The same questionnaire elaborated within the frame of GYTS was applied for
the samples of 1993, 3765 and 2863 students.
Data was analysed within attitudinal categories valuable for smoking prevention. Significant differences in prevalence were found among boys (83.6%) and
among girls (68.0%) who had ever smoked cigarettes; 35.8% of boys and
23.2% of girls think that those who smoke have more friends, 9.4% of boys and
5.6% of girls think that those who smoke look more attractive.
Survey in Kaunas city and Kaunas region confirmed differences disclosed in
GYTS of Lithuania. The percentage of boys and girls who ever tried or experimented with cigarettes among all surveyed respondents increased from 7
through 9 grade as follows: 73,4-80,7-86,7 and 50,7-72,7-72,4. The differences
among boys and girls were found to be statistically significant.
In conclusion, the significant gender differences in smoking prevalence start
early in the school age and may be explained by traditional male and female
roles in Lithuania.
Method: Smokers were recruited when they called a helpline (N =1509), and
randomised to a personalised feedback group, or to a control group. Participants
were assessed at baseline on dependence, attitudes and self-efficacy measures.
This information was used to tailor the intervention and re-assessed six months
after recruitment, when current smoking status was also assessed.
Results: Preliminary analysis (N=692) shows that the tailored feedback
increased prolonged abstinence rates at the six month follow-up by 4.5%.
Determination to quit also predicted abstinence at six months, and there was an
interaction between socio-economic status and intervention, with a greater
advantage for tailored feedback in those more socio-economically deprived and
in manual occupations.
Conclusions: This study suggests that smoking behaviour and cognitions can be
influenced by individually tailored feedback. As smokers are increasingly concentrated in more deprived sections of society these results are particularly
encouraging.
44
Oral
STOP SMOKING: DIFFERENT SMOKERS NEED
DIFFERENT KINDS OF INTERVENTION
RESULTS OF THE SIX COUNTRY SMOKING PREVENTION
PROJECT ESFA
Schoberberger, R., Bayer P., Groman E., Kunze M.
University of Vienna, Institute of Social Medicine
Hein de Vries, Ph.D.* 1; Aart Mudde, Ph.D. 1; Stef Kremers,
M.P.H. 1; Carles Ariza, Ph.D. 2; Anne Fielder, Ph.D., 4;Klavs Holm, M.A.
5;Karin Janssen, Ph.D, 6; Riku Lehtuvuori, M.Ed. 7; Mat Candel, Ph.D. 1
Experiences from tobacco-consumers in general population (group A), from
nicotine-dependent smokers visiting specialized institutions for smoking cessation (group B) and from smoking patients in stationary treatment for smoking
cessation (group C) show that there are important differences among these
groups.
1;Maastricht Un; 2:Mun. Hlth Inst. Barcelona, Spain; 3: Portuguese Smoking
PreventionCouncil; 4: Un. Manchester; 5: Danish Cancer Society; 6: Dutch Smoking
& Hlth Found.; 6. Finnish Inst. Public Health;
According to a representative Austrian survey (n=2.059), 47% of tobacco consumers (group A) are consonant (not planning to quit in the next future) and
53% are dissonant. The proportions among the two other groups are: group B
(n=330): 25,5% to 74,5%; group C (n=93): 1,1% to 98,9%. There also differences among the mean degree of FTND (Fagerström Test for Nicotine
Dependence): group A: 3,6; group B: 4,8; group C: 6,9. Furthermore smokers
of group B and C are more often trough maintainers and have a greater amount
of barriers to smoking cessation than smokers of group A.
The results indicate that smokers in general can be reached by tobacco control
measures but smokers seeking for help have to be treated after a carefully done
diagnosis of smoking habits and nicotine dependence. The consequences for
treatment will be discussed.
The European Smoking prevention Framework Approach (ESFA) resulted in a smoking prevention project for six European countries. It included activities on four levels: adolescents,
schools, parents, and out-of-school. Common goals and objectives were developed, but countries could also include additional objectives. National diversities required country specific
methods. The most important common element was a school-based programme consisting of
at least five lessons paying attention to social influence processes and training refusal skills.
During the first year significantly more smoking prevention activities were realised in
experimental schools compared to control schools. Not all countries had the same number of lessons on resisting peer pressures.
Significant cognitive changes were observed in Spain, resulting in more negative attitudes, increased self-efficacy levels and a more negative intention towards smoking in
the experimental group. Counterproductive cognitive effects were observed in the UK.
Significant less onset of weekly smoking in experimental groups was found in Finland
(4.7%) and in Spain (3.1%). At this moment the data of the third and fourth measurement are analysed and will be presented during the conference. The preliminary data
analysis reveal positive effects for Finland, Spain and Portugal.
It conclusion, while having common objectives the ESFA approach allowed much
diversity. Moreover, fundamental research using dismantling designs is needed to be
able to detect the most effective elements of smoking prevention programmes for different age groups. Attention for parenting styles and practices is also needed.
EFFECTS ON WOMEN’S HEALTH OF INCREASING
EMPHASIS ON PROFIT AND PRODUCTIVITY. CHANGES IN
SYMPTOMS FROM PAIN TO BURNOUT
Sven Ingmar Andersson, PhD, Professor,
Department of Psychology, Lund University, Sweden
Three studies aimed at evaluating biopsychosocial problems as perceived by
women on sickleave in southern Sweden who reported widespread chronic pain
or fatigue. The first study was undertaken in 1995 and the last is still ongoing,
the three cohorts thus studied comprising some 1,000 subjects altogether.
Subjects in each cohort were investigated by means of questionnaires and interviews, demographic and medical data also being obtained.
A comparison of the results of the three studies indicated an increase in reference to fatigue and a decrease in reference to pain during this period as the
prominent symptom. In the 1995 study fibromyalgia was the major diagnosis
made, whereas today burnout and stress syndromes are the most common diagnoses for this group. This shift in diagnosis could be interpreted as reflecting
societal changes in conditions of work such that short-term productivity and
profit has increased the burden of stress on many women at their place of work.
Whereas fibromyalgia was most commonly a diagnosis seen in women of relatively low educational level engaged in low-paid work, the burnout and stress
syndromes are now the prevalent diagnoses in all socio-economic strata. It is
argued that rehabilitation efforts have often been unsuccessful due in part to a
lack of attention to the specific needs of the individual, efforts being made
instead to reinforce behaviours of effectiveness at work on the part of the
women, which readily results in their being overworked and the burnout symptoms recurring. Problems involved in leadership that one-sidedly emphasizes
cost factors are addressed in this connection.
STRESS AND ORGANIZATIONAL CLIMATE AUDIT OF A
PORTUGUESE COMPANY
Joao Salgado; Scott McIntyre; Ana Claudia Fernandes; Jose Costa Dantas;
Liliana Meira
Instituto Superior da Maia
Aims: This project aims at presenting the preliminary findings of a larger study
aimed at determining the relative importance of psychosocial indicators (perceived sources of stress, interpersonal behavior and coping style) in predicting
job stress. The audit will be done in a multi-national company based in
Northern Portugal and will assess the prevalence of clinically significant stress
symptoms and organizational climate variables (autonomy, participation, work
load, team communication). The influence of demographic and professional
variables on stress and organizational climate reports will also be investigated.
Methodology: The sample is made up of all of the employees of a multinational company located in Northern Portugal (N = 700). Stress symptoms
will be assessed by the General Health Questionnaire - 12 (Goldberg, 1992).
Organizational climate will be measured by the Organizational Climate
Questionnaire -QuACO (McIntyre, McIntyre, & Silverio, 1999).
Results: The data will be analyzed in terms of determining the prevalence of
job stress in a private sector company, as well as the role of demographic and
professional predictors. The analyses will produced a characterization of the
company in terms of organizational climate and the relationship between organizational climate variables and job stress symptoms will also be explored. The
implications of these findings in terms of the future assessment of job stress in
Portuguese workers will also be considered.
45
Oral
OCCUPATIONAL STRESS AND SUBJECTIVE APPRAISAL
OF PSYCHOLOGICAL AND PHYSICAL HEALTH
GOAL PROCESSES, GOAL ATTAINMENT AND WELLBEING: A LONGITUDINAL STUDY AMONG NURSES
Vesselina Russinova, Lidia Vassileva
Institute of Psychology - Bulgarian Academy of Sciences
Georgia Pomaki & Stan Maes
Leiden University
Many recent studies indicate health aggravation in Bulgarian people as a result
of different factors.
The aim of the following study is to analyze the dependence of subjective
appraisals about psychological and physical health on the sources of stress at
work, on some personality characteristics and on coping strategies used.
According to C. Cooper’s theory of occupational stress the subjective appraisal of psychological and physical health is a reliable indicator about objective
state of health. A Bulgarian adaptation of Cooper’s method - Occupational
Stress Indicator (OSI) is used in the study.
The sample consists of 472 subjects, men and women, aged between 19 and 52,
from different occupational groups. Correlation and regression analysis indicate strong interrelations between the parameters of occupational stress studied
including self-esteem of psychological and physical health.
A model of these interrelations is constructed. The results show that the influence of the sources of occupational stress (interactions in the work group and
work organization) on psychological and physical health is strongest, followed
by personality characteristics: type-A behavior, gender and education, and the
coping strategies. The interdependence between appraisals of psychological
and physical health is also very high. The establishment of factors that influence people’s state of health gives possibilities to work effectively for their
elimination.
This study investigated whether psychological processes (goal efficacy and
goal attainability beliefs) activated during the pursuit of middle-level work
goals would predict goal attainment, and whether goal attainment would
account for change in nurses’ work-related well-being (job satisfaction, emotional exhaustion and work stress) alone or in interaction with goal processes.
Goal processes - assessed at two measurement periods covering one year accounted for significant amounts of variance in nurses’ goal attainment. After
controlling for T1 well-being, however, goal attainment was not directly predictive of T2 well-being. Goal efficacy and attainability beliefs significantly
moderated the relationship between goal attainment and well-being at T2.
These results are discussed in relation to goal theories and to occupational
health research.
STRESS AND HEALTH INDICATORS. HOW TO EXPLAIN
GENDER INEQUALITIES? – THE SOMSTRESS STUDY.
CAN JOB STRESS DIMENSIONS ADEQUATELY PREDICT
(PSYCHO)SOMATIC COMPLAINTS AT TWO DIFFERENT
TIME POINTS?
Kittel F1., Fontaine J.², Mangelschots. S²., Godin I1.
De Gucht*, V., Fontaine**, J., Mangelschots***, S., Fischler***, B.
* Leiden University (Netherlands); ** Ghent University (Belgium); ***
University of Leuven (Belgium)
1
Public Health School , Université Libre de Bruxelles, Brussels, Belgium
² Katholieke Universiteit Leuven, Leuven, Belgium
Purpose : To find out possible explanations for the observed ‘classical’ gender inequalities in health
Background : Many studies have evidenced the relationship between stress
and health indicators. Other studies have repeatedly shown that women were
more at risk for most health problems. Very few studies have used simultaneaously two models, and even less so have investigated simultaneously stressors
outside work
Methods : Baseline survey of the Somstress included socio-demographics,
questions related to both the JDCS ( Karasek) or the ERI (Siegrist) stress models and data on health indicators. Two of the 4 enterprises received additionnaly
questions concerning stressors outside work. Cross-sectional logistic regression analyses (N=1828) – controlling always for relevant sociodemographics were applied in 3 stages : first stage workstressors, second addition of home
stressors, third controlling for neuroticism.
Results : The association of gender with the health indicators varied interestingly.
Already after adjusting for work stressors gender was not anymore associated
with Self-Rated Health. The association remained for the other health indicators: Anxiety (OR :1.3), Psychotropic Drug Consumption (OR :1.4),
Depression (OR :1.7) and Somatization (OR :1.8). After adjustment additionnally for home stressors, only Depression and Somatization remained significantly linked with gender. Controlling for Neuroticism left only Somatization
to be associated with gender.
Conclusion : These cross-sectional findings indicate the interest of taking into
account both stress at and outside work in order to better understand their influential mechanisms on health
Purpose: (1) To study the contribution of job stress dimensions to (psycho)somatic symptoms and syndromes in a working population, (2) to examine the stability
of the psychosomatic symptoms and syndromes over a one-year follow-up period,
and (3) to investigate to what extent time-specific job stress could account for
additional variance in the psychosomatic complaints after taking into account their
temporal stability. Methods: At baseline, 1462 employees from a large company
participated in the study. At follow-up, 659 employees filled out the questionnaires. The Leiden Quality of Work Questionnaire (LQWQ) was used to measure
job stress. Psychosomatic complaints were defined as (a) the presence vs. absence
of two discrete somatoform syndromes, namely irritable bowel syndrome (IBS)
and functional dyspepsia (FD), and (b) number of psychosomatic complaints
reported (SCL-90R somatization subscale).
Results: The LQWQ accounted for 10%, 11%, and 18% of the variance in the IBS,
FD, and SCL-90R somatization scores respectively. The scores on the three psychosomatic measures proved to be rather stable over the follow-up period: 55%,
53%, and 58% of the variance of the IBS, FD, and SCL-90R somatization scores
at follow-up could be accounted for by their respective first measurements.
Finally, after taking into account their temporal stability, the time-specific stress
dimensions accounted for an additional 4%, 4%, and 5% of the variance in IBS,
FD, and SCL-90R somatization scores respectively. More sophisticated analyses,
controlling for sociodemographic variables, work conditions, and personality
dimensions, will be presented.
Conclusion: Job stress has a direct and substantial effect on psychosomatic wellbeing.
46
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THE BECK DEPRESSION INVENTORY AS A MEASURE OF
SUBJECTIVE WELL-BEING: A CROSS-NATIONAL STUDY
ILLNESS AND TREATMENT BELIEFS PREDICT QUALITY
OF LIFE IN END STAGE RENAL DISEASE
Dianne A. Van Hemert, Fons J. R. Van de Vijver, & Ype H. Poortinga
Tilburg University, Tilburg, The Netherlands
Griva, K.; Hansraj, S.; Thompson, D., Davenport, A., Harrison, M. & Newman,
S. P Unit of Health Psychology ; Centre of Behavioural and Social Sciences in
Medicine, University College London
Aims: This presentation will address the question whether the Beck Depression
Inventory (BDI), which is one of the most widely used instruments to assess
depression, can be used to measure differences in subjective well-being at
national level.
Aims : To investigate the effects of illness and treatment beliefs on quality of
life (QoL) in patients with End Stage Renal Disease. Comparisons were undertaken between haemodialysis (HD) and peritonealdialysis (PD) patients and
patients with a cadaever (CAD) or a living related renal transplant (LRD).
Methods: Studies using the BDI in normal populations from 28 countries were
collected. In order to establish the meaning of depression scores at country
level, the functional equivalence (i.e., similarity of meaning) of depression
scores at individual and country level was examined. In addition, BDI scores
and subjective well-being were correlated with a number of country characteristics in order to test three theories of cross-national differences in subjective
well-being, i.e. livability theory, stressing the importance of objective living
conditions, comparison theory, focusing on relative living conditions, and folklore theory, stating that cross-national differences can be explained by some
national trait (e.g., beliefs and values concerning happiness).
Methods : 117 transplant (mean age = 50.3 yrs) and 145 dialysis patients
(mean age = 50.1 yrs) completed questionnaires assessing illness perceptions
(IPQ), treatment beliefs (Treatment Effects Qestionnaire; BMQ), mood
(PANAS; BDI) and QoL (SF-36).
Results: Cross-national differences in depression and subjective well-being
could be explained by livability theory and folklore theory. BDI scores were
negatively correlated with subjective well-being and other happiness-related
variables.
Conclusion: These findings suggest that depression had the same meaning at
individual and country level and that depression is an adequate measure of (a
lack of) subjective well-being at country level.
Results : Illness and treatment beliefs did not differ between the dialysis
groups, nor between CAD and LRT transplant recipients. Transplant recipients
were more likely to hold an acute timeline, perceived more control, less consequences, less symptoms and less illness and treatment related burden compared
to dialysis (ps < .01). QoL was impaired in dialysis, particualy in physical SF36 dimensions compared to transplant patients and general population norms.
Post hoc analyses revealed that PD patients had more compromised QoL than
HD (ps < .05) and transplant patients (ps < .001).
Hierarchical multiple regressions indicated that illness and treatment intrusiveness, consequences and medication concerns predicted HQoL in both dialysis
and transplant patients over and above the effect of sociodemographic, medical, and mood variables. Explained variance ranged from 28.4% to 65.8%,
with different variables emerging as significant predictors in emotional and
physical SF-36 dimensions.
Conclusions : Our findings suggest that different treatments may induce distinct illness and treatment beliefs which appear to have a direct influence.
THE ROLE OF SELF-EFFICACY, SOCIAL SUPPORT, AND
COPING FOR QUALITY OF LIFE AFTER TUMOR-RELATED SURGERY
PSYCHOLOGICAL OUTCOME AND QUALITY OF LIFE
FOLLOWING LIVER TRANSPLANTATION: A PROSPECTIVE, NATIONAL, SINGLE-CENTRE STUDY
Sonja Boehmer, Ute Schulz & Nihal E. Mohamed
Freie Universitaet Berlin, Department for Health Psychology
R.E. O’Carroll*, M. Couston, J. Cossar, G. Masterton & P.C. Hayes
University of St Andrews* and Scottish Liver Transplant Unit, Edinburgh
Royal Infirmary
From a stress-theoretical perspective social and personal resources like selfefficacy beliefs and social support can promote the recovery from critical life
events like experiencing a severe illness. The aim of the present study was to
investigate in a sample of cancer patients whether these protective factors
directly facilitate the adaptation process or if they are mediated by coping
strategies.
After hospitalization, patients were approached three times: one month, six
months and one year after surgery (n = 105). The questionnaire comprised the
EORTC-QLQ-C30, the General Self-Efficacy Scale, the Berlin Social
Support Scales as well as subscales of the Brief COPE, and the Mental
Adjustment to Cancer Scale. Structural equation modeling was used for data
analyses.
Self-efficacy, received social support, and the coping strategies of positive
reframing, acceptance, fighting spirit, and planning one month after surgery
were found to have a positive effect on global quality of life five months later.
Regarding the question on mediation, SEM-analysis revealed that the effect of
self-efficacy on global quality of life was completely mediated by positive
reframing. Positive reframing was also found to be a complete mediator for the
relationship between received social support one month after surgery and global quality of life five months later.
Liver transplantation is a well established treatment for liver failure.
Prolongation in survival is accepted, but the long-term effects of liver transplantation on cognitive and psychological outcome are unclear.In the present
study, psychological data were prospectively collected in 164 patients who
were assessed for liver transplantation. Memory impairment, psychomotor
slowing, anxiety and depression were commonly observed. Severity of liver
disease at assessment was significantly associated with slowing of reaction
time. Memory impairment distinguished those who were not listed for transplant because of illness severity.
One year post transplant, follow up data from transplanted patients revealed
significant improvement inmost psychological domains relative to both healthy
comparison participants and patients with chronic liver disease who were not
transplanted. Immunosuppression (cyclosporin versus tacrolimus) did not have
differential effects on quality of life, fatigue or affective status, although those
taking cyclosporin showed greater improvements at one year follow-up on simple and choice reaction times. Elevated levels of anxiety and neuroticism at
pre-transplant assessment were associated with poorer psychosocial outcome
one year post transplant. Severity of liver disease was not related to psychological outcome at one year.
Good psychological outcome at one year was maintained at three year follow
up.
47
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EFFECTS OF SOCIAL SUPPORT GROUPS ON COPING
ABILITIES, STRESS, AND HEALTH RELATED QUALITY OF
LIFE (HRQOL).
IMPACT OF THE FIRST THREE YEARS OF HAART ON HEALTH
RELATED QUALITY OF LIFE OF HIV INFECTED PATIENTS:
ROLE OF THE RELATION WITH THE PHYSICIAN
Gerd Inger Ringdal*, Kristen Ringdal, Randi Dulin, Eva Faanes
Norwegian University of Science and Technology, Faculty of Social Science
and Technology Management, Department of Psychology, NTNU,
Trondheim,Norway
PREAU, Marie1,2 SPIRE, Bruno2 LEPORT, Catherine3. GRANIER, Philippe4 ,
CHENNEBAULT, Jean-Marie5, PETIT, Christine2 VEYSSIER, Pierre6 VUITTON,
Dominique7 CHENE, Geneviève8 MORIN, Michel 1,2 and the APROCO study
group
1University Aix-Marseille I, Aix en Provence 2 INSERM U379/ORS PACA,
Marseille 3 Faculté X. Bichat, Paris 4 Fleyriat Hospital, Bourg en Bresse 5 Regional
Hospital, Angers 6 Compiègne Hospital, Compiègne 7 MinjozHospital, Besançon 8
INSERM U330, Bordeaux
Main aim: In the last decades there has been a strong growth in the number of
voluntary social support support groups for cancer victims and family members
both in Norway and other countries. Systematic evaluations of the utility of
these groups are, however, scarcely reported in the literature. Therefore, the
main aim is to study the effects of social support through group participation
on coping abilities, on stress, and on health related quality of life.
Methods: This prospective, non-randomized study of the Norwegian Cancer
Society’s voluntary support groups includes almost all courses that have been
running in the groups: Learn to live with cancer (8 courses), Ca Prostate (5
courses) and Ca Mammae (16 courses), in the region of Mid-Norway from
February 2000 until February 2002. The sample comprises cancer victims and
family members who answered a questionnaire (including the EORTC QLQC30, IES, HADS, and open-ended questions about their own evaluation of the
course) before start (pretest, N=239), after finishing the course (posttest,
N=183), and six months afterwards (follow-up, N=166).
Results and conclusion: An analysis based upon a repeated measurement
design showed no statistical significant differences in mean HRQOL either
across time or between groups. Still, the minor observed differences across
time are in the expected direction for all three groups. HRQOL improves somewhat from pretest to posttest. The results will be presented in more detail at the
conference.
Objectives: We investigated factors associated with health-related quality of life
(HRQL) of HIV-infected patients in the first three years of highly antiretroviral therapy (HAART). Methods: Socio-behavioural and clinical data from the French APROCO cohort. A self-administered questionnaire gathered information about HRQL
(MOS-SF36), and relationship with medical staff (trust, importance of trusting physician and satisfaction of provided explanations). Two aggregate scores, physical (PCS)
and mental (MCS) component summary adjusted for baseline-HRQL, were used as
dependent variables in the linear regressions to identify factors associated with HRQL.
Results : Of the 611 patients followed through M36, complete longitudinal data were
available for 360 patients. Factors associated with high MCS were receiving social support, reporting trusting physician, young age, male gender, and <2 treatment switches.
The importance of establishing a trustful relation with the physician was also independently associated with high MCS among patients who experienced adverse events.
Giving less importance to a trustful relationship with the physician was associated with
higher MCS levels in patients with longer treatment history. Factors associated with
higher PCS levels were satisfaction with the explanations given by the medical staff,
employment, having no children, being sexually HIV-infected, advanced clinical stage
and longer treatment history.
Conclusion : Our results underline the role of the relation patient-physician on high
HRQL. It is essential to distinguish the belief in the importance to establish a trustful
relation with the physician and the trust itself. Our results underline the need of
improving patient-provider relationship for attaining higher HRQL in the long-term.
PSYCHOSOCIAL RESOURCES, ILLNESS PERCEPTIONS
AND QUALITY OF LIFE IN CORONARY HEART DISEASE
WHAT DO PATIENTS THINK ABOUT THEIR TREATMENTS
FOR CORONARY ARTERY DISEASE? THE DEVELOPMENT
OF THE TREATMENT REPRESENTATIONS INVENTORY
(TRI)
Aalto, A-M* (1), Heimans, M. (2) Aro, AR (3), Weinman, J (4)
(1) Stakes, Helsinki, Finland
(3) National Public Health Institute, Helsinki, Finland
(2) NIVEL, Utrecht, NL
(3) Guy’s, King’s and St Thomas School of Medicine, London, UK
SP NEWMAN, UNIT OF HEALTH PSYCHOLOGY, UNIVERSITY COLLEGE
LONDON, UK
SP HIRANI, UNIT OF HEALTH PSYCHOLOGY, UNIVERSITY COLLEGE
LONDON, UK
DLH PATTERSON, The Whittington Hospital NHS Trust and UCL, UK
AIM: The study examined the correlates of illness cognitions among persons
with coronary heart disease (CHD), and how they with psychosocial resources
are related to quality of life (QOL) and self-rated health status (SRH).
METHODS: A questionnaire survey with one year follow-up was conducted
among persons (n=2745) with CHD, drawn from the drug register of the Social
Insurance Institution, Finland. The measures were Illness Perceptions
Questionnaire (Weinman et al 1996), CHD self-efficacy, Perceived
Competence (Wallston 1994), Social support (Sherbourne 1992), 100 mm
Visual Analogy Scale (VAS) for generic QOL, and single item for SRH.
RESULTS: Illness cognitions varied according to severity of CHD, and they
correlated with generic psychosocial resources (perceived competence and
social support). Psychosocial resources explained 7% of variance in SRH and
13 % in QOL, and illness cognitions contributed with further 16% and 10%
respectively. Particularly illness identity (B=-.19) and perceived consequences
of CHD (B=-.20) were related to better SRH and QOL in cross-sectional setting and they partly mediated the associations between generic psychosocial
resources and well-being. Illness cognitions also were modestly related to
change in QOL and SRH.
CONCLUSIONS: The findings suggest that both generic psychosocial
resources and illness representations have implications for outcomes in CHD.
-Mari Aalto, PhD
Background: This study describes the development and validation of the
Treatment Representation Inventory - a measure of the beliefs patients hold with
regards to the intervention offered to manage their illness.
Methods: Two hundred and fourteen coronary artery disease patients, 70 of
whom were undergoing medication, 71 to undergo angioplasty and 73 to undergo
surgery, completed a 58-item questionnaire regarding their treatment beliefs.
Responses were subject to principle components analysis (PCA) to investigate the
structure of these beliefs. Scales based on the resultant factor structure were correlated to explore inter-relations and utilised to investigate treatment group differences in treatment beliefs through analysis of covariance (ANCOVA).
Findings: The PCA indicated four factors accounting for 36.7% of the variance.
After excluding extraneous items, the final questionnaire consisted of 28-items,
clustered around four components: disease control, emotional impact, decision
satisfaction and cure. Scale inter-correlations revealed a coherent set of relationships (ranging from Pearson’s r = ± 0.048 to 0.497). Scale means scores and the
ANCOVAs showed significant differences on each scale (p<0.01), with the pattern of differences reflecting the distinctive natures of each treatment.
Discussion: Treatment representations are potentially important beliefs that may
influence illness beliefs and coping strategies, and potentially outcome after medical interventions. The development of the TRI provides a first step in the practical integration of such beliefs into health models.
48
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PATIENT DELAY IN SEEKING HELP FOR SYMPTOMS OF
ACUTE MYOCARDIAL INFARCTION
Dempster, M.; Carney, R. & Fitzsimons, D.
School of Psychology, Queen’s University Belfast & Belfast City Hospital
Trust
Delay time from onset of symptoms of myocardial infarction to seeking medical assistance can have life-threatening consequences. The aim of this study
was to explore potential predictors of patient delay from onset of symptoms to
time medical assistance was sought in a consecutive sample of patients admitted to a coronary care unit with acute myocardial infarction.
The Cardiac Denial of Impact Scale, Health Locus of Control Scale, Health
Value Scale and Pennebaker Inventory of Limbic Languidness were administered to 62 patients between three and six days after admission. Logistic regression analysis suggested that attribution of symptoms to heart disease and health
locus of control had a significant association with whether or not patients
sought help within 60 minutes from the onset of their symptoms, while previous experience of heart disease did not. The findings suggest that assisting
individuals to recognise the potential for symptoms to have a cardiac origin is
an important objective.
THE ROLE OF PREMORBID PSYCHOLOGICAL RESOURCES IN
SHORT- AND LONG-TERM ADJUSTMENT AFTER CARDIAC DISEASE. A PROSPECTIVE STUDY IN THE ELDERLY.
CHM van Jaarsveld, R Sanderman, AV Ranchor, J Ormel, GIJM Kempen
Northern Centre for Healthcare Research, University of Groningenn
The objective was to study the role of mastery (MA), self-efficacy expectancies (SE) and neuroticism (NE) in explaining individual differences in physical
and psychological adjustment to cardiac disease.
Methods: Physical and psychological functioning (depressive symptoms and
anxiety) were studied in 208 patients. Pre-morbid data were available from a
community-based survey in 1993. Incident cases with Acute Myocardial
Infarction (n=89) or Congestive Heart Failure (n=119), developed after 1993,
are prospectively followed. Assessments were done premorbidly in 1993 and at
6 weeks and 1 year after diagnosis.
Results: The results of this longitudinal study showed that premorbidly
assessed psychological resources do have a role in explaining individual differences in vulnerability to negative consequences of cardiac disease. Self-efficacy expectancies and neuroticism had independent effects on adjustment in
terms of physical functioning in the short-term (6 weeks after diagnosis).
Neuroticism was an independent resource for depressive symptoms and anxiety both in the short- and long-term (1 year after diagnosis). Although mastery
was also related to anxiety and self-efficacy expectancies were related to
depressive symptoms, these effects showed to be subordinate to effects of neuroticism.
Conclusion: Persons with unfavorable levels of psychosocial resources are
particularly at risk for physical and psychological maladjustment after cardiac
disease.
THE ROLE OF CULTURAL CHANGE AND SOCIAL CLASS
IN HEALTH INDICATORS OF US LATINO ADOLESCENTS
SWISS AND FOREIGN ADOLESCENTS AT RISK – SIMILARITIES AND DIFFERENCES
Scott C. Carvajal & Andrea J. Romero
University of Arizona, USA
Gebhard Huesler
University of Fribourg , Dept. of Psychology Switzerland
Aims. This study investigated differences in behavioural health protective and
risk factors among Latinos of various levels of social class and levels of acculturation using a bicultural acculturation model.
Problem. The bicultural model is consistent with current general cultural psychology theory on cultural change processes, yet has infrequently been applied
to understand adolescent health outcomes. The outcomes of focus in this study
are descriptive of Jessor’s theoretical framework for describing adolescents’
health status.
Methods. Participants included 644 Latino students randomly selected from
all middle schools of a Northern California district and who completed two
waves of data collection. Respondents completed project staff administered
self-reports surveys in their schools that included assessments of health behaviours, mental health, and sociocultural variables—including acculturation
level.
Results. The Latinos who were in the marginalised acculturation group—those
with less attachments and adaptations to Latino and other cultures, showed less
desirable mental health outcomes than the bicultural group, both cross-sectionally and longitudinally. Latino boys and those of lower social class generally
reported more health risk behaviors and fewer protective health behaviors.
Conclusion. These results extend prior research (e.g., Carvajal, Hanson,
Romero & Coyle, 2002) by focusing on Latinos and using the first analyses
from a longitudinal dataset. The study found important differences within
Latinos using a bicultural acculturation model. The use of the general bicultural acculturation model framework may have especial utility for addressing
health issues for not just US Latinos but for wherever minority or immigrant
populations interact with a dominant society.
About 18% of persons living in Switzerland are not of swiss orign. This
important part of the population is divided in several sub groups. Persons living in Switzerland their whole life but who never naturalised and persons living in this country for several years. The focus is on foreign and swiss adolescents who face problems and need some support. Our aim is to study what
the similarities and differences between adolescents at risk of the following
groups are. Swiss, non Swiss growing up in Switzerland and adolescents who
came to Switzerland just recently.
Method: To realize this comparison we use the sample of the supra-f study, a
national program in secondary prevention for adolescents at risk. This program
started in 1999 and collected till now more than 1000 adolescents all over the
country. This national program is divided in two sub groups an intervention and
a comparision group. The comparison group is collected under the same conditions as the adolescents in the intervention. We use the whole sample at entry
in the study before starting (cross sectional data) the intervention. Our purpose
is to describe the sample concerning family background, on psychological and
health related variables and on delinquenzy and substance use.
Conclusion: There are differences in well-being, life style and substance use.
The younger and older foreign adolescents consume less substances (alcohol,
tabacco and cannabis) they feel better (less anxiety and depresseion) and they
have less physical complaints than swiss adolescents.
49
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SEXUAL BEHAVIOUR, ATTITUDES TO CONDOMS AND EMERGENCY CONTRACEPTION AND SEX EDUCATION IN
YOUNGER TEENAGERS OF ASIAN AND WHITE ETHNICITY
HEALTH CONSEQUENCES OF PHYSICAL AND SEXUAL
ABUSE IN YOUNG WOMEN
Csilla Csoboth, Emma Birkás
Semmelweis University Institute of Behavioral Sciences, Budapest, Hungary
Wallace L M1, Evers KE2, Seedhouse K,1 and Sewell A3
1 Coventry
University
USA
3 Coventry Primary Care NHS trust
2 ProChange,
There is a rising frequency of physical and sexual abuse among women. The
experience of violence leads to different somatic and mental disorders, for
example, depression, anxiety, and chronic pain syndrome. The purpose of our
study was to gain epidemiological data on abuse in Hungary and to analyze it’s
relationship with physical and mental health.
Aims: The transtheoretical change model (TTM) is applied to pregnancy prevention among 12-16 year olds in England.
Problem addressed: Rates of at risk behaviour of pregnancy and STIs.
Methods: Data is presented from a questionnaire study of 450 12-16 year olds in
school in Coventry (mixed ethnicity, n=450, 25% Asian, 11% other non white),
compared to children in Doncaster (n=931, 93% white ethnicity), for TTM stage for
first sexual intercourse or condom use by those who are sexually experienced.
Results: In Coventry, 79% (N=357) and in Doncaster 69% (N =641) were virgins
and completed questions concerning their readiness to start having sex.
Unprotected sex (any method) was reported by 49% in Coventry and 38% in
Doncaster on at least one occasion. In the sexually experienced, 59% in Coventry
and 62% in Doncaster are in action or maintenance for condom use. Regression
elaborates the predictors of sexual activity and condom use in both samples. In the
Coventry sample, at last sexual intercourse 9% had used emergency contraception,
22% the pill, 16% femidoms and 65% condoms, some used more than one method,
13% used no method, or withdrawal (4%). Data on attitudes to sex education in
schools shows the low credibility of teacher delivered interventions, and fear of
embarrassment and exposure in accessing local contraceptive and pregnancy testing services, especially within the local, mainly Asian neighbourhood.
Conclusions: There is evidence of significant risk of pregnancy and STIs. These
findings have informed health promotion, and the development of a CD ROM
based TTM intervention.
Data was derived from the Better Health for Women study conducted in
Hungary in 1998. The study sample was nationally representative according to
age, school type or occupation, and region and consisted 3615 young women
ages 15-25.
More than 30% of the young women reported having experienced some type of
abuse sometime during their life. 22.9% were abused by an important person
and 7.4% reported being abused by partner. Sexual abuse was reported by
2.2% of the young female sample.
In the abused group, those having experienced sexual abuse were most at risk
of developing depressive symptoms (OR 6.4 (95% CI: 3.0-13.4)). Fear also
increased the risk of depression in young females (OR 5.2 (95% CI: 2.8-9.0).
Health risk behavior was more frequent among women who experienced abuse.
Abused women frequently seek medical treatment, but rarely admit to the cause
of their physical and psychological symptoms. It is especially important to deal
with sexual and physical abuse among young women, because the presence of
abuse in the younger age groups warrants specially designed interventions for
these women inorder to prevent the development of serious physical and mental disorders in this vulnerable population.
FINDING MEANING AFTER CANCER SURGERY
THE IMPORTANCE OF SELF-CONSTRUAL FOR ILLNESS
COGNITIONS AND RECOLLECTIONS
STEFFEN TAUBERT, CHARIS FOERSTER
AYSE K. USKUL & MICHAELA HYNIE
Free University of Berlin
YORK UNIVERSITY
Meaning and benefit finding have been considered crucial to how well patients
adapt emotionally to life threatening illnesses. 84 patients undergoing surgery
for gastrointestinal cancer were studied at four measurement points; three days
before surgery, then one week, one month and six months after surgery.
Meaning was compared with a variety of coping strategies, such as social and
intra-individual comparison, information seeking and behavioral engagement.
Results indicate that meaning plays the major role in dealing with cancer and
cancer treatment. Although meaning did not directly predict emotional adaptation and perceived quality of life, changes in meaning during the first four
weeks after cancer surgery predicted emotional adjustment. Younger patients
had a distinct increase of meaning compared to older patients, while older
patients benefited more from increased meaning.
Studies on culture, gender, and self have shown that individuals may differ on
the degree to which they incorporate significant others or groups into their selfconcept. Individuals with an independent self-construal tend to view themselves as unique, autonomous, and separate. In contrast, people with a collective or relational self-construal tend to include close others or groups into their
self-definition. To the extent that illness may threaten one’s ability to achieve
or enact the aspects of the self that are most central to one’s self-definition, illness concerns may differ as a function of the way one’s self is construed. The
first study was designed to examine whether type of self-construal plays a role
in the type of illness concerns one would experience in an imagined illness situation. 270 undergraduate students read illness scenarios and then responded to
37 illness concern items that tapped into individual and relational/collective
self-aspects. They also completed measures of independent, relational and collective self-construal. The results of this study revealed that individuals who
were high in collective self-construal reported having more relational/collective concerns, whereas individuals who were high on individual self-construal
reported having more individual concerns. The second study was designed to
answer the question if individuals remember self or other-focused aspects of
being ill depending on their self-construal when recalling a health problem they
experienced in the last 12 months. The results of this study will also be presented and the implications of the concept of self-construal in examining health and
illness will be discussed.
50
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SIGNIFICATIONS ABOUT CAUSES AND PREVENTION OF
DISEASES THROUGH ADULT LIFESPAN
Joaquim Reis & Fernando Fradique
Independent University - Faculty of Psychology and Education Sciences
There has been little recognition within health psychology of the potential contribution of lifespan developmental studies to help us understand issues of
health and disease across the lifespan. Studies in this domain are needed. So,
the authors will present an empirical research work on lay significations about
health and disease processes, endorsed by adults corresponding to each period
of adult life (i.e., young adults, middle-age adults and older adults). A sample
of sixty-seven adults, randomly drawn from the universe of lay persons, were
interviewed in depth. It was then possible to assess and analyse significations
typical of each period of adult life and also significations that characterize adult
life in general. The assessed significations were related to two important health
and disease dimensions: “Causes of Disease” and “Disease Prevention”. The
results show differences in content among the three groups considered, suggesting that (a) health related issues salient to young adults is different to those
of middle-age and older adults; (b) that clinical or preventive programs in
Health Psychology need to take those differences into account.
CAUSAL ATTRIBUTIONS, OPTIMISM, PERCEIVED CONTROL AND QUALITY OF LIFE OF CANCER, CHD AND
BACK PAIN PATIENTS
Deniz N. Sahin & Hakan Cetinkaya
Hacettepe University; Mugla University
The purpose of the present study is to explore whether patients with different
chronic diseases ascribe the causes of their illness to internal or external factors . Another aim is to examine the sense of control over the course of the
illness. The study also compares the optimistic perspective and the perceived
quality of life of the patients.
A total of 168 participants in three groups consisted of 56 cancer, 56 CHD and
56 with back pain patients were recruited. As the measures of dependent variables Causal Attribution Scale, Feelings of Control Scale, Life Orientation
Scale and Functional Assessment of Cancer Therapy Scale were administered.
Results revealed that both CHD and back pain patients ascribed the causes of
their illness more to internal factors.There was no difference in the
internal/external causal attibution of cancer patients. Patients’ beliefs about the
availability of sources of control changed both to age and type of chronic illness. While both personal control and social network based control was lower
in the older age group in cancer patients, in older CHD patients only social network based control was lower. In back pain patients social network based control was lower when compared to other groups. Optimistic perspective of life
was higher in the younger age group than the older age group only in cancer
patients; no age difference was found in other patient groups. Only in the physical wellbeing dimension of the perceived quality of life, CHD and back pain
patients were better than the cancer patients.
CHANGES IN SYMPTOM EXPERIENCES OVER TIME PREDICT
ADHERENCE TO HIGHLY ACTIVE ANTIRETROVIRAL THERAPY (HAART): RESULTS FROM A PROSPECTIVE STUDY.
THE RELATIONSHIP BETWEEN QUALITY OF LIFE,
HEALTH STATUS, FATIGUE, AND DEPRESSION IN VASCULAR PATIENTS
Cooper, V., Gellaitry, G., Hankins, M., *Fisher, M., Horne, R. Centre for Health
Care Research, University of Brighton and *Brighton & Sussex University
Hospitals NHS Trust
Annelies E.A.M. Aquarius, Jolanda de Vries, and Johan K. Denollet, Jaap F.
Hamming
(1, 2, 3) Department of Psychology and Health, Tilburg University, The
Netherlands; & (4) Department of Surgery, St. Elisabeth Hospital Tilburg, The
Netherlands
Background: HIV-positive individuals taking highly active anti-retroviral therapy
(HAART) are required to maintain an unprecedented level of adherence to ensure
clinical benefit and prevent viral resistance, yet sub-optimal rates of adherence prevail. We tested the hypothesis that changes in patients’ experiences of symptoms
over time impact on adherence and influence perceptions of HIV and HAART.
Methods: As part of a prospective study, consecutive patients (n=65) completed
validated questionnaires assessing the type and severity of symptoms they attributed
to HIV and those they attributed to HAART, perceptions of HIV and HAART and
adherence. Assessments were completed before starting HAART and after 1 and 6
months of treatment.
Findings: Participants who perceived an improvement in HIV-related symptoms
between baseline and 6 months reported higher adherence at six months (p<0.05).
Similarly, those who perceived an improvement in HAART related side effects
between 1 and 6 months were more adherent at 6 months (p<0.005). Results are consistent with a causal relationship, since improvement of symptoms was not predicted by earlier adherence (p>0.1).
Those reporting an improvement in symptoms or side effects had more positive perceptions of HIV and HAART (perceived fewer and more consistent symptoms,
fewer negative consequences, more control, fewer negative emotional representations, and were more convinced of their personal necessity for HAART and harboured fewer concerns) after six months of treatment. All relationships were significant at the 5% level.
Discussion: These findings are consistent with an extended self-regulatory model,
where symptom experiences guide adherence and influence perceptions of illness
and treatment.
Aims: The aim of the present study was to determine the relationship between
quality of life, health status, depression, and fatigue in vascular patients.
Background: Atherosclerosis is becoming a widespread, major health problem. Because of its chronic, progressive nature, relief of symptoms was the
main goal of treatment. During the last decade, quality of life (QOL) has
increasingly been acknowledged as an important outcome measure. Despite
this, little is known about the relationship between QOL and other psychosocial aspects in vascular patients.
Methods: A group of 200 patients with peripheral arterial disease and 35
patients with an abdominal aortic aneurysm, two common expressions of atherosclerosis, completed an adapted version of the WHO Quality of Life
Questionnaire (WHOQOL-100), the RAND-36, the 10-item Center for
Epidemiological Studies Depression Scale (CES-D), and the Fatigue
Assessment Scale (FAS). In addition, medical data were derived from patients’
medical files. The control group consisted of 50 patients with similar symptoms
as the patients with peripheral arterial disease, however, after medical examination they appeared healthy. Relationships will be studied between medical
outcomes, health status, depression, fatigue and QOL.
Results: The results will be discussed in terms of their implications for clinical practice.
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PREDICTING SOCIAL SUPPORT AND PHYSICAL OUTCOMES OF MALE PATIENTS IN CARDIAC REHABILITATION.
PERSONALITY PREDICTIS LONG-TERM PROGNOSIS OF
ACUTE MYOCARDIAL INFARCTION.
F. Bonaguidi , C. Carpeggiani, C. Michelassi, A. L’Abbate.
CNR Institute of Clinical Physiology, Pisa, Italy. On behalf of CNR-PF
FAT.MA investigators.
Shawn N. Fraser, Wendy M. Rodgers, Bill Daub, & Bill Black
University of Alberta, University of Alberta, Glenrose Hospital
Social status and social support are thought to influence morbidity and mortality in the general population as well as prognosis for patients with cardiovascular diseases. Although the exact mechanisms are unclear, higher-level models of social influences on health (e.g., Berkman & Glass, 2000) offer a framework for examining such influences. This study sought to examine the influence of social status characteristics on social support and health outcomes in
cardiac rehabilitation (CR). It was hypothesized that social status factors would
influence social support.
Second, it was thought that both social status factors and support would influence the exercise tolerance of new CR patients while controlling for perceived
severity of illness. Last, it was thought that these social factors would influence
exercise tolerance after the completion of a CR program controlling for attendance. Results of regression analyses offered support for our hypotheses where
social status factors explained 17% of variance in social support. Income and
age were positively and negatively associated with social support, respectively.
Social status factors and social support explained 25% of variance in baseline
exercise tolerance, controlling for severity of illness. Income and social support
were positively related to exercise tolerance whereas illness severity and age
contributed negatively. Finally, social status and social support explained 21%
of variance in post-CR exercise tolerance controlling for attendance.
Attendance and age contributed negatively and income and social support contributed positively. Results support previous research outlining the importance
of social factors on health and health outcomes of CR.
Background: Psychological and behavioural factors have been considered as
significant risk factors for coronary heart disease (CHD). The aim of this study
was to evaluate the role of personality in predicting long-term prognosis in
patients with acute myocardial infarction (AMI).
Methods: In a group of 240 patients who survived to AMI (mean age 55,
215 males), the personality traits, using the Sixteen Personality Factor
Questionnaire (16 PF), were evaluated in addition to clinical data such as sex,
age, traditional risk factors, peak value necrosis enzyme (CPK), left ventricular wall motion score and heart rate variability. Patients were followed up for
eight years for hard events (cardiac and non cardiac death plus non fatal reinfarction). A multivariate analysis (Cox model), including as covariates all the
variables considered, was performed to assess their relative contribution to the
occurrence of the events.
Results: During the follow-up, 30 patients died and 10 patients had a new non
fatal myocardial infarction. In both univariate and multivariate analyses
increase in heart rate and low score in Emotional Sensitivity personality factor
were predictive of all cause mortality with a relative risk of 2.38 and 3.49
respectively (p<0.003).
Conclusion: Low score in Sensitivity trait and tachicardia were significant predictors of long-term mortality. Emotional Sensitivity should be taken into
account as an important factor contributing to post infarction outcome in association with unbalanced autonomic control of the heart, in patients with
myocardial infarction.
PERCEIVED STRESS, PSYCHOLOGICAL WELL-BEING,
IMMUNOLOGICAL REPONSES AND HEALTH OUTCOME FOR
PATIENTS UNDERGOING CARDIO-PULMONARY BYPASS
SURGERY (CPB): ASSOCIATIONS BETWEEN PSYCHOLOGICAL FACTORS AND NEUTROPHIL ACTIVITY
GENDER DIFFERENCES IN RISKY BEHAVIORS
AND EMOTIONS
Stefanile, C.*, Meringolo, P.*, Moscardi, E.**
* Department of Psychology University of Florence,
**Trainee Department of Psychology Florence
D Ellard (1) JH Barlow (1) R Mian (1) R Patel (2)
(1)= Coventry University. (2)= University Hospitals Coventry and Warwickshire
(Walsgrave)
Aims - The attitude to risk - both as harmful behaviors and substance use - and
the willingness to take risky behaviors are largely highlighted in studies about
lifestyles in young people. Several studies suggested the importance of “sensation seeking”, defined by the need for varied sensations and experiences and
the willingness to take risks for them. In this research attitude to risk and risky
behavior in youth have been analyzed, exploring particularly weight of emotions linked with risky experiences and of gender.
Aims: Neutrophils components of the non-specific immune system have recently
been implicated in a number of disease states (e.g. myocardial infarction). This
study explored the relationships between a ‘naturalistic’ stressor (heart-surgery),
psychological well-being and both the ‘current’ levels of activity and the phagocytic capacity of neutrophils and the effects these may have on outcome.
Method - 232 participants - male (45,26%) and female, attending high school,
aged from 18 to 21 years have filled in a specifically adapted questionnaire to
gather information about their lifestyles, attitudes toward risk and behaviors.
By factor analysis indicators have been built to check features in lifestyles, values, subjective norms, attitude to risk and behavioral intentions. Participants
have been subdivided, by cluster analysis, in 3 groups, based on experiences of
both generic risk and substance use. By multiple discriminant analysis, differences in attitude and lifestyles in groups are verified, for male and female.
Methods: Ninety patients who were to undergo CPB were assigned to one of two
groups. An ‘elective’ group n = 64 (51 males, 13 females) and an ‘acute’ group n
= 26 (22 males, 4 females). Patients were tested on the evening before surgery and
at clinic six or seven weeks after discharge using standard measures to assess psychological well-being. Small peripheral blood samples were taken. Neutrophils’
‘Current’ activity was determined from whole bloods’ capacity to reduce nitro-blue
tetrazolium (NBT) (%NBT positive cells), phagocytic capacity, from stimulated
whole blood, luminol-dependant chemiluminescence.
Results and conclusion - Understanding attitude towards risk is useful to planning interventions to promote health in youth. Features as gender and emotions
seem to be significantly related to risky behavior. Data show risky behaviors in
lifestyle of interviewed subjects, and their availability in trying harmful situations, both for those who state themselves as substance (alcohol, cannabis,
ecstasy) users and for those who don’t state it. It seems that their evaluation
about individual vulnerability is characterized by unrealistic optimism, so they
don’t perceive any threat in unsafe behaviors.
Results: Results revealed a consistent, statistically significant association between
stress and %NBT cells pre and post-surgery (p < 0.001) in both groups. Phagocytic
capacity was significantly greater in the ‘acute’ group both before and after surgery
(p < 0.02). There was a significant difference on perceived stress (p = 0.009)
between the groups, pre-surgery, both significantly reduced post-surgery. The
‘acute’ group had the highest stress. No significant differences were found between
or within the groups for anxiety, depression, and positive and negative affect.
Conclusion: Results highlighted a consistent significant relationship between perceived stress and the ‘activity’ of neutrophils. The implication of which could be
that stress activated neutrophils may impair wound healing, cause tissue damage
and effect health outcomes.
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THOUGHT SUPPRESSION AND AFFECTIVITY AS PREDICTORS OF ADOLESCENT HEALTH
IMPACT OF MARITAL RELATIONSHIP ON ADULT´S CHILDREN HEALTH
Andrea Horn, Patrick Poessel, & Marting Hautzinger
University of Tuebingen
Pereira, M.G. & Araujo - Soares, Vera
University of Minho- Portugal
Many models of developmental psychopathology expect dispositional factors
and stress to influence each other and those transactions to be crucial to development and health status.
In this study affectivity and thought suppression, as a possible strategy to regulate mood, were measured as habitual factors that are supposed to affect coping with stress and to predict mental and physical health.
Goals: This project intends to analyze the impact of the marital relationship on
adult children using psychosocial and physiological measures.
Methods: 200 young adults composed the sample that was made of undergraduate students at the University of Minho from several fields of study.
Instruments - The variables accessed include the Portuguese Versions of: the
Separation-Individuation Process Inventory (Christenson & Wilson, 1985); the
Miller Social Intimacy Scale (Miller & Lefcourt, 1982); the Perceived Social
Support (Procidano & Heller, 1983); the Conflict Tactics Scale (Strauss &
Gelles, 1990); the Ways of Coping Questionnaire (Coyne, Aldwin & Lazarus,
1981); the Beck Depression Inventory (1973); the State- Trait Anxiety Inventory
(Spielberger et al.); The Rotterdam Symptom Check List (Haes et al., 1990); and
the Perception of Parental Relationship by their Adult Children (Pereira &
Araújo-Soares, 2002).
The physiological measures included heart rate, blood pressure and skin conductance.
Subjects had to fulfill a physiological protocol that included watching a movie
that elicited positive emotions and one that elicited negative ones. They were
assessed at several times: baseline, after each movie, relaxation and while talking about the experience.
Results: Young adults from problematic families (lower marital satisfaction) had
more physical and psychological morbidity, presenting less differentiation, more
problems in intimacy and higher arousal especially dealing with negative emotions. This relationship is stronger in face of lack of social support. They were
also differences found in terms of time needed to return to baseline measures for
this group.
Conclusion: The results emphasize the impact of the marital relationship on the
developmental process of grown up kids with implications on their physical and
mental health. The need for psychological intervention to minor the intergenerational risk of parental relational problems on kids’ health is emphasized.
150 adolescents (average age 14,21; 72 males; 79 females) were asked four
times at three months intervals to self report depressive symptoms, physical
health and daily hassles, absence days also were documented. Negative and
positive affectivity (PANAS) and habitual thought suppression (White Bear
Suppression Inventory) were measured once at the beginning. Hierarchical linear models (HLM) were used to explore the effects of the predictors, with daily
hassles on level one (time, daily hassles) and dispositional predictors on level
2 (positive and negative affectivity, thought suppression, sex).
Results reveal that thought suppression and negative affectivity are significant
predictors of depressive symptoms and influence also the relation between
stress and depression. Physical health was predicted by sex, and positive and
negative affectivity. Absence days were significantly predicted by stress, a relation that was influenced by positive affect and marginally by thought suppression.
Affectivity and thought suppression seem to have an influence on the relation
between mental health and stress and predict mental health as well as physical
health measures. These findings imply that interventions targeted on improving
mood regulation competences should be beneficial in terms of mental and
physical health.
RELATIONSHIPS BETWEEN STRESS, COGNITIVE EMOTION-REGULATION AND HEALTH PROBLEMS IN ADOLESCENTS
CAN SAFER-SEX PROMOTION LEAFLETS CHANGE COGNITIVE ANTECEDENTS OF CONDOM USE? AN EXPERIMENTAL EVALUATION
Nadia Garnefski & Vivian Kraaij
Associate professor at Leiden University, Department of Clinical and Health
Psychology
Charles Abraham, Barbara Kraheacute; & Renate Scheinberger-Olwig
University of Sussex (1st author) & University of Potsdam (2nd & 3rd authors)
Aim - The self-regulation of emotions through cognitions is inextricably
associated with human life, especially after stressful events. Scarcely, however, studies have explicitly focused on the question to what extent specific cognitive emotion-regulation strategies mediate and/or moderate between stress
and health. The present study will focus on the relationship between stress,
cognitive emotion-regulation and health problems in adolescents. More
specifically, the direct, mediating and moderating effects of the following
cognitive emotion-regulation strategies will be studied: self-blame, acceptance, rumination, positive refocusing, planning, positive reappraisal, putting
into perspective, catastrophizing and other-blame.
Method - A total of 271 secondary school students varying in age from 12 to
18 years filled out a self-report questionnaire. Information was gathered
among others on: negative life stress (NLEC), cognitive emotion-regulation
strategies (CERQ), and physical and emotional health problems (YSR).
Direct, mediating and moderating effects of life stress and cognitive emotionregulation strategies on health problems will be tested by means of multiple
regression analyses.
Results – Preliminary results show that the reporting of negative life stress is
related to both physical and emotional health problems. In addition, it is shown
that whereas cognitive strategies, such as self-blame and rumination are significantly associated with elevated levels of both physical and emotional health
problems, other cognitive strategies, such as positive reappraisal, are associated with lower levels of health problems, instead. Moderating effects in the relationship between life stress and health were found for the strategies of selfblame, other-blame and positive reappraisal. No evidence for mediating effects
was found. Conclusions and implications will be discussed.
Background: An experimental evaluation of a safer sex promotion leaflet was
undertaken to assess its capacity to change antecedent cognitions of condom
use. The leaflet was identified in a previous study as one which targeted
research-based cognitive antecedents of condom use. The study was based on
the theory of planned behaviour and the elaboration likelihood model.
Methods: A pre-posttest experimental study including three conditions was
conducted: (i) presentation of the leaflet; (ii) presentation of the leaflet plus
incentive for systematic message processing; (iii) no-leaflet control. Eight variables identified in a recent meta-analysis as correlates of condom use were used
as outcome variables. The sample consisted of 230 students aged 15 - 16 years,
from four schools in Berlin, Germany. Following baseline assessments, leafletinduced cognitive change was measured immediately following the intervention and at a follow-up four weeks post-intervention.
Findings: Presentation of the leaflet alone did not result in significant changes
in the cognitive antecedents of condom use compared to the control condition
However, in combination with an incentive for systematic processing, the target leaflet proved superior to the no-leaflet condition on outcome variables.
Discussion: The findings are discussed with regard to the development and
evaluation of research-based health-promotion materials. The importance of
motivated reading of materials is highlighted.
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PSYCHOLOGICAL FACTORS PREDICTING SUSTAINED
BREASTFEEDING IN UK FIRST TIME MOTHERS
DETERMINANTS OF MEDICAL CARE-SEEKING BEHAVIOUR OF
TURKISH AND DUTCH INHABITANTS OF A DEPRIVED AREA IN
THE NETHERLANDS.
O M Dunn (1), E M Alder (2) & L M Wallace (1)
1) Coventry University, 2) Napier University
Plass, AMC; Timmermans, DRM; Van der Wal, G.
Department of Social Medicine,Institute for Research in Extramural Medicine
Current UK Department of Health guidelines recommend breastfeeding until at
least four months, and WHO (2002) recommend 6 months exclusive breastfeeding. However only 27% of UK mothers currently breastfeed until even four
months (Hamlyn, et al 2002). Although much is known about prediction of
intentions and behaviour to breastfeed up to six weeks, little is known about
intentions to feed beyond this point. This is the first study to apply the Theory
of Planned Behaviour (TPB, Ajzen, 1991) to investigate attitudes of UK mothers who have breastfed to six weeks to sustained breastfeeding.
At present there is a need to change medical care-seeking behaviour because of the
increased demand for GP services.
Especially consultations for minor illnesses are a burden on a GP’s workload, and
decreasing the number of consultations for minor illnesses could have significant implications. In particular in socially and economically deprived areas GPs consider their
workload to be too high. Consequently, it is of great interest to understand the
medical care-seeking behaviour of patients with minor illnesses living in deprived areas,
which is the aim of the present study.
As part of a larger RCT of early intervention, demographic information and
TPB measures were collected from 338 first-time mothers at six weeks post
delivery. All mothers have been followed-up to six months, and this has continued until contact was lost or the last breastfeed. To date, 189 mothers have
reached an endpoint.
162 patients (amongst whom 72 Turkish and 70 Dutch) who frequently visit their GP
(more than 5 times a year), living in deprived areas of The Hague, were interviewed.
They were asked questions based on the Theory of Planned Behavior.
Also the GHPQ and the MLHC scale were assessed.
Nearly 60% of the variance in medical care-seeking behavior of the participants could
be explained. The number of different minor illnesses they reported that they had suffered from mainly determined their medical care-seeking behaviour.
In addition to this care-seeking behavior of the Dutch participants was mainly determined by perceived behavioural control over care-seeking and attitude to self-care,
while the care-seeking behavior of the Turkish participants was determined by
past general health perception and their attitude towards care-seeking. In order to
change care-seeking behaviour, future interventions should focus on attitude and perceived behavioural control both regarding care-seeking ?nd self-care.
The GHPQ and the MLHC scale proved to be reliable instruments that can be applied
to measure health, even of non-western subjects such as the Turkish participants in this
study.
Measures of attitudes, subjective norms and perceived behavioural control predicted 69% of the variance in intention to breastfeed to four months. Using a
model including both demographic and TPB variables, it was possible to correctly classify 77% and 73% of mothers’ breastfeeding status at four and six
months respectively. When considering those mothers who had reached an endpoint, it was possible to predict 22% of the variance in total duration of breastfeeding. TPB variables explain a significant amount of variance above demographic variables.
The TPB provides a focus for interventions to support mothers’ longer term
feeding intentions which can be targeted at non-demographic variables which
may be more amenable to change.
GENDER DIFFERENCES ON SELF - REPORTED MEDICAL
CARE: THE ROLE OF THE MODERN HEALTH WORRIES
AND SUBJECTIVE HEALTH COMPLAINTS
ATTITUDINAL AMBIVALENCE AND HEALTH BEHAVIOURS: ARE SOME PEOPLE NATURALLY MORE AMBIVA LENT THAN OTHERS?
Alves, N.C.; Figueiras, M.J.
Institute Piager – Almada (Portugal)
Anastasia Manola & Chris Fife-Schaw
This paper will address issues regarding attitudinal ambivalence in the area of
health behaviours. Recent literature (Conner & Sparks, 2002) has emphasised
the importance of examining attitudinal ambivalence towards health behaviours, as understanding the role ambivalence plays in determining behaviour
may be helpful in designing interventions.
Data from two studies will be reported. Both studies ask whether: a) there is
evidence that some people have a tendency to have more ambivalent responses across health behaviours, and b) there are personality correlates of healthrelated ambivalence, such as Need for Cognition and Personal Fear of
Invalidity (Thompson & Zanna, 1995), as well as Locus of Control and Self
Esteem.
The first study employed a sample of 150 students to examine ambivalence,
assessed by the split semantic differential method, in relation to the behaviours
of smoking, alcohol consumption, regular exercise and daily consumption of
fruit & vegetables. The study suggested that there are significant relationships
between personality traits and ambivalence but a higher order factor model
suggesting a generalised ambivalence trait did not fit the data.
The second study addresses methodological issues raised in the first study
regarding attitudinal ambivalence measurement in the area of health behaviours, by using an open-ended measure vs. a split semantic differential. The
questions of the first study are re-addressed, by using an open-ended ambivalence measure assessing ambivalence in the affective, cognitive and behavioural attitude components (Maio, Esses & Bell, 2002) which allows respondents
greater flexibility in range of responses and yields potentially better quality
data from respondents.
Objectives: The aims of the present study are twofold: (1) to investigate the
extent to which there are gender differences in beliefs such as worries about
modernity, self-rated health, dispositional optimism and health locus of control
and (2) to investigate what are the predictors of medical care utilization in a
sample of healthy individuals.
Method: A sample of 1113 Portuguese individuals recruited across the country (mean age = 31.03; 64% female) completed a self-administered questionnaire including measures of Dispositional Optimism (LOT), Health Locus of
Control (LOC), self-rated health, the Modern Health Worries Scale (MHW),
and information on health care use.
Results: The preliminary results indicate that there are gender differences in
health- related beliefs and in the relationship between the modern health worries and the use of alternative medicine.
Conclusion: The implications of the role of individual beliefs, and in particular the aspects of modern life as predictors of the use of conventional versus
alternative medicine will be discussed.
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TESTING A THEORY OF COMPUTER TAILORED
INTERVENTIONS
Arie Dijkstra
University of Groningen
Computer tailored interventions become widely used. However, only few tests
have been conducted to test whether tailored interventions are more effective
in motivating and supporting behavior change compared to standardized interventions. The state-of-the-art is that computer tailored interventions can be
more effective in subgroups of populations. The findings are far from robust.
Moreover, there is no theory of tailoring that can guide the development and
the testing of tailored interventions. The present study aimed at testing a
Theory of Tailoring distinghuishing between 1) the Tailoring working mechanism, which are the intervention features Personification, Adaptation and
Feedback; 2) the Intermediate process, that is, self-referent encoding and; 3)
the Effect location, that is, the threathened self. In the present dismantling study
over 200 students were randomized over four conditions in which they were
confronted with information on the negative effects of smoking: the
Standardized condition, the Personification condition; 3) the Adaptation condition; 4) the Feedback condition. As hypothsiezed the results indicated that the
three tailoring working mechanisms led to a greater threat of the self and this
effect was mediated by self-referent encoding. These first result confirm the
Theory of Tailoring and they suggest that tailored interventions, in order to be
effective, need elements that regulate the self-threatening power, for example,
by a self-affirmation procedure.
PREDICTORS OF HEALTH STATUS IN PATIENTS WITH
RHEUMATOID ARTHRITIS
R Curtis and A Groarke
National University of Ireland, Galway
The present study examined the extent to which psychological stress, social
support, coping strategies and clinical disease indicators predict physical,
social and psychological well-being in patients with rheumatoid arthritis.
Participants were 59 women recruited at an out-patient clinic at University
College Hospital, Galway. Data were available for 52 of the sample at one -year
follow-up. Disease status was indicated by physician ratings of joint
involvement. Inflammatory activity was assessed by laboratory indices of
erythrocyte sedimentation rate and C-reactive protein. Psychological measures
such as the Perceived Stress Scale, the MOS Social Support Survey the COPE,
the Coping Efficacy Scale the Arthritis Impact Measurement Scale and the
Positive and Negative Affect Scale were administered during a semi-structured
interview.
Findings from the assessments at baseline and one year later reveal a number
of statistically significant relationships (P<. 01), for example, higher perceived
stress and lower social support were associated with poor emotional
adjustment. Using strategies of avoidance, disengagement and emotional
ventilation to cope with stress were also positively correlated with
psychological distress. Frequent use of coping strategies such as acceptance,
positive reinterpretation and growth and seeking emotional social support were
associated positively with health status.
In hierarchical regression analysis psychological stress, entered after disease
variables, accounted for variance both concurrently and over time ranging from
17% to 61% ( p<.01) on three affective adjustment outcomes. A second series
of hierarchical regressions revealed that social support explained 10% of the
variance on the ESR marker of inflammatory activity (p<.02) and
psychological stress explained 15% of the variance in level of joint
involvement (p<.05). Findings examining the role of different types of social
support and coping strategies as possible mediators of the relationship between
psychological stress and adjustment are also discussed.
SOCIAL COMPARISON, IDENTIFICATION AND EMOTION INVESTIGATING
THE
IDENTIFICATION-CONTRAST
MODEL IN RHEUMATOID ARTHRITIS PATIENTS
Florian Vogt, *Dr. Michael Shipley, #Dr. Lynn B. Myers, +Prof. Stanton P.
Newman
# Health Psychology Unit, Department of Psychiatry and Behavioural Sciences,
University College London; * Department of Rheumatology Research,
University College and Middlesex School of Medicine, University of London;
+Department of Psychiatry and Behavioural Sciences, University College
London
BACKGROUND
People compare themselves to others in similar circumstances. However, not all
comparisons are helpful. The identification-contrast model contends that being
able to identify with others who are more fortunate than oneself and being able
to contrast oneself from others who are less fortunate than oneself leads to a
favourable emotional outcome. Perceptions of control and salience, as well as
perceptions of similarity between oneself and the comparison other are all factors which are claimed to influence identification.
METHODS
Rheumatoid arthritis patients (n=62) read a description of a fellow patient who
was doing remarkably well. Prior to reading the description perceived control
was assessed with a control over arthritis scale. Vividness, severity of rheumatoid arthritis in relation to the comparison other, identification with the comparison other, and emotional reactions were measured after reading the description.
RESULTS
Correlation analysis indicated that identification mediated the impact of perceived control and perceived vividness on emotional reactions. The observed
positive associations of perceived control (r=0.547, p<0.01) and perceived vividness (r=0.578, p<0.01) with positive affect disappeared (r=0.0839, p>0.05 and
r=0.2468, p>0.05) once identification was controlled for. Furthermore, perceiving the severity of the comparison other’s illness as less than one’s one, was negatively associated with identification (rho=-0.773, p<0.01) and positive affect
(rho=-0.464, p<0.01), but positively with negative affect (rho=0.300, p<0.05).
DISCUSSION
The study showed several associations that support the identification-contrast
model. In particular, it emphasises the important role of identification in social
comparisons and consequent emotions.
GENDER DIFFERENCES IN DIABETES ILLNESS
PERCEPTIONS
George B. Ploubidis, Anastasia Kalantzi Azizi, Haralampos D. Tountas &
Efstathiou G
National Kapodistrian University of Athens, Hippokrateion Diabetological
Centre
Insulin Dependent Diabetes Mellitus (IDDM) is an endocrine disorder resulting in high morbidity and mortality. A major aim of the management of IDDM
is to stabilize and reduce blood glucose levels in order for the patient to avoid
long term complications. The typical regimen consists of daily doses of
insulin, diet, exercise and glucose testing.
Objectives: The present study investigated the influence of gender on diabetes
illness perceptions.
Setting: Hippokrateion Diabetological Centre, Athens Greece.
Method: A cross sectional design was employed. 283 IDDM patients (18 -52
years old) participated in our study., Illness Perceptions, and Adherence were
assessed with the revised edition of the Illness Perception Questionnaire (IPQ
-R) and the Diabetes Self Care Activities Measure. In addition the biochemical
marker of adherence, Glygosylated Hemoglobin (HbA), was employed.
Results: Differences in illness perceptions were found between the two genders. The effect of these differences on adherence is discussed.
55
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LONG-TERM EFFECTS OF DIABETES REHABILITATION
FOR PATIENTS WITH PROLONGED SELF-MANAGEMENT
DIFFICULTIES.
OPTIMISM, FAMILY SUPPORT AND HEALTH-RELATED
QUALITY OF LIFE IN CANCER PATIENTS
Juhani Julkunen, M Gustavsson-Lilius, P Hietanen*
Department of Psychology, University of Helsinki, Finland; *University
Central Hospital, Helsinki
J.C. Keers1, T.P. Links2, J. Bouma1, R.O.B. Gans3, R. Sanderman1
1Northern
Centre for Healthcare Research (NCH), Groningen, the Netherlands
of Endocrinology, University Hospital Groningen, the Netherlands
3Dept. of Internal Medicine, University Hospital Groningen, the Netherlands
OBJECTIVES: The aim of this study was to investigate how optimism,
hopelessness and family support associated with health related quality of life
(HQL) of cancer patients. The main hypothesis was that optimism and high
level of family support predicted better HQL. The role of partners’ optimism
and hopelessness were also studied.
2Dept.
Aim: To determine long-term effects and determinants of effect of a
Multidisciplinary Intensive Education Programme (MIEP). MIEP is a 10-week
(and 2 booster sessions) outpatient rehabilitation programme based on the
empowerment approach, for patients that under benefit from regular care showing in poor glycemic control and/ or psychosocial problems.
Method: Ninety participants (age 47 (SD 14); diabetes duration 12 (SD 10
years); 45 %male) were measured at baseline (T=0), 3 (T=1) and 12 months follow-up (T=2). We measured glycemic control (HbA1c), health related quality of
life (HR-QoL: Rand-36 and disease-specific DQOL) and indicators of empowerment (health locus of control and coping). 231 non-referred patients served as
controls. Paired T-tests and regression analyses were conducted.ssss
Results: Both at T=1 and T=2 HbA1c improved compared to T=0, although initial improvement was partly lost. At T=1, sexes improved about equally, but
women consolidated improved HbA1c, whereas men relapsed. Patients
improved in several HR-QoL domains (Rand-36: mental health, vitality, social
functioning; DQOL: satisfaction with treatment), without relapse at T=2 and
sometimes showed a further improvement (vitality, social functioning). Patients
with worse baseline functioning improved most in HR-QoL. After MIEP patients
became more empowered (both at T=1 and T=2), which explained additional
variance in HR-QoL improvement. At T=2, participants did not differ anymore
from average, non-referred diabetes patients.
Conclusions: MIEP has beneficial long-term effects on HbA1c, QoL and
empowerment, especially for patients with poor status at baseline. MIEP hold
promise for patients with prolonged self-management difficulties, for whom
other forms of care have proven inadequate.
METHODS: The subjects were 89 female and 67 male cancer patients with
their partners. Optimism (LOT-R), hopelessness and family support were
measured within 2 – 3 months after the cancer diagnosis. Eight months post
diagnosis the patients filled in the RAND-36 Health Survey.
RESULTS: Path analyses revealed that high levels of family support and
optimism predicted good mental quality of life in female patients. On the
contrary, only low levels of hopelessness predicted good mental quality of life
in male patients. In addition, a significant interaction indicated that for female
patients high family support was helpful only when they were optimistic
themselves. In contrast to that, for male patients the perceived family support
was beneficial if they were pessimistic. Neither partners’ optimism nor
hopelessness were significantly related to patients’ factors.
CONCLUSIONS: Female and male patients did not differ in the mean levels
of optimism, hopelessness and family support. However, the interactional
patterns of these variables as predictors of HQL were different for men as
compared to women. These gender differences deserve more attention both in
future studies as well as in clinical practice.
GENDER DIFFERENCES IN HEALTH BEHAVIOURS IN
OLDER ADULTS
DOES CHANGING THE CONVENTIONAL ORDER OF
THREAT AND EFFICACY INCREASE THE PERSUASIVENESS OF A MESSAGE?
Jane Wardle, PhD and Anne Miles PhD University College London, UK
Cancer Research UK, Health Behaviour Unit Department of Epidemiology and
Public Health University College London
Sue Hall & Theresa M Marteau
Psychology & Genetics Research Group, King’s College London
Background: Conventional fear appeals inform people of a threat followed by
recommendations as to how to reduce this (efficacy information). This ordering of information is consistent with models used to develop and evaluate
health threat messages. There is, nevertheless, some evidence to suggest efficacy before threat information may be more persuasive for people engaging in
risky behaviours. The aim of this study is to test the hypothesis that informing
women smokers of the link between smoking and cervical cancer is more persuasive when the conventional threat followed by efficacy information message order is reversed.
The Institute of Medicine’s recent report noted that: “Being male or female is
an important fundamental variable that should be considered when analyzing
basic and clinical research” (2001). The aim of the present paper is to examine
gender differences across a range of health behaviours in older adults. Men
have often been shown to rate health behaviours as less important, and report
poorer health practices, than women, but most of these studies have been in
young adults. If gender differences derive partly from the young-male ‘risktaking’ culture, they might be expected to be less apparent in older adults. The
present study examines gender differences in smoking, diet, physical activity,
dental care, and participation in colorectal cancer screening, among 55-64 year
old men and women. 5,462 men and women who were taking part in the UK
Flexible Sigmoidoscopy Trial completed measures of health beliefs and behaviours, along with demographic measures, before invitations for screening were
issued. Matching findings from younger populations, men rated the importance
of health behaviours lower. They were also less likely to eat enough fruit and
vegetables or visit the dentist, and slightly less likely to report regular physical
activity. However, contrary to expectations, in relation to the upcoming screening test, men perceived the benefits of FS screening to be higher and the barriers to screening to be lower, and were more likely to attend (73% vs 67%;
c2=31.0 df=1 p<0.001). These results highlight the importance of investigating
gender differences in the factors promoting protective and preventive health
behaviours.
Methods: 178 women smokers aged 20–64 years were randomly allocated to
receive a leaflet with (i) threat followed by efficacy information, (ii) efficacy
followed by threat information, or (iii) no leaflet. The main outcome was intention to stop smoking within the next month. Secondary outcomes were recall of
information, persuasion, and threat and efficacy perceptions.
Results: Although women in the efficacy first group recalled more efficacy
information, and those in the threat first group recalled more threat information, the leaflets were similarly persuasive. Compared with women not sent a
leaflet, those sent either of the two leaflets had higher perceptions of vulnerability, response-efficacy and intention to stop smoking.
Conclusions: Written information informing women of the link between smoking and cervical cancer increases intention to stop smoking regardless of the
order of the threat and efficacy information. The implications of these findings
for models used to develop and evaluate health threat messages are discussed.
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CHANGES IN AFFECTIVE AND LIKELIHOOD RATINGS IN
RESPONSE TO THE PRESENTATION OF ABSOLUTE AND
COMPARATIVE RISK INFORMATION
BIASED APPRAISALS OF HEALTH RISK FEEDBACK
Britta Renner
University of Greifswald
Peter Harris
Centre for Research in Social Attitudes, University of Sheffield
The present study examined reactions towards repeated self-relevant feedback
concerning health risks. On two separate occasions, participants in a community health screening (N = 590) received feedback about their cholesterol level,
which was either positive or negative. Reactions to the first feedback demonstrated that negative feedback was devaluated, but only when it was unexpected.
When absolute and comparative risk were crossed experimentally, Klein
(1997) found participants were disturbed by their comparative risk but typically not by absolute risk. This study tests these intriguing findings in a US
(N=107) and UK (N=246) sample. The differences from Klein (1997) included smaller risks (more like those that arise in genetic testing), a no comparative information control, ratios to determine the above and below average figures where these were manipulated, and a broader range of DVs. The goal
was to implement recommendations for research made in a recent review of
experimental studies of this issue.
Analyses of the second feedback also incorporated feedback consistency.
Again, results showed that unexpected negative feedback was not always
devaluated; only when it was inconsistent with the first feedback. Furthermore,
positive feedback was not generally accepted. When receiving positive feedback which was unexpected and inconsistent with the first feedback, recipients
were doubtful about its accuracy and they felt less assured. These results suggest that biased appraisals might be an adaptive response to consequential
health feedback. Theoretical and practical accounts of this response pattern will
be discussed.
Participants were presented with hypothetical information about their risk of
Deep Vein Thrombosis (DVT) in a between-participants design. The low
(4/100,000) and high (30/100,000) absolute risks were the genuine chances of
experiencing DVT for those with or without a common protein deficiency. In
two conditions it was possible also to provide the genuine average risk
(5/100,000). Thus in four of the six conditions the numbers were genuine.
The risks were presented to participants as cases per 100,000 and as percentages.
Comparative risk information did not affect disturbance, whereas absolute
information did (in the US sample). However, perceptions of risk for the
average other did predict disturbance in the US sample. Overall, the balance
of evidence suggests people do respond primarily to absolute risk information. Discussion will explore reasons why Klein’s findings may differ from
these and others we have obtained and the theoretical and practical implications of the findings to date.
WOMEN FOR AN ECOLOGICAL LIFE-STYLE
FINDING MEANING AND ADJUSTMENT TO CANCER
Stefania Borgo
Center for Research in Psychotherapy, Rome - Italy
Nihal E. Mohamed
Free University Berlin, Germany
There is a considerable amount of research concerning the relationship between
stress, coping and general adjustment in cancer patients. However, a few studies focused on search for meaning and adjusting to cancer. According to the literature, search for meaning reflects both the pursuit for the “silver lining” of
adversities (Schwarzer & Knoll, 2001), that is the ability to focus on the positive, and making sense of the event by attributing them to specific factors
(Taylor, 1998).
Environmental problems related to human health and to the integrity of the
ecosystems are a growing concern at the local and the general level. A change
towards an ecological life-style is needed at short term.
What can the role of women in this change be?
Method: several surveys in different parts of Italy have been conducted to evaluate environmental perception and ecologically relevant behaviours, at the
individual and at the community level, in adults and adolescents. In some cases
it was also possible to determine the actual level of pollution.
The aim of the present study was to analyzing patients’ own search for meaning and to investigate its associations with depression, quality of life, pain, and
impairment due to illness.
The search for meaning was measured by a 7-item attribution scale (e.g., the
cause of my illness is my behavior.) and a 7-item benefit finding scale (Taubert,
2003). The attribution scale, a depression scale (CSD-D; Radloff, 1977), a
quality of life scale (EORTC-QLO-C30; Aaronson et al., 1993), and 3 visual
analogue scales to assess patients’ subjective health were applied in all assessments.
Results of 3 major studies (~ 4 thousand ss.): General:
- Perception of environmental risks appears related to the actual risks.
- Psychological variables seem to have a strong influence.
Gender-related:
- Women have a more accurate perception of air pollution, but not related to
protective actions unless non smokers.
- Women report to adopt significantly more safeguarding and less risky behaviours. The same is true for more educated subjects.
- This difference in protective and risky attitude towards environmental hazards
is already present in adolescents.
The sample consisted of 150 cancer patients (40% women), with mean age 63
years (SD=10.7, range=19-86).
Data analyses revealed that reports of benefits were high among cancer
patients.. Attributions made to fate were the most prevalent, whereas attributing cancer to character occurred least frequently.
Results also indicated that search for meaning is associated with higher level of
quality of life, lower levels of depression and exhaustion at one year post-surgery.
These results highlight the role of the search for meaning on adjustment.
Conclusions: Ecological life-style does not seem to be an integrated pattern.
Nevertheless, women can have a key role practising (management of the house,
children’s care) many ecologically relevant behaviours and teaching them to
the young generations. Women can be the target of ecological campaigns.
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PREDICTORS OF ADJUSTMENT TO BREAST CANCER:
A STRUCTURAL EQUATION MODEL
KARVELI Spyridoula, ANAGNOSTOPOULOS Fotios,
POTAMIANOS Grigorios
PANTEION UNIVERSITY
INTRODUCTION: The purpose of this study was to investigate the predictors of psychological adjustment in women with breast cancer.
METHODS: The sample consisted of 110 women with breast cancer, attending a private clinic for follow-up examinations. Participants completed a series
of medical, demographic and psychological instruments, the latter including
the Mental Adjustment to Cancer scale, Acceptance of Illness scale, Rosenberg
Self-Esteem scale and the Life Orientation test. Adjustment was assessed using
a 3-item scale, reflecting readiness to return to social and work activities, certainty that everything will run all right and closeness between expectations
about the course of the disease and reality. Structural Equation Modeling was
used to examine the impacts and relationships between predictors and latent
dependent outcome variables (adjustment).
RESULTS: The hybrid model revealed that a dysfunctional coping style characterized by hopelessness/helplessness, anxious preoccupation, fatalism, loss
of control and counter-fighting spirit, negatively affected adjustment. Higher
adjustment to illness was predicted by a sense of confidence in the self and the
personal resources and a sense of control over disease course. Low acceptance
of the illness predicted lower adjustment to the illness. The indices of Goodness
of Fit of the structural model were satisfactory (GFI=0.915, SRMR=0.061).
DISCUSSION: The findings of the study may offer useful information for clinicians concerning the design and implementation of interventions aimed at
improving patients’ coping efforts and adjustment to illness. Cognitive-behavioural interventions, aiming at the modification of dysfunctional coping styles
and establishment of problem-solving skills, are considered to have a beneficial effect on adjustment.
THE ROLE OF INTRUSIVE THOUGHTS AND GLOBAL
MEANING IN THE MENTAL HEALTH OF WOMEN WITH
BREAST CANCER
Kolokotroni Ph. , Anagnostopoulos Ph. , Christopoulou A.
University of Athens, Panteion University
Cancer diagnosis and treatment are often accompanied by psychological, existential and social crisis. The purpose of this study was to examine the way
intrusive thoughts, emotional expressivity and global meaning influence the
mental health of women with breast cancer.
Method and Measures: The sample consisted of 150 women with breast cancer, who had completed cancer treatment before participating in the study.
Their mean age was 58.49. The majority of them had been diagnosed with stage
0, I and II (94.9%) the last 5 years. We met the participants at a Public Cancer
Hospital, which they visited for the annual, programmed follow up. The Impact
of Event Scale (Horowitz, 1979) was used to assess intrusive thoughts, the
Emotional Expressivity Scale (Kring, 1994) to assess Emotional Expressivity,
the Life Attitude Profile (Reker, 1992) to assess global meaning, the MiniMental Adjustment to Cancer (Watson, 1994) to assess the psychological
adjustment styles and the Perceived Stress Scale (Cohen, 1983) to assess the
appraised stress. To assess mental health was used the SF-36 Scale (Ware,
1992).
Results: Multiple regression analyses showed that intrusive thoughts (Beta= 0.437, p<0.001) and global meaning (Beta=-0.405, p<0,001) significantly predicted mental health status. These results were also confirmed by using structural equation models. Specifically, women, who were overwhelmed by intrusive thoughts, were found to have poor adjustment and mental health. On the
contrary, women, who had a strong sense of global meaning mentioned to have
achieved better psychosocial adjustment and mental health. This model
explained the 44% of the total variance of mental health.
Conclusions: Psychotherapeutic interventions of existential orientation can be
planned and applied to help breast cancer patients to confront the psychological and existential crisis.
THE CONTRIBUTION OF PRIOR INTERPERSONAL TRAUMA AND LOSS OF RESOURCES TO TRAUMATIC STRESS
SYMPTOMS AMONG WOMEN WITH CANCER.
MaETA-ANALYSIS OF THE EFFECTS OF PSYCHOSOCIAL
INTERVENTIONS ON SURVIVAL TIME AND MORTALITY
IN CANCER PATIENTS
Evangelia Banou
GEIR SMEDSLUND* and GERD INGER RINGDAL
Department for Social Services Research, Directorate for Health and Social
Affairs, Oslo, Norway
Aim: Recent research suggests that development of trauma symtpoms in
women with cancer is not uncommon. Several studies have delineated that precancer traumatic history is associated with higher levels of posttraumatic stress
disorder (PTSD) symptomatology. However, research on this area is sparse.
The goal of the current study was to examine a theoretical model for predicting PTSD in women with cancer.
Hypotheses: We hypothesized that adult victimization and recent loss of
resources would mediate the relationship of childhood maltreatment and
PTSD.
Methods: Participants were fifty adult females with breast, gynegological or
other cancer seeking treatment at a hospital in a Midwestern city in US. They
were assessed for childhood sexual and physical abuse, adult sexual and physical abuse, recent loss of resources and current PTSD (both abuse and cancerrelated).
Results: Results indicated that childhood maltreament demonstrated direct and
indirect associations with current PTSD. Women with a history of childhood
maltreatment had higher levels of loss of resources, adult victimization and
traumatic stress symptoms.
Conclusions: The findings of this study supported the mediatonal role of adult
victimization and recent loss of resources in the relationship of childhood maltreatment and PTSD in women diagnosed and treated for cancer. Implications
of the findings for the development of interventions as well as the limitations
of this study are discussed.
58
The main aims of this study were to estimate effects of psychosocial interventions on survival time and mortality in cancer patients, and to provide an
overview of methodological aspects of the published studies. Methods:
Electronic searches, manual searches of reference lists from review articles and
retrieved papers were performed. Two coders independently coded study, subject, treatment, and outcome characteristics of the studies meeting selection criteria.
Results: Fifteen papers reporting results from 16 intervention studies were
retrieved. A standardized mean difference between a treatment and a control
group (i.e., an effect size value) was calculated. The studies were published
between 1980 and 2001 and were based on data obtained from 2,763 subjects.
Effect sizes were highly heterogeneous, but only two of the 16 effect sizes were
negative (range: d = -0.37- d = 1.65). The mean weighted d was 0.33 (95% CI
= 0.25-0.41). Interventions using individual treatment (n = 6) were more than
twice as effective (d = 0.54, 95% CI = 0.38-0.70) as interventions using group
treatment (n = 8, d = 0.22, 95% CI 0.08-0.36). For treatment of breast cancer
(n=8), the effect size was 0.31 (0.21-0.42). Conclusion: Because of the low
number of studies, it was not feasible to examine effects of specific types of
interventions. The results vary greatly, but they are in accordance with the
hypothesis that psychosocial interventions have a moderate life-prolonging
effect.
Oral
PERCEPTION OF HYPOTHETICAL RISK OF CARDIAC
EVENTS: ABSOLUTE VERSUS RELATIVE DIFFERENCES
BETWEEN PERSONAL AND SOCIAL COMPARISON RISK
LEVELS
WHICH FACTORS MOST INFLUENCE QUALITY OF LIFE
IN CARDIAC PATIENTS: PHYSICAL, SOCIAL OR
PSYCHOLOGICAL?
Stefan Hoefer 1, Lena Ring 1, Werner Benzer 2 and Stephan Doering 3
D Mason (a), SR Sutton (a), TM Marteau (b)
(a) University of Cambridge, (b) King’s College London
1Department
of Psychology, Health Services Research Centre, Royal College of
Surgeons in Ireland
2Department of Cardiology, Academic Hospital of Feldkirch, Austria
3Department of Medical Psychology and Psychotherapy, University of Innsbruck,
Austria
We describe the development of a web-based experimental study examining the
contribution of relative versus absolute differences between hypothetical personal and social comparison risk estimates for cardiac events. When a person
responds to discrepancies between hypothetical risk estimates for himself or
herself and for the average person, it is not clear whether they primarily attend
to the absolute difference between the point estimates, or to their ratio.
Health-related quality of life (HRQL) is increasingly used in health care as an accepted measure for treatment evaluation in patients with coronary heart disease (CHD).
Although significant differences in HRQL between different treatment methods can
be found, the explained variance by them is often low.
This work is in progress and we have so far recruited 120 participants via the
web. Participants are presented with different levels of hypothetical personal
and comparison risk and asked to compare their personal risk with the comparison risk. The groups form two parallel factorials where (a) absolute differences between risk levels are controlled at different levels of personal risk; and
(b) relative differences are controlled.
A large study was conducted to determine which factors from a biological-psychological-social model predict HRQL after medical or invasive cardiovascular interventions, and which accounts most of the unexplained variance between treatment methods. The aim of the secondary analysis presented here is to assess the influence of
anxiety, depression and social support on HRQL and its change over time.
In preliminary analyses we have found an interaction between level of personal risk and absolute difference between risk levels, but no interaction between
level of personal risk and relative difference between risk levels. Participants
so far appear to be responding primarily to relative differences between risk
levels.
In a multicentre study, 465 patients (68% male) were recruited at baseline before
angiography. All patients had acute angina and angiographically documented CHD.
Common treatments like ongoing medication, percutaneous coronary intervention
(PCI) and coronary artery bypass grafting (CABG) were evaluated in terms of HRQL
Following intention to treat, 44% (205) were treated with appropriate medication, in
addition 24% (111) were also treated with either PCI or CABG 149 (32%).
We expect eventually to recruit 400-600 participants. If our preliminary analyses are supported we will suggest that when patients are presented with risk
information, the information should stress the relative difference between a
patient’s risk estimate and population risk. We will discuss some of the benefits that use of web-based delivery afforded, and some of the disbenefits that
may have been avoided had more traditional delivery media been employed.
Patients received a self-adminstered battery of questionnaires including the Short
Form-36, the MacNew Heart Disease Questionnaire, the Hospital Anxiety and
Depression Scale, the Stait and Trait Anxiety Inventory, a questionnaire to assess
social support and an illness coping behaviour questionnaire. A total of 349 patients
(75 %) completed the one month postal follow-up, and 311 (67%) completed the
three month follow-up. The one year follow-up is still ongoing. Results will be presented at the conference.
PSYCHOLOGICAL DISTRESS AND CORONARY HEART
DISEASE RISK
GENDER DIFFERENCES IN CROSS-SECTIONAL ASSOCIATIONS OF TYPE-D PERSONALITY AND CARDIOVASCULAR MORBIDITY IN THE HUNGARIAN POPULATION
F. Rasul, S.A. Stansfeld, C.L. Hart, C Gillis & G. Davey Smith
Department of Psychiatry, Queen Mary University of London School of
Medicine
1Maria Kopp, 1Árpád Skrabski, 1GYÖRGY PUREBL, 2Johan Denollet
1Institute of Behavioural Sciences, Semmelweis University, 2Department of
Psychology and Health, Tilburg University
Background: The aim of this study is to examine the association between psychological distress and CHD using hospital admissions data and secondly to
examine if it is explained by existing illness.
Methods: The associations between psychological distress and CHD were
evaluated in a prospective cohort study of 6,920 men and women aged 45-64
years. Psychological distress was assessed at baseline (1972) using the General
Health Questionnaire (GHQ). CHD morbidity (ICD codes 410-414) data were
collected from coded hospital admissions to end of 1995. The main outcome
measures were 5, 10 year CHD incidence. The association between psychological distress and CHD risk was assessed using proportional hazards modelling,
adjusting for age, then socio-demographic and CHD risk factors, and additionally for existing physical illness.
Results: Five year CHD risk in distressed men compared to non-distressed
men was 2.15 (95% confidence interval [CI], 1.4-3.3) in age adjusted analysis,
2.43 (95% CI, 1.5-3.9) with socio-demographic, CHD risk factor adjustment,
and 1.95 (95% CI 1.16-3.3) with additional adjustment for existing illness.
Psychological distress was unrelated to 5-year CHD risk in women. In further
analysis, compared to healthy, non-distressed men, distressed physically ill
men had a greater risk of CHD than non-distressed physically ill men, a relative risk of 3.57 (95% CI 2.1-6.1) compared t0o 1.56 (95% CI 0.98-2.47).
Conclusion: Psychological distress is associated with an increased risk 5 year
CHD in men that is not explained by socio-demographic, traditional CHD risk
factors or existing illness. The presence of psychological distress amongst
physically ill men adds to increase CHD risk.
Objectives: The aim of this study was to analyse the gender differences in the
relationship between Type-D personality, i.e. high social inhibition (SI) and
negative affect (NA), and cardiovascular morbidity.
Methods: 12.570 people were interviewed in 2002, representing the Hungarian
population over the age of 18 according to age, sex and county. Type-D was
measured by the Hungarian-version of Type-D Personality Questionnaire.
Results: High NA was present in 19.5% of the subjects (men: 16.2%, women:
22.3%). However, high NA was significantly more prevalent in subjects with a
history of HY treatment: 31.5% (29.0% for men, 32.9% for women) or a history of MI:33.6% (men: 29.0%, women: 41.5%).
High SI was present in 23% of the subjects (men: 21.7%, women: 24.2%), but
significantly more so in HY subjects: 33.3% (men: 32,9%, women: 36.6%) and
MI subjects: 35.2% (men: 37.7%, women: 30.8%).
The prevalence rate of Type-D personality (combination of high NA and SI)
was 9.4% for the total population (men: 8.2%, women: 10.4%), respectively
15.7% in hypertensive subjects (men: 13.4%, women: 16.9%), and 14.0% in
MI subjects (men: 15.8%, women: 11.3%). After controlling for sex and age,
the risk of HY (OR) associated with Type-D was 1.94 (CI:1.45-2.59), the risk
of MI was 2.18 (CI:1.47-3.25).
Conclusion: Type-D was associated with a 2-fold increased risk of hypertension and myocardial infarction. Prevalence of Type-D was higher in the female
population. In the MI sample, however, social inhibition and Type-D were
more frequent among men, than among women.
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THE PERSONALITY VARIABLE SENSE OF COHERENCE
PREDICTS POST-TRAUMATIC STRESS DISORDER SYMPTOMS POST-MI
THE EFFECTS OF A FAMILY HISTORY OF CANCER ON
PSYCHOLOGICAL WELL-BEING, PERCEPTIONS OF CANCER RISKS AND INTENTIONS TOWARDS CANCER
SCREENING
Samantha O’Reilly, Ronan O’Carroll, Neil Grubb
University of St Andrews, School of Psychology (SMO and ROC);
Cardiovascular Research Unit, University of Edinburgh (NG)
Fichtinger A
Department of Psychology, University of Sussex, UK
Arts E, Falmer, Brighton, BN1 9SN
It has been reported that around 10% of myocardial infarction (MI) survivors
suffer from post-traumatic stress disorder (PTSD) in the year following MI.
Research suggests that psychological variables, and not biological markers of
MI severity, are critical determinants of psychological recovery following MI.
This paper describes a study that investigated the role of several psychological
variables in the development of PTSD symptoms in a large group of MI survivors. In particular, we were interested in the personality variable, Sense of
Coherence (SOC). One-hundred and eighteen male survivors of MI were
interviewed for symptoms of PTSD using a structured clinical interview.
Participants also completed self-report questionnaires that assessed PTSD
symptoms, social support, awareness of MI during the event, negative affectivity (NA) and SOC. Sixteen (13.6%) men reported sufficient symptoms to warrant diagnoses of PTSD according to the self-report questionnaire. When
symptoms were assessed by clinical interview, four (3.4%) men fulfilled DSMIV diagnostic criteria for PTSD. Hierarchical regression analysis was used to
determine the best predictors of PTSD symptoms. Age, awareness of MI,
social support and NA combined explained 36.9% of the variance in PTSD
symptoms. Sense of coherence contributed an additional 3.2%, for a total
explained variance of 40.1%. However, only the effects of SOC and NA were
significant. This study provides further evidence in support of the ability of
individuals who are high in SOC to cope with significant levels of adversity
and to remain mentally well.
Aim: To examine the contribution of a family history of cancer to perceptions
of cancer risks, general distress, cancer-specific worry, beliefs about cancer and
intentions towards screening behaviour in a non-clinical sample, where cancer
cues were not particularly salient.
Method: A cross-sectional survey design was used. The sample consisted of
213 participants: 134 reporting a family history of cancer (FHist) and 79 reporting no family history of cancer (NoFH). Participants completed a questionnaire
on general distress (GHQ-12), cancer specific worry, perceived cancer risks,
cognitions towards cancer screening, and demographic information.
Results: Multivariate analysis of variance revealed significant differences in
perceived cancer risk between groups. FHist participants had significantly
greater perceptions of personal cancer risk. Both groups perceived themselves
at a lower risk of developing cancer than the risks that they reported as being
faced by the general population. Although no differences between groups in
general distress scores were found, participants with a cancer history in their
immediate family (i.e. mother, father, siblings) were more worried about getting cancer than were other participants. Furthermore, hierarchical multiple
regression analysis showed that FHist and cancer specific worry added significantly to the amount of variance in reported intentions to attend cancer screening already explained by TPB constructs.
Conclusions: The results suggest that knowledge of a family history of cancer
is an influential factor in individuals’ risk perceptions, emotional wellbeing and
screening intentions. Future studies should include an assessment of subjective
cancer experiences in one’s family and investigate its role as a potential additional stressor that may further our understanding of potential causes of distress
and cancer screening behaviour in this population.
INVERSE RELATIONSHIPS BETWEEN RISK-TAKING
BEHAVIOUR AND RISK PERCEPTIONS.
ACCEPTABILITY, KNOWLEDGE AND WOMEN’S EXPERIENCE OF OPPORTUNISTIC SCREENING FOR CHLAMYDIA
TRACHOMATIS INFECTION
Stephen Brown
Department of Psychology, University of Central Lancashire
Dr. Lesley McMillan & Prof. Margaret Reid
University of Sussex & University of Glasgow
Research has suggested that risk-taking has a negative influence on the processing of risk information. However, risk-takers show higher risk perceptions than non-risk takers. This paradox might be resolved by removing the
confounding effects of risk takers’ increased exposure to risk, that is a component of traditional risk perception measures. A longitudinal survey was
administered to a community sample of 255 motorists to examine the extent
to which perceptions of personal risk in hypothetical speeding situations were
predicted by earlier self-reported speeding behaviour. Heirarchical regression
analyses, controlling for demographics and T1 risk perceptions, showed that
T1 speeding and T1-T2 speeding change both inversely predicted T2 risk perceptions 14 weeks later. Although multivariate effect sizes were relatively
small, the negative correlation between risk-taking behaviour and risk perceptions suggests that successive increments in risk-taking behaviour will lead to
progressively lower increases in personal risk perception. Possible foundations and implications of this effect are discussed.
Chlamydia trachomatis (CT) is the most common, curable, sexually transmitted infection in the UK. Untreated infection may have serious implications for
both men and women, and for women are particularly serious given CT is
thought to be the main preventable cause of pelvic inflammatory disease, a
major risk factor for infertility, ectopic pregnancy and miscarriage. Young sexually active people under 25 have the highest rates of infection. Previous
research has reported rates of infection amongst women ranging from 5%-16%.
This study is about women’s willingness to be tested for, knowledge about, and
the experience of testing for, CT. The research involved 523 women opportunistically screened whilst attending gynaecology clinics in two major city
hospitals in Scotland. Data collection involved self-complete questionnaires
analysed quantitatively. The study demonstrated a high first level knowledge
about CT although with the increasing sophistication of questions, knowledge
levels dropped substantially. The study found high levels of acceptance of testing, and low levels of reported anxiety and embarrassment. The small sample
of women testing positive reported high levels of anxiety about the result and
communicating it to others.
There has been considerable interest in beginning a national screening programme. Testing has beneficial effects; it identifies asymptomatic individuals
and allows them to access treatment, thus averting the sequalae listed above.
Success of screening programmes depends upon their acceptability to the populations involved. The research suggests a national screening programme
would be acceptable to women, but given the psychosocial impact, should
include further support for those testing positive.
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WHAT DRIVES RISK BEHAVIOUR CHANGE IN HIV – CAN
OPTIMISTIC MOOD ACCOUNT FOR CHANGES SEEN?
PROF L SHERR*, PROF J ELFORD+, G BOLDING +
Royal Free and University College Medical School, +City University
London
Objective:- To explore changes in
HIV sexual risk behaviour
over time and question the role of optimism about new Treatments as a driver
of such change. A series of questions are raised. Are gay men optimistic in
the light of new treatments? Has risk behaviour changed over time? Is there
an association between risk and optimism? Does the pattern differ between
optimistic and non optimistic men?
Methods:- 5 year annual survey data from gay men (HIV+ve, HIV-ve and
untested for HIV) in 1998-2002 (n=4,240). Optimism around new treatments
was measured according to treatment optimism and reduced infectiousness
optimism.
Results:- Over time there has been a significant rise in HIV sexual risk exposure in all three groups (p<.01) representing close on a doubling of risk behaviour over 5 years. Optimism levels were generally low. HIV+ve men were
significantly more likely to express optimism around new treatments than -ve
or untested. In cross sectional analysis optimistic HIV +ve and -ve men were
significantly more likely to record risk behaviour than non optimistic men.
However, when comparisons were made over time, using multivariate analysis,
for both HIV positive and negative men, year of survey and HIV optimism
were independently associated with high risk behaviour (p<0.01) with no significant interaction (interaction term p>0.1).
Conclusion:- Thus increases in sexual risk behaviour were found in both the
optimistic and the non optimistic and cannot be seen as the driver of risk.
Clearly other factors need to be considered.
HOW COMMUNITY-LIVING ELDERLY TALK ABOUT
FALLS: NEW PERSPECTIVES ON FEAR OF FALLING
(FOF) AND ITS EVALUATION
Chantal Piot-Ziegler and Thérèse Cuttelod-Brauchli
University of Lausanne, Institute of Psychology, Health Psychology
This study explored how 47 community-living fallers (m = 81.9 years, s = 6.6)
talk about falling through semi-structured interviews. Qualitative analysis was
performed, and four levels of FOF defined through physical, psychological and
social consequences: No Fear (NF), Moderate (MF), Constant (CF) and Intense
Fear (IF).
No links were found between either what caused falls or the emotions accompanying them and the level of FOF. A negative correlation was found between
the seriousness of the falls’ consequences and FOF (r = -.41), and no correlation between the time of the last fall and the level of fear (r = -.07).
The environmental situations found in other FOF evaluations (take a bath or
shower, climb up stairs) were also present in the interviews, but did not allow
any evaluation of the level of FOF, whereas other situations (fear of bad weather, differences in the pavement level) allowed a more sensitive discrimination.
In the first level NF, these situations did not lead to any adaptation of the elderly. In the second level MF, they forced the elderly into cognitive adaptation
(being more careful, need to anticipate the difficulties). In the third level CF,
they induced postural and behavioural modifications (looking down, slowing
down), which were associated in previous research with recurrent falls. In the
last level IF, most of the daily activities are systematically abandoned and
therefore cannot be used as a basis for evaluation.
These findings open new perspectives in the understanding of FOF, leading to
innovative paths for rehabilitation.
LAY THEORIES OF HEALTHY INDIVIDUALS ABOUT CANCER
AND MYOCARDIAL INFARCTION – A TRANSCULTURAL
COMPARISON
Fritz A. Muthny, Isaac Bermejo
Dept. of Medical Psychology, University of Muenster, Germany
There is a general consensus that subjective theories of illness have some influence
on patients’ compliance as well as on the use and the efficacy of medical treatment.
While it is generally assumed that lay theories on health and illness differ cross-culturally there are still hardly any empirical findings regarding the extent of these differences nor are there sufficient recommendations regarding the behavioural adaptations necessary in the provision and design of medical treatment.
Therefore two studies were carried out: Study one focused on possible impacts of
immigration on lay theories, including three ethnic groups: Germans in Germany,
Spaniards in Spain, and Spanish immigrants of the first generation in Germany (n
= 46 subjects in each group, the groups matched according to age, sex and education). The results show some significant differences between Spaniards and
Germans: Spaniards report more external attributions and control beliefs.
Compared to Germans they also report stronger beliefs on the efficacy of medical
treatment and more confidence that cancer and myocardial infarction could be prevented. Regarding the specific concepts about cancer and myocardial infarction
there were no significant differences of the lay theories between the three ethnical
groups. A psychosocial concept of illness is dominant for both diseases, but more
pronounced for myocardial infarction (main causes: unfavourable habits, job
strains, everyday-stress and family strain). All three ethnic groups consider their
knowledge about cancer and myocardial infarction to be limited. Moreover, the
three groups report equally high estimates as to the life threatening character of
both diseases.
In a second study different European cultures were compared with respect to their
corresponding views on health and illness in the Spanish, Greek, Norwegian and
German speaking realm (with respect to attributional processes, internal-external
locus of control and patients’ expectations of treatment efficacy).
Finally, it will be discussed what possible implications these cultural differences
might have for the German and European health system, especially with regard to
medical treatment programmes as well as preventive measures in an increasingly
multicultural society.
SOCIAL AND SEXUAL NETWORKS AS HEALTH
PROMOTING STRUCTURES
J. Grierson, A.M. A. Smith, M. Pitts
Australian Research Centre in Sex, Health and Society, La Trobe University
Objectives: The Victorian Networks Study (VINES) is the first Australian
study to critically examine the mechanisms through which structural and relational characteristics of gay men’s social and sexual networks influence their
sexual health practices.
Methodology and Findings: This is an interviewer administered questionnaire
study. The instrument covers characteristics of the participants’ social and sexual lives, sexual health practices and beliefs, and information seeking strategies. In addition, the instrument generates maps of the participants’ social and
sexual networks. Using a generative network sampling strategy, the study has
a direct sample of 213 participants and over 6000 namednetwork members.
Analysis includes not only that of individual characteristics, but relational and
structural analyses that give particular insight into the ways in which social
characteristics are related to both risk and protective practices. Networks can
be characterised not only by their size, but also by their constitution (for example in sexuality, gender, HIV status) and their structure (close knit, sparse or
disjointed). These characteristics are related to aspects of sexual and protective
practices, and to aspects of information flow and social influence.
Conclusions: Attention paid to the structural and relational qualities of social
and sexual networks of gay men provides particular insights into the mechanisms of social influence. This type of analysis also has high concordance well
with socially targeted health promotion activities.
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THE PROCESSING OF FEAR APPEALS ABOUT SMOKING
IN ADOLESCENTS
COMPUTER-FACILITATED SMOKING CESSATION SERVICES: HOW WELL DOES THE INTERNET DO IN THE
PROVISION OF FACILITATED SUPPORT?
Barth, Jürgen & Bengel, Jürgen
University of Freiburg, Institute of Psychology, Department of Rehabilitation
Psychology
ICA HOBBIS and SR SUTTON
University of Cambridge, Cambridge, UK
Fear appeals are often used in health education and many empirical studies and
theories described the persuasive effects thereof on individuals. In these studies the most relevant variable is the amount of attitude change in relation to the
induced or aroused fear. This study refers to the Elaboration Likelihood Model
(ELM) design in trying to get answers to the question of how adolescents
process fear appeals about smoking. The experimental design was realised in a
school setting using videos with a variation of induced fear (low vs. high) and
argument strength (low vs. high). Additionally, the sample was (additionally)
divided by a median split of aroused fear (low vs. high). More than 500 children ranging between the ages of 13-18 participated in the study and were interviewed by means of self-report questionnaires before and after watching an
audiovisual presentation containing persuasive messages. The independent
variables were the ability to recall contents of the film (recall), attitude toward
smoking (ATTS), and expected consequences of smoking (CONS).
Manipulation-check showed correct variation of independent variables in nonsmokers. For smoking children, the variation in of argument strength (low vs.
high) was showed no clear results. The results for smoking and non-smoking
children showed no significant difference in recall variable. For non-smoking
children there was no impact of aroused fear on ATTS and CONS. For smokers, aroused fear was associated with a greater amount of change in ATTS and
CONS. Induced fear has an effect on ATTS and CONS; additionally an interaction effect for CONS is shown: only in the high fear condition argument
strength has an effect on CONS. These results suggest different effects of fear
appeals in smoking prevention. In primary prevention, fear appeals are problematic because of the missing effect of induced fear on attitude change, while
in secondary prevention, fear appeals do have an effect on attitudes: Smokers
are more likely to process high fear messages in an elaborated way.
The Internet offers the possibility of wide-reaching easily accessible smoking
cessation services, with the added potential of creating tailored interventions
using personal assessment information. The number of generic sites currently
available is vast with variable content and reliability.
A review of web-based smoking cessation sites was conducted. Sites were
accessed via a generic search term, then links posted on these sites were
explored. English-language sites claiming to include tailoring or personalisation were targeted. Twenty-six sites met initial review criteria, of which twenty-one
were
reviewed
in
detail.
Sites
were
evaluated
according to the Health on the Net Foundation (HON) Code of Conduct for
content and for the degree of personalisation offered. Literature searches were
conducted for empirical evaluations of sites.
Results showed that the majority of sites are commerical, offering smoking cessation products, for example, NRT or self-help guides. A significant number
also offer generic education and advice to support quitting. Sites offering personalised tailoring of advice are minimal, with the degree and quality of personalisation varying significantly. Few sites currently meet HON criteria,
highlighting the potential for misleading and inaccurate information to be posted. Furthermore, there are few published evaluations of the effectiveness of
sites available.
In conclusion, whilst the Internet offers a rich and varied medium through
which smoking cessation services can be offered, currently this resource is
poorly used. The quality of services offered is also variable as the content and
reliability of advice is generally unmonitored. The development and evaluation of user-friendly, accurate, personalised services is encouraged.
SHORT AND LONG TERM EFFICACY OF A WEB-BASED
COMPUTER-TAILORED NUTRITION INTERVENTION
EFFECTS OF A SAFETY CAMPAIGN AMONGST
NORWEGIAN ADOLESCENTS
Anke Oenema & Johannes Brug
Department of Public Health, Erasmus MC, Rotterdam
Torbjorn Rundmo, Oddfrid Skorpe Skaug, Hroar Klempe, Hilde Iversen
Dept. of Psychology, Norwegian University of Science and Technology,
Trondheim, Norway
Diets high in saturated fat and low in fruit and vegetables are associated with
an increased risk for chronic diseases. Large population groups engage in
unhealthy diets. Therefore, there is a need for effective health education interventions that can reach large groups of people. Computer tailored health education is a promising strategy to motivate people to behaviour change. A study
was conducted evaluating the short and long-term efficacy of a web-based
computer-tailored nutrition education intervention. Respondents (N = 782)
were randomly allocated to a tailored intervention group, a generic nutrition
information group or a no information control group. Intake of fat, fruit and
vegetables, awareness and intention to change was measured at baseline and at
one and six-month’s follow-up. Post-test group differences were studied by
means of multiple linear regression analyses. Short-term effects of the computer-tailored intervention were found for awareness and intention to change fat
and vegetable intake, for actual intake of vegetables and for awareness, intention to change and intake of fruit. Long-term effects were found for the intention to change fat and vegetable intake.
It was concluded that the tailored intervention was effective in influencing the
intention to change fat, fruit and vegetable intake both on the short-term and on
the long-term, but that the effectiveness for changes in behaviour were limited.
In the future the tailored intervention should be extended by including strategies that more strongly induce the transition from intention to behaviour.
During the last few years the frequency of fatal injuries caused by traffic accidents has increased in Norway and this is a threat to public health. Young drivers and their passengers are high-risk groups and accidents amongst adolescents reduce the years of living more than most other threats to human health.
Therefore, the Norwegian Authorities of Public Roads prioritise to find measures aimed at reducing the number of health injuries caused by adolescent risk
taking in traffic. The present paper shows some results from an intervention
study aimed at evaluating the effects of measures implemented to promote adolescent safe driving behaviour.
The recipients were adolescents in a Norwegian county aged 18 years (n=182).
The intervention was made up of six groups. In four of the groups an attitude
campaign was implemented. Not all aspects of attitudes towards traffic safety
are important predictors of behaviour. Therefore, the countermeasures of the
campaign were implemented based on our results of multivariate analyses of
associations between safety attitudes and traffic behaviour based on two survey
materials amongst representative samples of the Norwegian public (see Iversen
and Rundmo, 2001a,b, 2002a-c). In the other groups behaviour modification
with positive reinforcement was applied. There was a change in self-report
behaviour, attitudes towards traffic safety and risk perception when the group
of respondents replying to the questionnaire before exposed to the measures
was compared to those who did so after.
Multivariate analyses also showed significant associations between risk perception, risk-taking attitudes and driving behaviour.
62
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THE EFFECTS OF A SCHOOL-BASED EDUCATION PROGRAM ON INTENTION TO REGISTER AN ORGAN DONATION PREFERENCE AMONG DUTCH HIGH SCHOOL ST
DENTS.
A. Reubsaet(1), H.W. van den Borne(1), J. Brug (1,2), M.D. Nijkamp(1),
J.P. van Hooff(3)
1) Maastricht University, (2) Erasmus Medical Centre, (3) Maastricht
University Hospital
Purpose: In 1998, a new organ donation registration scheme was implemented in the Netherlands in order to increase the number of potential donors and
to facilitate decisions and procedures concerning organ donation. However,
registration rate and registration choices failed to meet the expectations. In
order to promote registration of organ donation preferences among Dutch adolescents, a school-based education program (a video with group discussion, an
interactive computer program to provide tailored information, and a registration training) was developed to enable adolescents to make a well-considered
decision about organ donation.
Methods: The intervention was tested in a randomized experimental-control
group design with N=2965 students. Outcome measures were intention to register, negative outcome expectations, knowledge and self-efficacy related to the
registration procedure. Multi-level linear regression analyses were used to test
the impact of the intervention on the dependent variables.
Results: The results show that the education program resulted in an increase in
registration intention. Further, knowledge about organ donation and registration increased, negative outcome expectations decreased, and self-efficacy with
regard to completing a donor registration form increased significantly because
of the intervention. Adolescents evaluated the education program positively
and the majority thought that the information was interesting, credible, understandable, and useful.
Conclusion: It can be concluded that the school-based education program is
effective in enabling adolescents to make a well-considered decision about
organ donation. Because of the positive results and evaluation of the education
program, it will be implemented in Dutch schools for secondary and university preparation education.
SMOKING INITIATION: PLANNED BEHAVIOUR OR NOT?
Mudde, A.N.(1), Kremers, S.P.J.(2), De Vries, H.(2)
1) The Open University of the Netherlands, School of Psychology; (2)
University of Maastricht, Dept.of Health Education and Promotion
The present paper reports on a line of studies that has recently been conducted
on the process of adolescent smoking initiation. It is argued that adolescents
move through various distinct stages before they start smoking on a regular
basis. The motivational stage approach of the Stages of Change Construct and
the behavioural smoking initiation process have potential in describing and predicting adolescent smoking onset. However, new stage definitions within both
approaches proved to have additional value in predicting uptake of regular
smoking behaviour. Integration of the motivational and behavioural approach
originated in the construction of a new stage model of smoking initiation. This
model postulates that youngsters try smoking and experiment with cigarettes
without having concrete, rational, plans to smoke in the future. Decisions to
stop smoking will often be followed by repeated trial behaviour. When individuals commit themselves to nonsmoking, they become considerably less likely
to smoke in the future. When individuals make plans to start smoking in the
future, they become considerably more likely to actually initiate regular smoking behaviour. Implications for smoking prevention interventions are discussed. It is argued that dual-process models need to be applied in smoking prevention efforts, and hierarchies of effects should be taken into account.
COPING WITH HEALTH RELATED MESSAGES: THE
ROLE OF EDUCATIONAL LEVEL, PERCEIVED CONTROL
AND HEALTH SALIENCE.
Kraft, P. and Leganger, A.
University of Bergen, Norway
Health education messages are assumed to make people focus on their health
behaviour and create self-focused attention. The individual is to become aware
of behavioural standards and make a comparison between «is and «ought». A
perceived discrepancy between present and recommended behaviour may create a feeling of discomfort which people will possibly be motivated to reduce.
However, people can either close the gap by changing their behaviour or they
can avoid thinking about it by shifting attention away from themselves. The
two options are described as adaptive versus maladaptive ways of coping with
the situation. In the present paper we studied people’s response to printed
health information. In particular we wanted to study whether individual characteristics including educational level, health locus control (HLC), self-efficacy (SE), health consciousness and possible selves influenced the response to
health information. The sample consisted of 403 women aged 45 years.
Subjects were exposed to a selection of print media messages related to cancer
prevention. Coping was assessed by a measure of adaptive problem focused
coping (active and planning) and a scale representing non-adaptive/avoidance
coping (denial, mental and behavioural disengagement). Overall subjects
reported more use of adaptive than non-adaptive coping. Health consciousness,
SE and HLC (internal and powerful others) were positively related to adaptive
coping, while there was no relationship between adaptive coping and education. On the other hand, education was negatively related to non-adaptive coping. Furthermore, there was a positive relationship between non-adaptive coping and possible feared self and HLC (powerful others and chance).
PREDICTORS OF SMOKING CESSATION: ATTITUDES OR
PREFERENCES?
Wiggers LCW (a), Stalmeier PFM (b), Smets EMA (a), FJ Oort (a),
de Haes JCJM (a),Storm, MN (c), Vermeulen, H (c), Legemate DA (c).
Departments of Medical Psychology (a), and Surgery (c), Academic Medical
Center, Amsterdam; MTA and Radian (b), Nijmegen, The Netherlands.
Background: Social cognitive theories (i.e. ASE-model) propose that smoking
cessation can be accomplished by trying to change underlying cognitive determinants. Others have argued that people’s preferences for a health state can
also contribute to the prediction of behavior. Preferences constitute the degree
to which one is willing to give up a valuable good, in our study survival, in
exchange for a certain behavior (smoking or not smoking).
Objective: To investigate the impact of cognitive determinants and patients’
preferences on the prediction of smoking cessation.
Methods: Smoking outpatients (N=73, complete cases) with cardiovascular
disease were included. At baseline (T0), socio-demographic and clinical characteristics were measured. One week after inclusion (T1), ASE-cognitions
(attitudes (pros and cons), social support and self-efficacy) were assessed.
Preferences were assessed using a Time Trade Off (TTO) measure. For example: What do you prefer? 10 years survival without smoking or 9 years survival
with smoking? At T2 (8 weeks), we measured smoking cessation.
Analyses: Logistic regression analysis was used to compare models for the
explanation of smoking cessation by either ASE-cognitions (Model 1), or preferences (Model 2), or both (Model 3).
Results: A logistic regression model with ASE-cognitions and preferences
explained smoking cessation better than a model in which ASE-cognitions
were the only predictors (Model 1 vs. Model 3: CHISQ (1)=6.255, p=0.012).
Addition of ASE-cognitions to a model of preferences did not lead to improved
prediction (Model 2 vs. Model 3: CHISQ (4)=2.791, p=0.593). Percentages
correctly classified were 52.8, 67.1, and 68.1 for models 1, 2, and 3 respectively.
Conclusions: Preferences are strong predictors of smoking cessation
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DIABETES SELF-CARE: CULTURAL AND PSYCHOSOCIAL
PREDICTORS
Paddison, C., Hoera, J., Nikora, K., Faimalie, M., Vae’au, F., Flett, R., &
Alpass, F.
School of Psychology, Massey University, New Zealand
Introduction: Type 2 diabetes is a highly prevalent chronic illness that relies
primarily on self-management. While previous research has identified
psychological factors at an individual level that may play an important role in
determining self-care, the role of wider psychosocial factors requires further
attention. Exploration of cultural differences in self-management is also
necessary.
Aims: This study focused on two primary research questions: (a) What is the
role of family in determining diabetes self-management, and (b) What
influence does doctor-patient relationship have on diabetes self-management.
Specific attention was given to examining cultural differences within this
context.
Method: A questionnaire survey was the primary mode of data collection
(N=225). Three parallel studies were run to enable cross-cultural comparisons
among people with type 2 diabetes in New Zealand, (a) general population
(N=75), (b) Maori (N=75), (c) Pacific people (N=75).
Results: Research findings showed that relationships with family and doctor
are important determinants of diabetes self-care. Furthermore, results provide
evidence of cultural differences in predictors and patterns of self-management.
Conclusions: Results suggest socio-cultural factors can be important
determinants of self-care and health outcomes among people with a chronic
illness (Type 2 diabetes). While previous research has focused on factors within
the individual (e.g. illness and treatment representations) findings of the
present study suggest relationships outside the individual level may also be
important in determining self-management. This highlights the need for models
of health and illness behaviour to incorporate inter-individual determinants
(such as relationships with family and key health professionals) as predictors
of self-management.
DEVELOPMENT OF A TOOL TO ASSESS THE DELIVERY
OF A THEORY-BASED BEHAVIOUR CHANGE PROGRAMME
Wendy Hardeman, Susan Michie*, Toby Prevost, Ann Louise Kinmonth
Department of Public Health and Primary Care, University of Cambridge,
UK;
* Department of Psychology, University College London, UK
Study aims: This study aims to develop a tool to assess practitioners’ use of
behaviour change techniques in a theory-based programme (“ProActive”) to
promote physical activity among individuals at risk of Type 2 diabetes.
Problem addressed: Theory-based behaviour change programmes are increasingly delivered by health practitioners, but little is known about how faithful
practitioners are to psychological theories, and how best to assess intervention
fidelity. Unless such fidelity can be assured, it is not possible to attribute the
effectiveness of interventions to particular techniques or theoretical approaches.
Methods: Programme participants (30-50 years) were recruited via their parent with diabetes and consented to tape-recording of interactions. Tapes for
piloting checklists were selected without prior knowledge of participant and
practitioner. Checklists were based on intervention protocols, and developed
iteratively on the basis of independent scoring of transcripts, discussion of disagreements and subsequent revision of checklists.
Results: Practitioners’ use of specified behaviour change techniques was easier to score than appropriateness of omitting techniques. Assessment of practitioners’ use of non-specified techniques, and how participants responded to
techniques proved feasible. Individual techniques were grouped under selfmanagement skills that practitioners had been trained to use (e.g., goal setting,
action planning). Inter-rater reliability, strengths and limitations of this assessment approach will be discussed.
Conclusions: This study demonstrates the development of checklists to assess
practitioners’ use of behaviour change techniques derived from psychological
theory. The checklists will be used to assess to what extent practitioners can be
trained in theory-based techniques, based on interactions with 24 ProActive
participants.
WHY WOMEN USE COMPLEMENTARY AND ALTERNATIVE MEDICINE (CAM)?
CULTURE’ IN HEALTH PSYCHOLOGY: THE SIGNIFICANCE OF INTERDISCIPLINARITY
P. A. Jacobs
University of Plymouth
Chamberlain Kerry & Hepworth Julie
Sample: A cross-sectional study of a random sample of 1143 women aged 40
- 65 years registered with six health authorities in the UK with follow up interviews of 17 women.
Measures: Use, attitudes towards, and perceived efficacy of CAM and food
supplements, health and biographical measures, Global Quality of Life
(GQOL), current stress rating and health locus of control.
Results: Mean age of women 50.8 yr. SD, 6.6 yr. 529 (46.3%) of the women
had used vitamin and food supplements in the last 12 months. Mega-vitamins
had been used by 16.3% of the women. 322 (28%) of women had consulted a
CAM therapist in the last 12 months, most common therapies used were
acupuncture, homeopathy and reflexology. The majority of women (82%)
thought that CAM was an effective alternative to conventional medicine and
64% of women said they would be happy to use CAM in the future.
Multiple regression analysis suggest that who women who use CAM are typically better educated, believe their behaviour can effect their health, have a history of chronic health problems, and follow a special diet, i.e. vegetarianism.
Follow-up interviews suggest that women perceive CAM to be safe with no
side effects, that therapists are better communicators than medical practitioners, preferred a holistic approach to health, saw using CAM as taking control
of one’s own health problems and should be available without charge.
Typically, efficacy of CAM was evaluated using personal experience and recommendations by friends & family.
64
What constitutes “culture” in health psychology has important implications for
theory, research, and practice, not least because of the inherent power relations
between professional psychology and the representation of social groups marginalized due to race, gender, and/or class. Health psychology has relied on the
premise that culture is constituted by the observable characteristics of populations within specific geographical regions. In other words, an understanding of
culture with a big C has dominated whereby, as Ratner & Hui (2003) argue,
cross-cultural psychology is doomed by its very approach. Further, health psychology has failed to be informed by more sophisticated interpretations of culture in sociology and anthropology (Landrine & Klonoff, XXXX). Based on a
series of on-going debates about the constitution of culture, this research elaborates on the two key concepts of ‘micro-culture’ and ‘acculturation’ to illustrate the significance of interdisciplinary ideas for health psychology. In doing
this, it is the intention of the authors to disrupt the dominant use of culture and
progress an approach that engages both a more critical agenda and one in which
a reflexive methodology is imperative to practice.
Oral
DETERMINANTS OF MEDICAL CARE-SEEKING BEHAVIOUR OF TURKISH AND DUTCH INHABITANTS OF A
DEPRIVED AREA IN THE NETHERLANDS.
Plass, AMC; Timmermans, DRM; Van der Wal, Department of Social
Medicine,Institute for Research in Extramural Medicine
At present there is a need to change medical care-seeking behaviour because
of the increased demand for GP services. Especially consultations for minor
illnesses are a burden on a GP’s workload, and decreasing the number of consultations for minor illnesses could have significant implications. In particular in socially and economically deprived areas
GPs consider their workload to be too high. Consequently, it is of great interest to understand the medical care-seeking behaviour of patients with minor
illnesses living in deprived areas, which is the aim of the present study. 162
patients (amongst whom 72 Turkish and 70 Dutch) who frequently visit their
GP (more than 5 times a year), living in deprived areas of The Hague, were
interviewed. They were asked questions based on the Theory of Planned
Behavior. Also the GHPQ and the MLHC scale were assessed.
Nearly 60% of the variance in medical care-seeking behavior of the participants could be explained.
The number of different minor illnesses they reported that they had suffered
from mainly determined their medical care-seeking behaviour. In addition to
this care-seeking behavior of the Dutch participants was mainly determined by
perceived behavioural control
over care-seeking and attitude to self-care, while the care-seeking behavior of
the Turkish participants was determined by past general health perception and
their attitude towards care-seeking. In order to change care-seeking behaviour,
future interventions should focus on attitude and perceived behavioural control
both regarding care-seeking ?nd self-care.
The GHPQ and the MLHC scale proved to be reliable instruments that can be
applied to measure health, even of non-western subjects such as the Turkish
participants in this study.
A MULTIVARIATE INVESTIGATION OF ALCOHOL CONSUMPTION IN ENGLISH AND GREEK CULTURE.
Anna van Wersch, Eirini Vasilaki, Paul van Schaik
University of Teesside
The prevalence of depression is notable trend in Society. Several theories have
identified that culture, alcohol consumption and personality are correlated with
depression. The main aim of this study is to investigate whether or not culture
(England versus Greece), personality (neuroticism, extraversion, psychoticism)
and alcohol consumption (abstainers, light, moderate, heavy) have an effect on
depression.
A non-clinical sample of 200 participants (100 Greek and 100 English) aged 16
to 42 was used. Logistic regression showed that alcohol consumption was the
only significant predictor of gender, chi2(1) = 7.0798, p < 0.01. This supports
previous research showing that males consume more alcoholic drinks than
females. A further logistic regression showed that extraversion was the only
significant predictor of culture, chi2(1) = 11.3803, p < 0.0001, English being
more extravert than Greek; this might be related to the use of humour by the
English.
Multiple regression showed that significant predictors of depression were: neuroticism, t(196) = 8.536, p < 0.001; culture, t(196) = -2.182, p < 0.05; and psychoticism, t(196) = 2.045, p < 0.05, explaining 35% of variance. These results
confirm previous research highlighting the influence of neuroticism (Eysenck
& Eysenck, 1975; Saklofke et al.,1995) and culture (Kleinman & Good, 1985),
but contradict previous findings on psychoticism (William, 1990) and extraversion (del Barrio et al., 1997). In conclusion, both personality and culture were
predictive of depression, but not gender and alcohol consumption. However,
there is a difference in the level of alcohol consumption between males and
females.
ARE ATTITUDES TOWARD MENOPAUSE GENDER AND
CONTEXT SPECIFIC?
ATTITUDES OF HIGH-RISK ISRAELI MUSLIMS
TOWARDS ABORTION
Eleonora Bielawska-Batorowicz, Katarzyna Pilat
University of Lodz, Institute of Psychology
Neter, E., Volowolsky, Y., Borochovich, Z.
Ruppin College, Technion Institute of Technology
Menopause is usually analysed within the biomedical model, despite the fact
that it can also be conceptualised as a social and cultural phenomenon. The
influence of sociocultural paradigms on attitudes toward menopause was examined in the study that with the sample of Polish men and women replicated the
research undertaken earlier in the United States by L.Gannon and
B.Ekstrom.Study participants (n=360) were assigned to one of the three groups
that expressed their attitudes to menopause in different context.
One group described their attitudes toward three medical problems,including
menopause; a second group described their attitudes toward three life transitions, including menopause; a third group described their attitudes toward three
symbols of ageing, including menopause. In each context the same questionnaire was used that included positive, negative and neutral statements about the
event/problem. This questionnaire was based on original idea of the American
researchers, but was designed for the purpose of a present study. Positive and
negative sub-scales of the questionnaire for menopause were analysed for context, gender and age. The results indicate that the attitude toward menopause is
strongly related to gender and age - women and younger person express more
negative attitude. This attitude seems to be established as it has been similarly
negative despite the context in which menopause was embedded.
In the discussion the comparison between results of Polish and American samples will be drawn.
The attitudes of Muslims at-risk for cystic fibrosis (an incurable autosomal
recessive disorder) were measured.
The study was conducted on three groups: (1) a high-risk for cystic fibrosis
intervention group which received community genetic counseling; (2) a highrisk for cystic fibrosis control group and (3) a general control group. The last
two groups were exposed to minimal intervention consisting of a leaflet in
Arabic. Attitudes were measures two (control) or three times (intervention)
during a year.
The intervention addressed several domains, one of which was the religious tolerance towards abortion under particular circumstances.
This part was delivered by a Muslim clergyman. Subjects were asked under
which circumstances abortion should be allowed. They were given a list of
eight options and could mark more than one option. The options ranged from
‘never’ and ‘don’t know’ to social-economic circumstances and health problems (‘whenever the mother’s life is endangered’ or ‘when the baby is sick’)
and finally to parents’ attitudes towards the pregnancy (‘in case the woman is
interested’ ‘when the baby’s sex is discord with his parents’ wishes). Subjects
were also asked how they would personally respond in the case of a pregnancy with a child sick with CF.
The response options included consider favorably pregnancy termination, not
consider abortion, and don’t know. Subjects’ responses were coded into three
categories: conservative, ambivalent and liberal. The association of the
responses with demographical (age, sex, number of children, education, selfrated religiosity) and attitudinal (severity of disease, risk perception, subjective
norms) variables is reported. No change occurred in the responses of subjects
in the course of a year (control groups). Also no change was observed among
the experimental group who received an intervention.
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GENDER RELATED DIFFERENCES OF SELF HEALTH
ASSESSMENT AMONG SCHOOLCHILDREN
Antanas Gostautas, Laura Seibokaite
Habil. dr., Prof., Chief of Department; MA, Doctoral student
Vytautas Magnus University, Lithuania
The Lithuania State statistics show that adult males differ from females in the
rate of life expectancy, mortality rates and suicide.
These differences have no proper explanation.
This study is aimed to disclose whether self evaluated subjective health status
indicators differ among boys and girls from 5 through 12 grade and whether
these differences may be seen as early signs predisposing survival differences
among adults.
The total sample of 2811 schoolchildren in regional city of Lithuania was
investigated by using paper and pencil questionnaire.
Results indicated that more girls than boys were found having worse self health
evaluation (28,4 % versus 21,4 %), higher psychosocial stress (31,5% versus
20,9 %), and lowered mood (7,6 % versus 3,4 %). Also there was disclosed
clear expressed age depending increase of percentage of girls with worse self
health evaluation, psychosocial stress and lowered mood in senior grades. No
age related differences of self health assessment indicators were found among
boys. In conclusion, the findings confirmed presence of early starting differences in self health assessment among boys and girls. Also the findings indicated the differences in opposite direction to expected one being worse in the
girls group. These findings did not confirm the statement that early gender
related differences of self evaluated health may predispose the differences in
the rate of life expectancy, mortality rates and suicide among adult males and
females.
GENDER DIFFERENCES IN LAY BELIEFS ABOUT A.I.D.S.
AND RELATED PREVENTIVE BEHAVIOURS IN PORTUGAL: COMPARING THE HEALTH BELIEF MODEL AND
THE THEORY OF PLANNED BEHAVIOUR
Figueiras, M.J.; Alves N.C., Barracho, C.
I.S.E.I.T. - Instituto Piaget - Almada (Portugal)
Aims: The present study was undertaken to assess what are the main beliefs
concerning AIDS, in order to identify predictors of the adoption of preventive
behaviours in a sample of Portuguese healthy individuals. Two social cognition
models were used: The Health Belief Model (HBM) and the Theory of Planned
Behaviour (TPB), and in addition dispositional optimism and negative affectivity.
Method: The participants were 379 individuals (mean age 31.1) (67% female),
recruited at random from different working environments across the country.
They completed a self-administered questionnaire including measures of perceived vulnerability, seriousness, benefits, costs, attitudes, norms, intentions,
perceived control, self-efficacy, optimism and negative affect.
Results: The preliminary results indicate that there are gender differences in
the main beliefs concerning AIDS, as well as in the predictive amount of variance explained by the two models.
Conclusions: The implications of these results for health promotion will be
discussed.
DO FEAR APPEALS PROMOTE SAFER DRIVING? A TERROR MANAGEMENT THEORY PERSPECTIVE
MOTIVES AS PROXIMAL DETERMINANTS OF RISKIER
SEXUAL BEHAVIOUR
D. C. Jessop, I. P. Albery, and J. Rutter.
D. C. Jessop and J. Rutter are affiliated to the Department of Psychology,
University of Sussex , UK.
I. P. Albery is affiliated to the Division of Psychology, South Bank
University, UK
David K. Ingledew, Helen S. Cook, Dawn M. Gaff
University of Wales, Bangor
Reviews of the literature have questioned the effectiveness of fear appeals in
the area of health promotion. Nonetheless, high fear campaigns are often used
in attempts to persuade individuals to drive safely. The current study explored
whether such campaigns might actually promote risky driving behaviours in
some individuals. In accordance with Terror Management Theory, it was
hypothesised that individuals would respond to mortality-related information
about the possible consequences of risky driving by increasing their intentions
to take driving risks if they thought that driving had positive implications for
their self-esteem. Participants were 60 male students, aged 18-25, who had a
valid driving license and had been driving for at least one year. They were alternately allocated to either the mortality salient or the control condition.
Participants in the mortality salient condition read five facts about the possible
fatal consequences of risky driving, while those in the control condition read
five facts that were unrelated to either death or driving. Results revealed that
participants in the mortality salient condition were significantly more likely to
intend to take risks while driving. This effect was only apparent for those who
did not perceive driving to have negative implications for their self-esteem.
These results suggest that providing mortality-related information about risky
driving might actually increase intentions to drive in a risky manner for some
individuals. It is concluded, therefore, that health promotion campaigns which
make mortality salient could potentially have negative repercussions for health.
66
Purpose: Some previous research has suggested that motives are important
proximal determinants of health-influencing behaviours. In the present study, it
was hypothesised that motives for sexual behaviour would mediate the effects
of dispositional values and personality traits on riskier sexual behaviour.
Method: This was a cross-sectional questionnaire survey. The participants
were 102 males and 102 females, aged 19 to 25 years. They completed measures of values (Schwartz, 1992), personality (five-factor), motives for sexual
behaviour (Cooper, Shapiro, & Powers, 1998, rephrased so that individuals
could answer even if they had not yet had sex), and sexual behaviour (whether
they had ever had sex, and if they had, a brief index of the extent to which their
sexual behaviour may have put their health at risk). Data were analysed by
regression analysis.
Results: Those who had had sex, compared with those who had not, were characterised by higher hedonism and lower tradition values, higher extraversion,
and higher enhancement motive. Riskier behaviour was associated with higher
hedonism and lower benevolence values, lower conscientiousness, and lower
intimacy and higher enhancement and coping motives. Hierarchical analyses
were consistent with the effects of personality and values being mediated by
motives, except for a direct effect of extraversion on having had sex.
Conclusion: This study provides further evidence that motives can be viewed
as proximal determinants of health-influencing behaviours, mediating some of
the effects of more distal variables such as dispositional values and personality traits. For optimum impact, health promotion interventions should take
account of individuals’ motives.
Oral
YOUNG MEN’S BODY NARRATIVES AND HEALTH
Arto Tiihonen, PhD,
Researcher, Lahti Polytechnic, Finland
PLANNING AND IMPLEMENTATION OF A TYPE 2 DIABETES PREVENTION STUDY BASED ON CLINICAL TRIAL
EVIDENCE AND HEALTH PSYCHOLOGICAL THEORIES
ON BEHAVIOUR CHANGE
Pilvikki Absetz,1 Antti Uutela,1 Raisa Valve,2 Martti Talja,3 Mikael
Fogelholm,4 and Aulikki Nissinen1
In Finland men's life expectancy compared to women's is lowest in the western
world. Women study more than men, about 60% of the university students are
women. Occupations are still quite segregated. Men commit a great number of
suicides and they live dangerously. Women practise e.g. health sport (sport that
promotes health) nowadays more than men. These are hard statistics, but there
are numerous differences inside the genders, too. Narratives from young men's
meaningful body experiences in different sport subcultures describe also their
attitudes towards their body and health in general. Research data is based on
both collected narratives from young men, age 16-25, and also on cultural narratives e.g. from media. Study uses qualitative biographical methods and theoretical perspectives come from phenomenology and masculinity studies.
Qualitative research narrative describes and interprets micro level body experiences, the influence of masculine subcultures and macro level cultural meanings. Results show that those important body experiences - like winning an
important game/competition, injuries, joyful situations, feeling of able body,
positive social support - played a vital role in the construction of young men's
identity narratives. These deep episodes of life can be interpreted as thresholds
or initiations where young men negotiate their relation to gender (masculinity),
to themselves and also to their future health behaviour. E.g. some men prefer
dangerous life style, because their bodies learned to enjoy peak performances.
By telling and interpreting these normally hidden narratives there is also a possibility to make a change to young men's unhealthy ways of life.
1 National Public Health Institute, 2 Palmenia Centre for Research and
Continuing Education, University of Helsinki, 3 Päijät-Häme Hospital
District, 4 The UKK- Institute for Health Promotion Research
Translating behavioural science theories and theory-based methods into practical strategies in a way that will fit the environmental conditions and be feasible for implementation poses a real challenge for people working in the field of
public health promotion. In this paper, we present an effort to meet this challenge in a community-based life-style change programme to prevent type 2 diabetes. . The programme, implemented in the Finnish primary health care, is targeted at 50-65-year old men and women with a moderate or higher risk for type
2 diabetes. It is delivered as group counselling by trained nurses, consisting of
six structured sessions and related homework. In 2003, altogether 40 groups
will be functioning with over 400 participants. Using stage models as framework for programme planning, implementation and evaluation, the programme
development is described, emphasising the application of theories and theorybased methods. Goals for nutrition and physical activity are based on evidence
COMMUNICATION SKILLS: PROVIDING INFORMATION
TO WOMEN WITH BREAST CANCER
SELF-MANAGEMENT OF CHRONIC AND COMPLEX HEALTH
CONDITIONS: THE AUSTRALIAN EXPERIENCE
Liza Varvogli1, Ph.D. and Alta Paneras 2 Ph.D.(candidate)
1 Dept. of Psychology, Panteio University of Athens
2 Center for Counseling and Psychological Support, Aristotle University of
Thessaloniki, Greece
Dr Alexander Akritidis
City College, Thessaloniki
(affiliated institution of University of Sheffield)
Introduction
Women with cancer report a desire to be well informed. Effective communication, however involves a process of individually tailored explanation, problem solving and acknowledgment of the woman’s feelings, in addition to the
provision of information.
Psychosocial impact of breast cancer
Women with breast cancer face practical, emotional and psychological challenges, in addition to the difficulties resulting from their physical treatment.
Research shows that, although their psychological needs are significant, they
frequently go undetected or unmet. A comprehensive review of the psychosocial impact of breast cancer showed that 20-30% of women experience
disruption in their quality of life, including loss of role, changes in functional
ability and/or problems with social relationships, anxiety and depression.
Effective communication
Both patients and clinicians can benefit from improved communication which
enhances patient understanding and trust during the clinical interview,
increases compliance and satisfaction with treatment, improves emotional
health, patient education and reactions to potentially distressing procedures,
and reduces pain.
Clinicians can benefit from improved communication skills and more effective management of their stress and burnout in an oncological setting.
Effectiveness of communication skills training workshops
There is considerable evidence to support the effectiveness of communication
skills training in improving clinician confidence, self-awareness and a patient
centred approach. These studies show that basic interviewing and communication skills can be acquired.
Conclusion
The manner in which clinicians communicate with women with breast cancer
can have significant benefits for the woman and her family, including
improvements in psychological adjustment, decision-making, compliance
with treatment and satisfaction with care.
Coordinated care trials and self-management projects have been running for a
number of years in Australia and a number of lessons have been learnt in relation to system change, delivery of health care and consumer needs. Self-management is one such area of interest. The Coordinated Care Training Unit
(Flinders University of South Australia) were directly involved in running trials and developing processes and tools for chronic condition self-management.
A literature review and extensive consultation with consumers, health professionals, academics and the government, led to the development and trialling of
a self-management program for health professionals working in general practice and other settings. The program is based on six principles of self-management and is underpinned by the behaviour change model. There are many
effective interventions identified for and advocated in the program for consumers such as symptom action plans, information provision, care plans and
monitoring diaries. Health professionals are encouraged to utilise (as a part of
routine clinical care) a number of strategies to promote self-management in
consumers e.g., self-management assessment (Partners in Health Scale), collaborative problem definition and goal setting, and longitudinal care planning
involving a multidisciplinary team of health professionals.
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ENVIRONMENTAL INTERVENTIONS IN WORKSITE
CAFETERIAS AND SUPERMARKETS AIMED AT CHANGING DIETARY BEHAVIOUR
Ingrid Steenhuis
Open University, the Netherlands
High saturated fat intake is associated with an increased risk of coronary heart
disease, and also contributes to overweight. However, fat intake of the Dutch
population is still too high, as in many other countries. It is increasingly being
argued that educational interventions are not sufficient to achieve populationwide behavioral changes and that they should be supplemented by environmental interventions. Environmental interventions can be defined as strategies that
reduce barriers or increase opportunities for healthy choices, i.e by creating
more healthy choices, making them more accessible and require healthy
options to be available. However, it is still unclear how effective environmental interventions in fact are, and what their additional value is to educational
interventions.
Two studies into the effectiveness of environmental interventions will be presented. In the first study, an intervention comprising an enlargement of the
range of low-fat products available in worksite cafeterias was tested. In the second study, a labeling intervention for low fat products was tested in supermarkets. The design in both studies consisted of a randomized pretest-posttest
experimental control group design. Thirteen worksite cafeterias and thirteen
supermarkets participated in the studies. 1013 customers of worksite cafeterias
and 2203 customers of supermarkets were included. Total fat intake of
cutomers and behavioral determinants of eating less fat were measured by a
questionnaire. In worksite cafeterias, sales data were also collected. Multilevel
regression models were used for the analysis. The two experimental studies did
not show convincing evidence for the effectiveness of the environmental strategies. Recommendations for future research in this area wil be given
FATIGUE, HEALTH COMPLAINTS, AND QUALITY OF LIFE
IN DUTCH AND CROATIAN SARCOIDOSIS PATIENTS
Helen J. Michielsen, Jolanda De Vries, Marjolein Drent, Tatjana Pero -Golubi
1+2: Tilburg University, Tilburg, Department of Psychology and Health, 3:
Academic Hospital Maastricht, Maastricht, Department of Pulmonology, 4;
Klinika za plu ne bolesti “Jordanovac”, Zagreb
Aims: Sarcoidosis is an inflammatory disorder of unknown etiology, particularly situated in the lungs. In addition, rather non-specific symptoms such as
fatigue appear to be a major problem. The purpose is this study was to get
insight in the quality of life in Dutch and Croatian sarcoidosis patients, as well
as gender differences in their quality of life.
Methods: In the present study, participants were (i) approximately 75 Croatian
patients (study not finished yet) and (ii) 1046 Dutch patients (390 men, 617
women, 39 unknown; response 45%; median age range 45-49). All patients
completed a booklet of questionnaires, containing: demographic variables,
health complaints, fatigue (FAS; Michielsen, De Vries, Van Heck, Van de
Vijver, & Sijtsma, accepted) and quality of life (WHOQOL, WHOQOL group,
1995). stepwise regression analyses were performed. Age, gender, and time
since diagnosis were entered in block 1, while block 2 contained health complaints and fatigue. Quality of life was the dependent variable. The analyses
were performed for both pat
SCREENING AND COMMUNICATION IN COLORECTAL
FAMILIES
PREDICTORS OF DISCREPANCY IN RECALLING GENETIC CANCER RISK
Bowen Deborah J, Christensen, Catherine L, Meischke, Hendrika
Fred Hutchinson Cancer Research Center
Aro AR*, Absetz P*, Schreck M*, Poyhonen# M, Rautalahti M.
*National Public Health Institute, Finnish Cancer Society
Little is known about how family members communicate about
cancer: who family members talk to about cancer and how much they talk to
them. The application of this communication to understand the motivations
for screening can identify opportunities for intervention. Knowing this information can help family members understand and cope with their risks for cancer. We collected data from 50 pairs of family members, a cancer case and a
first-degree relative (FDR), from our Cancer Family Registry -colorectal cancer (CRC). Communication frequency was low, ranging from 3% to 50%,
depending on relative type. Mothers (46%) were the most frequent
relatives to receive communications, followed by siblings (37%). Case and
FDR communication frequency differed, with FDRs reporting more frequent
communication with other relatives. Most participants (80% of cases and 87%
of FDRs) named someone in the family as the Family Health Informant
(“someone who would feel comfortable communicating with other family
members about health issues and would know about health issues in your family”). The existence of communication in families predicted screening in
FDR’s, as did the case’s and the FDR’s concern about cancer. These data indicate that individuals do not necessarily communicate well with other family
members about CRC risk and that the existing patterns of communication can
influence important health behaviors. These data have important implications
for intervention in family settings to improve screening rates.
Our aim was to study predictors of discrepancy between notified genetic cancer risk and recalled risk. Predictors were assessed pre-counselling (T1), follow-ups were two (T2) and 12 weeks (T3) post-counselling. Subjects at T1
were 66 clients, who attended genetic counselling by the Finnish Cancer
Society (response rate 92%, 61 women, 5 men, all ethnic Finns). At T2 and T3,
there were 61 and 51 responders, respectively. Notified genetic cancer risk was
based on family history. Risk perception and recall were assessed in mailed
questionnaire. Data also included knowledge of cancer and genetics, perceptions, social support, mood (POMS), anxiety (STAI), optimism (LOT), illness
attitudes (IAS), and socio-demographic factors. Discriminative function analysis was used to differentiate respondents with accurate recall from under- and
over-estimators. At T2, 93% (n=27/29) of those with accurate recall, 100%
(n=22) of under-estimators, and 75% (n=4/5) of over-estimators were correctly classified by two linear functions (p= 0.007 and p=0.280). The best
discriminators were family history of cancer and the POMS dimensions depression, fatigue, confusion, and tension. At T3, 95% of those with accurate recall,
and 100% of both over- and under-estimators were correctly classified by two
functions (p=0.019 and p= 0.739). The best disciminators were knowledge,
optimism and social support. On short-term, emotional factors seem to explain
the discrepancy between notified and recalled genetic cancer risk, whereas, on
longer term, cognitive, personality, and social support factors become more
important.
Counselling sensitive to emotional factors is important at the early phases after
risk notification
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IMPACT OF GENETIC TESTING IN A LARGE FAMILY WITH HERITABLE PROTEIN C DEFICIENCY (IPCI: INTERNATIONAL PROTEIN C INVESTIGATION)
I.M. van Korlaar(1), C.Y. Vossen(2), F.R. Rosendaal(2), E.G. Bovill(3), S.
Naud(3), P.Callas(3), G. Long(3), J. Emmerich (4), L.Cameron(5) & A.A.
Kaptein(1)
(1) Unit of Psychology, Leiden University Medical Center, The
Netherlands, (2) Department of Clinical Epidemiology, Leiden University
Medical Center, The Netherlands, (3) University of Vermont, USA, (4)
University of Paris V, France, (5) University of Auckland, New Zealand
Background: The increasing availability of genetic testing for venous thrombosis risk has led to a growing need to assess the psychological consequences
of such testing. Protein C deficiency is a heritable coagulation disorder. People
with Protein C deficiency have a 50% chance of developing venous thrombosis. There are few studies assessing the impact of genetic testing in heritable
coagulation disorders.
Aim: The aim of this study was to investigate the impact of genetic testing
for protein C deficiency in a large family.
Method: Subjects were 116 adult family members of whom 44 (37.9%) were
protein C deficient, and 72 (62.1%) were never tested before or did not know
their genotype. All subjects filled out a scale measuring risk perception of getting thrombosis (2 items on a 7 point Likert scale, range 2-14, r = .90), a scale
measuring worry about throm-bosis (2 items on a 7 point Likert scale, range 214, r = .87), and scales measuring psychological distress, psychological benefits, and health benefits of genetic testing for protein C deficiency (4-6 items
each, range 0-6).
Results: All subjects perceived the psychological and health benefits of genetic testing as high, and perceived low distress. Subjects who scored higher on
worry (>7) also scored significantly higher on psychological distress (p<0.05).
Conclusion: In general, genetic testing for protein C deficiency is seen as beneficial. However, people who worry more, tend to have more psychological
distress from testing too. Health care givers should take these phenomena into
account in their clinical care.
GENETIC COUNSELING DURING PREGNANCY; CAUSES
OF A LESS APPROPRIATE TIMING
C.M. Aalfs (1), E.M.A. Smets (2), E.D. Mollema (1), J.C.J.M. de Haes (2),
N.J. Leschot (1)
(1) Department of Clinical Genetics and (2) Department of Medical
Psychology, Academic Medical Center
Background
Reproductive genetic counselling preferably takes place before conception.
However, about 10 to 20% of the women attending our department of clinical
genetics were pregnant already. The current study aimed to identify women’s
characteristics that affect the timing of genetic counselling.
Method
Consecutive pregnant (N=100) and non-pregnant (N=100) women visiting the
clinical genetics department completed a questionnaire immediately prior to
the consultation. The questionnaire asked for (a) background characteristics:
i.e. socio-demographic, obstetric and disease characteristics, (b) personal characteristics: i.e. knowledge of the risk factor involved, risk perception, worry,
child wish, attitudes towards abortion and participation in decision making, and
(c) reasons for the timing of counselling and questions to be addressed during
counselling.
Results
Preliminary univariate analyses showed pregnant women, as compared to nonpregnant women, to be more likely to be married or living together, to have a
higher level of education, to consider their prior children as healthy and to have
a second degree relative to be affected rather then themselves.
Non-pregnant women estimated the chance of getting a genetically affected
child as higher and they worried more. Furthermore, non-pregnant women
were less inclined to consider abortion as an option. There were no differences
between groups in knowledge, perceived severity of the risk factor, child wish
and desired participation in decision making.
Conclusion
Women who seek preconceptional genetic counselling differ from pregnant
women who seek counselling in their degree of worry but not in their knowledge.
CANCER GENETIC CONSULTATIONS: PSYCHOSOCIAL
FACTORS RELATED TO THE INFORMATION SEEKING
BEHAVIOR
SOCIO-CULTURAL DIFFERENCES IN DOCTOR-PATIENT
COMMUNICATION IN TEN EUROPEAN COUNTRIES.
Cypowyj Cathya 1,2 , Morin Michel 1,2, Eisinger Francois
1,3, Sobol Hagay 1,3,Chabal Franoise1, Julian-Reynier Claire1.
1 NIVEL
1)INSERM 2) Universitait d’Aix-Marseille1 ;
3)Institut Paoli-Calmettes ; 4)INSERM E9939.
Aims. In medical encounters, good doctor-patient communication is of utmost
importance in the health care process. The influence of doctor, patient and
organizational characteristics has been showed in many studies. Scarce studies
have indicated the importance of cultural characteristics on communication.
Cultural differences find their expression along important dimensions
(Hofstede 1991), as power distance and masculinity versus femininity. It was
studied how these dimensions were reflected in doctor-patient communication
and whether they agree with Hofstede’s context, i.e. multinational institutions.
Research questions. (1) What are the differences in doctor-patient communication between European countries in terms of power distance and masculinity vs femininity? (2) How can the differences be interpreted in terms of these
dimensions? (3) Do the findings agree with Hofstede’s findings?
Methods. Data was derived from the Eurocommunication Study I and II (1999,
2003). In total 307 general practitioners and 5820 patients from 10 Westernand Eastern-European countries participated in the study. Consultations were
videotaped and communication was assessed using Roter’s Interaction
Analysis System. T-tests and oneway analyses were performed.
Results. There were substantial socio-cultural differences between the ten
European countries Power distance was greater in Central- than WesternEuropean countries. Masculinity/ femininity also differed between the ten
countries. The reflection of the dimensions in communication considerably differed from Hofstede’s findings in the context of multinational institutions.
Conclusions. Power distance and masculinity vs femininity depend on context
and time.
No data are available on information seeking behavior (ISB) of women outside
the cancer genetic consultation when BRCA testing is considered. The objective of this study was to describe ISB for genetic testing complementary to the
genetic consultation and their related factors.
A prospective ongoing cohort study is including all women who attended at
one cancer genetic clinics in France after a BRCA1/2 analysis has been proposed. Closed questionnaires were administrated before and after the occurrence of the 2nd cancer genetic consultation. This consultation aims to confirm
the decision to be tested. The questionnaires contained scales to appraise psychosocial factors (such as: depression, coping, sociodemographic and medical
characteristics) and closed questions to ask women about their ISB.
Preliminary results were analysed (N=104). Prior to the second consultation,
36% of the women had actively looked for information on BRCA1/2 testing
compared to 23% afterwards. After multivariate adjustment by logistic regression, the before consultation information seeking behavior was related to higher satisfaction with the cancer genetic consultation occurring afterwards Oradj
(95%CI): 1.04(.99-1.08), with the certainty to be a gene carrier Oradj:3 (1-8).
Those who actively looked for complementary information were also more
often attending with a family member Oradj:5(2-14). The other tested variables
were not significant (p<0.05). These results highlight the fact that women who
actively seek for information on breast/ovarian cancer genetic testing differ
from those who do not, not only for their a priory beliefs but also for their satisfaction with counseling and for their social support.
A. van den Brink-Muinen, Ph.D. 1, L. Meeuwesen, Ph.D.2
(Netherlands institute for health services research)
2 Utrecht University, Dept. General Social Sciences
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IMPROVING DOCTORS’ COMMUNICATION SKILLS AND
PSYCHOSOCIAL BELIEFS IN PATIENT CARE IN ITALY,
PORTUGAL AND SPAIN - THE EXPERIENCE OF THE
SOUTHERN EUROPEAN PSYCHO-ONCOLOGY GROUP
STUDY. (*)
Luzia TRAVADO*; Cidalia VENTURA; Cristina MARTINS (Hospital S.
Jose, Portugal); Francisco GIL (Institut Catalan Oncologia, Spain);
Luigi GRASSI (University of Ferrara, Italy)
International Psycho-Oncology Society (IPOS);
Portuguese Academy of Psycho-Oncology
European Health Psychology Society (EHPS) in process
Introduction. Medical doctors in Italy, Portugal and Spain do not have formal
education in communication skills during their medical training. 60-70% of
psychological disorders among cancer patients go unrecognised deteriorating
their quality of life. Adequate doctor-patient communication is a critical factor
in cancer patients’ adaptation and quality of life. With the purpose of assessing
doctors’ difficulties in communication skills and addressing psychosocial
issues with their patients in our 3 countries we conducted a pilot study for its
assessment prior and after providing them specific designed training, as part of
a multicenter project by the Southern European Psycho-Oncology Group.
Methods. A total of 65 doctors/oncologists participated in this study for the 3
countries. Their communications skills were self-assessed through Peter
Maguire’s Self-Confidence in Interviewing Skills and Expected Outcomes of
Patient Communication Questionnaire, the Physician Belief Scale and the
Maslach Burnout Inventory, prior and after the training workshops
.Results and Discussion. The results for the 3 countries are presented and
compared, before and after the training, concerning general difficulties perceived by doctors’ in their communication skills (e.g., dealing with denial,
manage uncertainty, assess anxiety and depression, promoting patient-family
openness, breaking bad news), outcome expectations of patient communication
(e.g., too close to patients, workload unmanageable) and beliefs on psychosocial aspects of patient care. We discuss the need to provide further continuous
training in these areas for the doctors in our 3 countries.
(*) Project funded by the European Commission Health and Consumer
Protection -Commission on Cancer Agreement University of Ferrara, Italy
SI2.307317.2000CVG2-02
SATISFACTION OF PATIENTS ON DIALYSIS AND AFTER
RENAL TRANSPLANT WITH THE RENAL SERVICE AND
TREATMENT
Orr, Anne; Finn, Paul; Britton, Peter & Holmes, Michael
University of Teesside
Background: This study investigated satisfaction with the renal service and
treatment in ESRD patients, comparing age, year of transplant and kidney function level (where relevant).
Method: All patients attending a North East Renal Service who underwent kidney transplants between 1994 and 2000 were invited to take part. 122 successful and 15 unsuccessful transplantees plus 29 patients on dialysis agreed to participate. Each participant completed the Renal Service Satisfaction
Questionnaire (RSSQ) and Renal Treatment Satisfaction Questionnaire
(RTSQ). One-way ANOVA and Kruskal-Wallis tests were used.
Results: The successful transplantees had significantly higher total scores on
both questionnaires compared to the other two groups (p<.01). On the RTSQ,
the oldest group (over 60) were most satisfied (p<.05). Those successful transplantees with good kidney function were more satisfied (p<.01).
On the RSSQ, successful transplantees’ areas of greater satisfaction included
information, advice consistency, waiting times and staff accessibility (p<.01).
More recent transplantees (1999/2000) were more satisfied with information
and resource availability (p<.05). Older patients were more satisfied with waiting times and resource availability (p<.05). Those with poorest kidney function were more satisfied with staff accessibility (p<.01).
Discussion: Successfully transplanted patients, older patients and more recently transplanted patients were most satisfied.
70
EFFECTS OF PALLIATIVE CARE PROGRAMS ON THE
HEALTH RELATED QUALITY OF LIFE (HRQOL) IN FAMILY MEMBERS TO CANCER VICTIMS
Gerd Inger Ringdal PhD,* Kristen Ringdal PhD, Marit S. Jordhøy MD,
Marianne Ahlner-Elmqvist RN, Magnus Jannert PhD, Stein Kaasa PhD.
THE STUDY WAS APPROVED BY THE ETHICAL REVIEW COMMITTEE IN
MEDICAL RESEARCH, THE NORWEGIAN UNIVERSITY OF SCIENCE AND
TECHNOLOGY (NTNU), TRONDHEIM, NORWAY.
The main aim of this longitudinal intervention study was to compare the health
related quality of life (HRQOL) of family members to patients who participated in a program of palliative care (intervention family members) to those in
conventional care (control family members).
Methods and results: The HRQOL was measured by the short form (SF-36)
health survey questionnaire, including eight subscales. The longitudinal intervention study includes two sites: Trondheim, Norway, and Malmø, Sweden.
Our first hypothesis was that the HRQOL of the family members would deteriorate over time in the terminal phase and reach a low point a few months after
the death of the patients, for thereafter to gradually increase. This hypothesis
was fully supported by the trajectories for the five scales; role limitation due to
physical problems, vitality, social functioning, role limitation due to emotional
problems, and mental health, but only partially so for the remaining three
scales; physical functioning, bodily pain, and general health perception. From
a second hypothesis we expected the trajectories of the HRQOL scale scores
for the two groups to show an increasing difference over time in quality of life
in favour of the intervention group. This was the case for two of the scales: role
limitation due to emotional problems and mental health. Before we may reach
a definitive conclusion on the effects of palliative care programs on the
HRQOL in family members, we need further longitudinal intervention studies
with large samples.
PLACEBO EFFECTS AND PATIENT-PRACTITIONER
INTERACTIONS: A SYSTEMATIC REVIEW OF RANDOMISED CONTROLLED TRIALS
Zelda Di Blasi, Elaine Harkness, Edzard Ernst, Amanda Georgiou, Jos
Kleijnen
Deparment of Health Sciences, University of York (Zelda Di Blasi),
Department of Complementary Medicine, University of Exeter (Elaine
Harkness and Edzard Ernst), Nuffield Institute, University of Leeds (Amanda
Georgiou), Centre for Reviews and Dissemination (University of York)
Background
Throughout history, doctor-patient relationships have been acknowledged as
having an important therapeutic effect, irrespective of any prescribed drug or
treatment. We did a systematic review to determine whether there was any
empirical evidence to support this theory.
Methods
A comprehensive search strategy was developed to include 11 medical, psychological, and sociological electronic databases. Based on Leventhal’s SelfRegulatory theory, the type of non-treatment care given in each trial was categorised as cognitive or emotional. Cognitive care aims to influence patients’
expectations about the illness or the treatment, whereas emotional care refers
to the style of the consultation (eg. warm, empathic), and aims to reduce negative feelings such as anxiety and fear.
Results
Published in the Lancet, we identified 25 eligible randomised controlled trials.
Of these, 19 examined the effects of influencing patients’ expectations about
treatment, half of which found significant effects. None of the studies examined
the effects of emotional care alone, but four trials assessed a combination of
both cognitive and emotional care. Three of these studies showed that enhancing patients’ expectations through positive information about the treatment or
the illness, while providing support or reassurance, significantly influenced
health outcomes.
Conclusion
There is much inconsistency regarding emotional and cognitive care, although
one relatively consistent finding is that physicians who adopt a warm, friendly,
and reassuring manner are more effective than those who keep consultations
formal and do not offer reassurance.
Oral
EATING DISORDERS PREVALENCE AMONG ADOLESCENT POPULATION IN SPAIN
GENDER DIFFERENCES IN BORDERLINE EATING
BEHAVIOURS IN AN OBESE OUTPATIENT SAMPLE
GANDARILLAS, A., ZORRILLA, B. & SEPÚLVEDA, A.
Comunidad De Madrid
Lucio Sibilia (1), Donata Tridici (2), Lucrezia Carro, Francesca Ferrari
Background: Recently, eating disorders have become of growing interest in
medical and social fields. Eating disorder prevalence has one of the highest
prevalence rates to be found in chronic health problems amongst teenagers as
well as presenting a significant mortality and morbidity rate.
Objective: To estimate the adolescent eating disorder population prevalence in
the Region of MadriD and assess associated factors.
Method: A two phase transversal study using an self-report questionnaire
along with individual interviews in the classroom, in a representative sample of
1534 teenage girls between 15 and 18 years of age, in 17 schools. The survey
questionnaire included the Eating Disorder Inventory (EDI), The Eating
Actitudes Test (EAT). The survey questionnaire also included items related to
eating disorders. The interview protocol used was the EDE (12th edition). The
case diagnosis was based on DSM-IV criteria. Prevalence of eating disorder
population is estimated with a 95% confidence interval. The design effect was
also corrected. With a logistic regression, the association between case probability and presentation of different factors, was analysed.
Results: The students’ response rate was 81,4%. The eating disorder prevalence was 3,4% (1,9-4,9); Anorexia nervosa prevalence was 0,6% (0,1-1), for
bulimia nervosa, it was 0,6% (0,2-1,1) and for eating disorders not otherwise
specified (EDNOS) was 2,1% (1-3,3).
Conclusion: Findings in this study of eating disorder prevalence in Spain is
similar to previous studies carried out within Spain as well as in other Western
European countries. These results reflect the importance of surveillance in this
health issue and to include preventive programmes in school curricula.
1) Dipart. di Scienze Cliniche, Univ. degli Studi di Roma La Sapienza
2) Center for Research in Psychotherapy - Rome
Problem. The concept of “borderline eating behaviours” (BEB) is proposed as
encompassing those habits in between the normal and abnormal range, which
impart overlooked nutritional excesses, but do not fit the clincal definition of
bulimic symptoms. A scale has been built (SENICAL), comprising items derived both from the cognitive-behavioral analyses of obese patients, and the
usual targets of effective cognitive-behavioral tratments for weight reduction.
A previous psychometric study has shown satisfactory properties of the scale,
and a factor analysis has evidenced 4 factors: 1) Generalised eating, 2) Statedependent (emotional) eating, 3) Compulsive eating, and 4) Bulimic-like
problems.
Aims of this study are to clarify differences between the genders in those BEB
in a sample of obese outpatients, and their relationships with the degree of
overweight, and of emotional (anxious and depressive) disorder as well. The
underlying hypothesis is that weight cycling and emotional disorders favor the
weight gain in the long run by disrupting eating habits.
Methods. The SENICAL was administed to a sequential series of 140 subjects,
together with an inventory of anxious and depressive thinking (the Automatic
Thoughts Questionnaire).
Results. A gradient was found in total BEB along the body mass index (BMI),
independently from gender and age (ANCOVA: p(F)=.0032). Also a significant
rise paralleling BMI was found for Factor 1 (ANCOVA: p(F)=.00487) and 2
(ANCOVA: p(F)=.004). Both genders showed significantly higher total BEB
and total ATQ scores, if they were dieters, or prone to nutritional restrictions.
More serious obese males showed significantly more often Generalised eating,
while obese females more often State-dependent eating.
EATING FOR ONE? DIETARY CHANGE DURING PREGNANCY
STAGE MODELS FOR HEALTH BEHAVIOUR CHANGE:
HOW MANY STAGES ARE NEEDED?
Helen Pattison, Jasmine Bhagrath
Birmingham University
Falko F. Sniehotta, Sonia Lippke, Urte Scholz & Jochen P. Ziegelmann
Maternal diet during pregnancy has been shown to have important implications
forboth maternal and foetal health. However tensions arise between the perceivedneeds of the foetus and those of the mother. Specifically between
increasing dietaryenergy intake and the maternal desire to return to pre-pregnancy shape. Between risk messages concerning certain foods, and the cravings, aversions, nausea and hunger which are such an important part of the
‘social construction’ of pregnancy. Between advice on healthy eating and
encouragement to abandon normal dietary restraints.
Very little is known about the ways in which women change their diet during
pregnancy and their perceptions of these changes. In this study a structured
interview was used to investigate food choice, dietary change, concepts of
healthy eating, risk perception, self efficacy and somatic experience of pregnancy in 60 women.
The interview included both open and closed format questions including some
items adapted from the ‘Food Choice Questionnaire’ (Steptoe et al, 1995).
Participants were recruited from community midwifery services. They were
all primiparous and were either at an early, middle or late stage of pregnancy.
The results showed considerable commonality in the attitudes of the participants. However the way that these attitudes were reflected in behaviour was
dependant on individual experience and perceptions of risk and social norms,
and, to some extent, the stage of pregnancy.
Purpose: Based on a comparison of the Transtheoretical Model (TTM) with
the Precaution Adoption Process Model (PAPM) and the Berlin Stage Model
(BSM) the utility of further stage differentiations made in the PAPM and the
BSE is studied. The PAPM divides the precontemplation stage into three
stages: unaware of the issue, unengaged by issue and decided not to act while
the BSM subclassifies preparation into a pre- and a post-planning (disposition
and preaction) stage and further differentiates the action stage into a
implementation, a fluctuation and a habituation stage.
Method: Three cross-sectional studies have been conducted to test the PAPM
(N=812) and the BSM (N=808 & N=164) in the fields of meat consumption
and low-calorie diet. Data have been tested for discontinuity patterns concerning social-cognitive measures in congruence with Sutton (2000).
Results: Evidence suggests that the division of precontemplation into three distinct stages as specified in the PAPM as well as the division of preparation into
disposition and preaction and the subdivision in three action stages are justified
by significant differences based on discontinuity patterns. Distinctions within
the actional phase can be justified empirically when they are based on psychological criteria such as intention to maintain or the habituation whereas timebased distinctions were not supported in the present studies.
Conclusion: Implications on the number of distinct stages, problems that are
raised if such differences are ignored and strategies to test such comprehensive
models will be discussed. Theoretical and methodical problems are raised and
some solutions are suggested and discussed.
71
Oral
The Role of Media Use in the Development and Perpetuation
of Eating Disorders
Marleen Williams
Brigham Young University
Media culture influences have been identified as being related to the development and perpetuation of eating disorders. As the world develops a more unified, international subculture based on a shared media experience, the prevalence of eating disorders is increasing worldwide. Eating disorders, particularly anorexia, are associated with multiple health problems and high mortality
rates.
Women are inundated with a barrage of media messages that sell the ultra-slim
body as being necessary for womens’ happiness. Although many women are
exposed to these messages, not all of these women develop an eating disorder.
This presentation will present both quantitative and qualitative research that
explores the psychological processes and mechanisms that create vulnerability
for some women. The research suggests that media exposure alone, even in
large or frequent quantities does not explain the increase in eating disorders.
The presentation will cover eleven family and sociocultural vulnerability factors that were found to contribute to distortions in processing media messages.
These distortions contribute to the development and perpetuation of eating disorders but also create specific motivations for increased reliance on media use.
The research suggests an interactive process for understanding the relationship
between eating disorders and media use. That process resembles other addictive models. A model for use with eating disorders will be presented. Strategies
for assessing media impact in eating disorder patients will also be presented.
Recommedations for prevention will also be explored.
72
Poster
Presentations
73
Posters
LACK OF AWARENESS OF HEALTH RISK BEHAVIOURS:
INTERPRETATIONS AND CONSEQUENCES FOR THEORETICAL MODELS AND
PRACTICE
DISENGAGEMENT BELIEFS IN THE SELF-EVALUATIONMOTIVATION MODEL
Arie Dijkstra
University of Groningen
L. Lechner, J. Brug, C. Bolman, C. de Ridder, E. Hendriks
Netherlands Open University
Social psychological models, like the Theory of Planned Behavior or the ASEmodel, and the often used Stages of Change concept have proven their strength
in many studies. However, these models suggest that people have a good and
thorough insight in the extent to which their behaviour is more or less healthy.
Possible misconception or lack of awareness that people have about their own
behaviour could have several consequences for the usefulness of the mentioned
theoretical models. This paper studied the prevalence of lack of awareness of
risk behaviour and the possible consequences of this misconception the usefulness of the ASE model and the Stages of Change concept. Furthermore, possible causes of misconception of health behaviour were studied.
Data were used from studies on nutrition behaviour, sun behaviour, sun bed
behaviour, physical exercise, and alcohol consumption. In all these studies subjects’ actual behaviour - is it according to the (inter)national norm for the
healthy behaviour- was compared with their own subjective estimation of their
behaviour. Results from these studies indicate that there were large differences
between subjects’ own perceptions of their health related behaviour, and their
actual health behaviour. Psychosocial determinants were more strongly related
to the self-rated estimation that people have of their behaviour, than to their
actual performed health behaviour. Furthermore, this misconception has important consequences for the application of the Stages of Change concept, resulting in misclassification into different stages. Finally, possible causes of misconception of behaviour were studied. These findings and their implications for
health education and promotion will be discussed.
ROLE OF BELIEFS AND ATTITUDES IN FORMATION OF
INTENTIONS TO PRESCRIBE STATINS ACCORDING TO
CLINICAL GUIDELINES
1) Dr Arash Rashidian, 2) Prof Ian Russell
1)Health Services Research Scholar, Department of Health
Sciences, University of York, UK; 2)Director, Institute of Medical and
Social Care Research, University of Wales Bangor, UK
Objectives Clinical guidelines are increasingly used to improve general practitioners (GPs) prescribing, however GPs’ adherence varies widely. An approach
based on psychological theories such as the Theory of Planned Behaviour
(TPB) may enhance understanding of this variation. This study was part of a
three-phase project (Study of Adherence to Guidelines and Evidence), aiming
to explore the ability of TPB to explain and predict GPs’ adherence to national guidelines.
Methods. Qualitative and pilot studies were used to develop a four-page
long questionnaire. The questionnaire was designed to assess the components
of TPB. It included demographic questions, measures of intentions to prescribe
statins, self-reported past behaviour, attitudes, subjective norms, perceived
behavioural controls as well as behavioural, normative and control beliefs. We
surveyed a national stratified random sample of GPs in England. Further relevant information of general practices was obtained from databases.
Results. Data were collected from a total of 154 GPs. The TPB variables
explained 34% of variance in intentions to prescribe, with past behaviour
increasing the explained variance to 41%. Behavioural beliefs and control
beliefs, and not normative beliefs (peer pressure) were predictors of change in
intentions.
Discussion. Theoretical approaches may enhance identification of
variables that predict prescribing intentions and hence help planning of theoryinformed trials of intervention to improve clinical guidelines implementation.
Further research is required to explore the utility of the TPB in explaining variation in prescribing behaviour.
74
Emotions and negative emotions in particular are primary energizers and motivators of health behaviors. Negative self-evaluative emotions, however, have
hardly been studied in health psychology although self-reports of such emotions as shame and regret are widespread. The Self-Evaluation Motivation
model (SEM based on Bandura’s SCT) maps self-evaluative emotions in their
relations to more commonly used construct in health psychology such as outcome expectation and intentions. Furthermore, the model defines
Disengagement Beliefs (excuses or dissonance reducing beliefs) which regulate the extent of the negative self-evaluative emotions. The present study
aimed at identifying different clusters of Disengagement Beliefs and their relations to other constructs in the SEM. Over 500 smokers filled in a T1 questionnaire assessing 121 Disengagement Beliefs to be explored, negative self-evaluative emotions, outcome expectations and self-efficacy with regard to quitting
smoking. After nine months the T2 questionnaire was send to assess smoking
behavior. Because little is known about Disengagement Beliefs and their structure, firstly, a principal component analysis was conducted. On the basis of several different tests, five factors were derived and used as scales: Effect minimizing, Advantageous comparison, Autonomy, Avoidant argumentation and
Emotional reactance. Prospective analyses showed that the scale “Effect minimizing” predicted point prevalence quitting significantly over and the more
commonly used predictors. Only self-evaluative emotions predicted quitting in
the presence of the disengagement beliefs scale. The results are used to adapt
the SEM and it is concluded that Disengagement Beliefs may increase our
understanding of the regulation of motivation in health behaviors.
UTILITY OF THE THEORY OF PLANNED BEHAVIOUR IN
PREDICTING THE PRACTICE NURSES INTENTIONS TO
USE CLINICAL GUIDELINES AND PROVIDE SMOKING
CESSATION ADVICE: EXPLORATORY STUDY
Suezann Puffer; 2) Dr Arash Rashidian
1) Research Assistant, Department of Health Sciences,
University of York; 2) Health Services Research Scholar
Objectives. Available evidence indicates that although nurses are increasingly
using clinical guidelines to ensure higher quality of care, there is a wide variance in their adherence to them. The utility of the Theory of Planned Behaviour
(TPB) has not been previously investigated in explaining this variance in community nursing. The primary aim was to examine the utility of TPB in explaining variations in practice nurses intentions to offer smoking cessation advice in
accordance
with
the
coronary
heart
disease
guidelines.
Methods. A cross-sectional survey using a postal questionnaire was performed.
A 52-item questionnaire was administered on forty-eight practice nurses in
York, England. The questionnaire was designed to assess the components of
TPB and included measures of intentions to offer smoking cessation advice,
self-reported past behaviour, attitudes, subjective norms, perceived behavioural controls, behavioural beliefs and evaluations, normative beliefs and motivation to comply, and control beliefs and evaluations.
Results. TPB explained up to 46% of variance in intentions to offer
smoking cessation advice. Attitudes and perceived behavioural controls were
the most important predictors of intention. Among other elements of TPB indirect attitudes and indirect perceived behavioural controls had significant positive
contributions
in
explaining
variance
in
intention.
Discussions.
Future trials of interventions to increase practice
nurses’ adherence could attempt to address those elements identified as important factors.
Posters
THE QUEST FOR HELP: ILLNESS PERCEPTIONS AND PSYCHOLOGICAL HELP SEEKING BEHAVIOR IN PATIENTS
WITH CHRONIC DISEASE
IMPACT OF PARENTS’ SELF-REGULATORY COGNITIONS
ON PSYSICAL ACTIVITY ON THEIR CHILDREN’S COGNITIONS AND PRACTICE OF PHYSICAL ACTIVITY
Liu Cha-Hsuan, Stan Maes, Margaretha Scharloo
Leiden University
Vera Araújo-Soares*, Teresa McIntyre* & Falko F. Sniehotta**
* University of Minho. ** Free University of Berlin
Objective: To explore chronic patients’ illness perception, their psychological
help seeking behavior and the representation of relevant determinants in the
Taiwanese society.
Method: 124 patients with rheumatoid arthritis (RA), asthma or end-stage renal
disease (ESRD) completed a questionnaire during their counseling period or
during their treatment. The questionnaire included items from IPQ-R, HADS,
Quality of Life related questions and items about patients’ attitude and behavior related to Health psychological help seeking.
Result: (1) The patients in this study generally perceived their illness as chronic. There were significant illness perception differences between the three
groups: RA, Asthma and ESRD in the timeline (acute/chronic) and in the timeline cyclical dimensions. There was no difference found in the consequences-,
personal control- and emotional representations dimensions between the three
groups. (2) Chronic patients’ attitude towards help seeking from a psychologist
tended to be negative. Only 2.4% of the patients have made use of the psychological counseling service to solve their psychological problems related to their
illness. 30.8% of the patients showed an intention to seek help from a health
psychologist.
Conclusion: In this study, the results of IPQ-R provided confirmation of the
theoretically derived factors labeled timeline (acute/chronic), timeline cyclical,
consequences, personal control, and emotional representations. A picture of
chronic patients’ illness perception was shown. The result of patients’ intention
of help seeking from a health psychologist points at the fact that help from
health psychologists should be available in the Taiwanese health care system.
Background: Bandura proved that a significant part of what we learn is due to
modelling; behaviour, cognitive and contextual factors interact in such a strong
way that one is an indissoluble determinant of the other. Despite the growing
importance of peers during adolescence, parents continue to act as important
models for health and risk behaviours (Finkelstein, 1993).
COGNITIONS OF THE GENERAL DUTCH POPULATION
REGARDING NEEDS AND OUTCOMES OF INFORMATION
ON HEREDITARY CANCER
A TRANSTHEORETICAL APPROACH: FALLS AMONG
OLDER PEOPLE
jHein de Vries, 2: Ilse Mesters; 1; 3: Hermanna van de Steeg 2;
4; Cora Honing 2
1; Maastricht Un; 2: Dutch Cancer Societye
During the last two decades significant advances in molecular genetic technology have been accomplished. It is expected that most, if not all, human genes
will be mapped and sequenced. This poses health education organisations for a
new challenge with respect whether and how to provide information on hereditary cancer. While many studies focus on perceptions of genetic counselling in
persons that have been diagnosed with a hereditary proposition, few studies
analyse the needs of the general public.
The goal of this study is to analyse the general public’s need and perceptions
concerning receiving information on the role of hereditary factors with regard
to cancer.
A questionnaire was developed using the Attitude-Social influence-Efficacy
Model for Motivational and Behavioural Change. This model integrates
insights of various social cognition models. In total 457 respondents of 18-50
years filled out the questionnaire.
The results revealed that recognition of warning signs was low, as was the
recognition of inheritance patterns. Participants wanted to know the types of
cancer with hereditary aspects, how to recognise hereditary cancer in the family, personal risks and the steps to be taken when hereditary predisposition is
suspected. The most popular information channels mentioned were leaflets, the
general practitioner, and the Internet. Respondents interested in receiving information on heredity and cancer were more often female, had had experiences
with hereditary diseases, had more knowledge, perceived more advantages,
encountered more social support in seeking information, and had higher levels
of self-efficacy. Education should outline the most important facts about hereditary cancer, how to get support, and create realistic expectations of the impact
of genetic factors.
Aims: To investigate the relationship between parents’ self-regulatory variables
(TPB and HAPA models), planning and behaviour regarding physical activity,
and their children’s corresponding self-regulatory processes and behaviours.
Sample: 250 young adolescents of both sexes attending 6-7th grades, ages 1115 and 250 parents.
Method: Cross-sectional design. Instruments used for parents and children:
Health habits and health risk behaviours questionnaire and a Health Behavior
Assessment for Physical Activity that includes, theory of planned behaviour
measures (attitude toward behaviour; behavioural beliefs; outcome evaluation;
subjective norms; normative beliefs; motivation to comply; perceived behavioural control; control beliefs), health action process approach measures (risk
perception; outcome expectancy; perceived self- efficacy; intention) and a
measure of planning.
Results: Data will be analysed in terms of determining the predictive value of
parents’ self regulatory cognitions on their children’s cognitions and levels of
physical activity.
C.L.Brace, R.A.Haslam
Loughborough University
Falls are a persistent cause of mortality and morbidity and are a particular problem among older people. A third of individuals over 65, and nearly half of
those over 80, fall each year.
Falls can lead to three types of impairment: injury, restriction of activity, and
psychological anguish. The latter includes anxiety of falling again, restrictions
in activity/mobility, and increased need of assistance. Loss of confidence in
the ability to ambulate safely can thus result in further functional decline,
depression, feelings of helplessness, and social isolation for many older persons.
Fall prevention activities have been plentiful among the medical fraternity,
although with the emphasis on physical rehabilitation. Far less has been done
to look at the psychological distress caused and very little has been done to
assess the use of a health psychology framework as a preventative tool. This
paper will discuss health behaviour amongst a group of older people who have
been influenced by educational interviews, which highlighted key risk factors
for falls.
A sample of 177 older people were interviewed and information was gathered
on their behaviour and their stage of change, using the framework developed
by Prochaska and DiClemente (1982). A year later, further interviews were
conducted to determine differences in status in the cycle of behaviour. The
results have also been investigated with regard to measures of individuals’
health, socioeconomic position and other fall related behaviour.
The paper will conclude with the implications of this application of health promotion for health professionals in dealing with the epidemic of falls among the
older population.
75
Posters
ADULT SIGNIFICATIONS ABOUT HEALTH AND DISEASE:
A COGNITIVE-DEVELOPMENTAL PERSPECTIVE
Joaquim Reis & Fernando Fradique
Independent University - Faculty of Psychology and Education Sciences
This study focuses upon lay people’s significations of health and disease
processes, which coexist and compete with those endorsed by health professionals. A cognitive-developmental perspective suggests that significations
about health and disease processes may present different levels of openness,
flexibility, inclusiveness and autonomy, and can be ordered into different levels of socio-cognitive development. Within this framework we present empirical research work on lay significations about health and disease processes,
endorsed by adults. Sixty-seven adults were interviewed. The results show that
different persons are also different in their socio-cognitive developmental competences related to health and disease processes. For each dimension of significations of health and disease, it was possible to sequence lay adult significations developmentally. Each developmental sequence is distinct qualitatively,
which means that each sequence or level includes responses characterized by a
higher degree of differentiation, integration and complexity than the previous
level. Examples of developmental levels of significations will be presented.
Finally, the implications of this approach to clinical and didactic/educational
methods are discussed.
AUGMENTING THE THEORY OF PLANNED BEHAVIOUR
BY THE PROTOTYPE WILLINGNESS MODEL: THE PREDICTIVE VALIDITY OF POSITIVE VERSUS NEGATIVE
PROTOTYPES FOR YOUNG PEOPLE’S HEALTH-RELATED
INTENTIONS
Amanda Rivis
Paschal Sheeran
University of Sheffield, UK
Christopher Armitage
This study examined augmentation of the Theory of Planned Behaviour (TPB)
by the Prototype Willingness Model (PWM). A questionnaire assessed the predictive validity of healthy and unhealthy images of people who perform particular behaviours (prototypes) in relation to a variety of health and risk behaviours. Two hundred and forty seven adolescents (aged 15-18 years) completed
measures of prototypes that either do (Condition 1; N = 123) or do not
(Condition 2; N = 124) engage in health/risk behaviours, along with standard
measures of TPB variables, PWM variables, and past behaviour. Regression
analyses showed that prototype perceptions significantly predicted intentions to
engage in healthy and risk behaviours, even after variables from the TPB and
past behaviour had been taken into account. Contrary to the negativity bias
hypothesis (cf. Blanton, et al. 2001), evaluation of a positive prototype—but
not evaluation of a negative prototype—significantly predicted intentions to get
seven or more hours of uninterrupted sleep. Overall, the findings (1) support
the predictive validity of prototypes in relation to healthy and unhealthy behaviours, (2) replicate previous findings by suggesting that acquiring the characteristics of health and risk images are goals among young people, and (3) highlight the need to identify the conditions in which negative images are more
salient and informative than positive images in the prediction of health-related
intentions.
76
PATIENTS’ CAUSAL ATTRIBUTIONS PREDICT DEPRESSION AND LONG-TERM PROGNOSIS FOLLOWING ACUTE
CORONARY SYNDROMES
Yori Gidron, Ph.D, Tikva Armon, MD & Harel Gilutz, MD
Dept. of Psychology, Southampton University. Highfield
Southampton SO17 1BJ, United Kingdom
Background Depressive symptoms predict mortality in acute coronary syndromes (ACS). The ability to prevent or treat such symptoms may depend on
identification of patients at risk for depression. We examined whether a psychological precursor of depression, causal attributions, predicts depressive
symptoms and prognosis in ACS patients.
Methods Forty-nine ACS patients were assessed in hospital for their causal
attributions concerning their ACS (their attributed reason for their cardiac
event, and whether that reason is internal/external, stable/unstable and of global/specific effects). One month later, they were assessed for depressive symptoms and followed up for nearly three years for cardiac events (myocardial
infarction or unstable angina). Results Global causal attributions predicted
depressive symptoms (r = 0.37, p < .01). Attributing initially a stable cause to
the ACS significantly predicted new cardiac events at follow-up, independent
of patients’ initial age and left-ventricular functioning (relative-risk = 3.75,
95% confidence-interval: 1.14-12.38).
Conclusions To the best of our knowledge, this is the first study demonstrating
that a psychological precursor of depression, the manner in which patients
explain the cause of their cardiac event, predicts their short-term depressive
symptoms and long-term prognosis. Illness-specific causal-attributions are easily assessed and are modifiable via cognitive therapy. Hence, these results may
have implications for improving ACS patients’ prognosis.
USING HEALTH PSYCHOLOGY MODELS IN IMPLEMENTATION RESEARCH: PLANNED INVESTIGATIONS
Liz Shirran(1), Anne Walker(1), Debbie Bonetti(2), Martin Eccles(3), Jeremy
Grimshaw(4), Marie Johnston(2), Nigel Pitts(5), Nick Steen(3)
1)Health Services Research Unit, University of Aberdeen; (2)School of
Psychology, University of St Andrews; (3)Centre for Health Services
Research, University of Newcastle upon Tyne; (4)Clinical Epidemiology
Programme, Ottawa Health Research Institute, Canada; (5)Dental Health
Services Research Unit, University of Dundee
Purpose: This poster describes the application of theories and methods from
health psychology in two planned implementation research projects.
Background: Implementation research demonstrates that multi- faceted complex interventions can change clinical practice, but provides little information
to guide the choice or optimise the components of such complex interventions
in practice. Two approaches are necessary to identify the ‘active ingredients’ in
implementation interventions. One is to develop an understanding of the factors underlying clinical practice, in order to identify the processes which
should be targeted to achieve practice change (‘process modelling’). The
other is to develop an understanding of how the interventions themselves work
(‘intervention modelling’).
Key points: PRIME will test the power of theoretical constructs drawn from
six theories (theory of planned behaviour, social cognitive theory, operant conditioning, implementation intentions,
Leventhal’s self regulatory theory and a ‘stage of change’ model) to predict
clinical practice amongst general practitioners and dentists. It will use postal
surveys to assess psychological variables and use these to predict behaviour
measured from routine information sources (e.g., prescribing data). INTERIM
will simulate implementation interventions in ‘intervention modelling experiments’ (IMEs). IMEs are experiments in which key elements of an intervention are manipulated in a manner that simulates a real situation and where short
term interim effects (usually stated behavioural intentions) are measured rather
than actual behaviour or healthcare outcomes. INTERIM will also focus on
GPs and dentists, using a variety of techniques (postal surveys, group meetings
etc) to manipulate elements of interventions and measure behavioural intentions.
Posters
PERCEPTION OF DISCRIMINATION AND MENTAL
HEALTH AMONG WOMEN: THE MODERATING ROLE OF
PERCEIVED CONTROL
DAMBRUN MICHAEL
The main goal of this study was to examine the moderating role of perceived
control on the relation between perception of future discrimination (PFD) and
mental heath (i.e. psychological distress and level of organism tension). It was
predicted that perception of future discrimination (PFD) increases both psychological distress and the level of organism tension only when discrimination is
perceived as highly uncontrollable. Using valid self-reports measures, this
hypothesis was tested among a sample of women (N = 83) living in ClermontFerrand (France). The results reveal a significant interaction effect between
PFD and perceived control on mental health (p = .01). As expected, a high level
of perceived future discrimination was associated with greater levels of psychological distress and organism tension only when the discrimination was perceived as highly uncontrollable. In addition, while PFD and perceived control
were not significantly related (r = .037), psychological distress and the level of
organism tension were highly and positively correlated (r = .61). Implications
of the results are discussed.
THE ROLE OF ILLNESS PERCEPTIONS AND MEDICATION
BELIEFS IN COMPLIANCE WITH HIV PATIENTS
Gauchet, A. ; Tarquinio, C. ; Fischer, G.N. ; Dodeler, V.
Metz University France
OBJECTIVE : The aim of this study was to assess relations between illness
perceptions, beliefs about medication and reported compliance to antiretroviral medication.
METHOD : Subjects: 118 HIV patients have filled up a questionnaire at the
occasion of their quartely consultation at the Metz Hospital (France). Material:
The subjects had to answer the compliance scale, with three sub-scales (respect
of observance of prescription; observance of medical appointment; health
behaviour), as well as the Illness Perception Questionnaire, with five sub-scales
(identity, timeline, cause, consequences and cure/control beliefs), and the
Beliefs Medication Questionnaire. We made multidimensional analyses (PCA:
Principal Component Analysis; and Multiple Regression Analysis), in order to
show the principal variables subjacent to scales.
RESULTS : The results revealed that perceived consequences was the only illness perception significantly associated with compliance self-report whereas
both necessity beliefs and concerns about medicines were significantly correlated with compliance. Stronger beliefs in the necessity of antiretroviral medication were associated with higher reported compliance. Illness perceptions
influenced compliance, via medication beliefs that, in turn, were the strongest
predictors.
CONCLUSION : This finding are consistent with Leventhal’s self-regulatory
theory of illness but suggest that the power of the model to explain treatment
compliance may be enhanced by specific assessment of treatment beliefs.
DEVELOPMENT OF A BRIEF SCREENING SCALE FOR
THE ASSESSMENT OF PSYCHOLOGICAL DISTRESS IN
CARDIAC REHABILITATION PATIENTS.
Miglioretti M., Nasorri C., Conti M.*, Cagliuso R.**, Corsiglia L.**, Petrilli
F.**,Pirlo F.**, Viale G.**, Petillo A.**
Psychological Unit, *Data Analysis Center, **Division of
Cardiorehabilitation, Istituto Cardiovascolare Camogli (ISCC)
Psychological care in cardiac rehabilitation must necessarily use a screening
instrument to identify patients suffering from psychological distress, commonly experienced in relation to Coronary Heart Disease. Aim Showing a brief
visual analogue scale to assess psychological distress in cardiac rehabilitation
patients. Methods 188 patients (age:62,6±8,4; M: 131; F: 57) were consecutively recruited at the beginning of the rehabilitation program. They compiled a
eight items visual analogue scale based on a self-evaluation of anxiety, depression, stress, relaxation and illness perception. The first 102 patients (age:
62,01±8,8; M: 73; F: 29) compiled a STAI-Y1, STAI-Y2 and Beck Depression
Inventory too.
Results The factor analysis of the visual analogue scale shows a three factors’
structure: two factors including three items and one including only two items.
We considered these factors as three sub-scales; the reliability analysis of these
sub-scales presents a Crombach á coefficient good enough for sub-scale 1
(á=0.63) and for sub-scale 2 (á=0.69). Therefore, the items forming sub-scale
3 have been eliminated from the final version of the scale. Sub-scale 1 appears
highly related to state anxiety’ s score obtained from STAI (r2=0.702) and to
Beck Depression ‘s score (r2=0.589). This result consent to consider this subscale as a measure of the psychological distress reactive to illness. Sub-scale 2
is highly related to trait anxiety (r2=0.618). Conclusions These data put in evidence that this instrument is able to screen the patients in psychological distress. Its briefness and simplicity of employment make this visual analogue
scale particularly apt in cardiac rehabilitation.
QUESTIONNAIRE FOR THE EVALUATION OF THE
DEGREE OF THE SATISFACTION OF THE PATIENT
Truzoli Roberto
Psicologia Clinica, Facoltà di Medicina e Chirurgia, Università degli Studi di
Milano
In this research, we introduce a questionnaire to evaluate the degree of satisfaction between physician (doctor in general medicine) and patient. The questionnaire has been developed taking into consideration factors that are relevant for
the satisfaction of the patient. The questionnaire is composed of 10 items and
the answers are expressed on a nominal scale (yes - no). The items are taken
from the following dimensions: clarity and completeness of the physician’s
communication, the physician’s listening ability, the physician’s reinforcement
of the adherence, the patient’s perception of the adequacy of the examination,
the patient’s perception to be understood and his/her intention to change physician. The questionnaire has been submitted to a sample of resident in two
regions of Northern Italy. The items and the psychometric characteristics (content validity, coherence, reliability calculated according to the method of Winer
and normative values) of this questionnaire will be presented. The tool can be
used by the physicians to improve the quality of the relationship with individual patients and their adherence.
77
Posters
HEALTH-RELATED QUALITY OF LIFE IN ADULTS LIVING
WITH HAEMOPHILIA. DEVELOPMENT OF THE NEW DISEASE SPECIFIC QUESTIONNAIRE TO LATINO AMERICAN
COUNTRIES
E Remor; N Bosch; M Garcia, S Grana; B Y S Marques de Aquino; R Martinez
Triana; B Moreno; G Piraquive Torres; R Ramos de Carvalho; L Rizzo
Battistella; M Rodriguez Otero; in representation of ‘The Latino American
Working Group in Health Related Quality of Life in Hemophilia’
The clinical symptoms of haemophilia in terms of spontaneous or traumatic bleedings and the complications such as arthropathy or viral infections (HIV or HCV)
affect the every-day life of haemophilia patients.
A little information is available about quality of life (QoL) in people living with
haemophilia in Latino American Countries, and there isn’t any specific instrument
available an to assess QoL in adults living with haemophilia.
To assess the impact of this disease on quality of life we develop a health-related
quality of life questionnaire (HRQoL) for adults with haemophilia. We planned a
cross-cultural study in eight Latino American countries. The questionnaire was
developed simultaneously into Spanish and Portuguese.
Method: The development process include a qualitative study (semi-structured
interview schedule) with fifty patients in the eight countries. The study was limited to men, aged between 18 to 56 years old with haemophilia type A and B (89,5%
severe; 7,9% moderate; 2,6% mild).
Qualitative content analysis was performed to analyse the interviews transcript.
The content analyses identify 348 answers (verbatim) who was grouped in different response categories. The categories was transformed into items to compose the
disease specific questionnaire. After, a preliminary version of the questionnaire
was sent to ten experts in haemophilia to make an evaluation (0 to 10) regarding
comprehensibility, adequacy and relevance to haemophilia of all items generated.
Ten patients have also rating the items.
Results and Conclusions: A new Latino American disease specific HRQoL questionnaire was developed to assess QoL in adults with haemophilia. The 48 items
questionnaire contain six domains: physical functioning, pain, treatment, emotional functioning, mental health, social functioning and social support. Experts and
patients ratings indicated that content validity ofthe questionnaire is high. Next
steps to validate the questionnaire will be a pilot study and a field study in the eight
Latino American countries.
SLEEP HABITS, ALTERATIONS AND ONEIRIC CONTENT:
DEVELOPMENT AND PSYCHOMETRIC ANALYSIS OF A
QUESTIONNAIRE FOR CHILDREN AND ADOLESCENTS
Cuenca, J.M & Beleacutendez, M.
Dep. Sociologiacute;a II, Psicologiacutea, Comunicacioacuten y
Didaacutectica
One of the life stages where more physiologic and psychological changes take
place is in adolescence. Sleeping and dreaming do not avoid these changes.
However, adolescence is the evolutionary stage less studied. Questionnaires
and elaborated instruments for such a purpose are very specific.
It is quite difficult to find studies which in the most complete way possible try
to approach more extended ways to cover all those aspects which go around
and influence the very process of sleeping and dreaming in adolescence. Many
of the instruments developed for the investigations are prepared to be written
by observers who are strangers to the person himself.
We think that sleeping should be studied from the greatest number of points of
view possible, since this is not something, which can be observed in a differentiated way. An appropriate knowledge and diagnosis of sleep obligatorily needs
to know previous habits when sleeping, patterns and times of sleep, possible
sleeping alterations and the oneiric content of dreams.
The instrument used for the investigation has been a questionnaire produced by
our own, the Questionnaire of Sleep for Children and Adolescents (QSCA)
which is divided into three independent Scales. The first scale has been denominated “Scale of Previous Habits when Sleeping (SPHS)”, the second “Scale of
Sleep Alterations” (SSA) and the third “Scale of Oneiric Content of Dreams”
(SOCD).”
The questionnaire was administered to 1585 pre-adolescents and adolescents
between 8 and 18 years. The psychometric properties of the CSNA were established.
78
MEASURING DIABETES-SPECIFIC FAMILY BEHAVIORS:
DEVELOPMENT AND PSYCHOMETRIC PROPERTIES OF A
NEW SCALE
BELÉNDEZ, M. & SURIÁ, R.
DEP. SOCIOLOGÍA II, PSICOLOGÍA, COMUNICACIÓN Y DIDÁCTICA.
UNIVERSITY OF ALICANTE. SPAIN
Family variables have been identified as a crucial psychosocial factor that
affects treatment adherence among diabetic population (Gonder-Frederick,
Cox & Ritterband, 2002). The supportive behaviors from family can be considered of paramount importance in helping diabetics successfully manage this
complex treatment regimen.
The purpose of this study was to describe the psychometric properties of a
questionnaire for measuring diabetes-specific family behaviors.
A total of ninety-one adults with diabetes, 39 males and 52 females (aged 1871 yrs), completed the original version of the Diabetes-Specific Family
Behaviors Scale, DSFBS (35 items) and several scales on diabetes self-care,
social support and perceived barriers to treatment. Glycosylated hemoglobin
(HbA1c) was used as a measure of metabolic control.
The initial factor analysis yielded five factors that explained 69,35% of the
variance. The final scale included 16 items. With the exception of one subscale,
the DSFBS demonstrated acceptable internal consistency measured with
Cronbach’s alpha. Relationships with demographic variables (age, gender, illness duration) and with measures of social support, perceived barriers to treatment, adherence and metabolic control were assessed.
This study shows initial support for the internal reliability and validity of the
Diabetes-Specific Family Behaviors Scale. Further research is needed to determine its validity in larger samples and its predictive validity.
The work presented here was supported by project GV00-056-7 from the
Generalitat Valenciana (Spain).
QUALITY OF LIFE MEASUREMENTS: COMPARISON OF
METHODS FOR ITEM GENERATION PROCESS
Spitz Elisabeth, (1), Francis Guillemin, (2), Michele Baumann,(2) , Nathalie
Retel-Rude,(3) , Anne-Christine Rat, (2), Jacques Pouchot, (4), Joel Coste, (5)
(1) Health Psychology, EA3477, University of Metz, Metz, France
(2) EA 3444, University of Nancy, Vandoeuvre-les-Nancy, France,
(3) University of Besançon, France,
(4) University of Paris 6, Garennes-collombes, France,
(5) Biostatistics, University of paris 5, Paris, France
Background: No methodology is standard for item generation process during
scale development.
Purpose: To compare methods of item generation for development of a lower
limbs osteo-arthritis (OA) quality of life (QoL) scale.
Methods: All methods compared relied on extraction of verbatims collected
during tape recorded interviews, transcribed and analysed by 2 teams of health
psychologists and sociologists independently. The 5 methods compared were:
health care professionnals and caregivers interviewed with standard interview
guide with 1) individuals, 2) focus group, and OA patients in 3) focus group,
4) individual standard interview and 5) individual interview using a cognitive
interview technique to enhance memories.
Results: 83 individual and focus interviews were conducted with 32 caregivers
and 96 OA patients. After exclusion of speeches not related to QoL (i.e. satisfaction, coping), 80 verbatims were identified relevant. With caregivers, focus
group produced only 35% of verbatims, while individual interviews contributed 80% of verbatims. With patients, focus group produced 74% of verbatims, while both individual methods contributed 99% of resulting items.
Caregivers provided a narrower picture of consequences on QoL. Focus group
methods contributed some theme more in-depth while individuals gave broader insights. Guided interview contributed known QoL themes while cognitive
interview provided more fine tuned verbatims on exchanges with and perception by others about their condition, as well as perspective in life and fears from
future dependency Selected items were 43 in the final scale. Using this scale as
a gold standard, the sensitivity and specificity, i.e. the contribution of each
method to the scale, was estimated (table).
Comments: The resulting self-administered questionnaire has benefited from
the contribution of the various sources. One can recommend to use structured
guided interview of individual patients in sufficient number, conducted by
interviewers preferably non-specialist of the explore condition
Posters
ADAPTING TO CHRONIC DISEASE: THE LOSS ACCEPTANCE SCALE (LAS).
DEVELOPMENT OF INTERPERSONAL PERCEPTION
SCALE FOR JAPANESE HIGH SCHOOL STUDENTS
J.N. de Voogd, M. Appelo, A. Groenink, J.B. Wempe, G.H. Koëter, K.
Postema, R. Sanderman
University Hospital Groningen, the Netherlands, Northern Centre for
Healthcare Research, Groningen,
The Netherlands.
Yasuo SHIMIZU
OBIRIN University, Tokyo
Introduction: Chronic disease or disorders are associated with experiences of
loss of social status, social and physical activity, and perspective. Bereavement
is considered to be a normal reaction to these losses. Acceptance of these losses is important for a successful adaptation to a chronic disease. Moreover,
acceptance is considered to be an important prerequisite to reach clinically relevant rehabilitation goals.
In this study we examined the construct validity of the Loss Acceptance Scale
for patients with a chronic pulmonary disease.
Methods: The Loss Acceptance Scale (LAS) was developed to assess the level
of bereavement and acceptance of patients with a chronic disorder or disability and was validated for chronic psychiatric patients. The LAS has 20 items and
measures symptoms of bereavement (the Loss sub-scale: 13 items), and the
level of acceptance and orientation on the future (the Acceptance sub-scale: 7
items).
Pulmonary patients (N=240), mainly COPD and Asthma, 50.4% male, mean
age 57 years were assessed with the LAS and other psychological questionnaires among others: the Symptom Check List (SCL-90), the Beck Depression
Inventory (BDI), the Hospital Anxiety Depression Scale (HADS).
Results: The Validity of the LAS is supported by significant correlation of the
Loss sub-scale with depression, anxiety and neuroticism scales. The
Acceptance sub-scale significantly correlates with active coping style, social
support seeking and cognitive coping styles.
Conclusion and Discussion: The LAS is a valuable tool for assessing the level
of bereavement and acceptance among patients with chronic pulmonary disease. Theoretical issues and its usefulness in clinical practice concerning the
concept of adaptation will be discussed.
Purpose The aim of this study was to develop the psychosocial scale that
would be useful for teachers and counselors to assess the levels of interpersonal perception and the social support resources of high school students. The categories of the psychological scale were the relationships with family members,
classmates, friends out of school and people in communities, which were
extracted in the preparatory survey conducted preceding this study.
Method The subjects were 2,200 high school students (15-18 yeas old) of 18
high schools in Kanagawa, Japan. In May 2001, the subjects were asked to
answer two types of questionnaires, one with 10 questions of Self-Esteem Scale
(Yamamoto, 1982) and the other with 108 questions of Interpersonal
Perception Inventory (IPI) developed for this research. The questionnaires
were distributed during classroom periods. Factor analyses were conducted
using SPSS 11.0. Principal axis factoring method was employed and promax
rotation was chosen for each process of factor analysis. Multiple regression
analyses were conducted to clarify the relation between Self-Esteem Scale and
IPI.
Results Significant positive correlations were found between Self-Esteem
Scale factors and IPI factors. Items were devised to assess twenty aspects in six
categories of IPI. The Cronbach’s alpha reliability coefficients generated from
the sub-scales of IPI were .63 to .89.
Conclusions The major finding of this research implies that support from family members rather than support from classmates and friends had the most significant impact on high school students’ self-esteem.
MEASURING INTERNET ADDICTION: THE PROBLEM
INTERNET USE QUESTIONNAIRE (PIUQ)
ARE PLACEBO RESPONDERS TOLD WHAT THEY GOT AT
TRIAL CLOSURE?
DEMETROVICS, Zsolt - SZEREDI, Beatrix NYIKOS, Emese
Eotvos Lorand University, Institute of Psychology, Department
of Personality and Health Psychology
Zelda Di Blasi a, Ted J Kaptchuk b , John Weinman c , Jos Kleijnen d ,
a Department of Health Sciences, University of York, York YO10 5DD, b
Osher Institute, Harvard Medical School, 401 Park Drive, Boston, MA 02215,
USA, c Unit of Psychology, Guy’s, King’s, and St Thomas’s School of
Medicine, London SE1 9RT, d NHS Centre for Reviews and Dissemination,
University of York, York YO10 5DD
Aims: Despite the fact that more and more clinical case studies and research
reports are published on the growing problem of internet addiction, no standardized tool is available to measure problematic internet use or internet addiction. The aim of our study was to create such a questionnaire. Method: Based
on earlier studies and Young’s (1999) questionnaire we have created a 30 item
questionnaire. Data collection has happened between 2000 and 2002, through
the internet. Beside problematic internet use we have also measured the following characteristics: depression (CES-D), anxiety (STAI), satisfaction with
life (SWLS), self-esteem (Rosenberg), characteristics of internet use.
Results: We have collected data from 1037 persons (54.1% male, average age
23.3
year; sd 9.1). As a result of reliability analysis and factoranalysis we have created a questionnaire consisting of 18 items. The questionnaire contains three
subscales which are the following: obsession, neglect and control-disorder.
The cronbach-alfa of Problem Internet Use Questionnaire is 0.872, and all subscales
have
rates
higher
than
0.7.
Beside,
presenting
he questionnaire the authors also provide data according to the most important
socio-demographic variables. Conclusion: The Problem Internet Use
Questionnaire is capable of measuring the extent of problems caused by the
“misuse” of internet.
Objectives: To assess whether and how investigators of placebo controlled randomised trials inform participants of their treatment allocation at trial closure
and to assess barriers to feedback.
Design: Postal survey with a semi-structured questionnaire.
Participants: All investigators who published a placebo controlled randomised
trial in 2000 in five leading medical journals, and a random sample of 120 trials listed in the national research register database.
Main outcome measures: Number of investigators who informed participants
of their treatment allocation at trial closure, methods for delivering the information, and barriers to unmasking treatment.
Results: 45% of investigators informed either all or most participants of their
treatment allocation, and 55% did not inform any participant or only informed
those who asked. The main reasons for not informing participants were that the
investigators never considered this option (40%) or to avoid biasing results at
study follow up (24%).
Conclusion: Further research is required to examine sensitive ways to communicate treatment information to trial participants.
79
Posters
THE FULL MONTE CARLO: A REVIEW OF EMPIRICAL
TESTS OF CLUSTER ANALYSIS AND THE IMPLICATIONS
FOR HEALTH PSYCHOLOGY
HOW MANY SELF-MEASURED BLOOD PRESSURE READINGS ARE NEEDED TO ESTIMATE ADULTS’ “TRUE”
BLOOD PRESSURE?
Jane Clatworthy, Matthew Hankins, Deanna Buick, John Weinman & Robert
Horne
JC, MH and RH: Centre for Health Care Research, University of Brighton;
DB: Macmillan Cancer Relief, London; JW: Guy’s, King’s and St Thomas’
School of Medicine, London
Garcia-Vera, M.P., Sanz, J., Risco, M., Magan, I.
Universidad Complutense De Madrid
Cluster analysis is potentially useful for identifying the target groups of interventions and research in health psychology. There are numerous methods of
cluster analysis from which to choose, yet no guidelines to aid the choice of one
method over another.
Many empirical tests of cluster analysis have been conducted with the goal of
determining which method is ‘best’. These studies generally employ Monte
Carlo sampling techniques to generate artificial data sets containing a known
number of groups. A range of cluster analysis methods are then applied and
evaluated with respect to their success in recovering the predetermined group
structure.
Twenty-two such studies were reviewed to assess the implications for method
selection in health psychology. There was wide variation in the methodology
employed and the types of data generated. Although Ward’s method and kmeans cluster analysis were generally found to perform well, it is likely that
these findings were artefacts of flawed methodology. Furthermore, many of
the artificial data sets did not resemble the types of data found in health psychology (e.g. they contained very well-separated clusters), making generalisation of the findings to health psychology (and elsewhere) inappropriate. It was
therefore impossible to draw firm conclusions regarding the most suitable
method of cluster analysis for health psychology research.
As a result, a Monte Carlo study using data modelled on heath psychology data
was conducted. The findings of this study will be presented.
Many psychological and social risk factors for essential hypertension have
been identified by studies carried out with adults selected from general population and with sphygmomanometer measurements taken in a clinic setting by
a physician or a nurse -clinic blood pressure (BP) measures-. However, there is
increasing acceptance that clinic measures may not be a reliable estimation of
individuals’ true level of BP (the average level of BP over a prolonged time)
and that pressures measured outside the clinic may improve the reliability of
such an estimation. The present study was aimed at determining the number of
self-measured blood pressure (BP) readings needed to attain reliable estimates
of true BP in adults. One hundred and twenty adults self-recorded 36 readings
of BP (at home and at work) and generalizability theory were applied to those
readings of BP. Previous studies of our research team has showed that, for
patients with essential hypertension, it is enough to take two readings, one at
work and the other at home, from each of three consecutive days to get reliable
estimates of systolic BP and diastolic BP across settings (García-Vera
and Sanz, 1999). This study also tested if this criterion would be valid to get
reliable estimates of BP with samples selected from the general population.
WELL BEING IN FOREIGN UNIVERSITY STUDENTS AS A
FUNCTION OF ACCULATURATION ORIENTATIONS,
LOCUS OF CONTROL AND CULTURAL DISTANCE
ATTENTIONAL BIAS IN SOCIAL ANXIETY: MANIPULATION OF STIMULUS DURATION AND SELF-EVALUATIVE
ANXIETY
G. Krampen & Ev. Petroglou
University of Trier, Department of Psychology
Miss Margarita Ononaiye, Professor Graham Turpin, Dr John Reidy, Professor
Glenys Parry.
Presents empirical results on the impact of acculturation orientations, locus of
control beliefs, and cultural distance on well being and acculturation stress in
foreign university students living in Germany.
Various theoretical accounts suggest that socially anxious people are either vigilant towards external anxiety cues or internal anxiety cues. A previous study
by the authors has investigated the specificity of the attentional bias displayed
by the socially anxious and found some evidence to support a cognitive bias
towards internally cued stimuli. The current study sets out to replicate these
findings and also to investigate whether such a bias operates at either the preattentive automatic processing or at the strategic conscious processing stage, in
high (n=40) and low (n=40) socially anxious participants, under conditions of
high or low self-evaluative anxiety. A modified version of a visual dot probe
detection task was employed incorporating four different threatening word
groups, included to assess the specificity of the bias. Two of the word groups
(somatic and negative evaluation) represented a more internally threatening
source and two symbolised a more external threat (physical and situational).
The stimuli were presented for 14ms (+ masking for 186ms) to detect automatic processing and 500 ms (no mask) to examine strategic processing. It was
expected that the high socially anxious would automatically attend to all socially threatening stimuli in both experimental conditions. In the strategic stage of
processing, however, they would only attend towards the negative evaluational words in the low-anxiety condition and the somatic words in the high anxiety condition. Reaction times and attentional bias scores for each word group
were analysed using analysis of variance. The results were discussed in relation
to previous findings and theoretical perspectives.
Questionnaire data were obtained in a sample of 71 female and 35 male students from various countries studying in Germany. Acculturation orientations
(e.g., subjective integration, assimilation, separation, and anomia) were measured sensu the taxonomy of J.W. Berry. Data on locus of control refer to the
self-concept of own competence, internality, powerful others externality and
chance control (Fragebogen zu Kompetenz- und Kontrollüberzeugungen; FKK). Further more, subjective cultural distance was measured by a 9item-scale and well-being by the Brief Symptom Inventory (BSI). Results refer
to the bivariate and multivariate interdependences of the variables. Multiple
regression analyses show that 8 out of 11 BSI-scale-scores can be predicted significantly by acculturation orientations, locus of control and cultural distance.
80
Posters
SOCIAL CAPITAL AND MIDDLE-AGED FEMALE AND
MALE MORTALITY RATES IN A CHANGING SOCIETY
ARE SUBJECTIVE HEALTH COMPLAINTS A RESULT OF
MODERN CIVILIZATION
1Árpád Skrabski, Ph.D., 2Maria Kopp, M.D., Ph.D.
1Apor Vilmos College, 2Institute Of Behavioural Sciences, Semmelweis
University
Hege R. Eriksen, Brit Hellesnes, Peer Staff, Holger Ursin
University of Bergen
Objectives: Social capital have been linked to mortality rates. We examined the
relationships between measures of social capital, neighbourhood cohesion, religious involvement and male/female mortality rates across 150 sub-regions in
Hungary.
Methods: 12,660 people were interviewed in 2002 (the “Hungarostudy III” survey), representing the Hungarian population according to sex, age, and subregions. Social capital was measured by three indicators: lack of social trust,
reciprocity between citizens, and membership in civil organisations.
Neighbourhood cohesion was measured by 10 items of Chicago Community
Survey Questionnaire, religious involvement was measured by two questions
on participation in religious services and subjective importance of religion.
Socio-economic status was measured by basis of income tax, and years in education. Gender-specific mortality rates were calculated for the middle-aged
population (45-64 years) in the 150 sub-regions of Hungary.
Results: All of the social capital variables, neighbourhood cohesion and religious involvement variables were protective factors in connection with middle
aged mortality. Social distrust showed the strongest association with male mortality. Religiousness and membership in civic organisations showed the
strongest negative connection with female mortality. Socioeconomic status was
a much stronger predictor of male mortality than of female mortality.
Objective: Subjective health complaints are common in the Nordic European
countries and a frequent reason for encounter with the general practitioner and
for long term sickness leave and disability. The aim of this study was to investigate if subjective health complaints are common complaints also in primitive
or developing cultures.
Design: Cross-sectional interviews. Setting: One “native” and one “coastal”
population from the Mindoro Islands were interviewed and compared to a representative sample from the Norwegian population.
Subjects: 120 aborigine Mangyans representing the “native” population (mean
age = 33.5 years, 72.5% women) and 101 subjects representing the “coastal”
population (mean age = 33.8 years, 60.4% women) were interviewed. Main
outcome measures: Prevalence and degree of subjective health complaints
(SHC). Results: The prevalence and degree of subjective health complaints
were higher in the native (Mangyan) population living under primitive conditions in the jungle in the Philippine island of Mindoro compared to the
Norwegian population. High levels were also reported from the coastal population of the same island. The entire native, 97% of the coastal, and 82% of the
Norwegian populations reported musculoskeletal complaints. 97.5% of the
natives, 94% of the coastal, and 65.1% of the Norwegian population reported
“pseudoneurologic” complaints, and 80.8% of the natives, 87% of the coastal,
and 59.8% of the Norwegian population reported gastrointestinal complaints.
Conclusion: Subjective health complaints are common also in non-industrialised populations. Therefore these complaints can not be attributed to the
stressors of industrialised societies.
Conclusion: There are gender differences in relative importance of social capital, socio-economic status, neighbourhood cohesion and religious involvement
in connection with middle-aged mortality rates.
IMMUNISATION OF SIX-WEEK OLD INFANTS LIVING IN
NEW ZEALAND
Dr Janis Paterson
Co-Director, Pacific Islands Families Study, Research Co-ordinator, Division
of Public Health and Psychosocial Studies
Pacific children have been shown to have poorer health status than other New
Zealand children with hospital rates for respiratory conditions, infectious and
parasitic diseases exceeding national rates. The New Zealand immunisation
schedule includes DTAP-IPV and Hip-Heb B vaccines for children at sixweeks of age. The aim of the presenation is to describe (1)the percetage of children were were immunised,(2)the satisfaction with care and treatment provided in this context, and (3)the factors associated with the immunisation status of
the infant.
data were collected as part of the Pacific Islands Familes: First Two Years of
LIfe (PIF)Study, a longitudiinal investigation of a cohort of 1398 infants born
in South Auckland during 2000 and their mothers and fathers. Six weeks after
the birth of the child,Pacific interviewers, fluent in both English and a Pacific
language, visted the mothers in their homes and administerd a questionnaire.
Findings revealed that there was a low uptake of immunisation with 73.1% of
Pacific infants being taken to the relevant health professional for this purpose
at six weeks. Socio demographic and maternal factors associated with immunisation will be presented and the cultural implication for health policy and promotion will be discused.
HEALTH-RELATED ATTITUDES AND THE WILLINGNESS
OF HEALTH INVESTMENTS AMONG MIDDLE-AGE PEOPLE IN HUNGARY
Eva Susanszky, Zsuzsa Szanto
Institute of Behavioral Sciences, Semmelweis University
Aim of the study: In Hungary, negative changes in the health status occur
around the 40th life year. Our research focused on the age group of 35-45 at the
threshold of ill health.
Method: A representative population survey was conducted on a random sample of 1000, 35-45 year old persons. We examined the psychological correlates
of health behavior through a self-report instrument, the Multidimensional
Health Questionnaire (MHQ). For measuring the willingness of health investment, we constructed a 20-item scale using explorative factor analysis
(Cronbach Alfa = 0,71). The items referred to health-conscious diet, regular
exercise, utilization of health screening services, studying healthy lifestyles,
and the need of securing future circumstances.
Results:
1. Women scored significantly higher than men on the health investment scale
(8.3 vs. 6.9).
2. 9 MHQ factors showed significant gender differences. Self-blame and health
satisfaction were more characteristic to men, while health consciousness,
health preoccupation and health as a source of anxiety and depression were significantly more typical to women.
3. Using stepwise analysis, we examined the relevance of MHQ factors in the
gender differences of health investment intentions. Men and women have different motivations. Women have a future-conscious, defensive motivation: they
wish to escape future ill health. Men, on the other hand, have a more presentoriented motivation: they want to conserve their current good health.
81
Posters
PERCEPTION OF THE PAIN AND QUALITY OF LIFE OF
THE CHRONIC LOW BACK PAIN PATIENTS BEFORE AND
AFTER A BACK SCHOOL.
PSYCHOLOGIC AID IN THE GLOBALISATION EPOCH
Henryk Sklodowski
Academy of Management
A., Duveau (1,2), N. Majery (1), I. Lempereur (1), C. Tarquinio(2).
(1) Service de Sante au Travail Multisectoriel, Luxembourg. (2) Universite
de Metz, Laboratoire de Psychologie, France.
Purpose: Back school is a therapeutic program with the objective to treat the
chronic low back pain in group sessions in collaboration with a multidisciplinary team. Thus, the patients, who are in a chronicisation process, take part in
theoretical as well as some practical lessons. So the objective of this research
is to study, at the beginning and the end of a rehabilitation program (10 days
over 6 weeks), the perception of the pain intensity and its repercussion on the
quality of life.
Methods : The measurement of the intensity of pain (at the moment of the evaluation, the morning and at the end of the evening, during the last 3 days) were
evaluated by Visual Analog Scales. In addition, the patients (n=32) answered a
part of the Dallas Pain Questionnaire (Lawlis & al. 1989).
Results : All the results showed a significantly lower pain intensity at the last
day of the back school than on the first. (respectively, t(28)=2,56 ; p< .05 ;
t(28)=3,86 ; p< .05 ; t(27)=3,15 ; p< .05). In addition, the pain significantly has
more repercussion on work and leisure before this program than after
(t(28)=2,80; p<.05). In the same way, an improvement of the quality of life,
with regards to depression and anxiety, was found, (t(26)=2,25 ; p<.05).
Conclusions: Results showed beneficial effects of on patients, undergoing a
multidisciplinary rehabilitation program. The effects were both physical and
psychological in nature. Project sponsored by the social European fund.
THE IMPACT OF FINANCIAL CIRCUMSTANCES ON STUDENT HEALTH
D. C. Jessop, C. Herberts, L. Solomon and H. E. Dittmar
D. C. Jessop, L. Solomon and H. E. Dittmar are affiliated to the University of
Sussex; Falmer, Brighton, BN1 9SN, UK. C. Herberts is affiliated to Middlesex
University, Enfield, London, EN3 4SF, UK.
The current study explored the impact of students’ financial circumstances on
their mental and physical health. An opportunity sample of 89 British students
and 98 Finnish students completed a questionnaire which assessed their debt,
financial concerns, mental and physical health, smoking and drinking behaviours, work in addition to study, and perceptions of control. Mental and physical health were assessed using the Short Form 36 Health Survey (SF-36) and
the General Health Questionnaire (GHQ). British students reported greater levels of debt and financial concern than Finnish students. They also reported significantly worse health on all the dimensions of the SF-36, except change in
health, and on the GHQ. Financial concern was a significant linear predictor of
physical function, role limitation due to emotional problems, social functioning, mental health, energy/vitality, pain and general health perception as
assessed by the SF-36 and mental health as assessed by the GHQ. For all of
these health-related variables, increased financial concern was associated with
worse health. There was no evidence that students’ smoking or drinking behaviour, work in addition to study or perceptions of control substantially mediated
the relationship between financial concern and health. The results support the
position that students’ financial circumstances might have serious implications
for their health. It is proposed, therefore, that recent changes in UK government
funding policies for students could have a negative impact on student health
and exacerbate finance-related health inequalities. Further research is required
to identify factors that may mediate or moderate the impact of financial concern on health.
82
Signum temporis of our times, in other words - the world’s shrinking to the dimensions
of “the global village” - is the result of dynamic development of
communication.Globalisation affects all the most important spheres of life and becomes
a real challenge for occupational counselling. Its social and economic consequences
affect in an extremely critical way among others the kind of occupational work, changing the whole of requirements in relation to potential employees and ruining the sense
of stability and safety of individuals and the whole community.
Technological progress was to shorten people’s working hours giving them in this way
more freedom, meanwhile this shortening paradoxically results in progressing unemployment. Along with it there occurs the necessity to change the job and more and more
frequently - to requalify. The chance to get a job has to be related with readiness to
move, to change the place of residence and thoroughly reorganize the way of life led
hitherto. Countless numbers of psychic burdens related to this situation cause the fact
that the time has come for psychologic aid (apart from information and professional
education) to play an important part in occupational counselling. This aid should refer
to several basic fields:
1. finding oneself in the world of new requirements and values;
2. getting to know oneself, one’s psychic trumps, gifts and predispositions helpful in
improving professional qualifications;
3. work on one’s character in order to gain minimum flexibility necessary while changing life situations;
4. solving problems of existential nature related to the expansion of consumer civilisation;
5. coping with occupational competition;
6. getting the sense of safety and self-confidence in the changing life situation;
7. absorption of foreign cultures and simultaneous assistance in protection of individual
and cultural identity;
8. overcoming individual negative established patterns impeding professional success,
having its source in childhood and in family problems;
Globalisation means more and more common lack of direct contact among people and
depersonalization in communication. These phenomena regard labour market as well more and more people suffer psychically due to that and need psychologic aid - including psychotherapy appearing in the process of occupational counselling. The particular
role of psychotherapy should be emphasized here.
It is worth remembering that modern life counselling cannot limit itself to emergency
aid but has to be engaged in research work conceived on a wide scale, with the application of well-known scientific methods using experimental knowledge which could give
the possibility of widely comprehended teaching and learning “through activity”. The
knowledge gained in this way will enable such planning of the progressing globalisation
to make it friendly to human beings.
ACCULTURATIVE DISTRESS IN CYPRIOT ADOLESCENTS: A
RISK FACTOR FOR PHYSICtAL ILLNESS AND EMOTIONAL
DISTRESS
Marios N. Adonis, MA., & Sonia Suchday, Ph.D.
Ferkauf Graduate School of Psychology & Albert Einstein College of Medicine
of Yeshiva University
Acculturation is a phenomenon originally conceptualized for migrating people, but
it may also result from the adaptation of indigenous groups to ongoing ecological
and social changes within their own society. The current study investigates the
effects of acculturative stress (ACS) in an indigenous population of adolescents in
Cyprus. Forty adolescents (22 females, 18 males) ages 14-18 were recruited from a
private high school in Larnaca, Cyprus. Participants were asked to complete a
series of questionnaires that assessed acculturative distress using a scale (WADIS)
developed for the purpose of this study, perceived stress using the PSS, and physical functioning (PF), general behavior (GB), mental health (MH), and self-esteem
(SE) using the Child Health Questionnaire (CHQ-CF87). Results: All analyses
were conducted controlling for age and socioeconomic status. Gender differences
were found in the way ACS was associated with the quality of life measures, even
though boys and girls did not differ from each other on any of the variables. In girls,
the partial correlations between the personal impact subscale (PI) of the WADIS
with PSS, PF, GB, MH, and SE were .68, -.57, -.77, -.77, -.79, respectively, all at
p<.001 with the exception of PF, which was at p<.01. In boys, the only association
that was evident was between PF and the cultural impact subscale (CI) of the
WADIS (-.70, p<.003). Conclusions: ACS is strongly associated with self-report
measures of physical and emotional well-being, and these association are different
in male and female adolescents.
Posters
PART OF IT BY PROXY: A SOCIAL IDENTITY APPROACH
TO HIV COMMUNITY AMONG GAY MEN
J. Grierson, M. Pitts, A. Smith
Australian Research Centre in Sex, Health and Society, La Trobe University
Background: The concept of community has been central to the response to
HIV/AIDS. This has been particularly true of gay men living with HIV/AIDS.
The term HIV communities has come to signify segments of the HIV positive
population that share common identifications and cultural norms and are thus
amenable to community-centred education and support services.
Methodology and Findings: This paper reports on HIV=Community?, a qualitative study of 30 HIV positive gay men in Melbourne and Sydney, Australia,
about their relationship to constructs of gay and HIV community. Additional
supportive material is drawn from the HIV Future 3 Survey, a national quantitative project with 894 participants. Participants in both studies were asked
about and the importance of personal characteristics including gender, sexuality and HIV status and their participation in various subcultures. Social Identity
Theory has been employed to interrogate the relationship between these identifications and health and community practices. In general the men’s identity as
gay was superordinate to that as HIV positive. In particular, HIV identity was
more often seen as contextual while gay identity was seen as constitutive. The
centrality of HIV is unrelated to health status and clinical history, but is significantly related to a range of health maintenance and service access practices.
Conclusions: These differences suggest that social networks and collective
identifications play an important role in the ongoing management of HIV, and
have critical implications for HIV service delivery and health promotion.
A PROSPECTIVE STUDY TO INVESTIGATE FACTORS
INFLUENCING PARENTAL DECISIONS ABOUT CHILDHOOD MMR VACCINES
Wroe, A.L. & Salkovskis, P.M.
Institute of Psychiatry, King’s College London, UK
Background Previous research has suggested that decisions about early childhood immunisations are made by weighing up the perceived pros and cons.
However, these reasons include only those on which the decision maker
focuses at that time and include emotional factors such as responsibility and
anticipated regret if harm were to occur (Wroe et al, 2003). These emotional
factors are associated with ‘omission bias’ i.e. the assumption that causing
harm through action is worse than allowing harm to occur through inaction
(e.g. Baron, 1990).
Aim The study described in this paper is a prospective study to investigate the
role of both utilitarian type factors (perceptions of benefits and risks of immunisations) and emotional factors (anticipated responsibility and regret) on decisions about the Measles, Mumps, Rubella (MMR) vaccine, an issue that has
received much media attention.
Method Carers (n=100) of children aged 10-12 months completed a structured
telephone interview about the MMR vaccine. This included questions about the
immunisation decision, perceptions of risks of the diseases and risks of the
immunisations, as well as questions about feelings of responsibility for harm,
and regret of decisions leading to harm. Carers were contacted after the date of
the first expected immunisation, to ask about the immunisation decision.
Results Regression analyses and t-tests suggest that immunisation decisions are
influenced by utilitarian type factors as well as emotional factors.
Conclusion Decisions about MMR appear to be strongly influenced by emotions such as anticipated regret and responsibility. Clearly, any intervention to
aid such decisions must address emotional factors and the possible role of
omission bias.
PREVALENCE AND PSYCHOSOCIAL RISK FACTORS OF
ERECTILE DYSFUNCTION IN A HUNGARIAN RANDOM
SAMPLE
Robert Urban and Bela Marian
Eotvos Lorand University and Marketing Centrum
The prevalence and risk factors of erectile disorder (ED) were examined in a
Hungarian random sample. The sample consisted of 613 sexually active males’
self-report which was collected in a Hungarian Lifestyle research in 2002.
In the total sample, 72 % of participants did not reported any problem with
erection, 18 % had reported minimal ED, 8 % moderate ED and 2 % complete
impotence. In the subsample of males between 40-70 ages, the prevalence rates
were different (54 %, 29 %, 14 %, 3 %, respectively). Logistic regression
analysis was applied to determine the relative risks (odds) of ED in our sample.
In the total sample, age, residence, psychological stress and two or three chronic diseases formed significant risk factors to ED. Other factors that are frequently mentioned related to ED, such as smoking, and overweight did not produce significant odd ratios in our analysis. The explanatory power of the model
is good (R2=0,36).
PSYCHOSOCIAL FACTORS IN ASTHMATIC’S HEALTH
CARE
Lamouroux Aurore, Vervloet Daniel and Morin Michel
Department of Social Psychology and Department of Respiratory Diseases
Asthma is an increasing threat for individual and community health. French
Health Authority have recently emphasized an urge for secondary preventive
actions based on patient educational stratégies. Results so far have been
unsatisfactory since patients seem reluctant to attend to programs which are
offered to them. A research program has been built up in an hospital in the
south of France. It is focused on psychosocial factors affecting motivation in
astmatic patients’ health care. After a qualitative exploratory step, survey
based on a self-administrated questionnaire : illness perceptions, treatment
beliefs, quality of life (HRQL scale, Juniper abreged), self-efficacy questionnaire (Schwarzer,1992) and depressive symptoms scale (CES-D), illness
behaviors, patients education behaviors . Our questionnaire was administrated
to 81 male and female subjects, diagnosed with clinical asthma. Results confirmed the impact of HRLQ and self-efficacy on motivation in health care.
Lower HRQL and lower self-efficacy were significantly the strongest predictors of motivation. Patients’ intention to participate in such programms was
influenced by both factors. To conclude, this research shows the interest to support health education programs which take into account psychosocial factors
like beliefs about treatment as well as illness perceptions and factors, HRQL
and self-efficacy, with a special attention to lower levels but also to denial
process and optimistic control illusions.
83
Posters
THE IMPACT OF ANXIETY ON PREOPERATIVE COGNITIVE FUNCTIONING – A COMPARSION OF THE WEEK
AND DAY BEFORE SURGERY
Stygall, J., Mulligan K Steed L , Harrison M; Newman, SP,
Unit of Health Psychology, Centre of Behavioural and Social Sciences in
Medicine, University College London.
Backgound; Decline in cognitive performance has been found following
CABG. The baseline measures are customarily performed the day before surgery. This study assessed whether the timing of the assessments prior to surgery
influenced anxiety and cognitive performance.
Aims: To compare anxiety levels at 1 and 7 days before elective cardiac surgery and to investigate the relationship of anxiety levels to cognitive performance.
Methods: Two hundred and thirty age-matched participants were assessed on a
battery of 6 neuropsychological tests (Trail Making A & B, Choice Reaction
Time, Letter Cancellation, Rey Auditory Verbal Learning Test, Symbol Digit
Replacement Test) and state anxiety (STAI) prior to surgery. Assessments were
either conducted one week (n = 124) or the night before surgery (n = 106).
Results: Those assessed one week prior to surgery were more anxious than
those assessed the night before surgery( p =<.005 ). Standard scores were
derived for each neuropsychological test and a total performance score
obtained. Cognitive performance did not differ between the groups. There was
also no correlation between anxiety and performance on any test or total test
score for either group.
Conclusions: These results suggest that anxiety does not influence the cognitive tests customarily performed to assess the impact of cardiac surgery.
Surprisingly anxiety levels were found to be higher for those assessed the week
rather than the day before surgery. This may reflect the reduced anxiety about
whether the surgery will proceed in the group assessed at 1 day before their
operation.
PERTENSION VERSUS SUSTAINED HYPERTENSION AND
NORMOTENSION
Garcia-Vera, M.P., Sanz, J., Espinosa, R., Fortun, M., and Magan, I.
Department of Clinical Psychology, Universidad Complutense de Madrid,
Spain
The aim of this study was to determine whether patients with isolated clinic
hypertension, in comparison with sustained hypertensive patients or normotensive persons, display normal levels of hypertension-related psychological characteristics such as trait anxiety, maladaptive problem-solving skills, and Type
A behaviour pattern. To get this aim, 42 male patients, with stage 1 to stage 3
essential hypertension (mean ± SD age 45 ± 9 years) divided into two
groups after self-monitoring blood pressure (BP) (24 with isolated clinic hypertension -self-measured BP < 135/85- and 18 with sustained hypertension -selfmeasured BP ≥ 135/85-), and 22 normotensive men (clinic BP < 140/90
and self-measured BP < 135/85) matched by age with patients, completed the
trait scale of the State-Trait Anxiety Inventory (STAI-R), the Social ProblemSolving Inventory (SPSI), and two scales (Type A behavior pattern and harddriving behavior/competitiveness) of the Jenkins Activity Survey (JAS, Form
C), and their scores on these questionnaires were compared.
SOCIAL COMPARISON IN CHRONIC PAIN: A STUDY OF
REVIEW
PSYCHOLOGICAL ASPECTS OF EXPERIENCE OF CHRONIC ILLNESSES: CANCER AND ARTERIAL HYPERTENSION
PASTOR M.A.,PONS N., LLEDO A.,MARTIN-ARAGON.,LOPEZ-ROIG
S.,TEROL M., NEIPP, MC., JIMENEZ
Health Psychology Department, Miguel Hernandez University. Alicante.
Spain
Anita Galuszka
Faculty of Education & Psychology, Institute of Psychology, Silesian
University
Though the social comparison and its conceptualisation like cognitive resultant process of the interaction with others was initiated by Festinger (1954). In
the area of the Health Psychology, social comparison has received special interest among people experiencing chronic pain and facing other chronically
threats (Affleck et al., 1987; Taylor et al., 1990; De Vellis et al., 1990).
Aim: To analyse the role of the social comparison in chronic pain patients by
reviewing empirical studies.
Method: A search of databases (Medline, Psychoinfo) was conducted for relevant articles published between 1980 and 2003 We introduce the descriptors:
social comparison, lateral comparison, upward comparison, downward comparison, fibromyalgia, rheum *, rheumatoid arthritis, osteoarhritis. Selected criteria used to review was focused on instruments of evaluation of social comparison, their adequacy and their adaptation according to the theoretical construct of comparison (orientation to the comparison, aspects that are compared,
modals of comparison, type and frequency of upward and downward comparison and identification - contrast). Finally we reviewed the results of adjustment
in health related to social comparison process.
Results: We selected 8 studies from the 9 found due to our selected criteria. The
review of the literature supports the importance of the social comparison
process as a cognitive strategy to cope with chronic diseases and the health outcome results depending on upward or downward comparison related to different aspects of illness situation and regard to others. However, it is necessary to
compare and adapt social comparison instruments in order to assess this
process and get more precise health outcome results.
84
The aim of the work has been to find the differences in cognitive and emotional functioning and meaning of life between patients suffering from two diseases: cancer and arterial hypertension. An attitude toward own disease is connected to cognitive process (especially the patients` own evaluations concerning condition of their health), emotions (particularly fear and hope as the most
important and typical emotional responses towards a disease) and meaning of
life.
There were three phases during the researches. The first one has been performed until ten days after diagnosis. The second phase has been done about 5
weeks after the first phase. The final stage has been realised about 5 months
after the second phase.
There were three tools used in this study (the Gottschalk-Gleser Content
Analysis Scale measured fear and hope, interview concerning own evaluation
of health which estimates the health including the general evaluation and
changes in health situation, the Purpose in Life Test of Crumbaugh and
Maholick measured meaning of life).
The results have shown that at the first stage of the research the hope referred
to the group of patients with cancer as compared to the ones with hypertension
decreased. However, this hope increased in the first group in the next phases
reaching higher level than in the group with hypertension. The patients in both
groups showed similar tendencies regarding the evaluation of condition of their
own health. The findings have shown no differences in meaning of life between
both groups of patients.
Posters
PSYCHOLOGICAL INSULIN RESISTANCE.
TIVE STUDY.
A QUALITA-
Pop Mirela
Center of Diabetes, Nutrition and Metabolic Diseases, Cluj-Napoca Romania
Objective: To explore the experience of insulin treatment initiation in romanian patients with type 2 diabetes, in regard to the representation of insulin therapy, the factors influencing this representation and theyr attitudes towards
insulintherapy.
Design: Qualitative study of sujects’ experience of insulin therapy and its perspective, using semi-structured interviews, phenomenological analysis and
content analysis.
Subjects: 11 romanian patients with type 2 diabetes, in the situation of having
to choose whether to admit or not insulin therapy. They were recruited from the
Diabetes Center, Cluj-Napoca.
Results. The results show that the participants have a wide variety of representations regarding insulintherapy, mainly concerning: the effects of insulin, the
causes that produced the need for insulin administration, the procedure of
insulintherapy and its consequences. Several constructs were detected in relation to factors that might influence the patients view of this treatment and theyr
choice for the future. The main factors identified as responsible for patients
representations and atitudes towards insulin therapy are: social influences,
physician-patient relationship, the presence of other disabilities, the fear of
related complications.
Conclusions. Psychological insulin resistance is not just a new concept, but a
reality. This reluctance is not due merely to the fear of an injectable drug, but
it is a much more complex phenomena. Knowing the patients real psychological barriers may be an important therapeutic tool for the health-care team, and
for the patient itself.
BELIEFS OF FAMILY CAREGIVERS OF PATIENTS WITH A
TRAUMATIC BRAIN INJURY: 12 DEVELOPMENTAL CASE
STUDIES
NATACHA SILVA* & LUIS JOYCE-MONIZ**
*PRIVATE PRACTICE; **UNIVERSITY OF LISBON
This study IS aimed at the characterization of the beliefs or significations of
family caregivers of patients with a traumatic brain injury, structuring their
ordering by means of developmental and dialectic criteria (Joyce-Moniz,
1993). In addition to the levels of signification, the modes of emo-tional
expression and congruency were identi-fied. For this purpose, responses of
twelve care-givers to dillematic situations (involving proce-dures to its resolution and dramatizing) con-nected to the three most relevant topics of the literature: prognosis of the trauma evolution, dependance on caregivers and aggressive and bizarre behaviours were analyzed. Almost all the significations were
classified in levels two and three of the developmental hier-archies of the
model which comprise five levels and in modes of cathartic and congruent expression. Emotional disturbance was also de-creased, mainly in cases of meaningful hyperva-lence of level three. The implications of this de-velopmental
characterizing to the adjustment of caregiving processes were examined.
SEXUAL DYSFUNCTION, NEGATIVE AFFECT AND GENDER DIFFERENCES IN DIABETIC PATIENTS
HYPERTENSION, STRESS AND GENDER DIFFERENCES IN
DIABETIC PATIENTS
Silva, I., Ribeiro, J., Cardoso, H., & Ramos, H.
Faculdade de Psicologia e de Ciencias da Educacao da Universidade do
Porto; Hospital Geral de Santo Antonio; Study supported by Grant Praxis
XXI BD/21804/9
Silva, I., Ribeiro, J., Cardoso, H. & Ramos, H.
XXI BD/21804/9
OBJECTIVES: The objective was to examine the effects negative affect on
sexual dysfunction and the presence of gender differences associated to this
diabetes squeal in 316 diabetic patients.
METHOD: Sample design: A cohort of 316 individuals, 44.6% of which were
males; 41.8% with Type 1 diabetes; aged between 16 and 84 (M=48.39;
SD=16.90); 17.7% unmarried; 72.5% married; 3.8% divorced and 6.0% widower; 21.2% (n=67) suffering from sexual dysfunction was studied.
Procedure: Participants answered to the psychological scale in the context of a
personal interview.
Measures: Portuguese version of the Hospital Anxiety and Depression Scale.
RESULTS: Results suggest that men (40.43%) present more frequently sexual
dysfunction (÷2(1,316)=56.31; p<.00001) than women (5.71%). Patients with
sexual dysfunction report lower anxiety (t(314)=2.37; p<.05), but do not differ
from those who do not have this problem concerning to depression and total
negative affect. Women report higher anxiety (t(314)=6.76; p<.0001), depression (t(314)=3.87; p<.0001) and total negative affect (t(314)=6.34; p<.0001)
than men.
CONCLUSION: Results showed that men report more frequently sexual dysfunction and that patients with this problem present less anxiety, but do not differ concerning to depression and total negative affect. Women report higher
anxiety, depression and total negative affect than men.
OBJECTIVES: The objective was to examine the effects stress on hypertension
and the presence of gender differences associated to this diabetes squeal in 316
diabetic patients.
METHOD: Sample design: A cohort of 316 individuals, 44.6% of which were
males; 41.8% with Type 1 diabetes; aged between 16 and 84 (M=48.39;
SD=16.90); 17.7% unmarried; 72.5% married; 3.8% divorced and 6.0% widower; 46.2% (n=146) suffering from hypertension was studied.
Procedure: Participants answered to the psychological scale in the context of a
personal interview. Measures: Life Events Scale
RESULTS: Results suggest that there are no significant gender differences concerning hypertension diagnosis. Patients suffering from hypertension report
less positive life events during the last year (t(314)=4.84; p<.0001), as well as
less total stress than patients without this diabetes complication (t(314)=2.80;
p<.01), but they do not differ in the negative life events reported. Women
report more positive (t(314)=2.46; p<.05) and negative life events
(t(314)=2.10; p<.05) during that period of time than men, however they do not
differ in the total stress reported.
CONCLUSION: Results showed that hypertensive patients present less positive and total stress, but not show higher negative stress. Women report higher
positive and negative stress, but not higher total stress.
85
Posters
IMPLANTATION OF ORTHOPAEDIC MATERIALS : THE
PATIENTS’ COGNITION AND APPREHENSION.
PRELIMINARY REPORT.
PERCEPTION OF PROGNOSTIC RISK IN PATIENTS WITH
MULTIPLE SCLEROSIS: THE RELATIONSHIP WITH ANXIETY, DEPRESSION AND DISEASE-RELATED DISTRESS
Givissis, P., Hionidou, Chr., Heinz, El., Pournaras,J.
Aristotle University of Thessaloniki, Medical School. Papanikolaou Hospital.
Cecile Janssens, Pieter van Doorn, Josien de Boer, Frans van der Mech?,
Rogier Hintzen, Jan Passchier
Erasmus Medical Center Rotterdam: department of Public Health, department
of Medical Psychology and Psychotherapy, department of Neurology
The last two decades have witnessed a significant increase on theories and
research concerning several aspects related to the meaning of illness. On the
basis of a research done by the first author ten years ago at the first orthopaedic
department of Aristotle University of Thessaloniki and according to recent references a new research is in progress at the same hospital focusing on the
patients’ cognition and apprehension of the implantation of orthopaedic materials. The previous research (106 questionnaires, 51 men and 55 women, average age 50,2 years) shows that women’s and eldest’ acceptance of the implants
is greater than that of men and younger patients even in acute cases.
Misinformation and misconception were also found in a very high percentage
of the questioned patients (approximately 70%). In order to enlighten the previous findings at the first phase of the current research, semi-structured interviews are taken from orthopaedic patients who underwent major or minor operations. The results of interviews are going to be used for the structure of a new,
more specific questionnaire.
The qualitative analysis of 24 interviews is presented and the results are discussed.
Objectives: Expectations about future disease progression may be
an important factor in the psychological well-being of patients
with chronic diseases. The aim of the study was to investigate the
relationship of perception of prognostic risk on anxiety,
depression and disease-related distress in patients with multiple sclerosis (MS).
Method: In a 2-year follow-up study, perception of the 2-year,
10-year and lifetime risk of wheelchair dependence (a frequent and
well-known consequence of the disease), disability status, anxiety,
depression and disease-related distress were assessed in 101
patients with MS. Distress was measured as the intrusion and
avoidance of MS-related thoughts and feelings.
Results: Patients overestimated their 2-year and 10-year risk of
wheelchair dependence. Higher perceptions of the 2-year and 10-year
risk of wheelchair dependence were associated with higher levels of
anxiety, depression and disease-related distress. Perception of
the lifetime risk was only significantly related to intrusion of
MS-related thoughts and feelings. Moreover, higher perception of
the 2-year risk at follow-up was associated with higher levels of
anxiety, depression and disease-related distress. All relations
were independent of clinically assessed disability status. Conclusions:
Expectations
of
short-term
wheelchair
dependence
were
significantly related to psychological well-being in patients with
MS. These findings point out that, in their consultations with
chronically ill patients, doctors should not only address long-term
prospects of the disease, but also add information on the short-term prognosis.
IMPACT OF THE PSYCHO-ORGANISATIONAL AND MOTIVATIONAL FACTORS ON THE PERCEIVED MUSCULOSKELETAL PAIN
CHARACTERISTICS OF ALLERGIC PATIENTS WITH OR
WITHOUT ANXIETY
LANFRANCHI, J.B., DUVEAU, A. AND TARQUINIO,C.
LABORATORY OF PSYCHOLOGY, UNIVERSITY OF METZ, FRANCE
STAUDER A, KOVACS M
Semmelweis University Institute of Behavioural Medicine
The purposes of this study were: (1) to take into account the
musculoskeletal disorders (MSD) through the perceived pain in terms of intensity and prevalence during the last 6 months 2) to seek the psycho-organisational and motivational factors related with this pain.
Methodology: a self-administered questionnaire was made from two models,
one about professional stress (Job Strain Model ; Karasek, 1979) and the other
about work motivation (Job Characteristics Model ; Hackman & Oldham,
1980). Also, a scale of perceived musculoskeletal pain (PMP) adapted from
«Standardized Nordic questionnaire » (Kuorinka, & al., 1987) was used. For
this study, 400 blue and white collar employees were recruited at the
occupational health service.
Results: First multiple regression analyses showed that the perceived
musculoskeletal pains could be positively predicted by work implication
(high internal work motivation), by degree of control and knowledge of work
results. On the other hand, PMP could be negatively predicted by job satisfaction, by experienced meaningfulness of the work and the job demands.
Conclusion: The findings of this study indicate that emotional, cognitive
and conative dimensions of these stress and motivation work models
contributed to the comprehension of the MSD.
Background: Psychological problems like anxiety can have a great influence
on the development and treatment of allergic diseases, however they are
often neglected in clinical practice. Objective: In the present study we
compared the characteristics of allergic outpatients with and without
anxiety symptoms in order to identify possible risk factors and diagnostic
cues. Methods: Self-administered questionnaires were completed by
consecutive patients in six outpatient allergy clinics. The main allergy
symptoms of the 646 respondents were rhinoconjunctivitis (59,3%), asthma
(26,8%) or other allergy (13,9%). The men/women ratio was 44.1 / 55.9%,
the mean age of the sample was 33,4Â?12,3 years (range 16-65). Anxiety was
determined on the basis of the Trait Subscale of the Spielberger State-Trait
Anxiety Inventory (STAI-T). The threshold for clinically significant anxiety
was STAI-T>52, for low anxiety STAI-T<48. Results: Using this threshold,
19% of the sample was in the high anxiety and 67.8% in the low anxiety group.
Independent risk indicators of high anxiety were female gender; asthma;
perennial allergy symptoms. Useful diagnostic cues were non-specific factors
like physical load, stressful situations, strong emotions, triggering or
worsening the allergic symptoms; problems with sleep; and considerable
limitation in daily activities due to the allergy symptoms. Conclusions: We
could identify subgroups of allergic patients at higher risk of anxiety
disorder. Certain allergy related complaints are more common, or more
severe, in patients with high anxiety. Self-administered questionnaires such
as STAI-T can provide reliable help to identify anxiety problems.
The research was supported by the Hungarian National Research Found
(OTKA) grant number F029857.
86
Posters
A CONFRONTATION BETWEEN DEFENSIVE STYLES AND
FAMILY FUNCTIONING STYLES IN SUBJECTS OF
NEAPOLITAN SECONDARY SCHOOLS
Sommantico, M., De Rosa, B.
Department of Relational Sciences “G. Iacono” - University of Naples
“Federico II”
In the classical psychoanalytical theory defence mechanisms are considered
as a complex of operations aimed to resolution and suppression of each modification dangerous for the bio-psychological individual’s integrity. Adolescent
and post-adolescent phases represent particularly significant moments for
studying defences because they are characterised by typical defence mechanisms and because of structuration of personality characteristics and individual defence modalities. Family psychology too conceptualise late adolescence
as an highly critical period presenting overlaps with the preceding family life
cycle phase (adolescence), and with the following, (the “long family” of the
young adult).
In agreement with previous papers aimed to analyse typical defensive modalities in the late adolescence, the present contribution has the purpose to confront defensive styles and family functioning styles in a group constituted by
148 students (53 males, 95 females) of the secondary schools of Naples’ territory an by their parents.
To evaluate of defensive styles we used the DMI Defense Mechanism
Inventory a test that permit to measure the intensity with which the subjects
utilise the five defensive classes individuated basing on conflict management
modalities (Aggressiveness, Principalisation, Projection, Address toward the
self, Overturn). To evaluate family functioning styles we utilised the FACES III
Family Adaptability and Cohesion Evaluation Scale, a self report instrument
specifically destined to evaluate Cohesion and Adaptability We report principal results emerging from the data analysis effected using SPSS.11 and considering descriptive and correlational statistics as correlation coefficients and variance analysis.
SOCIAL SUPPORT IN ADOLESCENTS` PERCEPTION
Anna Worsztynowicz
Silesian University
Purpose: This study explored adolescents` perception of social support.* Three
sources of support were tested: parents, friends and teachers. The purpose of
the study was to answer the following questions: Who is the strongest source
of support for adolescents in their opinion? Are there any differences between
girls and boys with regard to this opinion? Who: girls or boys receive stronger
social support?
Method: Subjects were 270 students (aged 18-19) of the last grade of secondary vocational schools. They were asked to fill out a set of self-report questionnaires: The Social Support Scale (in versions regarded to support from mothers, fathers, friends and teachers) and The Sociodemographic Questionnaire.
Results: The strongest source of support as well in girls as in boys were mothers. Girls received stronger support from friends than from fathers, boys inversely. The weakest source of support in girls and in boys were teachers.
Moreover in group of girls support from mothers, friends and teachers was significantly higher than in group of boys, but there was no gender difference
referring to support from fathers.
Conclusions: The results determine to search the answer to subsequent questions: Are there any differences between adolescent girls and boys with regard
to the level of expected support? (It is possible that adolescent boys need more
support than girls), and: Are there any gender differences referring to a competence for using received support?
* The study is a part of larger research project supported by: grant No. 1 HO1F
022 19 from KBN in Warsaw to the author.
HABITS AND LIFE STYLES IN A SUBURBAN POPULATION
OF SCHOOL-AGED CHILDREN AND ADOLESCENTS
THE DIFFERENCES BETWEEN SELF- ESTEEM AND QUALITY OF LIFE IN TEENAGERS WITH ACNE VULGARIS
Fernando Fradique & Luisa Barros
Universidade de Lisboa
Monika Kowalska*, Joanna Zaremba**, Adriana Zagorska***
Medical Academy of Warsaw, **Provincial Occupational Health
Service,Wloclawek; ***Univercity of Warsaw
Compared with other age groups, adolescents seem to be a healthy group.
However, different types of behaviour during adolescence may constitute serious threats for health. These behaviours usually are established during youth
and may persist into adulthood. In order to prevent them and promote healthy
behaviours among youth, it is necessary to characterize risky and healthy
behaviours patterns and their eventual inter-relations on the target population.
The following poster gives an overview of how a large sample of school-aged
children and adolescents (10-19 years old) attending school in a suburban
region responded to a questionnaire addressing several habits and life styles
related to alcohol and drug use, nutrition and meals schedule, physical activity,
dental caring, and tobacco use, in addition to disease personal history and use
of health professional facilities.
Acne vulgaris is one of the most common skin diseases. According to literature
data problem concerns 80-100% patients of age 11-30
The essence of acne is hypersecretion of oil glands and increase hornification
of hair follicles, leading to close the oil glands outlets. This causes the origination of comedos and pustules. Disease is the chronic one. The face ,back
and other oil areas are the main places of the rush. It is a long-lasting cosmetic problem ,requiring long treatment ,and obviously exerts strong influence on
patients, changing their self -esteem and quality of life. That is why aim of this
study is psychological estimation of the disease influence on self- esteem and
quality of patients” life and differences between men & women.
The following, psychological methods were used: Adjective Check List (ACL)
- H.G. Gough and A.B. Heilbrun; The Scale of Anxiety D. Schailling
Initially elaborated results of our study indicated that there are valuable differences concerning gender, self - ego picture and emotional reactivity.
87
Posters
SENSE OF COHERENCE IN ADOLESCENTS IN THE CONTEXT OF CHOSEN VARIABLES OF FAMILY LIFE
Maria John-Borys and Ewa Augustyniak-Nawrot
Faculty of Pedagogy and Psychology, Silesian University, Katowice, Poland
PURPOSE:The subject of analysis are relations between adolescents’ sense of
coherence (SOC)and their perception of parental attitudes and social support
obtained from both parents. Dependences between SOC and parents’ education
and family material status are also examined. The examination is rooted in both
Antonovsky’s concept and Roe and Siegelman’s theory of parental attitudes.
HYPOTHESIS: 1.Global SOC level and height of its components in adolescents depend on mathers’ and father’ parental attitudes.
2.Global SOC level and height of its components depend on kind and range of
social support obtained from both parents.
3.Global SOC level and height of its components depend on parents’ education
and family’s material status.
EXAMINED SAMPLE: The sample consisted of 105 pupils in the age between
18-19 from two chosen and random secondary schools in Katowice.
METHODS:The following methods were used in the examination: “Life
Orientation Questionnaire” (Polish adaptation of Antonovsky’s Sense of
Coherence Questionnaire),Roe and Siegelman’s Parents-Child Relations
Questionnaire, Kmiecik-Baran’s Social Support Scale,questionnaire concerning parents’ education and family’s material status, stayistical methods of
analysis.
CONCLUSIONS: The obtained results showed that there were relations
between SOC and parents’ attitudes but mothers’ attitudes had bigger importance.The relations between SOC and parental social support were also
found.The examination also proved high correlation between SOC and parents’
education and family’s material status.
THE EFFECTS OF A SCHOOL-BASED EDUCATION PROGRAM ON INTENTION TO REGISTER AN ORGAN DONATION PREFERENCE AMONG NATIVE AND NON-NATIVE
HIGH SCHOOL STUDENTS IN THE NETHERLANDS
M.D Nijkamp 1, A. Reubsaet 1, J. Brug 1,2, J.P. van Hooff 3, H.W. van den
Borne 1
1 Maastricht University, 2 Erasmus Medical Center, 3 University Hospital
Maastricht
Purpose: In order to promote registration of organ donation preferences
among adolescents in the Netherlands, a school-based education program was
developed to enable high school students to make a well-considered decision
about organ donation. The effects of the intervention were compared for
native and non-native students.
Methods: The intervention considered 2 classroom sessions in which a video
was used followed by group discussion, an interactive computer program to
provide tailored information, and a registration training. The intervention was
tested in a randomised controlled trial. Subgroup analysis compared the control
and experimental data of the native and non-native students. Results: Subgroup
analysis within the control group showed that non-native adolescents were less
involved in the subject of organ donation, scored lower on knowledge specifically related to the health problem, reported less social outcome expectancies,
and had more negative outcome expectancies. In addition, self-efficacy scores
were lower for non-native students. Correspondingly, less non-native students
(33.4%) intended to register compared to native students (52.4%). In the experimental group 58.1% of the non-native and 69.3% of the native Dutch students
would register their preference.
Conclusion: The program increased the intention to register preference with
respect to organ donation in both non-native and native students. Although differences were found with respect to the determinants of intention to register, it
was decided to plead for a general program for all non-native and native adolescents. Future research should analyse the influence of primary networks
(social outcome expectancies) in non-native and native students on organ donation registration.
A QUALITATIVE ANALYSIS OF YOUNG PEOPLE’S CONTRACEPTIVE USE: GAINING A GREATER UNDERSTANDING
SYMPTOMATOLOGY OF DEPRESSIVE STATES IN ADOLESCENCE: A CROSS-CULTURAL COMPARISON
BETWEEN AN ITALIAN AND A SPANISH SAMPLE.
Katherine E Brown, Madelynne A Arden & Keith M Hurst
Sheffield Hallam University
Centre for Research into Human Behaviour
School of Social Science and Law
*Camarri C., **Pruneti C., *Todaro C., **Frassi F.N., *Rota S.
*Clinical psychology Outpatients Department, S.Chiara Hospital, Pisa, Italy
**Department of Psychology, University of Parma, italy
Much of the existing literature looking at sexual health behaviour, identifies
and measures variables that affect behaviors such as condom use (e.g. Lauby et
al., 1998; Bennet & Bozionelos, 2000). Comparatively little research has
focused on general contraceptive use, and pregnancy prevention. The purpose
of the present research was to explore the possibility that factors other than
those identified in existing literature (e.g. attitudes; Ajzen, 1991) may influence general contraceptive behaviour. Interviews were conducted with 6
males, and 13 females, aged between 16 and 30 years. The interviews were
transcribed, and Interpretative Phenomenological Analysis (IPA) applied to the
data. Four major themes were identified as illustrative of the shared experience
of participants. Firstly, Lack of confidence in knowledge people have about
contraception, reveals how both male and female participants rely on anecdotal evidence, their feelings, and their experience of risk-taking, to make contraceptive decisions. Secondly, The pill for women is associated with control of
their bodies, illustrates that the pill is used and feared by women because of its
effect or perceived effect on their bodies. Thirdly, Cultural impacts evident in
the text, illustrates participants’ talk of themselves in relation to cultural norms,
pregnancy and its prevention. The final theme considers Patterns of risk taking behaviour with particular evidence of a need for increased communication
between sexual partners. Emergent themes reveal that variables such as efficacy of future plans and partner communication, routed in peer culture, may facilitate a greater understanding of contraceptive behaviour, than traditional models of health behaviour alone.
88
OBJECTIVE The present work aims to do a comparative evaluation of this disorder during adolescence in two European Countries: Italy and Spain.
METHOD.To this aim the Depressive States Rating Scale (S.V.S.D., Pruneti
and Muratorio, 1990) was used. The S.V.S.D. is a self-report questionnaire
administrable to subjects between 8 and 18 years old, composed by 3 subscales about symptoms of anxiety, depression and interpersonal relationships,
and 4 factorial scales (depressive mood, cognitive aspects, somatic symptoms,
school context) SAMPLE The test was completed by 351 Italian students and
347 Spanish students aged between 13 and 16. Furthermore, gender differences
related to depressive symptoms were examined in both samples.
RESULTS Data analysis, by mean of MANCOVA, showed significant differences between the two samples: the Italian students, compared to the Spanish
ones, pointed out on average more difficulties in interpersonal relationships and
more cognitive aspects connected to depressive feelings. Besides, a lower (o
minor) effect of the variable “nationality”, in interaction with that of the gender variable, emerged. Broadly, the most important differences between the two
Samples were found in those constructs which are more sensitive to cultural
influences.
COCLUSIONS The work confirms previous research about gender differences,
according to which females tend to have symptomatic behaviours more than
males, especially with internal symptoms (such as anxious and depressive
ones).
Posters
GENDER SEGREGATION IN EDUCATION AND VULNERABILITY TO LIFE STRESS
GENDER DIFFERENCES IN HEALTH INVESTMENT
INTENTIONS
Tony Cassidy
Thames Valley University
Zsuzsa Szanto-Eva Susanszky
Semmelweis University of Medicine, Institute of Behaviuoural Sciences
There tends to be an annual debate about the benefits or disadvantages of coeducation, a debate which focuses solely on academic issues and ignores the
broader issues of social development and health. A growing literature in
psychology shows that one cannot ignore the role of social and emotional
development in the process. The current study looked
at 200 young adults (17-19 years old)who had attended either a co-education
school or a gender segregated school. The analysis of data suggests that the
impact of coeducation is mediated by gender. Males from single sex schools
exhibited significantly lower self esteem than any other group. It is suggested
that the debate about coeduaction needs to be much broader and to include
social and emotional factors and implications for health.
Aim of the study: In Hungary, both male and female life expectancies at birth
are lower than the average in the EU countries. The average gender difference
in the EU countries is 6 years while it is 9 years in Hungary. In respect of mortality, the group of middle age men is particularly at risk. The study was constructed to explore the health behavior this population group. Our study
focused on the age group of 35-45 years, which is at the threshold of deteriorating health.
GENDER STRUCTURE OF FAMILIES AND HEALTH
GROWING OLDER AND MORE HELPFUL: GENERATIVE
IDENTITIES INTO LATER LIFE
Megan Arroll & Tony Cassidy
Some previous research has suggested that the psychological and physical
health of young adults may be influenced through the way in which the gender
structure of families impacts on the family relations. It is suggested that regardless of whether the family is a traditional two parent situation or any other of a
number of formats, the number and gender of siblings plays a strong role in
whether the relationships exist are experienced as expressive and cohesive. The
nature of relationships that exist in turn influence teh development of cognitive
styles such as achievement motivation, optimism and problem-solving style.
The current study explores this relationship in a sample of 655 participants
(227 males and 428 females). The study used measures of family environment,
achievement motivation, problem-solving style, optimism, psychological and
physical health as well as details on the strucure of the family. Using path
analysis the results show that the relationships in the family are a better predictor of health than the family structure and these effects are mediated by problem-solving style, achievement motivation, optimism and the gender of siblings. It is argued that the major explanatory route is through the openness to
emotional expression generated in all female siblings and the positive impact
of emotional expression in terms of resistance to life stress
Method: In a national representative population survey of 1000 persons we collected data on interrelationships between health status, risk behavior, and health
investment intentions. In order to measure health investment intentions, we
constructed a 20 item scale with the method of explorative factor analysis
(Cronbach alfa=0,71). The items measured health conscious diet, regular exercise, utilization of screening tests, conscious efforts of learning about healthy
life styles, and demand for risk protection in the future. As expected, women
scored significantly higher (8.3) than men (6.9) on the health investment intention scale. Considering the sub-scales, women performed better on the health
conscious diet and the conscious learning scales.
A. O’Hanlon1+2 & P. G. Coleman1,
Departments of Psychology, 1University of Southampton
Generativity refers to the vital role that adults in mid and later life have in
teaching, guiding and supporting younger generations. Although developed by
Erikson and colleagues1 and widely used as a concept, there is little empirical
evidence on generativity. The current study sought to test a new measure of
generative identities, and to examine its relationship with
attitudes to ageing and psychosocial well-being. Ethical approval for this
research was given by the University of Southampton. Adults of all ages were
recruited in the community (n=322) and from the world wide web (n = 1 245).
Items for the new Generative Identity Measure (GIM) were developed mainly
from a detailed literature review. Additional measures included the General
Attitudes to Ageing Scale, psychosocial well-being and experiences in close
relationships. Replicated across sample groups, results indicated: 1) that the
new 5-item GIM had good reliability and validity, 2) that generative identities
were significantly related to both attitudes to own ageing and psychosocial
well-being, 3) that experiences in close relationships explained part of the variance in generativity scores and 4) that generative identity increases with age as
predicted by theory. The newly developed Generative Identity Measure (GIM)
has good psychometric properties and is easy to read and score. This new measure may be useful for professionals interested in challenging ageist stereotypes
and facilitating optimal well-being through generativity for individuals and
communities.
89
Posters
GENDER DIFFERENCES IN DIMENSIONS OF FORGIVENESS AND THEIR RELATIONSHIP TO PSYCHOLOGICAL
HEALTH AND VARIOUS SOCIAL AND COGNITIVE VARIABLES
Louise Barber
Sheffield Hallem University, Centre for Research into Human Behaviour
There is evidence to show that forgiving people can reap significant mental
health benefits by reducing anger, depression, anxiety and other related symptoms (Azar 1997; Coleman, 1989). But as yet more work is needed to look at
other variables associated with forgiveness and if there are gender differences,
which could affect the ability to forgive and the therapies to promote the human
virtue. Studies are reported that examine the relationship between forgiveness
of self and forgiveness of others with various social and cognitive variables
such as general health, self esteem, emotional intelligence, optimism and parenting style. Questionnaire based studies utilized undergraduate students
enrolled at a northern University (N = 286) and a general population sample (N
= 240). Females have been shown to be more forgiving of others than males
and forgiveness of others has been found to share significant positive correlation’s with emotional intelligence in both males and females. Forgiveness of
self-correlates with emotional intelligence, self-liking and self-competence in
males and females and also with optimism in females. This is discussed in
terms of previous finding in the forgiveness literature and the implications the
gender differences may have on the therapeutic settings to promote forgiveness.
GENDER DIFFERENCES IN HEALTH BEHAVIOUR IN
ESTONIA 1990 -2002
Kasmel,A
University of Southern Denmark
Introduction: Social inequalities in health are a key concern for health
policies. In Estonia, until recently, inequalities in health were not given
much explicit attention in health sector policies. There are strong reasons
to be concerned with the health of disadvantaged groups in Estonia.
In the present report, we aim to provide a first comprehensive description
of gender inequalities in health related behaviour indicators in Estonia and
to assess whether these inequalities have diminished or widened since
independence.
Methods: The data were collected since 1990 biannually by using analogous
mailed questionnaires among 16 - 64 year old Estonian population. A
stratified random sample was drawn from Population Register. The response
rates have been from 63 to 83%. Trends in smoking and dietary habits,
physical exercises, use of health services, alcohol consumption and
preventive behaviors were analyzed.
Results: As compared to men, women have more health enhancing behaviour,
except inconsumption of butter on bread, physical activity, and blood cholesterol measurement. Gender differences are largest for addictive behaviour
(smoking and alcohol consumption). Between 1989 and 2000 differences in
health-related behaviour generally increased, both between non-Estonians and
ethnic Estonians and between high and low educated persons, but gender differences in health related behaviour have remained stable for most behaviours.
Conclusion: Inequalities in health may be addressed by interventions and policies that focus on specific risk factors and on specific gender.
GENDER DIFFERENCES RELATED TO HEALTH STATUS,
PSYCHOSOCIAL STRESS, AND PSYCHOSOCIAL CLIMATE
OF ENTERPRISE
THE RELATIONSHIPS BETWEEN SECRETORY
IMMUNOGLOBULIN A (sIgA) AND LIFE STYLE IN MIDDLE-AGED AND ELDERLY SAMPLE
Gh. Balaceanu, R. Danulescu, Eugenia Danulescu, Cristina
Cordoneanu
Public Health Institute, Iasi, Romania
Urara Hirata
Masahisa Kodama
Aim: Gender differences concerning the relationships between health status
(HS), psychosocial climate of enterprise (PCE) and stress resistance to psychosocial challenges (SRPC).
Material and methods: In a stratified randomized sample of 250 Ss - 181 males
(M) and 69 females (F) from a car supplies enterprise, as concerning: HS, PCE
reception and SRPC evaluation by Sense of Coherence (SOC) scale, with 3
components - Comprehensibility (C), Manageability (MA) and
Meaningfulness (ME). The significant gender differences were considered at a
p-level <.05.
Results - no significant gender difference about mean age and length of service; significant higher SRPM in M (p = .001); significant higher mean points
of M to responsibility-autonomy, politics of social opening and involving PCE
subscales; significant more frequent unhealthy F (p =.01);
- significant negative correlation in F between HS and ME (R= - .263, p=.02),
urinary affections and the ME (R= - .258, p= .03), central nervous system affections and MA (R= - .246, p= . 04); - significant positive correlation in M
between digestive affections and C (R= .146, p= .04); - significant relationship
in M, between HS and supervision suppleness (2=4,53, p= 0,03) and
PCE (2=5,16, p=0,02); significant relationship in F between HS and
responsibility-autonomy (2=5,07, p=0,02) and taking into consideration (2=5,15, p=0,02) subscales of PCE.
Conclusions: The data analysis support the idea that different level of PCE and
SRPC can influence the health status in different manner depending on gender.Gender Stress Otherspecif: Psychosocial climate of enterprise and health.
90
The study’s purpose was to examine the relationship between salivary
immunoglobulin A (sIgA), life style and mental health among middle-aged and
elderly sample. sIgA was collected from 52 people (23 male, 29 female, mean
age 64.15?7.21) who participated in a lecture of “Laughter and Health”.
Subjects were also administered questionnaires for life style and mental health
(scaled by General Health Questionnaire-28 [GHQ-28]). As a result, it was
revealed that there was a positive correlation especially between sIgA concentration and habit of exercise (more than 20 minutes) and also that there was a
negative correlation between sIgA concentration and mental health, particularly between that of somatic symptoms and anxiety/insomnia. It was suggested
that habit of exercise increase sIgA concentration level and also that sIgA can
be useful for that representative sample base as a possible index for the expression of mental health state.
Posters
RATE AND SIGNIFICANCE OF DEPRESSIVE AND ANXIETY
SYMPTOMS IN THE HUNGARIAN OLDER POPULATION
LIFE STYLE, SOCIO-DEMOGRAPHICAL AND RISK FACTORS ASSOCIATED WITH OSTEOPOROSIS IN WOMEN
OVER 50 YEARS OLD.
Kovács M*, Purebl Gy*, Kopp M*, Rózsa S**
*Semmelweis University, Institute of Behavioural Sciences, Budapest,
Hungary
**Eötvös Lóránd University, Faculty of Personality and Health Psychology
Purpose: Evaluate the prevalence of depressive and anxiety symptomatology in
older Hungarian individuals.
Methods: National representative health survey of the Hungarian population
over the age of 18 years (N=12668), which was conducted in 2002 by means
of personal interviews at home. Depressive symptoms were measured by the
Shortened Beck Depression Inventory (BDI), and anxiety symptoms by the
Hospital Anxiety and Depression Scale anxiety subscale (HADS-A).
Results: BDI scores were increasing with age, and was significantly higher in
those with 60+ years than those under 60 (BDI mean: 11.4 vs. 6.6, p£0.001).
Those with 60+ had a risk of 2.3 to have depression scores above the normal
level (BDI³10) compared to those under 60 (41.3% vs. 23.7%), rates of clinically significant depressive symptomatolgy (BDI³19) were: 60£: 22.9%, <60:
9.9%, OR: 2.7). Women were significantly more depressed than men. Only
7.5% of those 60+ with clinically significant depressive symptomatology had
been treated due to depression in the last 12 months. Rate of anxiety symptoms
was also significantly higher in women than men, but was not significantly different between older and younger individuals (HADS-A mean: 60£: 5.46, <60:
5.36). 12.0% of those 60+ had mild anxiety (HADS-A=8-10), and 14.7% had
marked, probably clinically significant anxiety symptomatology (HADSA=11-21).
Conclusion: Older individuals seem to form a growing marginal population of
Hungary, with a high rate of depressive and anxiety symptomatology. Since
depression and anxiety are underdiagnosed and treated in the elderly, with serious health consequences such as increased somatic morbidity, suicide rates,
decreased psychosocial functioning and quality of life, screening, treatment
and prevention of these disorders need more attention.
Other: Mental health in late life
SYMPTOM REPORTING AND TIMING OF MENARCHE. A
LONGITUDINAL STUDY.
Christin Mellner and Bassam Michel El-Khouri
Department of Psychology, Stockholm University, Sweden
Dr. Faisal-Cury,A .; Dr. Cury, PZK; Dr Elkis, J; Dr Tedesco, JJA ;
Dr Quayle, J.
0Sao Paulo, Brazil
Objectives: To investigate the association of socio-demographical and life style
aspects with osteoporosis in a population of women over 50 years old.
Methodology: From March to June 1998 a transversal study comparing 819
consecutive results of bone densitometry in a private laboratory in Sao Paulo
was conducted. Socio-demographical (race, age, menarche, body mass index BMI) and life style (sedentarism, tobacco, coffee use) data were collected during clinical interview. Patients with less than one year of amenorrhea were
excluded. Hormonal Replacement Therapy and time after amenorrhea were
considered. Exam was performed using LUNAR SCAN. Osteoporosis was
defined as 2.5 SD and osteopenia as 1.0 to 2.49 SD below average of young
adult bone mass densitometry RESULTS: Age varied from 51 to 96yrs, with
an average of 63.2 (SD= 8.01). Average time of amenorrhea was 13.71 years
(DS 8.39). Thirty-six percent of the patients had results compatible with osteoporosis, 46% with osteopenia and 18% were considered normal. The comparison showed a positive association between BMI and osteoporosis, where thinner women had increased risk for the condition (c2=43.17; p=0.001). Black
women of this group showed a lower risk for osteoporosis (p=0.004). All other
aspects investigated didn’t show a significant statistical association.
Conclusion: Black women and those with a body mass index above 25 were
those who showed less osteoporosis.
ROMANIAN WOMEN’S MENTAL REPRESENTATION OF
MENOPAUSE AND HORMONE REPLACEMENT THERAPY- A QUALITATIVE APPROACH
Saupe B. Mirela
Babes- Bolyai University Romania Dept. of Psychology
Self-reported somatic complaints among females were studied cross sectionally as well as longitudinally between age 15 and age 43. Specifically, the relationships between symptom development and timing of menarche were of
interest. The sample consisted of 477 females representing the general Swedish
population. Two types of stability in somatic complaints in relation to timing of
menarche were studied: correlational stability for single somatic complaints,
and stability in patterns of somatic complaints for the individual female. All the
included symptoms were significantly related to each other both at ages 15 and
43, respectively. Moreover, longitudinal correlational stability was also found
for all the overlapping symptoms between ages 15 and 43. However, only
headache and sleeping difficulties at age 15 were associated with menarcheal
timing. Individual stability in patterns of somatic complaints was found in
terms of that more females than expected by chance who were symptom free at
age 15 also reported being symptom free at age 43, whereas fewer than expected of the females with high symptom frequencies at age 15 reported being
symptom free at age 43. Moreover, at age 15, more females than expected with
late menarcheal timing reported being symptom free, whereas fewer of the
early maturing females did. Also at age 43 fewer early maturing females then
expected reported being symptom free. In conclusion, there was individual stability in symptom reporting for nearly thirty years, and early menarcheal timing could in this context be regarded as one risk factor that helps identify
females at risk for poor health at a young age. Further, the effect of early
menarche on symptom reporting extends into middle age.
The poster presents results of the investigation of mental representation of
menopause and of the hormone replacement therapy (HRT) used by Romanian
women to control negative somatic consequences of menopause. The study has
as a theoretical background Leventhal’ self- regulation model and Horne &
Weinman’ s findings in the area of illness representation and also it takes into
consideration the cultural influence on these theoretical concepts.
The problems addressed were the content and dimensions of Romanian
women’s attitudes toward menopause and its treatment and also the relation
between these representations and adherence to HRT. The study used a qualitative methodology based on semi-structured interviews and observations of 17
middle aged women with menopause.
Phenomenological analysis and discourse analysis showed a great impact of
the cultural factor on the attitudes of the participants. Menopause is seen mainly as a disease for which treatment is absolutely necessary. This “biomedical”
attitude is greatly influenced by physicians who are saw as the active factor of
decision regarding illness and treatment .The passivity of the participants is
correlated with an acute lack of information and a limited understanding of
women biological functioning. Besides the physicians, the close social feminine network of the participants has a huge role in constructing representation
of menopause, modeling the behaviors and offering support. “Treatment efficacy” was evidenced as a new dimension of treatment representation. The results
are interpreted taking into account the cultural factor. “Rewriting” patient informational leaflet is discussed as a practical application of the study.
91
Posters
THE ASSOCIATION BETWEEN FEMALE GENITAL MUTILATION AND SEXUAL DYSFUNCTION
Saulo Sirigatti, Lucrezia Catania, Silvia Casale
University of Florence
Introduction: Female genital mutilation (FGM) is a term used to describe any
alteration of the external genitalia done for non medical reasons. All forms of
FGM are reportedly associated with the potential for diminished sexual pleasure and, in certain cases, inability to experience a orgasm (Shell-Duncan,
2001). El-Defrawi et al. (2001) ‘ results showed that mutilation has a negative
impact on women’s psychosexual life. Nevertheless, a recent study (Okonofu,
Larsen, Oronsaye, Snow and Slanger, 2002) suggests that female genital mutilation did not attenuate sexual feelings.
Purposes: to investigate psychosexual impact of female genital mutilation
among a group of mutilated women. This research aims to find out if mutilation decreases: sexual fantasies, sexual desire and pleasure, ability to experience orgasm.
Method: the sample included 137 women with FGM and 137 unmutilated
women. A semi-structured interview was applied by a skilled gynaecologist to
elicit information on the women’s sociodemographic characteristic, first intercourse and sexual history.
Results: there are no significant difference in this group between cut and uncut
women in the frequency of reports sexual fantasies, desire and pleasure. In
addiction, no significant differences were observed in the proportions reporting
experience of orgasm during intercourse. Our study suggests that FGM in this
group of women has no a negative impact on psychosexual life (fantasies,
desire and pleasure, ability to experience orgasm).
PSYCHOPHYSIOLOGICAL MECHANISMS OF AGING
Georgiy Korobeynikov
National University of Physical Educational and Sport, Kiev, Ukraine
Purpose. The purpose was study of psychophysiological mechanisms of perception and informational processing with ageing people.
Materials and methods. The 80 men and 90 women in three age groups: 30-39,
40-49 and 50-60 were examined. Psychophysiological functions: visual perception and information processing were studied by special computer test with
three algorithm changes.
Results The results of the study are indicates on the best cognitive functioning:
perception, attention, memory, thought in men in comparison with women. The
psychophysiological aging is connected with reduction of perception and visual information processing protraction. According to conception of short-term
memory activity information processing has two strategies of response organization. The strengthening of psychophysiological functions under the influence
of algorithm changes was observed in age group 30-39. The acceleration of
involution process in age group 40-49 results in decline of perception and
information processing. There are changes of response organization strategy by
self-finishing quest along with reduction of protraction of one information processing stimulus in women group 40-49. The result of this response organization shows the stabilization of visual perception and information processing
capability. Apart from, there are no reliable differences between women age
groups 30-39 and 40-49 for parameters: attention volume, volume of short-term
memory and coefficient of operational thinking. The aging decrease of capability of psychophysiological functions with decline of visual information processing is shown in age group 50-60. This corresponds to the strategy by selffinishing quest response in comparison of positive elements in short-term
memory, in accordance with the element of test information.
HOW DO FEMALE UNIVERSITY STUDENTS THINK
ABOUT FEMALE SELVES OF THEIR OWN ?
Kazuyo Mori
Obirin University, Tokyo
DECISION-MAKING ABOUT HORMONE REPLACEMENT
THERAPY (HRT) BY WOMEN IN ENGLAND AND
SCOTLAND.
Amanda Welton1, Julie Hepworth2, Nicola Collins1, Deborah Ford1, Carol
Knott1, Sarah Meredith1, Anne Walgrove1,Helen Wilkes 1, Madge Vickers1
on behalf of the WISDOM team.
MRC General Practice Research Framework at MRC Clinical Trials Unit,
London1 and Department of Psychology, Queen Margaret University College,
Edinburgh2.
Objective The aim of this study was to explore women’s decision-making
about the balance of risks and benefits of taking hormone replacement therapy
(HRT) based on the latest evidence from the Women’s Health Initiative’s
(WHI) trial of combined HRT.
Methods Women aged 50-69, who were eligible for the Women’s International
Study of long Duration Oestrogen after Menopause (WISDOM) trial, were
invited to participate in one of eight focus groups. Participants were asked to
discuss their views about taking HRT based on the latest international evidence.
Results and Conclusions Eighty-two participated overall. Qualitative content
analysis was applied to the discussion transcripts. Women regarded the decisions they make about taking HRT as highly personal and for women currently taking HRT, the overwhelming reason for continuation was perceived
improvement in quality of life regardless of either the risks or benefits in the
longer term.
92
The purpose of this study is to examine the relationship between acceptance of
female selves and their personal views of femininity. According to previous
researches, most people agree that personal views of gender are linked to various attitudes in our daily life. Gender role conflict should effect so much influence on social adaptation and self-image especially on adolescents.?
The subjects were 96 female university students who live in Tokyo area(mean
age 19.1). The subjects answered three questionnaires. Those were one questionnaire concerning about acceptance of female selves and two kinds of gender role scales (the scale for two aspects of Masculinity-Femininity
(Yamaguchi 1989)and M-H-F scale (Ito 1978)).
The results showed that 82% of the subjects accepted their femininity and
expressed that they were happy to be female. Most of the reasons for those
answers were less social responsibility and more freedom than male role, and
reproductiveness. A few relationships could be found between acceptance of
female selves and their personal views of femininity. Many statistical significant differences were found between personal tendency on femininity of the
subjects’ own and social expectances on femininity. Considering the subjects’
high rate acceptance of their female selves, they are supposed to have less gender conflict. The implication of this research is that Japanese female university students know the social expectancy on femininity but they may think they
are free from the social expectancy.
Posters
EMOTIONAL EFFICACY, GENDER AND HEALTH
Dr. Changiz Mohiyeddini
Psychological Institut University of Zurich
Objective: The complex societal structures of daily life require people to regulate their emotions according to the demands of the situation. Adequate emotional regulation is regarded as a necessary precursor for psychological wellbeing. The regulation of emotions primarily depends on whether individuals
perceive themselves able to control and adequately express their emotions. This
raises the question oh whether a perceived deficit in the ability to control emotions corresponds to indicators of psychological well-being. This has rarely
been studies and was, therefor, the primary aim of the present investigation.
Method: 1630 subjects participated in three studies. A lack of emotional efficacy was assessed with the “Lake of emotional efficacy” scale. Additional scales
assessed depression, rumination, self-esteem , Self assertiveness, generalized
self-efficacy and overall life satisfaction.
Results: As expected, the results show that a perceived deficit of emotional
efficacy is positively associated with depression and rumination and negatively associated with self-esteem, self assertiveness and self-efficacy and overall
life satisfaction. Subjects los in emotional efficacy score higher on depression,
ruminate more, have less self-esteem, self assertiveness and overall life satisfaction.
Conclusion: The results support the assumption that perceived emotional efficacy as a primary requirement for emotional regulation is an important correlate of psychological well-being. Further studies are necessary to investigate
whether an increase in emotional efficacy as brought about a training program
can lead to greater psychological well-being and whether a lack of emotional
efficacy is associated with substance abuse and/or eating disorders.
PREDICTORS OF SOCIAL SUPPORT AND SOCIAL
RESOURCES
Iva Solcova, Vladimir Kebza
Institute of Psychology, Prague, Czech Republic; National
Institute of Public Health, Prague, Czech Republic
Problem: The present study is part of more extensive research conducted in the
Czech Republic. The present contribution addressed the question of social
resources (anticipated and received social support, social contacts with family
and friends) in a representative sample of the Czech population.
Method: A total of 2638 respondents aged 18 to 75 years (1213 women, 1425
men) completed an inventory addressing Social Contacts (with family and with
friends - 6 items), Anticipated Social Support (2 items), and Received Social
Support (3 items). Moreover they completed the Personal Views Survey (a
measure of Hardiness) and Eysenck’s Personality Inventory. As dependent
variables Anticipated Social Support, Received Social Support, Social Contacts
(with family and friends) and Social Resources (a composite variable) were
employed. As independent variables were considered: sex, age, education,
occupation, employment status, health status, and marital status.
To process data logistic regression (Forward Stepwise Method) was employed
using SPSS, version 7.0, software.
Results: Occupation, neuroticism, social desirability and age were determined
as predictors of anticipated social support.
Received social support is predicted by sex and hardiness.
Social contacts with family are predicted by sex, marital status, health status,
hardiness, and extraversion, whereas social contacts with friends are predicted
by age, marital status, occupation, and extraversion.
Education, sex, hardiness, and extraversion are predictors of a more general
variable - social resources.
The results are discussed with respect to recent findings of other researchers.
The study was supported by a grant no. A8025902 of the Grant Agency of the
Czech Academy of Sciences.
SITUATIONAL AND PERSONAL DETERMINANTS OF PERCEIVED SOCIAL SUPPORT
CORRELATES OF SUPPORT MOBILIZATION UNDER
STRESS:
CONSOLATION
OR
EGO
DAMAGE?
Oddfrid Skorpe Skaug, Torbjorn Rundmo
Norwegian University of Science and Technology
Nina Knoll, Nina Rieckmann, & Ralf Schwarzer
Charite, Berlin, Germany; Mount Sinai School of Medicine, New York, USA;
Free University Berlin, Germany
The aim of the present paper is to examine the extent to which the perceived
social support reflects characteristics of the situation, the perceiver, and the situation-perceiver-interaction. Additional objectives were to examine the way in
which empathy, support seeking, and close relationships may be related to perception of others supportive behaviour.
The sample consisted of 335 participants. They were all high school students
aged 16-18 yrs. The sample was randomly drawn and were representive of the
Norwegian adolescents in a suburbian area of the relevant age group. The participants viewed videos of 3-minutes conversations between a person discussing a problem and a listener (see also Lakey et.al. 1996). Following topics
were discussed: a mates drug abuse, an unhappy love affair, and sexual abuse.
The participants were asked to jugde the supportiveness of the listener by
answering 10 questions from the Perceived Social Support Scale (Heller and
Procidano, 1983). In addition, they answered a self-complition questionnaire
which included Goldberg Health Questionnaire (Goldberg 1978), the empathic
dimension of the Interpersonal Reactivity Index (Davis 1996), Quality of
Relationships Inventory (Pierce et.al. 1991), Agreeableness from NEO-PI-R
(Costa and McCrae, 1992), and new meausures of affectivity and support seeking.
The results showed that there were significant differences in percevied social
support depending on situation characteristics. GLM analysis was used to analyze the interaction effects. There were no significant interaction effects with
the perceivers’ gender and their personal experience with similar situations.
However, Structural Equation Modelling showed that there were significant
associations between their support jugdements and personality variables, as
well as the quality of their own close personal relationships.
There is growing evidence that support mobilization under stress may be related with negative consequences for the emotional well being of the help seeker. This study had two goals: First, higher-order personality factors and emotional well being were examined in their roles as antecedents and consequences
of support mobilization in the context of an acutely stressful situation.
Secondly, possible moderating qualities of gender and chronological age were
investigated in the mobilization-outcome relationship.One hundred and ten
cataract patients (ages 43 to 89 years; 56, 4% women) were tested at four measurement points in time during a six- to seven-week period surrounding their
scheduled surgery. Personality traits (i.e., Neuroticism, Extraversion, and
Openness to Experience) and support mobilization were measured once upon
admission to the hospital (t1). Short-term outcomes (affect and coping satisfaction) were assessed repeatedly throughout the assessment period. Overall, associations between Neuroticism, support mobilization and states and changes of
negative affect pointed to less adaptive antecedents and consequences of seeking support in a stressful context. Interactions with sex and age further qualified the support mobilization-outcome relationships. Preceding surgery,
younger patients reported more positive affect in connection with higher levels
of support mobilization. With negative affect pre-surgery, men who sought support also had elevated levels of negative mood. In light of the present findings,
possible ego-relevant features of support mobilization are discussed.
93
Posters
ATTACHMENT STYLE PRE-EMPTS PERCEIVED SOCIAL
SUPPORT EFFECTS: REPLICATION AND EXTENSION
VACATIONS, HEALTH AND HAPPINESS: SENSATION
SEEKING AND VACATION PREFERENCES.
Joao M. Moreira
University of Lisbon
Peter Eachus
School of Community, Health Sciences and Social Care,, University of Salford,
Frderick United Kingdom
In a panel study with a sample of Portuguese nursing students, it was found
that, after controlling for attachment style effects in a hierarchical regression
analysis, the effects of perceived support were no longer significant, while previous control for the effects of support did not preclude the significance of
attachment style effects. These results replicate those previously found by the
same author, but also extend them, by showing that the effect is found for both
for positive and for negative emotionality outcomes, and even when previous
levels of the outcome variables are controlled. It therefore supports the view
that perceived social support is to a major extent a personality variable, closely related to attachment style.
A WEB STUDY OF HEALTH-RELATED POSSIBLE SELVES:
THE ADDED BENEFIT OF INCORPORATING PROCESS
Rosie Meek
University of Sussex, UK
AIMS
Possible selves are future-oriented constructs formulated in relation to hopes,
fears and aspirations for the future. Individuals construct and develop possible
selves by evaluating their own traits, abilities and circumstances. These hypothetical constructs can serve a useful and important function in the identification of personal goals and the development of strategies to realize such goals.
The present research seeks to explore the effectiveness of incorporating a planning component when identifying possible selves
METHODS
A web survey method was used to gather data relating to people’s self-generated possible selves at two time points over a six month period. Participants
from a range of backgrounds were recruited and submitted qualitative and
quantitative responses relating to their most hoped for ‘future selves’ for the
coming year. Measures of goal conflict / ambivalence, temporal orientation,
self discrepancies and Theory of Planned Behaviour constructs were taken,
with participants randomly assigned to one of two conditions – process orientation or outcome orientation. This manipulation prompted participants to
either a) focus on how to reach the desired goal and the necessary steps that
should be taken (planning strategy) or b) simply describe the outcome once the
desired goal is reached (no planning strategy)
RESULTS
Results are presented with a particular emphasis on the following features:
prominence of health-related themes within identified hopes and feared possible selves, ambivalence / goal conflict, and process versus outcome simulation
of achieving goals. Results are discussed, with attention paid to the implications of the study and the advantages of conducting web-based interventions.
94
Physical and mental health, social well being, and perceived quality of life all
improve as a result of vacations. However, not all vacations types are equally
beneficial and some may actually be harmful. Deciding what sort of vacation
is the most appropriate is not a trivial decision and many factors including economic, social, and individual will be involved. The aim of this research was to
focus on the latter, i.e. personality, and in particular to examine the role played
by sensation seeking in predicting vacation preferences. The Brief Sensation
Seeking scale was administered to a sample of 300 participants and of these 111
were returned by 67 females and 39 males (5 people didn’t indicate gender)
with an age range of 17 to 75 years (mean = 36.13, sd= 13.80). The participants
were a convenience sample obtained from the staff and students at the
University of Salford, United Kingdom. Vacation preferences were determined
using a four factor scale designed to assess preferences for vacations whose
central theme could be described as either, Adventurous, Cultural, Beach, or
Indulgent.
The results of this survey in part confirmed the psychometric properties of the
BSSS and showed that it had utility in predicting vacation preferences. Using
the BSSS scale as a whole significant correlations were obtained for
Adventurous and Beach preferences. Cultural and Indulgent preferences were
found to be significantly correlated with sub scales of the BSSS. It was concluded that the sensation seeking personality was predictive of vacation preferences and that these preferences are likely to be important in determining
health and well being.
CHANGE OF THE HEALTH IDENTITY
Martin, Merbach Dipl.-Psych.; Prof. Elmar, Braehler; Dipl.-Soz. Ulla, Wittig
University Leipzig
Modern definitions of identity refer to nationality, region,
profession, gender or the self. Health identity, i. e. a person’s
self-concept about health, illness and body, is rarely considered
and a description of the development of health identity is missing.
People who change their cultural context and enter into a new health
system have to reorganize their health identity. The aim of the study
is the theoretical and empirical analysis of health identity change
during the migration process. A longitudinal study with two groups
(ethnic Germans and Turkish migrants) was conducted to find out
attitudes towards health, illness and body, behavioural tendency
and their determinants at different moments. We used questionnaires
to ask for different aspects of health identity. A small sample was
asked for individual and biographical aspects in the development of
health identity in a narrative face-to-face interview. At the moment
the first examination period is completed. The sample contained
300 ethnic Germans from the former Soviet Union and 116 Turkish migrants
who stayed in Germany from 1 to 6 month. In comparison with a German
representative sample the Turkish migrants report a better health status.
Ethnic Germans have the worst health status. Both migrant groups
show a higher level of external and internal health locus of control.
We also found differences in health behaviour. Possible reasons are
differences in culture and in health system.
Posters
HEALTHY HOLIDAYS? MOTIVATIONS, INTENTIONS AND
PERCEPTIONS OF HEALTH/SPA TOURISTS - A PILOT
STUDY.
PERSONALITY AND HIGH BLOOD PRESSURE: IDENTIFYING PSYCHOLOGICAL RISK FACTORS FOR ESSENTIAL
HYPERTENSION
Mike Weed
School of Sport and Exercise Sciences, Loughborough University
Sanz, J., Garcia-Vera, M.P., Magan, I., Risco, M.
Universidad Complutense De Madrid
This pilot study aimed to provide preliminary insights into motivations, intentions and perceptions of actual and potential participants in health/spa
tourism.
This study is an extension of a broader research programme into sports tourist
motivations. Utilising the sports tourism participation model proposed by Weed
and Bull (2003), the differences between ‘intenders’ and participants, the role
of health/spa activities in holiday decision making processes, and participants’
perceived health benefits were investigated.
The research took place at a country house hotel with significant health/spa
facilities, the majority of which incur an additional cost. It was chosen because
it provided access to non-health/spa facility users, ‘incidental’ users for whom
the facilities were insignificant in holiday choice, and those for whom
health/spa activities were the prime trip purpose. A semi-ethnographic
approach was used: a ‘participant observer’ recruited and conducted three
focus groups during a five day stay, one with each of the cohorts described.
The results showed that differences between cohorts related to perceptions of
the activities’ health benefits rather than any cost considerations. Of those participants for whom health/spa activities were the prime trip purpose, the majority were regular health/spa tourists. Those in the ‘incidental’ category generally had the highest participation in similar activities at home.
There was a general perception that the activities were relaxing, and as a prime
trip purpose made for a recuperative break. However, considerable disagreement existed about the extent to which many activities provided specific health
benefits. The findings suggested that further, more detailed research would be
useful.
In spite of the fact that there is an empirically substantiated relationship
between stress and high blood pressure, there is not so much agreement with
the identification of the psychological variables that would predispose people
(1) to experience a greater number of stressful events that could generate essential hypertension (HT), and/or (2) to get aroused in a greater extent when facing stressful events. This increased reactivity, if long-term repeated, would
facilitate, in turn, the development of essential HT.
The identification of those psychological variables would allow one to lay the
foundations of psychosocial programs to prevent or treat essential HT. This
study examined the relationship of blood pressure with the following personality variables: neuroticism, hostility and trait anger, controlling for the effects
of well-known biological and psychosocial risk factors for essential HT (cholesterol, glucose, body mass index, sex, age, education, occupation, smoking
behavior, intake of alcohol, salt and coffee/tea).
The study also tested the relationship of blood pressure with the interaction
between personality variables and stressful events. To get these aims, the
STAXI, the NEO-PI R and the SRLE were administered to 120 adults who selfrecorded 36 readings of blood pressure (at home and at work).
PERSONALITY INTEGRATION IN PATIENTS WITH UNEXPLAINED SOMATIC SYMPTOMS
EYSENCK PERSONALITY DIMENSIONS AND THE PERSONALITY OF CANCER PATIENTS
Gy. Kokonyei, S. Rozsa, Zs. Kulcsar, A. Holics
Eotvos Lorand University, Personality and Health Psychology Department
Shulamith Kreitler and Michl M. Kreitler
Tel-Aviv University [first author] and Tel-Aviv Medical Center [both
authors]
The theoretical and methodological basis of our study was a model of personality integration by Sheldon and Kasser, (1995, 2001), considering personality integration as dependent on two personality constructs; congruence and
coherence of strivings (in terms of Emmons 1986, 1992).
While the strivings construct proved to be a predictor of well being and health,
no previous research was done to measure the construct in patients with
somatoform disorders. In our study, the method of Sheldon and Casser was
applied to compare measures of personal strivings of female somatizers
(patients with at least one unexplained physical symptom with a minimum of 6
month duration, N = 24; age range 25-35 years, S) and paired controls (N = 21;
C). Neither S nor C Ss had ever been under psyciatric care and all of them were
drug free for more than 2 weeks.
Method: each subject was asked first to generate 10 personal strivings, and than
rate them as “external”: C2, “introjected”: C1 (controlled reasons) “identified”:
A1 or “intrinsic”: A2 (autonomous reasons) on 9 point scales. The second rating task was based on the strivings’ content: Ss had to rate each striving on 9
point scales as to the extent of their serving intrinsic: I or extrinsic: E goals.
Measures:
1. Controlled reasons or external determination: doubled C2 plus C1 scores
2. Autonomous reasons or internal determination: doubled A2 plus A1 scores
3. Intrinsic vertical coherence: sum of I scores
4. Extrinsic vertical coherence: sum of E scores
5. Summed coherence: sum of I and E scores as a raw measure of “striving
strenght” or motivation.
Results: External determination, extrinsic vertical coherence, and the summed
coherence were significantly higher in the S group.
Conclusion: somatizers seemed to be at a lower level of personality integration
and showed a higher level of motivation (perhaps to meet the expereimenter’s
expectations). These characteristics might contribute to the pathology both as
causal and preserving factors.
Previous studies showed that different dimensions of the Eysenckian personality model characterized cancer patients. The goal of this study was to characterize cancer patients of different diagnoses in terms of the basic Eysenckian
dimensions. Gender is of special importance in this context in view of the association of some cancer diagnoses with gender (e.g., breast, prostate). The
hypotheses were that extraversion and the lie scale would differentiate between
individuals with and without cancer, and neuroticism and conformity would
differentiate between cancer diagnoses and disease stages. Gender was expected to be associated with the lie scale and neuroticism. The participants were
180 cancer patients with different diagnoses and in different disease and 140
healthy controls. Patients and controls did not differ significantly in age, education, and gender distribution. All participants were administered a
Background Information questionnaire and the Eysenck Personality Inventory.
Medical information was extracted from the patients’ files with their consent.
Comparisons of cancer patients and controls showed that the main differentiating dimensions were extraversion and the lie scale. Neuroticism and the lie
scale differentiated between patients with different diagnoses and in different
disease stages. Psychoticism also had a contribuion in some diagnoses. The
conclusions were that the EPI provides a fine-grained characterization of cancer patients and their subtypes. The results indicate that it is not justified to consider all cancer patients as manifesting the well-known Type-C.
95
Posters
PSYCHOLOGICAL DISTRESS AND FUNCTIONAL DISABILITY STATUS IN CHRONIC NEUROLOGICAL DISEASE.
COMORBIDITY OF ALLERGY AND MYOGENIC PAIN IN
INPATIENTS WITH DEPRESSION/ANXIETY
Lorna Jane O’Doherty, Dr. Anne Hickey (1), Dr. Orla Hardiman (2)
(1) Dept. of Psychology, Royal College of Surgeons in Ireland, (2) Dept. of
Neurology, Beaumont Hospital
Roland Straub, Reka Baranyai*, Adrienne Stauder* and Maria Kopp*
Center for Psychiatrie Weissenau/ Psychiatry I University of Ulm and
Institute of Behavioral Sciences*, SOTE University Budapest
Purpose: This study aimed to investigate functional disability status (FDS),
perceived quality of life (QoL) and psychological distress in three neurological
patient populations - motor neuron disease (MND), multiple sclerosis (MS) and
post-poliomyelitis syndrome (PPS).
Methods: Cross-sectional design.
Participants: N=50 patients in 3 groups: MND (N=19), PPS (N=14) and MS
(N=17). 26 male, 24 female, age range 29-74 years. Patients were recruited
through two specialist neurological disability clinics at Beaumont Hospital.
Measures: include a) Hospital Anxiety and Depression Scale (HADS); b) Beck
Hopelessness Scale (HS); c) ALS Functional Rating Scale-Revised (ALSFRS);
d) Life Orientation Test (LOT); e) Stanford Health Assessment Questionnaire
(HAQ) and f) Schedule for Evaluation of Individual Quality of Life-Direct
Weighting (SEIQoL-DW). All were administered as part of a semi-structured
interview conducted at Beaumont Hospital or at the patient’s home.
Results: Data indicated a statistically significant difference in FDS between the
MND and other two groups (p<0.001). Mean anxiety and depression were
within the normal ranges for all three groups. However, there was a significant
difference in levels of hopelessness, MND patients having significantly higher
scores (p<0.05). Furthermore, there was no association between FDS and hopelessness. Nor were there group differences in terms of perceived quality of life
(QoL) or any association between FDS and perceived QoL.
Conclusions: Severe functional deficits predict neither poor perceived QoL nor
psychological distress. Rather, the preponderance of high hopelessness in
MND appears to relate to patients’ realistic acceptance of their prognosis that
does not necessarily predispose them to anxiety and/or depression.
Myogenic pain problems as well as allergic symptoms are found in separate
studies to be closely associated with depression. Anxiety problems often precede depression and seem to heighten the risk of chronic depression with poor
success in antidepressant therapy. In separate studies we found that such
depressed patients with a preceding anxiety disorder and comorbid myogenic
pain describe themselves as the subgroup with highest depression. Similar
results we found in further studies with allergic depressed patients. Surprisingly
there exist no studies, focussing on aetiology of the prevailing number of
depressed patients suffering by multicomorbidy except anxiety and depression.
There exist instead mostly etiologic theories for each disorder alone. Knowing
more facets about a supposed common pathway and possible stress-interrelations in a psychophysiological/ endocrine- immunological approach as well as
influences of psychosocial factors could improve aetiologic knowledge and
preventive diagnostic-therapeutic strategies. Having this in background our
here described examined hypothesises were (1) depressed patients with allergy
in combination with myogenic pain problems describe themselves as most
depressed and anxious in comparison to noncomorbid depressed patients. (2)
Depressed allergic patients will have in general higher electrodermal activity
than depressed patients with myogenic pain.
Out of two large samples of depressed and anxiety patients which we examined
over years in an routine experiment we selected age and sex matched depressed
patients (n= 106) where allergy problems and myogenic pain problems were
described in additional questionnaires regarding psychophysiological and psychosocial variables in anxiety, allergy and myogenic pain. Besides measurement of electrodermal parameters (SCL, SFL, Amplitude) patients filled in
questionnaires (BDI, STAIG, B-L). Results show that comparing depressed
patients without a myogenic pain problem but with and without allergy symptoms don’t differentiate in depressive, anxious and bodily complaints but only
in electrodermal activity by a significant higher level. Patients with additional
myogenic pain problems as well with or without allergy show all significant
highest levels in depression anxiety and scores of bodily complaints.
Aetiological aspects and implications for preventive therapeutic strategies in
health promotion will be discussed.
THE RELATIONSHIP BETWEEN PERSONALITY TRAITS
AND PSYCHOPHYSIOLOGICAL STRESS PROFILE
ALEXITHYIMIA AND MYOCARDIAL INFARCTION
F.N. Frassi, E. Fiori e C. Pruneti.
Department of Psychology, University of Parma
The psychophysiological profile (PPF) is one part of the clinical-psychological
evaluation which forms the set of procedures aimed at obtaining a multimodal diagnosis of human behaviour. This study has tried to understand and
take a closer look at the relationship between personality traits and some patterns of responses. We can suppose, based on studies presented in literature,
that it is possible to trace back to typical neurovegatative response mechanisms
in order to determine personality configurations. With this aim in mind, the
PPF was carried out. The PPF continually picks up and records different physiological parameters such as, skin conductance, heart rate, muscle tension and
peripheral temperature throughout 4 consecutive phases: Adaptation, Baseline,
Stress Presentation and Recovery in the meantime the 16-Personality Factors
was administered. (form A). 103 people were examined. Recruited among the
outpatients of a psychology clinic they presented different psychopathological
characteristics which had been previously diagnosed. For statistical analysis,
the Breavis-Pearson r coefficient of correlation and the analysis of Variance
(ANOVA) were carried out. The significance of the statistics gathered supports
and confirms the possibility of tracing relationships between mean values
regarding psychophysiological indices, and some stable personality traits
measured by the 16PF placing this study in the wide panorama of research
which tends to show a connection between physiological response mechanisms
and temperamental traits supporting the well-known, though still highly debated, integration of mind and body.
96
Marina Guerra, Sandra Torres, Florbela Marinho, Julia Maciel
Oporto University, Faculty of Psychology and Educational Sciences; Faculty of
Medicine
Alexthymia has been associated with a variety of diseases, as well as sociodemographic characteristics such as the male gender, old age and low socio-economical level (Waldstein, et al. 2002). In a recent investigation the same
authors found out that alexithymia in older adults was associated with some
psychosocial characteristics that may predispose to cardiovascular disease,
although there was no relation with biomedical risk factors, such as high cholesterol levels, hypertension and obesity.
Our study addressed the level of alexithymia, by comparing two different
groups of adult middle age males, the first with cardiovascular disease (post
myocardial infarction) and the second composed by healthy males. These two
groups had an identical socio-economic-level and age.
The instruments used were the Portuguese version of Toronto Alexithymia
Scale (TAS) of 20 items (Prazeres, Parker &Taylor, 1998), as well as a short
version developed by Torres and Guerra (2001) to assess alexithymia which
has been shown in a previous study to have a high correlation with the TAS
(Torres, Guerra & Lencastre, 2002).
These results will be discussed, highlighting the importance of psychological
intervention in the underlying alexithymic tendency of the male patients with
cardiovascular disease, stressing that the participants are middle aged men and
not an old age group, in which the presence of alexithymia has been mostly
associated.
Posters
TRAIT ANXIETY AND ILLNESS ANXIETY IN WHITE
COAT EFFECT AND ISOLATED CLINIC HYPERTENSION
Sanz, J., Garcia-Vera, M.P., Calabozo, F., Izquierdo, A., and Lopez, J.E.
Department of Clinical Psychology, Universidad Complutense de Madrid,
Spain
Anxiety is widely believed to play a role in both white coat effect -the transitory increase in blood pressure (BP) when is measured in a clinic context- and
isolated clinic hypertension –elevated BP when measured in the clinic, but normal BP when measured out of the clinic-, but this assumption has received
mixed empirical support. Contradictory results may have examined the role of
trait anxiety conceived as an unitary construct, for example, as Anxiety
Inventory (STAI-R). However trait anxiety may be conceived as multidimensional and, therefore, it can be distinguished specific traits of anxiety that
reflect individual differences in anxiety proneness with respect to certain
dimensions of situations. In this study, we examined whether illness anxiety, an
specific trait of anxiety, might be more related to the white coat effect or isolated clinic hypertension than trait anxiety does. One 36 self-measured BP
readings and completed the STAI-R and an bridged version of the Illness
Attitudes Scale (IAS).White coat effect was estimated as the difference
between the first and the three last clinic BP readings, whereas isolated clinic
hypertension was estimated as the difference between clinic and self-measured
BP readings. These indexes were correlated with the measure of trait anxiety
from the STAI-R and the following measures of illness anxiety from the IAS:
(1) worry about illness, (2) hypochondriacal beliefs, (3) thanatophobia, and (4)
disease phobia.
DOES POSITIVE EXPECTANCIES AND OPTIMISM RELATED TO THE ANTIRETROVIRAL TREATMENT ENHANCE
ADHERENCE TO TREATMENT IN PEOPLE LIVING WITH
HIV?
Eduardo Remor
Facultad de Psicologia, Universidad Autonoma de Madrid
OBJECTIVE: Verify if both positive expectancies and optimism related to antiretroviral treatment could facilitate or enhance adherence to antiretroviral treatment in people living with HIV. METHOD: A hundred thirty one subjects with
HIV Infection (44 asymptomatic; 43 symptomatic; 42 had AIDS) enrolled at
university hospital in Madrid was assessed in the following measures: (a)
Positive expectancies and optimism related to antiretroviral treatment (Three
single questions with likert response format 1 to 5); (b) Adherence to treatment
(CEAT-VIH Adherence to Treatment Assessment Questionnaire-HIV; Remor,
2002); (c) Viral load level. We computed descriptive statistics for sociodemographic and clinical data and performed Spearman (ordinal variables) and
Pearson (quantitative variables) correlations to assess the association between
variables.
RESULTS: The results show significant association between both positive
expectancies (positively expectant with treatment x adherence r=. 36, p<.001;
the treatment causes positives outcomes over illness x adherence r=.36,
p<.001) and optimism related to treatment (optimistic with treatment x adherence r=.43, p<.001) and adherence to treatment level. The adherence to treatment level was negatively associated with viral load level (r= -.18, p<.05).
APPLICATION OF RESULTS: There is evidence that beliefs about the treatment have a major impact on patient’s acceptance of prescribed treatments, yet
this is an aspect seldom explored during normal consultations. If Health Care
Professionals intend enhance levels of adherence to antiretroviral treatment
change of expectancies and optimism related to treatment must be an important
issue to take into account in consultations.
DIFFERENCES BETWEEN OPTIMISTS AND PESSIMISTS
OVER THE EXPERIENCE OF PHYSICAL SYMPTOMS
DO PERSONALITY DIFFERENCES EXIST AMONG INDIVIDUALS WITH CHRONIC DISEASE?
Eduardo Remor; Montserrat Amoros Gomez; Jose Antonio Carrobles
Facultad de Psicologia, Universidad Autonoma de Madrid
H.L. Williams, G.V. Bancroft, J.H. Barlow, C. Wright, A.P.
Turner Coventry University
Optimists are people who expect good things to happen to them; pessimists are
people who expects bad things to happen to them. Scientific literature has support that this difference among people is important in many aspects of living.
One of that aspects are they health condition.
Objective: The aim of this study is to verify differences between optimistic and
pessimistic people related to their experience of physical symptoms.
Method: Eighty six college students (65 women and 21 men, mean age 20,3;
range 18-40 years old) were assessed in the following variables: optimism-pessimism trait (LOT-R and EASQ) and the experience of physical symptoms
(frequency and intensity). To assess the optimism-pessimism trait we use both
questionnaires Life Orientation Test (LOT-R, Scheier & Carver, 1994) and
Expanded Attributional Style Questionnaire (EASQ, Peterson & Villanova,
1988). To assess experience of physical symptoms we ask to the participants to
report frequency of they have experienced physical symptoms during last week
and the intensity of this symptoms.
Results: Relationships were found between optimism-pessimism trait and the
experience of physical symptoms. An inverse correlation was found between
optimism (LOT-R) and the experience of physical symptoms (frequency r= .402**; intensity r= -.410**). A direct correlation was found between pessimism (EASQ) and the experience of physical symptoms (frequency r=
.328**, intensity r= .255*). No gender differences were found regarding all
variables.
Conclusions: Optimistic and pessimistic people have differences in their experience of physical symptoms. Optimistic persons experienced less frequency
and intensity of physical symptom over time than did persons who were less
optimistic.
Very little research has focused on differences in personality traits between
individual with different chronic diseases. The aim of this study was to explore
whether individuals with different chronic diseases display different personality characteristics.
Method The participants (n=84) were recruited through member organisations
of the Long Term Medical Conditions Alliance (LMCA) and had all previously participated in a lay-led Chronic Disease Self-Management Course
(CDSMC). A between groups design was used and participants were assigned
to one of four groups according to their chronic disease (osteoporosis (n=23),
polio (n=20), ME (N=32) and endometriosis (n=9).) The NEO five factor
inventory was used to measure five domains of personality in order to explore
personality at the broadest level. One-way between groups ANOVA were used
to measure differences between the mean scores of the four groups across the
five personality domains.
Results Statistically significant differences between means of the four groups
were found on the neuroticism domain [F(3,81)=4.869, p<0.05] and the extraversion domain [F(3,81)=3.262, p<0.05]. No other significant differences were
found. Post hoc analyses showed that participants with endometriosis scored
significantly higher than the three other groups on both of these domains.
Discussion The results of this study suggest that an understanding of personality differences is important when working with individuals with chronic diseases as it may help to understand their health behaviours. Personality differences may also be important as they may have implications for which of the
self-management skills taught on the CDSMC individuals will benefit from
most. Further quantitative research must be undertaken to explore this.
97
Posters
DOMESTIC VIOLENCE AND ITS CONSEQUENCES ON
HEALTH: SOME EMPIRICAL DATA.
PRIMARY PREVENTION PROGRAMS FOR CHERNOBYL
DISASTER SURVIVORS
Ferrer-Perez, Victoria A., Bosch-Fiol, Esperanza, García-Buades, Esther &
Torrens-Espinosa, Gema
Department of Psychology. University of Balearic Islands
Georgiy Korobeynikov, Galina Fedko, Lesia Korobeynikova
National University of Physical Educational and Sport & Institute of
Gerontology, Kiev, Ukraine
Aims: For the WHO (1998) violence against women is a very important social
and health problem. This work is focused on a specific form of violence against
women: domestic violence.
We know that domestic violence victims suffer several psychological and physical health problems (Follingstad et al., 1991; Goodman et al., 1993; Acierno
et al., 1997; Resnick et al., 1997).
This work analyses the domestic violence impact on physical health.
Method: A sample of 142 battered women was studied though an extensive
interview. This interview included questions about themselves, their relationship and their partners. Results about physical health consequences of this violence are presented here.
Results: The average age of these women was 39.38 years old (range 18-72).
Of them, 52’1% had primary education, 31% secondary education and 16’9%
university education. 57% of them was occupied, 19% housewives, 16’2%
unemployed and the rest (7’8%) were students and pensioners or retired.19%
of them had some physical health consequence of the violence. Among them,
respiratory problems (14.8% of them), chronic pain and digestive problems
(11.1% of them respectively) were the consequences most frequently informed.
Conclusions: These data show that domestic violence had physical health consequences for an important number of battered women. We analyse and discuss
the implications of these results and the possible relations between physical and
psychological health consequences in these women.
Note: This work was realised in the frame of a research project financed by the
“Sectorial Program of General Promotion of the Knowledge”, Headquarter of
Higher Education and Scientific Investigation. Ministry of Education and
Culture (PB98-0122).
Purpose: The purpose of the study approbation of the prevention primary prevention programs for Chernobyl disaster survivors.
Material and methods: Sixty persons, disaster survivors and workers of
Chernobyl station aged 32-56 have preventive rehabilitation during 21 days.
The effect of preventive programme of premature ageing for Chernobyl disaster survivors was study. As criterion of health status the functional age were
studied.
Results: The results showed the increasing of the functional age (71,7+5,62)
and tempo of ageing (1,58+0,09) for comparative of calendar age (48,81+1,91)
in patients in the moment of start of the prevention course. This associated with
the premature type of ageing and decline of health in Chernobyl disaster survivors. The structure analysis of the functional age shows the increase of arterial blood pressure for concerning health norm. This fact demonstrates the significant role of heart health for Chernobyl disaster survivors. After preventive
course program, the average parameters of functional age in-patients decrease
(66,76+4,31). According to this data the main factor, which determined of ageing structure in Chernobyl disaster survivors after preventive course is arterial
blood pressure. The decrease of arterial blood pressure, heart rate in rest and
after physical load, increase of vital capacity of lungs and static balance are
showed about health promotion in Chernobyl disaster survivors during the preventive course programme. According to data the subjective estimation of selfsense, activity and mood in Chernobyl disaster survivors improve during preventive course. This fact indicated the promotion of health psychology of
Chernobyl disaster survivors during the prevention programme.
PTSD DEVELOPMENT- EMPIRICAL VERIFICATION OF
HOROWITZ’S AND FOA’S HYPOTHESES
VICTIMIZATION, EXTERNALIZATION VS. INTERNALIZATION BEHAVIORS, AND PSYCHOSOMATIC SYMPTOMS
AMONG STUDENTS.
Bohdan Dudek, Jerzy Koniarek
Work Psychology Department, The Nofer Institute of Occupational Medicine,
Lodz, Poland
Within cognitive framework, two theories can be used for describing the development of PTSD. Horowitz suggests that people who are inclined to perceive
the world as an extremely safety and predictable one with a positive self concept react with extreme emotional arousal to a traumatic event and tend to
develop posttraumatic stress symptoms. This theory is partly accepted by Foa
and co-workers. They suggest that two groups of persons are at risk of PTSD
development: those who are inclined to see the world as the safety one and
those that usually perceive the world as an extremely dangerous. Therefore two
hypotheses can be formulated:
1) The strong SOC subjects should develop more intensive posttraumatic stress
symptoms than the medium and low SOC subjects (Horowitz’s theory).
2) The strong and low SOC subjects develop more intensive posttraumatic
stress symptoms than the medium SOC subjects (Foa’s theory).
The hypotheses were verified in three cross-sectional and one prospective
study on firefighters and police officers. In these two professional groups, the
exposition to traumatic events is thought to be very frequent. The hypotheses
have not been confirmed by results of cross-sectional studies. Relationship
between SOC and intensity of posttraumatic stress symptoms appeared to be a
linear one and correlation coefficients ranged from r = - 0.27 (p< 0.001) to r =
- 0.47 (p<0.001). On the base of results obtained we can conclude that SOC is
a protective factor in the posttraumatic stress symptoms development.
However in the prospective study the Pearson correlation coefficient between
both variables was closed to zero (r = 0.03) and the relationship appeared to be
non-linear one. The highest intensity of posttraumatic stress symptoms was
observed in the groups of subjects with high and low SOC. Unfortunately; the
relationship was not statistically significant. Possible explanations of results
obtained will be discussed on the poster.
98
Houbre Barbara, Tarquinio Cyril, Duveau Aurelie & Tragno Michel
University of Metz
The aim of this research is to study the nature of the relationships between certain psychosomatic manifestations and the child status in the two following
cases: he is a “pure victim” or “victim / aggressor”.
Recent studies showed a relationship between the fact of being a victim of an
aggression and the manifestation of psychosomatic symptoms (Natvig & al.,
2001). However, in both cases, “pure victim” or “victim / aggressor”, those
researches show contradictory results (Kaltiala & al., 2000 ; Krumplainen &
al., 1998).
Besides, some searchers did show that the more a person is going to adopt an
internalization behavior, the more this one seems to develop symptoms at a
psychosomatic level, in comparison to people who develop externalization
behaviors. Besides it seems that children in the “pure victim” category would
have a tendency to manifest internalization behaviors, whereas “victim /
aggressor” would on the other hand show externalization ones (Krumplainen &
al., 1998).
We can then assume that “pure victim” children will develop significantly more
psychosomatic symptoms than “victim / aggressor” children.
School students (n=150, age between 11 and 16 years old) did answer to 3 different survey measuring: emitted or received aggressive behaviors, externalization behaviors vs. internalization behaviors, physical and psychological psychosomatic symptoms.
Results show that “pure victims” tend to have more psychosomatic symptoms
than “victims / aggressors”. Furthermore, girls tend to have more psychological complains than boys who principally show physical symptoms.
Those results show without any doubt the existence of a relationship between
health and victimization process.
Posters
HOW SPIRITUAL COPING STRATEGIES MEDIATE THE
NEGATIVE EFFECTS OF TRAUMATIC LIFE
EXPERIENCES IN WOMEN
Annette Jerome, Ph.D. and Marleen Williams, Ph.D.
Brigham Young University
While some conceptualizations of coping are equated with mastery over specific conditions, coping appears to be more related to management of stress
rather than alleviation of symptoms. Coping can be defined as the strategies a
person employs to manage the external and internal demands that exceed personal resources during a stressful period.
Because coping is embedded in culture, people translate their orienting system
into specific methods. A spiritual orientation often provides an orienting system for coping, thus spiritual strategies are often employed to manage the stress
associated with traumatic life events. The spiritual domain is distinctive from
other coping categories in that it offers a way to reframe cognitions and regulate emotions associated with stressful events rather than control or change
them.
Gender has emerged as a variable of individual difference when evaluating the
use of spiritual strategies in coping. Quantitative and qualitative data from this
study revealed spiritual processes and practices that fostered resiliency, adjustment, existential well-being and improved mental health for women. This
research suggests a relationship between spiritual coping, positive reappraisal,
and planful problem solving during traumatic life events. Utilization of spiritual processes appears to reduce symptom distress while improving interpersonal functioning and social role performance.
This presentation will (1) help participants better understand how women use
spiritual coping to improve well-being; (2) describe four processes that facilitate effective coping; and (3) introduce a proposed practice model that encourages the use of spiritual processes to strengthen coping skills for women who
express a spiritual orientation.
REACTIONS TO VIOLENCE AT WORK AND OCCUPATIONAL FUNCTIONING OF NURSES
Dorota Merecz, Agnieszka Mocicka
The Nofer Institute of Occupational Medicine
AIM OF THE STUDY was to explore the role of immediate reactions to
aggressive behaviors experienced at work in the development of burnout and
work dissatisfaction
METHODS: The study comprised the sample of 400 nurses employed in various health care settings. To assess the direct reactions to violence the RA
Questionnaire was used (Merecz, Mocicka, 2002). The tool allows for assessment the basic types of reactions to violence in the terms of avoiding, aggression, and assertiveness. In the study burnout and work satisfaction together
with some sociodemographic and personality characteristics (TABP, and anxiety trait) were also diagnosed.
RESULTS: The high level of anxiety as a personality trait and type A behavior pattern were related to aggressive reaction to violence. Low level of anxiety and type B behavior pattern were related to more frequent use of assertiveness when faced the violence at work.
The tendency towards assertive reactions to aggressive behaviors of others was
positively correlated to the level of personal achievement at work and higher
level of work satisfaction.
CONCLUSIONS: In the studies on negative effects of exposure to violence
at work, personality characteristics and ways of coping with violence should be
controlled as the modifying variables.
PSYCHOLOGICAL IMPACT OF MOTOR VEHICLE ACCIDENTS ON PORTUGUESE AMBULANCE PERSONNEL AND
EMERGENCY SERVICES WORKERS
VIOLENCE AS AN OCCUPATIONAL STRESSOR - CONSEQUENCES FOR HEALTH AND OCCUPATIONAL FUNCTIONING
Ângela Maia, Eugénia Fernandes e Susana Moreira
Universidade do Minho
Braga, Portugal
Moscicka Agnieszka
Institute of Occupational Medicine, Lodz, Poland
In Portugal there is a large amount of motor vehicle accidents that involve
death and injury. The number of vehicle accidents and death victims is the
highest of Europe. The present study aims to determine the psychological
impact of exposure to current events of death and physical injury occurred in
the context of motor vehicle accidents. Participants were selected amongst the
rescue workers of the Ambulance Personnel and the Medical Emergency
National Institute. The ambulance personnel were selected in the north of
Portugal in geographical areas where there is no activity of Medical Emergency
National Institute. The Medical emergency workers are medical doctors and
nurses recruit from emergency centers from Northern Portugal. The measures
included: Clinical and demographic questionnaire, General Health
Questionnaire 12 (Goldberg, 1978, Portuguese version, McIntyre, McIntyre &
Redondo, 1999); PTSD Scale (McIntyre, 1993), Questionnaire of PeriTraumatic Dissociative Experiences (Marmar et al, 1997; Portuguese version
Maia, Fernandes & McIntyre, 2001) and Ways of Coping Questionnaire
(Coyne, Aldwin & Lazarus, 1981; Portuguese version McIntyre, McIntyre &
Redondo, 1999). The results show a difference in the impact of vehicle accidents in the two groups.
AIM:
1. assessment of prevalence and forms of violence in health services.
2. analysis of relationships between exposure to violence at work health status
and occupational functioning of victims.
HYPHOTESES: Occupational exposure to violence is related to disturbances
in mental health status, higher level of occupational stress, burnout, lower level
of work satisfaction, and higher rate of somatic complains.
METHODS: The study comprised the sample of 400 nurses. Assessment of
violence exposure and its consequences was done by the mean of standardized
questionnaires.
RESULTS: The most of nurses have experienced at work some form of violence during one-year period. The most frequent was psychological harassment
at work. Experience of violence at work was correlated with higher level of
somatic complains, anxiety, insomnia, burn-out, and stress. Nurses experiencing ?on duty? violence were less satisfied with their work.
CONCLUSIONS: Psychological and physical violence is an important factor
influencing well-being and occupational functioning of nurses.
The high rates of exposure to violence obtained in presented study points the
urgent need of primary and secondary prevention development for these group
of employees.
99
Posters
DYSFUNCTIONAL ENVIRONMENT AND TRAUMATIC MALTREATMENT IN STREET BOYS IN LIMA
COGNITIONS AND COPING IN PRISONER SELF-INFLICTED DEATH
Carbajal de Carozzo Gladys
Asociacion Psicologos Independientes.U N M S M Psychology Post Grade
Unit Lima PERU
Liz Regan, Tony Cassidy, Jo Borrill & Rebecca Teers
Thames Valley University and the Safer Custody Group of the
Prison Service, UK.
A group of 20 homeless, 11 to 13 year old boys were compared to a 30 schoolboys group same age. Although they were as poor as the prior group, they
lived with their parents or relatives, did not suffer traumatic maltreatment and
attended school regularly. Street Children instead had run away from home
due to traumatic maltreatment and sexual abuse experience in their dysfunctional environments. It was important to find out, through the Cognitive Triad,
how these facts had affected their perceptive functioning. Therefor, both
groups were given individually the Rorschach cards with the Exner
Comprehensive System. It was also given a questionnaire to obtain information about adult mental health and traumatic maltreatment ways and practices
in both groups environment. It was obtained a regression equation that makes
a differentiation with an 82% of efficiency mainly on the following variables:
Zf (Organization Activity), Perseverance Index or Cognitive Flexibility (EB
Per) and Hypervigilant (HVI). Variables which scored higher in the homeless
group. This reveals that although they are able to make decisions and show
initiative organising their ambiguous and complex environment, the choices
they make do not lead them to adequate adaptive behaviour because they are
not able to amend their conducts once they had make their choices. Although
they had been proved to be wrong. The high Hypervigilant Index reveals that
they live constantly under survival press and that this struggle for life had conditioned on them a continuos alert distrustful and suspicious disposition which
does not help the fluid and harmonious interpersonal relations. Such a severe
problem could be regarded as a psychosocial handicap. Meanwhile those characteristics do not appear in the school boys group, who do not show traumatic maltreatment in their homes and have not been impelled from them to the
street because of it. It was also found that 100% homeless boys had been maltreated and 22%sexually abused. 88 %of their parents or relatives abused of
alcohol and /or drugs,they had violent behaviour and acting out far more than
in the environment of the school boys population. .This finding could be
related to the uncontrolled impulse present in a severe disturbed personality. It is therefore recommended a diagnosis clinically oriented for the adults in
Street Children environment as well as therapeutic orientation and rehabilitation for the boys and their families or relatives who are in charge .It is of great
need the creation of health programs with such purpose as well as multiform
approaches indifferent areas and media broadcast intervention not only to
correct but also to prevent the emergence of street children social phenomenon.
Interviews and questionnaire measures were used to investigate cognitive
styles and role-related experiences in the psychological adjustment of 50 prison
officers who had dealt with prisoner self-inflicted death in the past year.
Quantitaive analysis identified 38% of officers exhibiting clinical level symptoms of Post Traumatic Stress Disorder (PTSD). Psychological adjustment was
related to the degree of involment in the incident of self-inflicted death, problem-solving style, perceived control and optimism. Prior experience with suicide had an indirect relationship through its impact on perceived control.
Social support did not seem to have any impact on adjustment, but was related
to problem-solving style and optimism in a way that suggests perhaps that support may be rejected by those who are most affected by the experience.
Qualitative analysis will be used to explore these findings further.
IDENTITY ALTERATION AND PSYCHOTRAUMATIC
IMPACT OF THE HOLD-UP SITUATIONS IN PROFESSIONAL
Tragno M, Tarquinio C, Tarquinio P
University of Metz (France)
This study investigates the relationship between a type of possible psychological reactions, in terms of posttraumatic stress disorders, and some characteristics of the self. 32 employees constituted our sample. 16 employees underwent
aggressions with weapon on their workplace, the 16 others, group controls, had
made the object or witness of no aggression. Pairing with the group of the victims was done by: age, gender, school level and function. We suppose that the
score of self-description, starting from negative features, obtained by the victims, will be weaker at the time of the second phase than at the time of the first
phase. We also wait until the recall of the negative features by the victims will
be weaker at the time of the second phase. In lastly, concerning the posttraumatic stress disorders, we suppose that there is a relationship between the perception which the employees victims have of themselves and the manifestation
of psychotraumatic disorders
The results achieved with a group of sixteen employees who were mugged and
with a group of sixteen employees forming the group of control show that the
employees who were mugged globally describe themselves in a more negative
way during the days following the attack than they do several months later. As
far as the measurement of posttraumatic stress disorders is concerned, the
analysis show that the positive self-esteems and the reminder of the positive
aspects have a negative influence on this parameter: the more the victims have
a high self-esteem, the less they are likely to develop psycho traumatic symptoms.
100
PROFESSIONAL PARADIGMS OF SUICIDE PREVENTION.
EVOLVING A CONCEPTUAL MODEL
Maila Upanne
National Research and Development Centre for Welfare and Health
Helsinki, Finland
In this four-part study professionals’ conceptions of suicide prevention were
analysed and interpreted using a theoretical model evolved for the purpose.
Testing the feasibility of the model empirically was another aim of the study.
The participants were psychologists (1-3) and professionals representing five
sectors (4). The data were conceptions of suicide prevention provided in the
project inquiries (1-3) and in operative action plans (4). In the qualitative data
analysis a pre-prepared coding frame consisting of descriptive and conceptual
criteria based on a theoretical analysis was applied. The study was a part of the
evaluation of the National Suicide Prevention Project in Finland.
The results showed that the views and practical activities adopted by the professionals could be described and interpreted as paradigms using the model
developed. Although the overview of the approaches was multifocussed
reflecting process theory of suicidal development, the main approach applied
was, however, the care approach relating to the medical model. Nevertheless,
the promotive aim remained, among the psychologists in particular, as a part of
the range of suicide prevention activities. The model proved to be a feasible
tool for describing and theoretically interpreting prevention and to scientising
the paradigms adopted. It provides a method worth while using in developing
or analysing interventions also in other fields than suicide prevention.
Posters
THE PROACTIVE FRAME OF SUICIDE ATTEMPT AND
SUICIDE PREVENTION
Valach, L.*, Michel, K., Dey, P., & Young, R. A.
* University of Zurich, Switzerland
Following the extensive research on suicide risk factors it is suggested that a
consideration of suicide related processes in a proactive frame of reference may
help in solving some of the problems in suicide research. We maintain that conceptualization of suicide attempt processes, the professional encounter with a
person after a suicide attempt and the organization of secondary suicide prevention could be enhanced by an action theoretically informed view. Analyzing the
narratives of 40 patients about their suicide related processes we indicate that
these processes are organized in terms of goal directed processes as suicide
careers, suicide projects and suicide actions.Looking at the encounter between
a patient after a suicide attempt and a health professional (psychotherapist or
psychiatrist) (N=18),as if it was a system of joint goal directed action, we found
that an adequate attending of the psychotherapist/psychiatrist to the actualized
emotion within steps of narrative action helped in developing a goal directed
helping alliance (Michel, Stalder, Dey, Valach, 2003). As the successful treatment programmes for suicide prevention contain an aspect of relationship
building enabling the suicidal patient to maintain a life enhancing project and
career, it is suggested that a successful suicide prevention should contain some
features of these proactive systems
LIVING AND SUFFERING WITH FAMILIAL AMYLOIDOTIC POLYNEUROPATHY
Fernando Fradique & Joseacute; Manuel Cardoso
Familial Amyloidotic Polyneuropathy (FAP), Portuguese (Andrade) Type, is a
dominant autossomic hereditary disease, with a multisystemic expression and
a progressive evolution. It results from a gene mutation of transthyretin protein
(TTR) located in the chromosome 18. This disease presents a wide range of
symptoms, affecting almost all the patient systems and organs. Elective treatment consists of liver transplantation.
Two main objectives of this study were: a) To characterize FAP patients not
yet subjected to liver transplantation (n=50), and FAP patients that had already
been subjected to the transplantation, in terms of several demographic, physical and psychological variables. As a control group it was used a sample of 73
patients suffering from chronic kidney insufficiency and subjected to kidney
transplantation; b) To accede, within a socio-cognitive framework, to the
themes more frequently endorsed by the transplanted FAP patients and that
structures their cognitive representations about Identity, Causality, Duration
and Consequences of FAP, and to the coping processes of these patients.
In addition to several quantitative assessment instruments, an in-depth interview was conducted with each FAP patient in order to obtain more qualitative
data. The obtained results are presented and their implications on the Quality
of Life of FAP patients are discussed.
THE ROLE OF INTERPERSONAL TRAUMA, PTSD AND
PERSONAL MASTERY ON HIV RISK BEHAVIORS AMONG
INNER CITY WOMEN
Evangelia Banou and Stevan Hobfoll
Kent State University
Aim: Trauma exposure has been associated with increased of HIV risk behavior. However, little empirical evidence exists on the mechanisms that might
explain the link of trauma history and engagement on HIV risk behaviors. This
study investigated how PTSD symptomatology and personal mastery influence
HIV risk behavior among inner-city women exposed to interpersonal trauma.
Hypotheses: We hypothesized that PTSD symptomatology and personal mastery would mediate the relationship of prior interpersonal trauma (both child
and adult victimization) and PTSD.
Methods: Participants were 131 inner-city women who sought obstretrical or
gynecological care at two clinics that serve low-income women in a midsize,
Midwestern city in the U.S. They were assessed for demographic information,
childhood maltreatment, adult sexual and physical abuse, current PTSD, personal mastery and HIV risk behaviors.
Results: Structural equation modeling indicated that PTSD symptomatology
and personal mastery partially mediated the link between prior interpersonal
trauma. Conclusions: The findings of this study supported the mediatonal role
of PTSD and personal mastery in the relationship of interpersonal trauma and
HIV risk behavior among inner-city women. Implications of the findings for
the development of prevention programs as well as the limitations of this study
are discussed.
CHANGES IN QOL DURING PULMONARY REHABILITATION RELATED TO PERSONAL CONTROL IN CHRONIC
OBSTRUCTIVE PULMONARY DISEASE.
R Arnold, AV Ranchor, GH Koëter, MJL De Jongste, J Wempe, V Otten, R
Sanderman
Northern Centre for Healthcare Research
Purpose
Rehabilitation for patients with Chronic Obstructive Pulmonary Disease
(COPD) is designed to reduce symptoms, to decrease disability and to improve
Quality of Life (QoL). Strengthening personal control of COPD patients is only
an implicit goal of rehabilitation, although control perceptions may be related
to the effects of rehabilitation. This study investigated whether COPD patients
in rehabilitation showed stronger improvements in personal control than outpatients who received care as usual. Furthermore, we studied whether personal
control was related to QoL after rehabilitation.
Methods
The sample under study included 39 patients in rehabilitation (mean age 61
(SD 9.0), 59.0% male) and 44 outpatients (mean age 68 (SD 8.2), 65.9% male).
Questionnaires were administered shortly before and after rehabilitation (average interval is about 6 months) and in the outpatient clinic at a four months
interval. Domains of QoL were measured with the Rand-36, Cantril’s ladder
measured overall perceptions of QoL, and the Mastery scale and the Self-efficacy scale measured personal control.
Results
Patients in rehabilitation improved significantly on overall QoL and self-efficacy, whereas no significant improvements were found for QoL domains and
Mastery. Outpatients did not improve on any of the measures. Furthermore,
improvements during rehabilitation in self-efficacy ‘maintain function’ contributed significantly to the explanation of QoL domains social and psychological functioning and overall QoL after rehabilitation.
Conclusions
Improvements in personal control were associated with a better QoL after rehabilitation. Remarkably, the perceptions of patients in rehabilitation of their
overall QoL changed significantly, in contrast to their actual functioning on
QoL domains.
101
Posters
THE IMPORTANCE OF ILLNESS BELIEFS ON QUALITY OF LIFE
AND PSYCHOLOGICAL STATUS IN PATIENTS WITH
ULCERATIVE COLITIS AND CROHN'S DISEASE
ENHANCING QUALITY OF LIFE: LIVING WITH URINARY
INCONTINENCE
CL RUTTER, A DURHAM-HALL, J WEINMAN and HM FIDLER
D McDonagh, G E Torrens, A Reid
CL RUTTER, King's College London; A DURHAM-HALL, University
Hospital Lewisham;
J WEINMAN, King's College London; HM FIDLER, University Hospital
Lewisham.
Aim: To measure the illness perception of IBD patients and to examine
whether illness beliefs are related to quality of life and psychological
adjustment in IBD. Methods: Sixty-eight IBD patients were recruited from
the out-patient clinic of the Gastroenterology Department of University
Hospital Lewisham. Patients completed the revised illness perception
questionnaire (IPQ-R), the Hospital Anxiety and Depression Scale (HADS),
and the Inflammatory Bowel Disease Questionnaire (IBDQ) - to examine
health related quality of life.
Findings: Patients who report that their bowel symptoms make them angry,
worried and afraid, report that their illness has serious consequences, has
been caused by stress, and their emotional state, and report that they do not
understand their illness. Multiple regression analysis has shown that the
illness perception of the IBD patients is significantly associated with their
quality of life and anxiety and depression.
Discussion: These findings have important management implications
regarding the education of IBD patients about their illness. Interventions
should be designed to educate and encourage adaptive illness perception and
discourage maladaptive illness beliefs.
By the year 2020 over 50% of the population will be over the age of 50, that
means that there will be twice as many people over 80 as there are now. The
Quality of life has been a major theme for the European 5th Framework. The
challenge is to produce appropriate assistive technology not necessarily high
technology solutions.
The aim of this study is to minimise the impact of intractable incontinence on
the quality of life of sufferers, their carers families and friends by developing
a novel non-invasive continence management system.
Urinary incontinence is a common problem that increases with age. It is also
likely to affect twice as many women as men. The burdens of this problem
will affect quality of life as well having economic implications. The incidence
of urinary incontinence increases in likelihood with age. The burden will rise
as the average age of the European population increases.
Female incontinence is a common condition that can have a
profound negative impact on the psychological well-being, social functioning
and overall quality of life of those it afflicts.
As of date there has been little advancement in the management of
this problem in the last 20 years. Continence aids and appliances cost the UK
Health service 70 million per annum. The current aids available are pads,
catheters and female urinals
This paper will provide an insight into the extent and prevalence
of female incontinence and how different individuals are affected by it and
the stigmas involved with this condition.
CORONARY HEART DISEASE, QUALITY OF LIFE AND GENDER
DIFFERENCES IN DIABETIC PATIENTS
Silva, I., Ribeiro, J., Cardoso, H. & Ramos, H.
XXI BD/21804/9
OBJECTIVES: The objective was to examine the effects of coronary heart
disease (CHD) and gender differences in quality of life of 316 diabetic
patients.
METHOD: Sample design: A cohort of 316 individuals, 44.6% of which
were males; 41.8% with Type 1 diabetes; aged between 16 and 84 (M=48.39;
SD=16.90); 17.7% unmarried; 72.5% married; 3.8% divorced and 6.0%
widower; 9.8% (n=31) suffering from CHD was studied.
Procedure: Participants answered to the psychological scale in the context of
a personal interview.
Measures: Quality of Life Scale for Diabetic Patients
RESULTS: Results suggest that there are no gender differences concerning to
CHD diagnosis. Patients suffering from this diabetes chronic squeal report
worst quality of life in the following domains: physical functioning
(t(306)=4.87; p<.0001), role-physical (t(311)=2.69; p<.01), bodily pain
(t(313)=2,67; p<.01), vitality (t(310)=3.10; p<.01) and worry about the future
(t(314)=2.45; p<.05). However, no significantly differences were found in
health transition, general health, social functioning, role-emotional, mental
health and satisfaction between patients with and without this complication.
Men present better quality of life, namely better physical functioning
(t(306)=3.50; p<.01), role-physical (t(311)=3.49; p<.01), bodily pain
(t(313)=4.97; p<.0001), general health (t(311)=2.99; p<.01), vitality
(t(310)=3.61; p<.0001), social functioning (t(314)=3.16; p<.01), roleemotional (t(312)=3.40; p<.01) and mental health (t(310)=6.69; p<.0001), but
no difference was found between genders concerning to health transition,
worry about the future and satisfaction.
CONCLUSION: Results showed that CHD is associated to worst quality of
life in diabetic patients and that men present better quality of life in the
majority of the domains than women.
102
DISPNOEA PERCEPTION AND QUALITY OF LIFE AFTER
PULMONARY REHABILITATION EXERCISE.
Medinas M, Ferrer V, Martinez P, Manassero MA.
University of Balearic Islands. Palma de Mallorca. Baleares. Spain.
Pulmonary Rehabilitation Programmes (PRP) improve the health and general
status of patients with chronic Obstructive Pulmonary Disease (COPD). The
present study was designed to invetigate changes in Quality of Life (QOL) and
Dispnoea perception in one group of COPD patients after 14 weeks of rehabilitation program in a Hospital of Spain. Twenty-one stable outpatients with
moderate to severe COPD were evaluated before and after the physiotherapic
program of exercise. We measured general and specific Quality of Life with
The Nottingham Health Profile Questionnaire (NHP) and Chronic Respiratory
Disease Questionnaire (CRQ); dispnoea perception was evaluated with medical
Research Council Questionnaire (MRC) and Borg Scale. The results showed
statistical differencies between QOL and dispoea perception after the pulmonary rehabilitation program (p<0,05); patients who completed the PRP at
our centre showed a significant increase in general and specific QOL, a
decrease in dispnoea perception (p<0,001)
Posters
OBSTRUCTIVE SLEEP APNEA SYNDROME, SLEEP QUALITY AND QUALITY OF LIFE IN WOMEN: A COMPARISON
STUDY.
Medinas M, Ferrer V, Alorda C, Lopez B, Vallejo E, Olmedo G.
University of Balearic Islands
The objetive of this investigation is determinate the effects of Obstructive Sleep
Apnea Syndrome (OSAS) on the Quality of Life and Sleep quality in women.
The study referred comparisons in two groups of women: with moderate and
severe OSAS that was experimental group (>30 apneas per hour of sleep) with
n=15 and a control group of 21 women (<5 apneas per hour) defined by an nocturnal polysomnographic diagnosis. Health story and demographic data were
obtained by structured interview and medical record review. Quality of Life
was assessed with the medical Outcomes Study SF-36 health Survey and sleep
quality with Oviedo sleep Quality Questionnaire and Functional Outcomes
Sleep Questionnaire (FOSQ) and polysomnographic measures. Results
obtained shows statistical differences in sleep quality (p<0,05) but didn?t show
differences in Quality of Life.
THE IMPACT OF SCHIZOPHRENIA ON CAREGIVERS
INDIVIDUAL QUALITY OF LIFE.
Nichola McCullough & Anthony G. Gallagher
Queens University Belfast
Background Caring for a relative with schizophrenia may have a negative
impact on caregivers well-being. The majority of research has investigated this
by applying the concept of burden. However this approach may be seen to
overlook the subjective nature of caregiving.
Aims To investigate the experience of caregiving by measuring the individual
quality of life of caregivers.
Method 37 participants(36 female, 1 male, mean age 56 years) completed the
Schedule for the Evaluation of Individual Quality of Life (SEIQoL).
Results This measure identified areas of common concern for those caring for
a relative with schizophrenia. Whilst there was overlap with traditional burden
measures, the relative importance attached to each area varied among caregivers.
Conclusions Caring for a relative with schizophrenia was observed to be a subjective experience. These findings suggest that measuring individual quality of
life may be a suitable approach with which to investigate the caregiving experience.
ILLNESS REPRESENTATION OF THROMPOPHILA SUSCEPTIBILITY AND ITS INFLUENCE ON QUALITY OF LIFE.
MOVEMENT FEATURES, EMOTIONAL LIFE AND HEALTH
RELATED ASPECTS IN PARKINSON PATIENTS
Razzaboni E., Gremigni P., Ricci Bitti P.E.*, Legnani C., Palareti G.**
* Dept. Psychology Bologna University (I) **URCT “M. Golinelli”, S.OrsolaMalpighi Policlinic, Bologna (I)
Lorena Candini, Manuela Carlini, Paolo Melani, Laura Ulisse, Franco
Valzania*, Pio Enrico Ricci Bitti.
Background. Application of Leventhal’s Self Regulation Model showed how
mental representation of illness developed by patients could affect outcomes.
Despite the large amount of studies, few of them have focused on genetic predispositions not implying an immediate risk of illness, such as Thrombophilia
Susceptibility (TS). Objectives. The aim of this study was to investigate how
representation of TS could affect quality of life in people carrying a Factor IV
-Leiden mutation.
Method. 76 people with TS, 53 women and 23 men, completed the IPQ-R for
Genetic Predisposition to assess illness representation, and the SF-36 to assess
quality of life. Results. No significant differences were found between our sample scoring and the SF-36 Italian Norms for healthy people. Multiple linear
regression analysis showed that some specific dimensions of illness representation, together with gender and age, play a significant role in predicting the
quality of life of people with TS. In particular, IPQ-R consequences of predisposition, age, and sex were the best predictors of the SF-36 index of physical
health (Adj R2 = .46, p < .0001), while coherence of predisposition and its
emotional representation were the best predictors of the SF-36 index of mental
health (Adj R2 = .22, p < .0001). Conclusions. We can conclude that the representation model developed by the subjects to give a sense to their TS influences
their quality of life, although the real risk of developing Thrombophilia is very
low. Further research is needed to replicate these results in people with genetic predispositions other than TS.
*Neurological Unit, Bellaria Hospital, Bologna ;Department of Psychology,
University of Bologna
Objectives: Our study aimed to evaluate the relationship between movement
features, emotional life and health related aspects in Parkinson?s Disease
patients.
Methods: We studied a group of about 34 Parkinson?s Disease patients (mean
age: 65.7) and a group of 38 healthy people (mean age: 62.7).
We used the following measures: LMA/KMP Observation Scale for the observation of movement features related to psychological features; SF36 for quality of life; Zung SDS for depression; Hoehn and Yahr and Schwab and England
neurological scales to evaluate the neurological features.
We compared the two groups to state the differences concerning movement
features and psychological features and health related aspects. We also
stated the correlations among movement features, emotional features, health
related aspects and illness indexes in PD patients.
Results: By comparing ratings of LMA/KMP observations, we found some significant differences concerning movement and emotional features. By comparing questionnaire ratings we found no differences related to emotional features
and some differences concerning health related aspects. We also found some
correlations among several considered variables (movement features, emotional features, health related aspects and neurological indexes). We can state that
the observation of movement qualities related to emotional features, together
with the evaluation of self-reported questionnaires enabled us to better understand the relationship among neurological, emotional and health related features in Parkinson’s Disease.
103
Posters
REPRESENTATION, PSYCHOLOGICAL MORBILITY, MARITAL SATISFATION AND QUALITY OF LIFE IN PATIENTS
WITH MULTIPLE SCLEROSIS AND THEIR CAREGIVERS
Pereira M.G. & Sousa C.
University of Minho - Department of Psychology, Braga, Portugal
Multiple sclerosis(EM)is a inflammatory disease of myelin from the Central
Nervous System of cause unknown, chronic, that affects young people. Its evolution creates sensitive, motor, autonomic and psychic’s deficits with consequences in quality of life. The goals of this study include the assessment of disease representation, psychological morbility, marital satisfation and quality of
life in patients with multiple sclerosis and their caregivers.
Methods: Sample - A group of 100 ambulatory patients with Poser defined EM,
age mean of 39.19 years, Expanded Disability Satatus Scale (EDSS) of 1.8, and
a group of respective caregivers participated in this study.
Instruments. The instruments used for patients were: Disease Representation
(IPQ Weinman & Petrie, 1996),Disease Adaptation (SIP - Deyo et al,
1982,1983), Hospital Depression and Anxiety (HADS - Zigmond & Snaith,
1983),Multiple Sclerosis Quality of Life questionaire (MSQOL-54 - Vickrey,
Hays, Harooni, Myer & Ellison, 1995, Index of Marital Satisfation (ISM Hudson, 1991)The instruments used for caregivers were: Caregiver Reaction
Assessment (CRA - Given et al, 1992), Beck Depression Inventory (BDI Beck, Mendelsohm & Mock, 1961), State Trait Anxiety, Inventory (STAI Spielberger, Grush, Lushene, Vagg e Jacobs, 1983)and the index maritaln satisfation.
Results A relationship between patients and caregivers was found in terms of
psychological morbility and quality of life as well as on the impact of the disease on marital satisfaction. Implications for intervention with this population
are discussed.
RESPONSE SHIFT IN QUALITY OF LIFE IN PALLIATIVE
TREATMENT OF SMALL CELL LUNG CANCER PATIENTS
M.J. Westerman, T. Hak, B.A.M. The, H. Groen, G. van der Wal
Dept of Social Medicine, EMGO, VU University Medical Center, Van der
Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
Quality of Life (QoL) is now considered as a necessary end point in clinical trials in cancer patients, and is particularly relevant in small cell lung cancer
(SCLC) patients, who receive in almost all cases only life-prolonging and “palliative” therapy. As yet there is sufficient evidence that changes in QoL scores
do not only represent actual change but also an as yet unknown degree of socalled response shift, caused by the changes in the patients’ standards, values
and concepts regarding QoL.
In our study of “Response shift in Quality of Life in palliative treatment of
small cell lung cancer patients”, a qualitative exploratory longitudinal multiple
case-study with 30 patients (cases), each patient is interviewed five times at
equivalent “assessment points” in their illness trajectory, resulting into a data
base of 150 interviews. Part of this study is an exploration of SEIQoL-DW as
instrument for measuring response shift. SEIQoL-DW allows respondents to
“define” QoL by nominating the five most important aspects of their lives at
that moment (“elicited cues”) and by indicating the relative contribution
(“weight”) of each cue to their overall QoL. Inspection of our data shows indications of different weighting when patients were consistently able to elicited
five cues in their interviews, which could indicate response shift.
THE RELATIONSHIP BETWEEN MENTAL STATE AND
EXTERNAL ENVIRONMENT IN PACEMAKER PATIENTS
RECURRENT NIGHTMARES DISORER: AN EPIDEMIOLOGICAL STUDY
Sawako Kuga, Masahisa Kodama
S. Grandi, S. Fabbri, E. Gonnella, L. Sirri, E. Tossani
In Japan, the use of cellar phones which have useful, convenient, and joyful
functions such as sending/receiving email, doing internet, watching movie, and
listening music has been dramatically increasing. And a lot of people enjoy
using them in any places. Commonly, it is widely known that the cellar phones
have negative effects on pacemakers. However, although the cellar phones
have been used in any places nowadays, there are a very few studies about the
relationship between the use of cellar phones and the QOL of the patients with
pacemakers.
64 patients (male 29, female 35, mean age 70.27±10.58 years) were asked to
fill out the open answer questionnaire. The physical symptoms, such as dizziness, palpitation and breathlessness which had reported by previous studies,
were also reported. About the psychological effects, 71.9% patients reported
that electric devises cased anxiety. Particularly, 25% patients complained cellar phones make them feel too anxious to go to crowded places. In addition,
31.3% patients reported that they tend to avoid getting close to cellar phones
and their users. Therefore, unlike previous studies, the patient’s recognition
towards environments should be also considered to improve the patient’s
QOL.
INTRODUCTION – Nightmares are defined as “dreadful awakening, without
an external cause, associated with strong feelings of fear and anxiety”.
OBJECT – The aim of the present study was to determine the prevalence of
recurrent nightmares in the Italian population and to explore socio-demographic variables of subjects suffering from nightmares disorder.
SUBJECTS AND METHODS - 1013 subjects (range: 18-70 years) attending
general practitioner’s ambulatories were evaluated using an epidemiological
questionnaire.
RESULTS – The results showed that 51 subjects (35 females and 18 males)
were actually suffering from recurrent nightmares, with the following frequency: only one person presented less than one nightmare a month, 19 reported a
nightmare a month, 13 one a week, 12 twice a week and 6 every night. 31 subjects recalled the entire nightmare and 20 only partially.
While in 28 subjects the nightmare’s content was the same, for the other 23 it
changed although the main topic was always the same.
DISCUSSION – All the results were consistent with authors’ expectations and
confirmed data of previous studies. According to previous studies, the prevalence of recurrent nightmares disorder is between 5 and 7%. The present study
displayed the prevalence of pathological nightmares as 5.3%.
CONCLUSIONS – This study underlines the existence of a sleep disorder that
had not yet received any psychotherapeutic treatment in clinical practice.
Although its low prevalence in the general population, recurrent nightmares
disorder impairs significantly patients’ quality of life. Consequently, it should
deserve adequate clinical attention and credit for future researches.
104
Posters
CITIZENS, PATIENTS, HEALTH PROVIDERS, HEALTH MANAGERS, AND EXPERTS’ CRITERIA TO FACILITATE A SECOND
OPINION TO PATIENTS WITH SEVERE DISEASES
PATIENT SATISFACTION WITH THE MEDICAL ENCOUNTERS:
A COMPARISON BETWEEN GREECE AND ENGLAND.
T. DALLAS & DR CANDAN ERTUBEY
Mira JJ, Blaya I, García A, Maciá O, Lorenzo S, Pérez-Jover V., Rodríguez-Marín J.
Universidad Miguel Hernández, Spain
University of Luton, UK.
Introduction: Patient-doctor relationship paradigm is changing from a paternalisticmodel to a shared-decision-model. Inform consent is the most salient fact of this change
but not the only one. The regulation of the patients with severe diseases rights’ to
receive a second opinion is another fact of this change. However, it is quite different to
regulate the right and putting this right into practice.
Objective: To analyze advantages, how to facilitate the right to receive a second opinion and how to overcome the barriers to put it into practice.
Methods: Metaplan, a qualitative technique, was conducted. 28 national “experts” were
invited to participate. Experts belonged to citizen’s organizations or patient’s associations. Health care professionals also participated in the expert panel, as well as experts
in health education, health care managers, and patient-attendant professionals. Experts
were divided in 3 groups. Three experienced professionals in qualitative techniques conducted the groups, and all the participants responded in the same order to the same questions to assure validity (triangulation). Analysis of data included: qualitative analysis
(categories of ideas), productivity (number of ideas), spontaneity (number of experts
that suggest the same idea), vividness (weighing assigned to each idea by experts), and
consistency (if the same idea is repeated in different groups).
Results: 680 different ideas were proposed (27’28 each expert). More vividness advantages were increase patients’ security, confidence, and satisfaction; increase health system’s perceived quality and credibility; decrease patients’ and relatives’ anxiety;
increase patient’s autonomy. Other advantage was expected a fees reduction of professional insurance policy. In turn, identified barriers were increase cost of assistance, the
need of a quick procedure to receive second opinion (overcome actual waiting-time),
saturation of reference health services, patient’s uncertainty between first and second
opinion, law gap between waiting second opinion and also during the time from second
opinion to assume any decision. Vividness risk was that all change to get nothing
change. Experts recommended to put in practice this right within an ample communication campaign to citizens and professionals, professionals training in communication
abilities, increase technology facilities to Evidence-Based-Medicine, restrict the second
opinion to determine severe diseases, diversified accessibility to second opinion, and to
take into account the point of view of all actors in this scene.
Conclusions: Second opinion will probably contribute to change the actual paternalistic
model to a shared-decision-model in which patients have more autonomy. However, this
change needs a strong drive from all actors involving it to overcome expected barriers.
Citizens and patients wish to be the leading of their own decisions.
INTRODUCTION The aim of this study is to identify the variables that affect
patient satisfaction. To do this we looked not only at variables like doctorpatient relationships but also those related to health systems. Patient satisfaction is important as it affects the patient’s level of engagement and the success
of the treatment (Lin & Kelly, 1995; Zabada et al., 2001). A comparison of the
two countries was made in order to identify differences between them. We were
particularly interested in differences the organisational and operational mechanisms within the hospitals that might influence the level of patient satisfaction.
For the past few years many European countries have promoted their institutions, procedures and international organisations and services that aim to evaluate all the factors related to quality (Theodorakioglou & Tsiotras, 2000).
METHODOLOGY A total of 24 participants (12 Greeks from Ioannia and 12
British from Luton) have been interviewed in their own country. Average ages
were 48 and 38 respectively. Their view of national health services is being
asked. Interviews were than analysed with ATLAS package programme.
RESULTS Greek Patient’s satisfaction was related to the quality of doctor
patient relationship. Patient’s expectations were related to information and support aspects of consultation. Patients evaluated the Greek health system generally good with some operational and organisational problems. They dissatisfied
with limited time spend during consultation and nurses’ attitude. British
Patient satisfaction was related to information and support, availability and
accessibility of the services and organisational/operational aspects of consultation. Patient expectations were related to communication and quality of medical care aspect of consultation. They were mostly satisfied with NHS. They
were dissatisfied in situations related to operational issues and the quality of
medical care.
CONCLUSION Greek and British patients were similarly satisfied with their
health services and the treatment they received. The problems for the Greek
were qualitative and included dissatisfaction with organisational issues (e.g.
DIFFERENCES BETWEEN ETHNIC GROUPS IN PARENTAL
SATISFACTION WITH COMMUNICATION IN A CHILDREN’S
HOSPITAL
EMERGENCY
DEPARTMENT
Tsimtsiou Z, Irakleidou M, Papaharitou S, Hatzichristou C
Aristotle University Thessaloniki
Mohammed Abbas Ramji, Helen Pattison
Patient-centeredness is increasingly regarded as a crucial element of quality for
the health care delivery system. However, the culture of medical education
seems to focus more on a biomedical, that on a patient-centred model of care.
Objective.
To describe the attitudes of medical students towards the patient-centred care,
for the first time in Greece, to find demographic parameters that are associated
with patient-cantered attitudes and to investigate whether these attitudes have
an influence on sexual beliefs.
Methods.
A questionnaire was administered optionally to 301 students in the fourth year
of medical school. The beliefs about doctor-patient relationship where measured with the Patient-Practitioner Orientation Scale (PPOS), an 18-item scale
that differentiates between a patient-centred versus a doctor-centred orientation. The students were also requested to answer anonymously to 34 sexual attitude questions and additional demographic data.
Results.
240 fully answered questionnaires were returned (response rate 79.7%). Greek
students were more doctor centred compared to American students, according
to the results of published papers. Female gender, origin from the lower-working class and being a civilian student (versus military) were significantly associated with patient-centred attitudes. Finally, patient centred orientation was
correlated with more liberal sexual attitudes.
Conclusion. The urge need for a more patient-centred medical education arises. The more open-minded attitudes even in sexual issues, that seem to be associated with the patient-centred orientation, reinforce this need
Satisfaction is an essential outcome of a consultation as it influences
adherence to prescribed regimens. So parent satisfaction with consultations
for their pre-school child is likely to have an impact on the child’s
health. This study explored satisfaction levels in parents of several
ethnic backgrounds attending a children’s hospital emergency department.
Forty-five parents were recruited in the waiting room and then were
interviewed in their own home using a semi-structured interview protocol.
All interviews were recorded, transcribed and analysed using ‘framework’
analysis.
Parental satisfaction was dependent on psychosocial aspects of care and the
perceived professionalism of doctors. The latter was characterised by
parental perceptions of : doctors providing clear and thorough explanations;
doctors’ sensitivity to the needs of parent and child; doctors having a
calm, reassuring and/or confident manner; the child being comfortable with
the doctor. Pakistani and Indian parents expressed most complaints about
expectations not being met, particularly perceiving investigations and
advice as incomplete. Nevertheless these groups negatively contrasted their
General Practitioners with the hospital doctors, who they perceived as
experts offering better healthcare. Physical amenities, organisation of the
department and outcomes of care were important but less influential on
parent satisfaction for all groups.
GREEK MEDICAL STUDENTS ATTITUDES TOWARDS THE
DOCTOR-PATIENT RELATIONSHIP AND COMMUNICATION.
105
Posters
GENDER DIFFERENCES BETWEEN DOCTORS IN BREAKING BAD NEWS TO PATIENTS WITH CANCER: DIFFERENCES IN PATIENT CENTREDNESS APPROACH.
P. Dartzalopoulou, J. D. Fisher, O. M. Dunn, D. C. Giles, M. Bernett
COVENTRY UNIVERSITY
It is important that bad news is broken to patients in a sensitive
manner. Experts suggest that patients can show additional distress if
they feel bad news is broken inappropriately (Fallowfield, 1993).
This study examines gender differences among ten male and ten female
Consultants based in a UK Hospital, from various specialties. Each was
given background information on a patient actor facing bad news relating
to cancer (initial diagnosis or reoccurrence). The Breaking Bad News
Assessment Schedule (Miller, Hope and Talbot, 1999) was used to assess
doctors’ skills in a typical session of breaking bad news (setting the
scene, breaking the news, eliciting concerns and information giving),
also the overall patient-centred approach that the doctors followed
during the sessions. Analysis of video taped consultations was conducted
in order to rate such behaviours.
Overall men (M) and women (W) were found to vary significantly in terms
of their mean total scores in their skills in breaking bad news (M=
56.50, W=82.38), women achieving higher total scores than men indicating
a more patient centred approach (t(14)=5.97, p<.05). Moreover, it was
revealed that women performed better in eliciting concerns (M=4.75,
W=9.5, t(8)=6.54, p<0.5) and also in the interview as a whole (M=15.63,
W=32.38, t(14)=10.92, p<0.5) when breaking bad news than men. There was
no significant gender difference in setting the scene, breaking bad news
or information giving.
The factor of gender is discussed as an important consideration to those
who teach and train medical students in the difficult task of breaking
bad news.
IDENTIFICATION OF PSYCHOLOGICAL PROBLEMS
FACED BY THE SURGEON WHEN DISCLOSING LIFETHREATENING INFORMATION TO SURGICAL ONCOLOGY PATIENTS
Joao Paulo Guerra*, Marina Prista Guerra**
* Portuguese Institute of Oncology Francisco Gentil, Porto Center **Faculty of
Psychology and Educational Sciences - University of Porto
One of the most difficult aspects when dealing with surgical oncology patients
is the disclosure by the surgeon of the real extent of the disease. Due to an
almost generalized intense and total psychological dependence by the patient
on someone who has “invaded” his or her organic frontiers in the process of
removing malignant tumours, there is frequently the feeling by the patient of
this being a decisive moment for the potential cure or death. Because of this
perception, it usually is a moment of intense stress, also felt and faced by the
physician. It is absolutely impossible to dissociate, in one hand, the fear of
causing further suffering, and on the other hand the ethical obligation of
informing the patient of his or her condition, full feeling a basic principle of
clinical practice. In spite of all the professional help that clinical psychologists
may give to this type of patients, making their contribution absolutely essential,
the surgeon still has to play a pivotal role. It is precisely this role and specifically how this information should be disclosed, as well as the associated psychological problems felt by a sample of surgeons in that precise moment of
truth, that we intend to present in this study, stressing the importance of a correct articulation between the surgeon and the psychologist.
AN INTERPRETATIVE PHENOMENOLOGICAL ANALYSIS
OF OLDER PEOPLE’S PERSPECTIVES AND ATTITUDES
TOWARDS RESUSCITATION ORDERS
HEALTH PSYCHOLOGISTS IN THE PROFESSIONAL
TRAINING: TUTORIAL EXPERIENCE IN A TRAINING
COURSE FOR HEALTH WORKERS
Tushna Vandrevala & Sarah E. Hampson
University of Surrey
Cauteruccio Maria Antonella*, Beltrami Silvia**, Chiambretto Paola#,
D’Alisa Simonetta°
Healt Psycologist; *Cardiology Rehabilitative. Mormanno Hospital. Italy
**Psychology unit, ASO “Maggiore della Carità” Novara. Italy#Psychology unit, Vitaresidence Nursing Home. Guanzate. Italy°Department of Neurology and Neurorehabilitation. Istituto Auxologico
Italiano IRCCS, Piancavallo (VB), Italy-
The purpose of the study was to investigate older people’s perspectives and
attitudes towards discussing resuscitation orders. While limiting and foregoing medical treatment at the end of life is now accepted on medical, ethical,
moral and legal grounds, many Britons continue to die with heroic measures
being taken to prevent their death. When the patient does eventually die,
attempts are made to revive the patients by performing cardiopulmonary resuscitation (CPR). Despite low survival rates, the widespread adoption of the donot-attempt to resuscitate (DNAR) protocols have not prevented CPR from
being performed. Eight community-based focus groups, consisting of 48 older
people, were convened to explore their perspectives of end-of-life decision
making, particularly with regard to resuscitation orders. Transcripts were
analysed using Interpretative Phenomenological Analysis. The results suggest
that the decision to opt for resuscitation or request a DNAR is often affected by
the older person’s attitude towards death and dying (acceptance, fear or denial).
These decisions are made based on individual values (such as, perceived quality of life, religious orientation) and often with consultation with doctors and
family members. Participants reported that there is a ‘right time’ to think about
and make these decisions, based on not discussing these issues ‘too early’ and
not waiting till it is ‘too late’. Gender differences in older people’s attitudes
towards resuscitation orders will also be discussed. Both theoretical and practical implications of these findings will be addressed.
106
A psychologist must have the competency to assist the various health workers
in facing possible communication difficulties. In literature, especially in cardiology, the psychologist is cited as well as integral part in medical-nursing training programs for the disease control, particularly regarding the improvement of
the health workers/patients-caregiver communication, to optimise the observance of prescriptions. One of the training targets is to encourage the development of know how, so that it doesn’t remain split by the working contexts. In
order to facility this development, in the training course, it could result successful to integrate the figure of the teacher with the tutor. This educational figure
is based on the conception that the learning process is mediated by the student’s
interior world. The tutor has the double task to follow the progressive learning
of knowledge, techniques and competency and to promote the development of
the professional identity. During a training course about the effective communication in the management of patients with chronic heart disease, for sectorial workers, we made a tutorial experience. Each professional figure has been
introduced in a working group where know how was experienced through roleplaying. As learning facilitating tools, to utilize during the role-playing, the
tutors used ad hoc prepared guide-schemes. These schemes contained specific
questions regarding the three areas wanted to be stimulated in the trainees: cognitive, emotional and managerial. The experience has allowed to underline two
positive feedback levels: on the side of learning and on the side of the quality
perceived by the organisation.
Posters
SEXUAL HEALTH, GENDER AND PRIMARY CARE:
A QUALITATIVE STUDY WITH PATIENTS AND GPs
Dr. Sharron Hinchliff, University of Sheffield, Dr. Merryn Gott, University of
Sheffield, & Elisabeth Galena, University of Sheffield
University of Sheffield , Sheffield Institute for Studies on Ageing, Community
Sciences Centre
Northern General Hospital Sheffield, S5 7AU UK
As part of an ongoing programme of research, the findings from two studies
that investigated sexual health in primary care are presented. Both identified
barriers that patients (Study 1) and General Practitioners (GPs) (Study 2) experience when discussing sexual matters in consultations. This paper explores the
barriers that have a specific link with gender.
In-depth interviews were conducted with 69 patients listed on the age/sex register of one General Practice in Sheffield (Study 1), and 22 GPs recruited from
different practice types across Sheffield (Study 2). Data were analysed thematically, assisted by the qualitative software programme NUDI*ST.
Analysis revealed congruencies between GPs and patients regarding genderrelated barriers. Both groups felt: more at ease discussing sexual matters with
a GP/patient of the same sex as themselves; that women were more likely to
seek help than men due to social taboos; that being female presented gateways
that allowed sex to be raised; and that embarrassment was an issue that had to
be overcome. Differences regarding the aetiology, embedded in some of the
accounts, are used for discussion.
As primary care was perceived to play a central role in the management of sexual health, it needs to advertise itself as an appropriate setting in which to raise
sexual concerns, particularly to men whose problems may go unnoticed. GPs
recognised that undergraduate and vocational training would improve such
consultations. Indeed, patients felt that their embarrassment would be lessened
if the GP had a sensitive approach.
PATIENTS’ PERCEPTION OF INFORMATION ABOUT
HIGHLY ACTIVE ANTIRETROVIRAL THERAPY (HAART):
IMPACT ON TREATMENT DECISIONS
G. Gellaitry, V. Cooper, M. Fisher & R. Horne
Centre for Health Care Research, University of Brighton and
Brighton and Sussex University Hospitals NHS Trust, UK
Background: The aim of this study was to profile patients’ satisfaction with
information they have received about highly active antiretroviral therapy
(HAART) in relation to treatment uptake.
Methods: As part of a prospective investigation into uptake and adherence to
HAART, participants (n=100) completed validated questionnaires investigating
their satisfaction with information relating to practical aspects and potential
problems of HAART, perceptions of information from different sources and
beliefs about HAART, following a clinically recommended treatment offer.
Results: There was a wide range of total satisfaction scores indicating variation
in patient satisfaction and information requirements. The most helpful sources
of information were specialist HIV staff: hospital consultants, pharmacists and
nurses as well as other people who are HIV positive. Those who declined
HAART (n=27)were less satisfied with the information they had received than
those who accepted the treatment recommendation (n=73)(p< 0.05). Lower
levels of satisfaction were associated with stronger concerns about the adverse
effects of medication (p<0.05).
Discussion: This study has improved our understanding of how information
about HAART is perceived by people faced with treatment decisions. It
emphasises the importance of providing information that meets patients’ personal needs and addresses their specific concerns, in order to support informed
decision making.
GIVING HEALTH BEHAVIOUR ADVICE: AN INVESTIGATION OF THE EFFECT OF EDUCATION ON MEDICAL
STUDENTS’ BELIEFS USING THE THEORY OF PLANNED
BEHAVIOUR
BARRIERS TO STEM CELL DONATION
Jo Hart, Marie Johnston
University of St Andrews
The current shortage of stem cell donors in UK and elsewhere means that many
patients with leukaemia, other blood and bone marrow diseases and various
malignancies have little chance of treatment. There are particular problems
in recruiting donors from UK minority ethnic and religious groups. Tissue
types tend to cluster in ethnic and some religious groups so that a patient
is most likely to find a matching donor from within their own group.
This study investigated perceptions and opinions regarding stem cell
donation amongst university students. Students were recruited by
advertising on campus and by direct contact via the University’s major
religious and cultural societies. Five focus groups were held with a total
of 23 students. Each group was recorded, transcribed and analysed using
‘framework’ analysis.
The major themes emerging were: a lack of awareness of, and information on,
the topic; personal anxieties about the procedure; religious and cultural
issues including the attitudes of family members. The main barrier was a
lack of knowledge about donation and this underpinned anxieties raised and
some of the religious and cultural misconceptions cited. Further research
is needed to ascertain whether additional barriers exist, including in
ethnic and religious groups not represented here. Furthermore, it is likely
that additional barriers will emerge as awareness and knowledge is
increased.
Introduction
Giving health behaviour advice (HBA) is an evidence based practice for general practitioners, but their rate of use of HBA is low. The current study examines medical students’ cognitions about giving HBA within the framework of
the theory of planned behaviour (TPB)
Medical students are trained not only in knowledge but how to apply their
knowledge in clinical settings. The current study investigates changes in cognitions about HBA with medical education and potential factors influencing
intention to give health behaviour advice using TPB constructs.
Methods
80 medical students completed questionnaires assessing their TPB cognitions
and possible moderators of change (including demographics, academic factors,
career aspirations, control beliefs) at the beginning and end of their pre-clinical
medical course, at a British medical school (St Andrews)
Results
The results show that at the second assessment, there were no changes in the
mean values of any of the TPB cognitions (e.g for behavioural intention
t=0.722, dF=78, n.s). However, a large proportion of students showed substantial changes.
Conclusion
The results suggest that medical education, including a course in behavioural
sciences, does not increase intention to give HBA. However, the course may
have prevented intention declining. Factors associated with increases and
decreases in intention are discussed.
Eleanor Sudbury, Helen Pattison
107
Posters
PSYCHOLOGICAL BURDEN AND HEALTH IN CARERS OF
CANCER PATIENTS IN GREECE.
Tony Cassidy & Maria Fotiadou
A survey design using a structured interview data collection technique was
used to explore the relationship between psychological burden, social support,
perceived control and health in carers of cancer patients. A sample of 65 caregivers (31 males and 34 females) of cancer patients in Greece were assessed
using a scale which combining the Zarit Burden Interview, the Clinical Anxiety
Scale, and questions to assess the amount of information supplied by health
professionals. The scale was administered as a structured interview. Principal
component analysis of the scale produced 6 factors which were labelled psychological burden, mental health, physical health, social support, information
received, and relationship with doctor. Hierarchical multiple regression analysis shows that psychological burden is a predictor of poorer physical and mental health and that this effect is mediated by perceived control. Income, education and time since diagnosis also have an impact of mental health. The results
support the link between psychological burden and the mental and physical
health of carers with the effect being mediated by control. Those carers who
had higher levels of perceived control reported few health effects of caring
despite the level of burden.
COPING AND CONTROL BELIEFS: THEIR IMPACT ON
PSYCHOSOCIAL ADAPTATION IN BREAST CANCER
PATIENTS AT FOLLOW-UP STAGE*
Neipp, M.C., Lopez-Roig, S., Terol, M.C., Pastor, M.A.
Health Psychology Department, Miguel Hernandez University. Alicante. Spain
Studies of cancer patients have shown that certain coping strategies and some
control beliefs were associated with better psychosocial adjustment and emotional status. At a follow-up stage, women with breast cancer have experienced
overcoming earlier stages (i.e., diagnosis and treatment) successfully. These
experiences might determine their subsequent coping strategies and control
beliefs regarding their cancer. Hence, breast cancer patients’ (BCP) coping
strategies with their illness and their beliefs about their control over their cancer might influence their psychosocial and emotional adjustment.
Aim: To determine the profile of coping strategies and control beliefs that are
the best predictors of emotional psychosocial adjustment over time.
Method: We interviewed 131 BCP with unilateral primary breast cancer, free
of disease attending a standard follow-up protocol in the oncology outpatient
unit at the Alicante hospital. Spain
Results: Cluster analysis of coping strategies produced three clusters. Cluster 1
used more cognitive and approach coping strategies, moderate avoidance
strategies, had the highest control beliefs and were better adjusted than women
from the remaining 2 clusters. Avoidance strategies predicted worse emotional
and psychosocial adjustment over time. Moreover high control beliefs predicted better adjustment across time.
Conclusion: Therefore interventions for BCP in this stage should be conducted to increase the use of approach strategies and their control beliefs over their
cancer and diminish the use of avoidance strategies.
*This work was supported by a grant from Fondo de Investigaciones Sanitarias
(FISS 99/0856).
108
COPING STRATEGIES IN PATIENTS WITH FUNCTIONAL
DYSPHONIA
U Willinger1, HN Aschauer2
1 University-ENT-Clinic, University Vienna, Austria
2 Department of General Psychiatry, University Vienna, Austria
Psychological factors such as personality traits and coping strategies are
assumed to play an important role for the etiology of conversion disorder, especially for the etiology of functional dysphonia (Morrison et al., 1986; Behrendt
et al., 1989). The aim of the present study is to investigate coping strategies in
patients with functional dysphonia, compared to sex-, age- and occupationmatched controls without functional dysphonia. Sixty-one patients, consisting
of 48 (79%) female and 13 (21%) male patients with functional dysphonia were
consecutively recruited at the University-ENT-Clinic and were compared to the
controls with respect to coping strategies. These strategies were measured by
the “Evaluation of stress coping” (“Stressverarbeitungsfragebogen”; Janke et
al., 1985). First results showed significant lower values in the patients than the
controls with respect to “reduction of importance by comparison with others”
(t-value = -3.49;df=58;p=.001), and significant higher values than the controls
with respect to “attempt of reaction vontrol” (t-value=2.56;df=58;p=.013),
“avoidance tendency” (t-value=2.04;df=58;p=.045), “finding no way out of
keeping one`s mind busy” (t-value=3.32;df=58;p=.002), “resignation” (tvalue=2.35;df=58;p=.022), “self-accusation” (t-value=2.57;df=58;p=.013). All
significant differences with exception of the higher tendency with respect to
“attempt of reaction control” refering to coping strategies, which are increasing
stress (Janke et al., 1997). In this way, our first results seem to indicate the need
of psychological treatment for patients with functional dysphonia with respect
to stress coping strategies.
Posters
STRESS, DEPRESSIVE SYMPTOMS, AND COPING STRATEGIES AMONG PREGNANT WOMEN
CHANGE IN THE COPING STRATEGIES IN POSTSTROKES PATIENTS
Spitz E*., de Tychey C.**, Briançon S.***, Costantini M.-L.*, Messembourg
C*., De Luigi V*., Vaillant M.* & Limousin B.*
University of Metz
D’Alisa Simonetta°, Beltrami Silvia**, Cauteruccio Maria Antonella*,
Chiambretto Paola#
Objective: To explore the relationship between coping strategies and depressive symptoms during pregnancy.
Method: The sample consisted of 156 pregnant women . The average age was
28.71 years (SD = 5.15 years, range = 18 - 40 years). Participants were interviewed during the late second or third trimester (26-35 weeks) of pregnancy.
They completed Edinburgh Depression Scale (EPDS, Murray & Cox, 1990)
and Brief COPE (Carver, Scheier & Weintraub, 1989). We divided the sample
between probable cases of depression and probable non-cases using a threshold of 12 on the EPDS.
Results:
32 pregnant women present a EPDS score superior or equal at 12, that leads to
21% of pregnant women reporting high levels of depressive symptoms.
Logistic regression models examining the relationship between coping strategies and depressive symptoms was proposed. Three coping strategies were significantly associated with depressive symptoms in early pregnancy: denial
(0,04), self-blame (0,01) and humour (0,03). Pregnant women who utilised
denial and self-blame were more at risk to present depressive symptoms. The
humour coping was a protecting factor.
Perspectives: At present, the mothers after childbirth were interviewed in order
to compare reported symptoms of depression at each stage.
MODEL OF STRESS-COPING IN FIBROMYALGIA
PATIENTS ATTENDED IN RHEUMATOLOGY SERVICES
Lledó, A., Pastor, Mª., Pons, N., Martín-Aragón, M., López-Roíg, S., Terol,
MC., Rodríguez-Marín, J. and Sanchez, S.
University of Miguel Hernández. Dpto de Psicología de la Salud.
Ctra.Alicante-Valencia, N-332, Km.87- E-03550 San Juan de Alicante, Spain.
INTRODUCTION: Fibromyalgia syndrome is identified as an important
source of stress (physical and emotional stress, familial context, lack of social
recognition, professional functioning among others; Van-Houvenhove,
Neerinckx, Onghena et al., 2002). These emphasise the importance of stress
management by coping efforts as a way to improve these psychosocial impact.
The research on control beliefs provides strong evidence for their relationship
to coping behaviour and outcomes of pain management. However the mediating mechanism underling these effects according to stress-coping models have
not been applied in investigations of coping with fibromyalgia.
AIM: We explore the utility of the Lazarus and Folkman (1986) theoretical
framework in examining the role paths between control beliefs (as a personal
resources) and coping strategies in health status outcomes.
VARIABLES: Spanish adaptations of following instruments: Chronic Pain
Self-Efficacy Scale (Martin-Aragón et al., 1998), Multidimensional Pain Locus
of Control (Pastor et al., 1990), Perceived Health Competence Scale (Pastor et
al., 1997), Chronic Pain Coping Inventory (Martin-Aragón et al.,1995) and
Sickness Impact Profile (Badía and Alonso, 1994).
METHOD: Personal interview to 189 fibromyalgia patients attending
Rheumatology Services of different Hospitals in Alicante county. Model analyses with LISREL using estructural equation model by observed variables of
Lazarus´s model.
RESULTS: Results from analytic casual relations supported that coping efforts
mediates the relationship between the majority of control belief on health status outcome. However global analysis do not support the model (EFI: 0.47).
CONCLUSIONS: These finding provides directions for interventions (cognitive control and confidence as a way to develop effective coping techniques),
further research (fixing some paths) as well as theory refinement.
Healt Psycologist. °Department of Neurology and Neurorehabilitation. Istituto
Auxologico Italiano IRCCS, Piancavallo (VB), Italy**Psychology unit, ASO “Maggiore della Carità” Novara. Italy
*Cardiology Rehabilitative. Mormanno Hospital. Italy
#Psychology unit, Vitaresidence Nursing Home. Guanzate. ItalyStroke is a major life event which induce change in the way of coping with the
transitory or permanent handicap consequent the pathological event.
The objectives of this study are: explore the type of coping strategies developed
after the stroke; verify whether coping strategies change along the time.
Twenty-six post-stroke (20 m; 6 f) patients were recruited: 10 were examined
within one week from the stroke (group A); 6 patients within two years of
stroke(group B); 10 patients from three years or more(group C). All patients
underwent assessment of cognitive functions using the neuropsychological
screening test MMSE (Folstein, 1976): the selection criterium is MMSE was
≥24. Coping strategies were assessed by means of the Coping Inventory
for Stressfull Situations (CISS,1994), including scales of task oriented, emotional oriented and the avoidance oriented coping. Task oriented and emotional oriented coping were the most frequently strategies used after stroke. The
avoidance oriented coping was usually less employed. Coping strategies
change over time: patients examined within a week of stroke (group A),
showed a significant task oriented (p< .05) and emotional oriented (p<.05) coping compared to more chronic patients (group B and
COGNITIVE DILEMMAS, STRATEGIES OF COPING AND
PROBLEMAS IN ADAPTATION TO UNIVERSITARY LIFE: A
QUESTION OF COHERENCE.
Fernandes E. & Maia, A.
University of Minho
Aims of investigation
Transition to university is for many students the opportunity to make some
changes in their life, along time waited, like construct a personal life project,
but this life transition is for some of them a great challenge of to their stability
of personal resources. This study used the cognitive dilemmas and coping to
investigate the impasse created during the first time of Life University that is
responsible for problems adaptation.
Method
One group of 50 new students of Minho University, who are at the university
for the first time volunteered to participate. They were interviewed about their
interpersonal constructs for make a repertory grid. They answer to two self
report questionnaires: one about psychological symptoms (SCL-90-R) and
another about strategies of coping (Problem Solving Inventory, Vaz-Serra).
Results
Preliminary results of this research indicated a significant and positive correlation between presence of cognitive dilemmas and the anxiety sub-scale of SCL90-R. The same results indicated that students who used negative or passive
strategies of life coping have more cognitive dilemmas than their colleagues
who used active strategies of coping.
In this poster we will present the final results and we will analyse the relations
between presence of cognitive dilemmas and symptoms, or presence of dilemmas and strategies of coping.
We will discuss the results relating them with the sense of personal coherence.
109
Posters
IMPACT OF THE ANATOMY DISSECTION ROOM ON STUDENT STRESS RESPONSES
EFFECTS OF CHRONIC PSYCHOGENIC STRESS IN
EXPOSED POPULATIONS.
A. Hickey(1) and A. McGarvey(2).
Departments of Psychology(1) and Anatomy(2), Royal College of Surgeons in
Ireland
E. Dimitroglou1,3, M. Zafiropoulou2, N. Messini-Nikolaki3, S.
Tsilimigaki1 and S.M. Piperakis1,
1DNA Repair Laboratory, Insitute of Biology, NCSR “Demokritos”, Aghia
Paraskevi,
Athens, Greece,
2Developmental Psychology and Psychopathology Laboratory, School of
Human
Studies, University of Thessaly, Volos, Greece,
3School of Biology, University of Athens, Athens, Greece,
4Department of Cystic Fibrosis, Aghia Sophia Hospital, Athens, Greece.
Aim: To examine stress levels of students studying anatomy in an anatomy dissection room using cadaveric specimens compared with students studying
anatomy in a laboratory setting using plastic specimens.
Methods: Sample: Two groups of 1st year nursing students studying the same
anatomy curriculum in two different settings (Anatomy dissection room (AR;
Group A) versus science laboratory (Group B)).
Measures: Impact of Events Scale (IES; Horowitz et al., 1986) and Lester
Death Anxiety Scale (LDAS; Lester, 1966); additional questions about personal experiences of the AR/science laboratory.
Procedure: Questionnaire administered a) before first exposure to AR/science
laboratory;
b) immediately after first exposure; and c) nine weeks later.
Results: Significantly higher stress levels reported by Group A immediately
after first exposure to the AR compared with Group B (p<0.01). Significantly
more physical symptoms reported also (t=4.2, p<0.01), continuing to the end of
the anatomy course (t=3.4, p<0.01). Impact of Events Scale results indicated
significantly greater impact of the AR initially, both in terms of intrusive
thoughts and avoidance, compared with Group B (p<0.01). However, significant improvement on both subscales was evident in Group A by the end of the
course (p<0.01).
Conclusions: Group A reported significantly greater difficulties after initial
introduction to the AR compared with Group B. These difficulties improved
significantly over the duration of the course, although continued to be significantly greater than controls in some areas. However, over 90% of students considered the experience positive and beneficial. Adjustments to the preparation
of students for the experience is recommended.
SELF-CONCEPT, STRESS AND LEISURE COPING STRATEGIES AMONG STUDENTS
Florbela Teixeira and L. Santos
Escola Superior de Enfermagem de Viana do Castelo
OBJECTIVES: To analyse (1) the importance of self-concept among university students and (2) the relation between stress, leisure coping strategies and
self-concept.
METHOD: Sample design: A cohort of 105 university students, 71.4% of
which were females; aged between 19 and 25.
PROCEDURE AND MEASURES: Participants answered the ICAC (clinical
inventory of self-concept), the LCSS (leisure coping strategies scale) and the
DASS (depression, anxiety and stress scale) in order to study the self-concept,
the leisure coping strategies and the stress.
RESULTS: Results suggest that there are no significant gender differences concerning the global self-concept and the stress levels; but different leisure coping strategies were used for male and female students.
Results also suggest that the self-concept was positively related with some
leisure coping strategies used; and stress level was negatively related with
some leisure coping strategies.
CONCLUSION: The study suggest that the global self-concept is related with
stress levels and with different leisure coping strategies and that gender is
important in the choice of leisure coping strategies.
110
OBJECTIVES: To determing the effects of chronic psychogenic stress on the
genetic material of humans (DNA).
METHODS: We used the comet assay technique to determine the DNA damage of lymphocytes from psychogenic stressed populations evaluated by STAI.
RESULTS: Endogenous DNA damage was found to be similar in lymphocytes
of both stressed and non-stressed (control) populations. The induction of DNA
damage by external factors (H2O2 and ?-irradiation), was also investigated. A
significant difference was found indicating that the chronically stressed population was more sensitive to the effects of the external factors, than the control
one. DNA repair systems operated efficiently in both groups. However, the
levels of repaired DNA in the stressed population do not reach those of the control. Gender does not alter these findings.
CONCLUSION: Our results suggest that psychogenic stress can be a contributing factor to cancer proness via a non-effective DNA damage-repair mechanism.
STAGE OF CHANGE FOR STRESS MANAGEMENT BEHAVIOR IN A JAPANESE ELDERLY REPRESENTATIVE SAMPLE.
Nanako Nakamura, Masahisa Kodama
Advanced Research Centre for Human Sciences, Waseda University
Abstract: Purpose. This study examined the distribution of stage of change
(SOC) for stress management and its characteristics in a representative sample
from a Japanese elder population.
Design and Setting. A Cross-sectional analysis of the sample comprised 2,129
community-dwelling older respondents from 5 administrative units of the city.
Measures. Gender, age, depressive symptoms with CES-D, subjective self-efficacy for managing stress, stress management activities, and SOC for stress
management were assessed.
Results. A large proportion of participants were in precontemplation and maintenance and the SOC distribution was different across gender and age categories. The preparation stage showed significantly higher depressive symptoms
than maintenance stage participants. Having some hobbies, talking to others,
and doing physical activities had a high proportion of the stress management
habit distribution of those who were in action and maintenance, whereas relaxation made up only few percentages.
Posters
CULTURAL CONTEXT OF STRESS AND HEALTH
BEHAVIOR AMONG A DIVERSE GROUP OF U.S.
ADOLESCENTS
Andrea J. Romero, Ph.D. & Scott C. Carvajal, Ph.D.
Mexican American Studies & Research Center, The University of Arizona,
Tucson Arizona
Lazarus (1997) argues that cognitive appraisal, or subjective evaluation,
of one?s cultural and social environment is key to understanding the psychological impact of stressors. Adolescents in the United States navigate a context
of multiple cultures and languages in school and at home; however, few studies have directly explored the perception of the cultural context of stress.
This study investigated the perceptionof stress in multiple ethnic groups
of U.S. adolescents due to intergenerational cultural gaps, within group
discrimination, out-group discrimination, and monolingual stress. 794 boys
and girls were sampled from 8th grade classes from a diverse U.S. public
school district. For analysis purposes the largest four ethnic groups were
grouped as Latino 40%, non-Hispanic Caucasian 27%, Asian 17%, and
other/multi-ethnic 16%. All groups reported comparable levels of being
uncomfortable with other cultures, though non-Hispanic Caucasians reported
significantly (p < .05) fewer experiences than any of the other groups of being
treated bad because of an accent, worrying about immigration, school problems
due to poor English, feeling bad because of negative ethnic jokes, and not feeling accepted because of their ethnic group. For the whole sample, more overall perceived stress (alpha = .94) was also associated with more alcohol problems, smoking, drug use, violence, and depression, and less optimism. In conclusion, minority groups reported higher levels of stress, due to intergenerational family differences, discrimination, and monolingual stress. Future health
promotion programs may consider addressing the multicultural context of
potential stressors that ethnic minority, and non-minority, adolescents
encounter.
COPING AND SURVIVAL IN "STREET CHILDREN" OF A
DEVELOPING COUNTRY ( LIMA, PERU)
Aurea Alcalde ; Maria Julia Alcalde
Universidad Nacional Mayor de San Marcos. Centro Peruano de Audicion,
Lenguaje y Aprendizaje (CPAL)
With a critical economic situation and increased poverty, as a developing
country, Peru presents a growing social phenomena called 'street children'.
The purpose of the study rises from the need to identify processes and
resources that street children must allocate day by day in order to cope with
survival situations. In order to achieve this, we compared the coping profile
of two groups of children: Street Children and Home Children, through the
Rorschach-Exner Comprehensive System. Data were collected among 60
male children, aged 11, 12 and 13 years. Participants were 30 street children
(who live in the street) and 30 home children (who live at home and belong
to low income families).
Findings report significant differences in the Coping Style and in the Coping
Deficit Index (CDI) between street children and home children. The usual
coping style presents a very peculiar characteristic of pseudo-control, related
to personal fragility and related to an overload of expectations and demands
among their needs. As a consequence, both groups are considered under risk,
in terms of imminent risk for the first group and potential risk for the other
group.
GENDER DIFFERENCES IN COPING STRATEGIES IN
CHILDHOOD
COPING STRATEGIES AND DISFUNCTIONAL ATTITUDES
IN POST-ADOLESCENT CRISES
Heike Eschenbeck & Carl-Walter Kohlmann
Institute of Humanities, Department of Psychology, University of Education,
Schwäbisch Gmünd, Germany
Aniko Kezdy
Objective. Clarifying individual differences that may influence coping is
important for understanding the association of coping with psychological
adjustment and physical health. Thus for adults, gender differences in coping
have been discussed with regard to their relevance to gender differences in
physical as well as mental health. However, little is known about the role of
coping in childhood. The purpose of the present study was a detailed analysis
of gender differences in coping strategies in childhood.
Method. 132 primary school children (aged 7-12 years) took part in this questionnaire study. Participants responded to a coping questionnaire with the subscales social support, problem solving, and emotion regulation.
Results. Separately for each of the subscales MANCOVAs with gender and
class as the between-subject factors, situation (dispute with friend, homework)
as the within-subject factor, and age as the covariate were performed. In general, girls scored higher than boys on social support and problem solving. No differences were found regarding emotion regulation. However, within the substrategies of emotion regulation significant gender differences were observed:
girls scored higher in “to feel sad and cry” whereas boys reported higher
amounts of “to be furious and break something” and “to curse”. These pattern
of gender differences in coping strategies could be replicated in a second study
with 78 primary school children (aged 8-11 years).
Discussion. Scale characteristics and health-related implications of gender differences in coping strategies during childhood are discussed.
Aims of the study: to explore the roles of coping strategies and disfunctional
attitudes in the different types of post-adolescent developmental crises among
students at Pazmany Catholic University, Piliscaba, Hungary (PPKE).
Hypothesis tested: 1. The most prevalent post-adolescent crises in the cultural
setting of PPKE are present in different degree than at other institutions. 2.
Certain coping strategies and disfunctional attitudes play a dominant role in the
various types of post-adolescent crises.
Methods used: Eleven crises domains (achievement, social phobia, authority
crisis, gender identity, self esteem, carreer choice, relationship to a partner and
to parents, vegetative symptoms, religious doubts, depression) as well as coping strategies and disfunctional attitudes were assessed in a survey among students at PPKE.
Results: The results showed significant correlations between the measured
degree of crises and non-adaptive coping strategies and disfunctional attitudes.
Conclusion: The results emphasize the importance of prevention in mental
health: individual and group councelling aiming at consciousness-raising and
changing of non-adaptive coping strategies and disfunctional attitudes would
be of help in post-adolescent crises.
111
Posters
PERSONAL RESOURCES; STRESS AND SUSCEPTIBILITY
TO
UPPER
RESPIARATORY
INFECTION
(URI)
STRESS REACTIONS AMONG PEACEKEEPING SOLDIERS:
A LONGITUDINAL STUDY
Schulz, Heiko; Vogele Claus; Renner, Britta
Per-Olof Michel, Tom Lundin, & Gerry Larsson
Swedish Armed Forces Medical Centre, Uppsala University, & Swedish
National Defence College
It is widely recognized that a variety of stressors have an impact on the immune
system and onset and progression to upper respiratory infection (URI). But
only a couple of studies demonstrated that this relationship is moderated by
personal resources, e. g. dispositional optimism. In a similar vein, the purpose
of the present study was to examine the influence of academic exam stress on
the susceptibility to URI. Moreover, it was examined to what extent frequency
and severity of URI are moderated by personal resources such as generalised
self-efficacy and dispositional optimism. Using a longitudinal design (N = 46)
students personal resources were collected three month before exams (t1). In
addition, the status of infection was obtained before (t1) and during examination (t2). Results showed an increase in both, the perception of academic stress
and the susceptibility to URI between time point 1 and 2. In addition, both
effects were less pronounced for persons with high personal resources than for
persons with low personal resources. Thus, these findings support the notion
that high personal resources functions as a buffer against onset and progression
to URI in stressful situations.
EFFECTS OF BREAST- FEEDING ON PERCEIVED MATERNAL STRESS AND MOOD STATES: PRELIMINARY FINDINGS IN A GREEK SAMPLE
Lambros Messinis, Argiris Biris, Dimitris Papalambrou
University Hospital Patras, TEI Patras
BACKGROUND: Research on the maternal effects of breast-feeding is sparse.
Studies have however indicated that breast-feeding (BF) may decrease maternal stress and alter negative mood states in breast-feeding mothers. The present study examined the effects of breast-feeding on perceived maternal stress
and mood states in a sample of Greek BF mothers.
METHODS: Using a between-subjects design, perceived stress and moodstates in the past 2 months were compared between 8 BF (BF exclusively or
with formula supplement) and 10 bottle-feeding (breast - fed < 1 month or
never breast fed before) mothers. Measures included the PSS (Perceived Stress
Scale) and POMS (Profile of Mood States) translated and adapted for the Greek
population. Data were analyzed using ANCOVAS, with the mother’s age, number of children and postpartum period as covariates.
RESULTS: Analyses of the data revealed that breast-feeders reported significantly lower perceived stress than the bottle-feeders during the past 2-month
period. It was further found that the BF group showed greater decreases in negative mood states than the bottle-feeders although this finding was not significant (non significant trend).
CONCLUSIONS: The above preliminary results suggest that breast-feeding is
associated with the enhancement of maternal mood and the reduction of perceived maternal stress. Although the above findings, support findings of previous studies, the small sample size, the preliminary nature of the study (study
design) and the uncertainty of the mechanisms underlying these findings, needs
to be further investigated in larger samples and further well controlled studies
in order to confirm these results.
112
Aims of the study. To study the mental health of peacekeeping soldiers and to
evaluate the importance of stressors encountered before, during, and after
deployment related to the mental health state. Probelm addressed. An increasing number of individuals are serving in peacekeeping operations within the
framework of UN or NATO missions. Soldiers and officers from different
countries and cultures shall function together in a different culture under stressful conditions. The mental health state following these missions seems to vary
as a function of the intensity of the conflict. However, longitudinal studies
involving the potential impact of pre- and postdeployment stressors are lacking. Method. Four assessments of mental health (GHQ-28) were perfomed on
a Swedish peacekeeping batallion serving in Bosnia before deployment, immediately after deployment, six months after deployment, and one year after
deployment. Complete responses at all assessemts were obtained from 316 participants (61%).
Results. The general level of mental health problems was low and did not
change significatly over time. Logistic regression analysis revealed that the
main contributors to poor mental health one year afte returning from duty
abroad were problems experienced postdeployment, such as relation problems,
death of a close relative, or economic problems. Other predictors of poor mental health were the predeployment variables family problems and suicide
thoughts. Traumatic experiences in Bosnina only made a difference at the postdeployment and 6-month assessments.
Conclusions. Serving in a peacekeeping mission in a low intensity conflict
appears to have little negative effect on mental health.
EMOTIONAL ASPECTS ASSOCIATED WITH ULTRASOUND
SCAN AND NUCHAL TRANSLUCENCY
Julieta Quayle, Maria de Lourdes Brizot, Mara Cristina Souza se Lucia ,
Marcelo Zugaib
Psychology Department and Obstetrics Department HCFMUSP- Brazil
Obstetric Ultrasound scans provoked significant changes in the way science,
culture and the law relate to the fetus, considered alternately a patient, a citizen
- and a son. The psychological repercussions should not be understated. We
observed the behavior of 110 pregnant woman during ultrasound in the first
trimester and evaluated their level of information. They were interviewed by a
psychologist and asked to grade their anxiety and preoccupation levels before
and after the exam. They aged between 13 and 45 years; 47% were married,
59% worked and 60% had only the first grade; 25 were primigestas, 41% didn’t have live children and 23% had previous gestational losses. 90% knew to
which exam they were going to undergo and 82% could refer to the objective
of the exam. Most patients were considered “calm” and “worried”, showing
passivity in short, 79% were calm; 57% quiet and passive; 52% didn’t spontaneously verbalize; 56% asked questions about the foetus; 22% of these referred
to the possibility of knowing the sex of the foetus. Considering self evaluation,
grade average of anxiety level was 5,4 before the exam and 2,5 after. The average of concern grades before the exam was 6,95, lowering to 5,64 after.
Ultrasound tended to be seen as an anxiety and concern rising situation, particularly concerning the results. After the exam, the anxiety level decreased,
and the most anxious patients before the exam were those with a history of previous losses or malformations. Data suggests the importance of systematic orientation of patients in relation to ultrasound, NT and its results, in a multidisciplinary framework.
Posters
ATTACHMENT STYLE AND INFERTILITY: AN ELUSIVE
RELATIONSHIP?
Justo, J. M. & Moreira, J. M.
PSYCHOLOGICAL IMPACT OF HIGH-RISK PREGNANCY:
A DEVELOPMENTAL-CONSTRUCTIVIST APPROACH
*MARTA SILVA & ** FERNANDO FRADIQUE
* INSTITUTO DE REINSERCAO SOCIAL; ** UNIVERSITY OF LISBON
It is known that many infertile couples do not show any biological factors
capable of explaining their situation. This suggests that psychological aspects
may be operative. However, research has met with enormous difficulties in
finding differences between fertile and infertile women, in terms of
personality or psychopathology variables. The study preceding this one
presented two innovations: a) the use of interpersonal constructs (adult
attachment style and quality of parental relationships in childhood); b) the
distinction between women with and without biological factors able to
explain their medical condition.
The results of that study showed that women with Infertility of Unknown
Biological Cause (IUBC) presented significantly higher levels of avoidant
attachment, particularly of dismissive avoidant kind, when compared with
infertile women with an identified medical cause, and also when compared
with a control group of fertile women.
The present study replicated, with additional methodological controls, that
previous study, namely: a) employing different measures of the interpersonal
variables, b) assessing psychological variables before the start of the medical
evaluation procedure and, c) using a more thorough approach for obtaining
biological accounts for infertility. Participating women (n=105) were
contacted when attending their first appointment at the infertility consultation
of a Lisbon hospital.
An effect in the predicted direction was found, i.e., the average result of the
IUBC group in the dismissive-avoidant scale was higher than that of the
medically infertile and medically sub-fertile groups. The effect was
significant after introducing the other attachment and early relationships
variables as co-variables.
The primary goal of this study was the psychological characterization of a sample of high-risk pregnant women, sustained in the developmental psychopathology model of Joyce-Moniz (1993), a developmental-constructivist
approach, in order to reflect on psychological intervention that seek the prevention/reduction of excessive and non-adaptative emotional responses.
In this investigation participated 49 high-risk pregnant women (HRP) whose
discourses were analysed in several dimensions: Central Themes (subjective
meanings of abstract and inclusive nature) associated to the psychological
experience of HRP; Dialectic Operations that structure those subjective meanings and underlying cognitive processes of causal attributions of HRP, and
health and disease conceptions.
Degrees of emotional symptomatology - depressive and anxious symptomatology -, trait-anxiety and coping strategies with the problem were assessed.
Of these 49 women, five participated in a psychological intervention program
and measures of depressive and anxious symptomatology and the different
styles of coping were compared in two moments.
Representative and Preponderant Central Themes related with the psychological experience of HRP were identified. The predominant Dialectic Operations
were faulty Restructuration and cognitive processes of 1, 2 and 3 Levels prevailed. This sample presented a higher anxious symptomatology, when compared with general population, and more then half of the sample presented, at
least, a soft intensity depression.
The degrees of depressive and anxious symptomatology were more intense in
the hospitalised women’s group with prescription of absolute bedrest, and no
differences were observed as function of the satisfaction with perceived social
support. Relatively to the coping strategies, the Instrumental and Distractive
styles prevailed.
ASSESSMENT OF THE EFFICACY OF A MULTIMODAL
PROGRAM FOR BIRTH PREPARATION
PERSONAL EXPRESSION OF THE IMPACT OF PREGNANCY
INTERRUPTION DUE TO GENETIC PROBLEMS, IN THE COUPLE
M. Graça Pereira & Benedita Aguiar
University of Minho - Department of Psychology
Goals:
To assess the efficacy of a multimodal program for birth preparation for both
the pregnant woman and her partner in terms of life style, maternal and paternal adjustment, depression, anxiety and marital satisfaction.
Methods
The sample is composed of 210 pregnant women and their partners divided by
three groups each of 70 participants. The first group receive only pre-natal
appointments - control group; the second group attended the pre-natal appointments and received a traditional birth preparation program that included only a
biomedical approach. Finally, the third group receives those pre-natal appointments and a birth preparation program with both a biomedical and a psychosocial approach.
This last program is multimodal and includes topics on pregnancy, nutrition,
pain control, lactation, physiological rehabilitation after birth, maternity’s representations, marital/partner relationship, psychological morbility during pregnancy and after the birth, social support, breast feeding and maternal bonding.
Instruments
All groups answered the following instruments: a demographic questionnaire,
BDI (Beck Depression Inventory), STAI (State-Trait Anxiety Inventory), ISM
(Index of Marital Satisfaction), MAMA (Maternal adjustment and maternal
attitudes towards the baby), PAPA (Paternal adjustment and paternal attitudes
towards the baby), and a questionnaire on Habits and Life style adapted from
Wardle & Steptoe (1991).
Results
There were differences in the three groups showing that those women who
received the multimodal program had less psychological morbility, a better
marital relationship and higher maternal attitudes towards the baby when compared with the other two groups. There were differences in the partners as well.
Implications of these results for intervention are discussed.
M. Graça Pereira & Lucilia Guerra
Goals: The study attempts to evaluate the impact of the interruption of pregnancy,
due to genetic problems, in the couple and its implications for health education
and promotion.
Methods: The sample is composed of 16 couples that decided to interrupt pregnancy due to genetical problems in the embryo.
All couples were interviewed once for 90 minutes approximately. The interviews
were composed by five general questions that assessed the psychological impact of
the diagnosis, the decision-making process, the support received during the
process, consequences of the decision on the couples’ relationship and future
expectations regarding procreation. The interviews were analysed using grounded
theory.
Results: The diagnosis of a genetic problem in the fetus is always unexpected and
hard to accept even in those situations where there are risk factors or genetic
antecedents. In general, couples felt lost and very confused especially by the time
frame they had to come up with a decision for which they did not feel prepared. The
decision-making process emerged as one of the most difficult decisions the couple
had to endure with losses whether they decide to keep the baby or interrupt the
pregnancy having in both ways unpredictable consequences. According to couples,
the reasons they had to decide to interrupt were the social and familiar “weight” a
deficient child brings to a family and in particular the parents’ concerns regarding
the child’s quality of life. Some couples reported receiving some help from health
professionals and family members but all agreed on the need for more help in particular from health services after the interruption. In terms of consequences on the
couple, the relationship seemed to get reinforced and the couple kept positive attitudes regarding new pregnancies.
Implications: This qualitative study showed the need for intervention in couples
before, during and after the decision to interrupt pregnancy in order to provide them
coping resources and help them find new meanings and regain control over their
lives.
113
Posters
SOME PSYCHOLOGICAL OF FETAL ECHOCARDIOGRAPHY
DISCLOSURE OF FETAL SEX DURING ULTRASOUND
SCAN: MATERNAL INITIAL REACTIONS.
Julieta Quayle, Lilian Lopes, Mara C Souza de Lucia, Marcelo Zugaib
Psychology Department and Obstetrics Department HCFMUSP- Brazil
Fabio Herrmann , Julieta Quayle, Seizo Myiadahira, Fernanda Rondon, , Mara
Cristina Souza de Lucia and Marcelo Zugaib.
CETEC, Psychology Department and Obstetric Department. Hospital das
Clínicas. São Paulo, Brazil
The possibility of assessing foetus heart function before birth introduced new
perspectives and dimensions in prenatal care. Impact of foetal echocardiography (FE) in parents is not yet well known The aim of this study was to investigate the comprehension of FE objectives and results by pregnant women. A
semi structured interview was employed by a psychologist with 121 pregnant
patients submitted to transvaginal EF, interviewed before and after the exam,
also asked to evaluate their own anxiety level before and after EF. Most patients
had stable relationships with partners (81%); 16,5% were under 20 years old;
47% from 21 to 30 and 36,5 were over 31. As far as education, 61,2% had elementary school, 31.4% high school and 5,5% had university. Over half were on
their second pregnancy (51,2%) and 20% were primigestas; 17% had previous
losses, 25,5% spontaneous abortions, and 5% reported malformed foetuses in
earlier pregnancies. The majority (89,3%) reported knowing the exam they
were going to take, but only 62% said it was to check the baby’s heart. Self
evaluation before and after the exam showed significant differences: grade
average before was 5,64 (SD = 2,9) and after 3,008 (DS = 3,3).When c2 was
calculated it resulted 25,465; p<.000, suggesting the exam results help women
cope with their concerns and anxieties, giving them information to support their
decisions .The majority of the patients enjoyed the opportunity of having the
exam, considering FE good (45,5%), excellent (20,7%) or interesting (4,1%).
Differently from the ultrasound scan where the foetus can be “seen”, FE doesn’t add a sense of reality to the foetus and his heart problem.
FATHERHOOD, MOOD AND CHILD DEVELOPMENT
S Dave, L Sherr, I Nazareth, R Senior
Royal Free and University College Medical School Primary Care and
Population Sciences
Background: Maternal depression is associated with adverse child development, but little is known about paternal depression. The study assessed: 1) feasibility of recruiting fathers, 2) prevalence of paternal depression and mood
state, 3) relationship between paternal mood and infant temperament.
Methods: Feasibility and cost-effectiveness of postnatal father recruitment: 1)
face-to-face on the postnatal ward (n=37), and 2) by post (n=61) was tested.
Fathers were initially screened for depressed mood (Hospital Anxiety and
Depression Scale, and Edinburgh Postnatal Depression Scale), and at six
months mood, infant temperament, couple relationship quality, alcohol use, life
events, parenting and demographics were recorded. Infant fussiness was
analysed in relation to paternal mood and other process variables using multiple regression.
Results: 76% of fathers recruited face-to-face and 33% of fathers recruited
postally completed depression screening measures. 9% of fathers reported
depressive symptoms above the cut-off for case definition. Face-to-face recruitment cost an estimated £8 (EU14) per subject and the postal method £14
(EU21) per subject. 48% completed the full set of measures. In the adjusted
model higher paternal depression score and increased recent life events were
related to a higher infant fussiness score (p=0.01 and p=0.067 respectively) and
better couple relationship quality was related to lower fussiness score
(p=0.069).
Conclusions: Face-to-face recruitment of fathers of infants to a study of mood
is feasible, cost-effective and more efficient than postal recruitment. One in 10
fathers had depressed mood, and lower mood was associated with negative
infant temperament. Fatherhood and paternal mood merits further study.
114
Ultrasound scan (US)introduces changes in parents’ relationship with the fetus
as it brings reality into view. It favors bonding with desired / normal child and
prepares parents to cope with problems diagnosed in the exam. Little is known
about parents reaction to the disclosure of fetal sex after US in developing
countries. The objective of this study was to investigate maternal expectations
and wish to be informed about fetal sex and their initial reaction.131 patients
were interviewed by a psychologist before and after US, and their behavior and
reactions were observed during the exam. 49% of these patients were married
and 58% already had children. 69% referred they could feel or guess the baby’s
sex: 36% thought they were boys and 33% girls. Almost all patients (96%)
wanted to know fetal sex: 55% for curiosity, 36% to prepare relatives and baby
clothes. In 72% of US scans fetal sex was visualized and in 63% the sex was
coincident with mothers’ expectations. When this happened, the reaction was
happiness and euphoria, while sadness, deception and frustration appeared otherwise. Under these circumstances, there was, emphasis on the importance of
baby’s health and preoccupation with partner’s reaction. A common saying
was: “I’ll keep on trying...”,; this should be taken into account for family planing. The intensity of reactions is probably associated with fantasies of control
of the reproductive process, reinforced by technological development, and difficulties to cope with reality and problems
TRYING TO DO MY BEST AS A MOTHER: DECISION-MAKING IN FAMILIES OF CHILDREN UNDERGOING ELECTIVE SURGICAL TREATMENT FOR SHORT STATURE
G. Kent
Department of Psychology, University of Sheffield, Sheffield S10 2TP, UK
Objectives. The aim of this study was to explore how families make decisions
about elective leg-lengthening surgical treatment.
Design. Interviews were conducted and analysed using Interpretative
Phenomenological Analysis (Smith, 1995).
Methods. Data were gathered using semi-structured interviews with nine mothers of children who had recently decided to undergo treatment.
Results. Overall, the decision process was guided by the mothers’ central concern to act responsibly as a parent. Thematic analysis indicated that the decision evolved gradually over several years as mothers and children gathered and
processed information about treatment. While mothers emphasised that ultimately it was their child’s decision, they monitored the decision process and filtered the information available, in an attempt to ensure that the children made
a well-informed and wise choice.
Conclusions. The decision was presented as an ongoing process by the mothers, their concerns representing their desire to do their best as parents for their
children. Theoretically, the mothers’ description of process can be largely
understood in terms of their attempts to resolve an ethical dilemma. Clinical
implications include recognition of the role of the psychologist in supporting
mothers in their decision-making and thus indirectly helping children.
Posters
SUBJECTIVE WELL-BEING AND MATERNITY BLUES DURING THE PERINATAL PERIOD IN JAPANESE WOMEN
COPING WITH INFERTILITY - CAN SATISFACTION WITH
LIFE HELP IN THE PROCESS?
Shigeko Tsuda*, Akira Tsuda** and Yoshiyuki Tanaka**
*Department of Nursing, **Department of Psychology, Kurume University
Kurume, Fukuoka 830-0003, Japan
Markus Wirtz
University of Freiburg Rehabilitation Psychology
CONTEXT Although it has been made little of postpartum mood disturbance
in Japanese women in childbirth among clinical practitioners, the perinatal
period is recently recognized as high risk timing for women in terms of mental
health from the point of view of Health Psychology.
OBJECTIVES This study is conducted to assess the predictive utility of subjective well-being to maternal blues by monitoring the perceived health mood
during the perinatal period.
HYPOTHESES It is hypothesized that subjective well-being would be negatively associated with maternal blues for the postnatal period. However, no
specific predictions are made as to which of the obstetrical factors would be
interacted with postnatal mood.
METHOD Seventy-five Japanese women were volunteers recruited from the
maternity division of Kurume University Hospital. Their average age was 30
(SD=4.6, 19 to 41 years old). Two of third of the subjects had previous children. The WHO Subjective Well-being Inventory and Stein’s maternity blues
scale were used as the measures of mood during pregnancy and postpartum at
the 36 weeks of pregnancy weeks, 5 days and 1 month following childbirth.
RESULTS Subjective well-being was associated with less maternity blues
symptoms during the perinatal period. In multivariate regression models,
maternity blues were associated with higher levels of negative feelings and
childbirth history. The obstetrical factors of complications were significantly
related to maternity blues, but other factors were not.
CONCLUSION This study suggests that subjective well-being appears to be a
reliable contributing factor to the differential susceptibility to maternity blues
during the perinatal period.
Coping with infertility may be a difficult task and couples react in many different ways. This study investigates whether satisfaction with life has influence on
coping styles.
The total sample size for analyses was N = 463 individuals. It consisted of couples taking part in medical infertility treatment at six different university clinics in Germany. The average time these couples received counseling for infertility was over three years. As part of the baseline diagnostics they were asked
to complete a questionnaire that included the survey on “satisfaction with life”
(subscales: health, job, financial situation, leisure, relationship, own person,
sexuality, friends, living situation) and the survey on “coping with involuntary
childlessness” (subscales: depressive coping, active coping, distraction, religiosity, trivialization).
There were significant differences between women and men in coping styles.
Women reported higher levels of depressive coping, distraction and trivialization (Cohen’s d = .66, .44, .29, respectively). For women, satisfaction with
health, own person and sexuality explained 23.4% of the variance of the
depressive coping style (stepwise regression). All other predictors showed significant bivariate correlations. For men, only the predictor satisfaction with
health explained 9.9% of the variance of depressive coping and satisfaction
with partnership and own person showed significant bivariate correlations. The
scales of the satisfactions with life survey only explained up to 5% of the variance for the other coping styles. Satisfaction with life seems to have some but
limited influence on how women and men cope with involuntary childlessness.
This may be an important finding for counseling.
EXPERIENCE OF SYMPTOMS BY PORTUGUESE EXPECTANT-FATHERS AND THE COUVADE SYNDROME:
RESULTS FROM AN EXPLORATORY STUDY
MOTIVES FOR PARENTHOOD AND PSYCHOSOCIAL
ASPECTS OF IVF IN GREEK AND ENGLISH FEMALES.
Rita Gomez*, Isabel Leal* & Eurico Figueiredo**
*Instituto Superior de Psicologia Aplicada - Lisboa/Portugal; ** Instituto
Superior de Ciências Biomédicas Abel Salazar - Porto/Portugal
Objectives: The ‘couvade syndrome’ (CS) is commonly referred to as a state in
which expectant men in industrialized cultures experience symptoms common
of pregnancy. The primary aim of the study presented herein was to examine
the occurrence of CS in portuguese expectant-fathers.
Methods: 11, 21 and 20 expectant-fathers in the first, second and third
trimesters of pregnancy, respectively, and 22 non-expectant men were compared in terms of the type and number of symptoms reported, and it was examined the effect of age, status of fatherhood (first-time or not) and planning of
pregnancy (planned or not) on the number of symptoms reported by expectantfathers. The ‘Symptomatology Inventory’, a checklist of 48 physical and psychological symptoms, was used.
Results: No statistically significant differences in the number of symptoms
reported were found between the four groups (although expectant-fathers in the
second trimester of pregnancy reported more symptoms), or in function of age,
status of fatherhood or planning of pregnancy among expectant-fathers. With
the exception of decreased sexual desire and decreased social interest, more
frequent in the pregnancy groups, no coherent differences in type of symptoms
were found between expectant-men and non-expectant men.
Conclusion: Results don’t confirm the existence of CS nor the common
assumption that male symptoms are distributed in a U-shape curve throughout
pregnancy. Methodological and theoretical implications are discussed.
Tony Cassidy & Penelopi Sintrivani
A quasi-experimental survey design using questionnaires data collection techniques was used to explore the relationship between the motives for parenthood, coping style, social support and psychological distress in 60 women
undergoing IVF. A sample of 60 women, (30 English women living in England
and 29 Greek women living in Greece), aged between 25-45 years, were
assessed in terms of motives for parenthood, coping style, social support and
psychological distress. Six motives were identified and labelled, identity/continuity, self-fulfilment, social pressure, materialistic, sense of family, and future
orientation. The English women reported significantly greater distress than
the Greek women but this interacted with duration of treatment. English
women who had been undergoing treatment for over 12 months were significantly more distressed than their Greek counterparts, but distress levels for both
groups were about the same for those in treatment for less than 12 months. In
terms of motives for parenthood Greek women were significantly more concerned with identity / continuity, self-fulfilment, social pressure, materialism
and future orientation but this effect was reversed for sense of family with the
English women scoring higher. For all women the self-fulfilment and future
orientation motives were significantly greater in those who had been less than
12 months on treatment. The results suggest that the psychological distress
associated with IVF is mediated by the motives for parenthood, age and stage
of treatment and that this is to some extent culturally grounded.
115
Posters
GESTATIONAL TROPHOBLASTIC DISEASE (GTD): PSYCHOLOGICAL IMPACT
PERSONALITY AND QUALITY OF LIFE IN PARENTS WHO
LOST A CHILD.
Claudia Fernandes Laham; Julieta Quayle, Fukushida,K.; Mara Cristina
Souza de Lucia, Marcelo Zugaib.
Psychology Department and Obstetrics Department
De Fruyt, F., De Clercq, B. J., De Vos, P., & Benoit, Y.
Department of Psychology, Ghent University Belgium
The psychological impact of the diagnosis of gestational trophoblastic disease
(GTD) is still not well established. Objective: To evaluate women who received
the diagnosis of GTD and investigate their perceptions of the disease, their
fears and expectations. Methods: Thirty-nine women who received the diagnosis of GTD were invited to participate in the study. They were interviewed by
a psychologist using a semi-structured interview. Results: Most women
received the diagnosis of GTD in the course of what they considered a normal
pregnancy. Motherhood fantasies and wishes were then suddenly broken , and
they refer that afterwards they started to fear for their lives, trying ton understand how their “babies” became a tumour, a cancer, a threatening disease.
Only 23% of these women referred that no particular changes had occurred in
their lives, and all those didn’t have the diagnosis of invasive GTD or carcinoma. All others could identify significant changes in their lives and routines, in
their attitudes and feelings. Concerning the latter, 49% described negative feelings, as they called, such as depression, sadness, fear, concern and nervousness.
69% recognize GTD as a tumour, or cancer; 15% thought it was GTD , 8%
could not recall the name of the disease, and 5% still considered themselves
pregnant. Conclusions: Reactions and feelings described are compatible to
those observed in other miscarriages, with intense grief reactions. It was
observed the complex psychodynamics’ occur when after being informed of
the diagnosis of a pregnancy, the patient is subsequently confronted with
GTD.Life, routine and plans have to be change to accommodate to a new reality Psychological counselling of these women is important to help the cope
with grief and loss as well as with the needs of the treatment
MALE HORMONAL CHANGES DURING PREGNANCY AND
PARENTAL BEHAVIOR: LITERATURE REVISION
Rita Gomez
Instituto Superior de Psicologia Aplicada - Lisboa/Portugal
Purpose: The psychoendocrinology of paternal behavior constitutes an emergent opportunity for research. Our aim is to review and to discuss the data
available so far on this area.
Background: Many animal studies show that males from different species
undergo hormonal changes during the pre and the postpartum period or when
submitted to parental stimuli. With respect to human beings, some studies
found associations between pre and postnatal hormonal changes in women and
the expression of maternal behavior, but investigation of the respective
processes in men is very recent and limited. The few existing findings are consistent with a developmental and biopsycossocial conception of fatherhood and
suggest a relationship between hormonal changes, occurrence of symptoms
during pregnancy (i.e., the so called ‘Couvade Syndrome’) and paternal responsiveness. Animal and human data further support the hypothesis that the
expression of parental behavior involves the same neuroendocrine circuits in
males and females.
Conclusions: Traditionally, the biologic argument of the differences between
the sexes and the idea of a ‘maternal instinct’ have served to over-emphasize
the role of mothers and to exclude fathers. Continuing research of the male
physiological and psychological experience of pregnancy and paternity can
promote our understanding of this developmental process in men, as well as
fundament a more equalitarian role for parents.
116
Both the childhood and adult literature on quality of life suggest substantial
overlap between quality of life measures and personality traits, with traits conceived as stable basic tendencies and quality of life as being more state-dependent. In addition it is often argued that bereaved parents need considerable time
to grieve, and hence a positive relationship is assumed between parental quality of life and time-span following the death of the child. The present study
examines how parental personality affects the relationship between this period
and parental quality of life in families who lost a child due to cancer. The study
focuses on quality of life and traits of both fathers and mothers. Children were
on average 9.3 years (range 2 to 13 years) at the time of decease, and the interval between decease and the present assessments was 7.3 years on average. We
further examine whether the relationships between different traits and quality
of life parallel the patterns found in intact families. Data are collected on 65
families who lost a child and a referent sample of 46 intact families. The parents were administered the WHOQOL (de Vries, & van Heck, 1995) and the
Dutch authorized version of the NEO PI-R (Costa, & McCrae, 1992; Hoekstra,
Ormel, & De Fruyt, 1996), providing assessments of quality of life and a
detailed personality description respectively. In the analyses we will focus on
differences between fathers and mothers and bereaved versus intact families.
The role of individual differences and the impact of the death of a child on
parental quality of life will be discussed from a life-event perspective.
ILLNESS REPRESENTATIONS IN GREEK PATIENTS WITH
CANCER: PRELIMINARY VALIDATION RESULTS OF THE
IPQ-R
Z. Giannousi*, I. Manaras**, V. Georgoulias*, G. Samonis*
UNIVERSITY OF CRETE, DIVISION OF MEDICINE, DEPARTMENT OF
MEDICAL ONCOLOGY, ** ROYAL COLLEGE OF SURGEONS OF
ENGLAND
Aim: In the first of a series of studies on the relationship between illness representations and depression of Greek patients with cancer and their carers, the
Illness Perception Questionnaire- Revised was used on Greek participants. The
aim of this paper is to present findings on the factor structure and reliability of
the IPQ-R when applied to the particular population.
Method: Eighty cancer patients cared for at the Department of Oncology of the
University Hospital of Irakleion, Crete, Greece have been recruited. A Greek
translation of the Illness Representations’ Questionnaire Revised (IPQ-R)
(Moss-Morris et al., 2000) and the Greek version of the Beck Depression
Inventory (B.D.I.) (Donias et al., 1983) were used. The measures were administered to both inpatients and outpatients.
Results: The factor analysis of the Greek translation of the IPQ-R among the
80 patients reflects the factors included in the original IPQ-R, except for “illness coherence”, whose items are absorbed by other factors. The six resulting
factors have good reliabilities (.74<alpha<.88). However, factor analysis of the
causal representations items revealed a different structure to that of the IPQ-R.
The four resulting factors of the greek version were: 1) Self attributions
(alpha=.81), 2) life-style (alpha=.62), 3) External / environmental causes
(alpha=.50) and 4) medical causes (r = .9). Aspects of validity are currently
being examined
Conclusion: The translation of the IPQ-R has good reliability and a structure
very similar to that of the original, and therefore allows comparisons with studies using the latter. The failure to confirm the structure of the causes section, as
well as the exclusion of illness coherence is in itself interesting and may reveal
cultural differences in understanding illness causation
Posters
ASSESSING LIFE STYLE EMOTIONAL EXPRESSION
Anna Laura Comunain & Cecilia Monacelli
Università di Padova Italy
Psychometric properties of the Lifestyle Defence Mechanism Inventory were
investigated in two samples of Italian population: healthy women (n = 90) and
women with benign breast tumors (n = 80). The LMD is distinguished by three
main features: (a) it assesses individual differences in the frequency that a person engages in rational non-emotional thought processes and behaviors; (b) it
integrates the efforts to achieve and maintain harmonious interpersonal relationships with family and friends, and (c) it utilizes defense mechanisms influences lifestyles that are characterized by rationalization, and the inhibition of
emotional feelings and aggressive behavior. In line with Spielberger and colleagues’ results, factor analysis reveals the stability of the two factors
Rationality and Emotional Defensiveness. Concurrent validity was used to
compare the four scales that constitute the LDM Inventory with the six scales
that constitute the State Trait Personality Inventory. The LDM subscale scores
significantly differ between the breast tumour group and the control group.
These results are congruent with those obtained by Spielberger and associates
supporting the hypothesis that tumour patients have specific behavioural patterns.
CONFIRMATION OF A TTM BASED INTEGRATIVE
MODEL OF PHYSICAL ACTIVITY WITH GREEK COLLEGE STUDENTS
Milena D. Anatchkova*, Kara L. Hall*, Polina Kontogianni**, Joseph S.
Rossi*, Konstantinos Karteroliotis**, Nelly Kontogianni** *University of
Rhode Island, US; **National and Kapodistrian University of Athens, Greece
The Transtheoretical Model (TTM) is a well-established heoretical approach
used to study change in a variety of health related behaviors including exercise.
The current study examines whether a prediction model utilizing the TTM and
developed for physical activity in a US population is valid for Greek college
students. The proposed model suggests that the influence of the constructs of
self-efficacy (á = .77), pros (á = .83) and cons (á = .68) on physical activity is
mediated by thestages of Change. The hypothesized model was first tested in a
cross sectional sample of 132 college students (63.1% female; mean age =
21.1) using structural equation modeling. Three nested models were examined.
The results suggested that the best fit to the data was for a mediational model
with a direct path from self-efficacy to physical activity, ÷2(36) = 32.14,
p > .05; CFI = 1.00; RMSEA = .00. The model was confirmed with longitudinal data on physical activity gathered 7 months later from 85 participants of
the original sample, ÷2(36) = 31.83, p > .05; CFI = 1.00; RMSEA = .00).
These results confirm the mediational role of stage of readiness for
exercise for pros and cons. However, in the present sample, self-efficacy
demonstrated a strong direct effect on physical activity. These findings
suggest that the TTM can be used as a framework for future interventions for
the studied population with a stronger focus on self-efficacy.
ASSESSING SOCIAL COMPARISON IN A SPANISH POPULATION: A PRELIMINARY VALIDATION STUDY.
BUUNK, PONS N., LLEDO A., NEIPP MC.,TEROL M.C., SANCHEZ P.,
PASTOR M.A, LOPEZ-ROIG S., MARTIN-ARAGON M.
In recent decades, the study of social comparison and its application to health
psychology has increased (Affleck, Tennen, Pfeiffer, Fifield & Rowe, 1987;
Taylor, Buunk & Aspinwall, 1990). Gibbson and Gerard (1991) describe
‘social comparison’ as a coping strategy that people can use to cope with a
stressful situation and designed two questionnaires to assess the Social
Comparison construct: the General Social Comparison Scale (Gibbons &
Buunk, 1999) and the Social Comparison Scale in Chronic Illness (Van der
Zee, Buunk, Sanderman, Botke & van den Bergh, 2000)..
Aim: To adapt and to validate these scales in a Spanish population.
Method: The questionnaires were back-translated. Currently, we are interviewing patients diagnosed with a chronic disease attending the Health Centre PLAHOSPITAL, Alicante, Spain. SPSS 11 version will be used to perform statistical analysis. In order to assess construct validity we will also administer the
Spanish adaptation of the EPQ-R (Eysenck & Eysenck, 1991) and Rosenberg
(1965) scales.
Results: We have completed 47 interviews to this point. According to the social
comparison construct, we expect to find two factors in the chronic illness
scales, as well as a relationship between the general and the chronic illness
social comparison scales. The psychometric properties of these scales will be
presented.
A GERMAN VERSION OF THE HOPE - SCALE OF R.
SNYDER
Konrad Reschke, Franziska Reschke
University Leipzig, Dept. of Applied Psychology
AIM and GOAL: The poster describes the first results of the revision of a
German version of the HOPE-Scale of Snyder(1991,1996). Hope is an important cognitive construct to describe an optimistic sense of the future orientation of the personality. Hope is the most effective antidote against the feelings
of helplessness and victimization. The cognitive theory of hope define hope
as “a thinking process in which the person clearly conceptualizes goals, but
also perceives that s/he can produce the pathways to these goals (called pathways thinking) and can initiate and sustain movement along those selected
pathways (called agency thinking).” The aim and goal of this study is to
revise the HOPE-Scale and prove the validity and reliability of the German
version.
METHODS and SAMPLE: 200 Students answered to the Hope Scale and significant other scales related to optimism and health (the Life orientation scale
of Carver and Scheier, the Self efficacy Scale of Schwarzer and the
Hopelessness Scale of Becker.
RESULTS: The results show clearly good results for reliability (consistency
and retest-reliability) as well as a good result for the convergent and discriminant validity of the scale. The German version can be used for further health
psychological research.
117
Posters
SPANISH ADAPTATION OF THE “POSTTRAUMATIC
GROWTH INVENTORY
CROSS-CULTURAL ADAPTATION OF THE “STRESSRELATED GROWTH SCALE”
Rodríguez-Marín, J.; Jarabo, C.*; Martin-Aragon, M.;
Pastor, M.A.; Quiles, M.J.; Sitges Maciá;, E.; Tirado González, S.
Department of Health Psychology, University MH. *Alicante
Mental Health Center.
Rodríguez-Marin, J.; Tirado, S.; Jarabo, C.*; Martin-Aragon, M.; Pastor, M.A.;
Quiles, M.J. and Sitges, E.
Department of Health Psychology, Universidad Miguel Hernandez. *Alicante
Mental Health Center.
We present results of the Spanish adaptation of the “Posttraumatic Growth
Inventory” (PTGI) (Tedeschi & Calhoun, 1996), to measure growth after traumatic events. After the double translation of the PTGI (Spanish-EnglishSpanish), we evaluated items and identified items that may be confusing to
Spanish sample, maintaining the original meaning. Then we tested how accurately the original connotative meaning has been captured in the translated version and identified problems of misunderstanding. The final Spanish version
(ICP) was administered to 256 subjects, aged between 20 and 80 years to obtain
its factorial structure. After 3 months we carried out a second administration to
75 subjects to confirm the factorial structure obtained in the first phase and to
evaluate the performance of the items. All items of the ICP have an important
discrimination capacity, with indexes between 0.42 and 0.69. The scale and its
factors present a good reliability, with high internal consistency, except in the
case of Spiritual Change factor. The factorial structure of the English original
scale included five factors (subscales): relating to others, new possibilities, personal strength, spiritual change and appreciation of life. In our work the resultant factorial solution show four factors. Our factorial analysis threw a solution
of 4 dimensions (exclude “new possibilities”) explaining 58,5% of the variance. Qualitative study of the items indicates a high theoretical coherence of
the items included in each factor. In conclusion: the adaptation and psychometric characteristics of this Spanish version of the Posttraumatic Growth
Inventory (PGTI) are satisfactory and ICP is a first valid and reliable instrument for Spanish populations.
Posttraumatic Growth is the tendency of survivors of crises to later report
increased functioning and positive change after enduring a trauma (Tedeschi &
Calhoun, 1996). Its quantitative assessment interview and paper-and-pencil
measures.
In this work we present the preliminary results of cross-cultural adaptation and
validation of the “Stress-Related Growth Scale - SRGS” into Spanish language.
The SRGS (Park, Cohen and Murch, 1996) has 50 items with a 0-2 response
choice (“not at all”, “somewhat” and “a great deal”) and reflect positive
changes in social relationships, personal resources and coping skills. Research
with the SRGS has not supported the existence of independent domains.
Method: Conceptual equivalence was pursued through a iterative process
including forward and backward translation and cross-cultural comparison of
the face validity of translations, in order to achieve functional and conceptual
equivalence. The final Spanish version was administered to 232 subjects. By
means of factorial analysis we proved the theoretical 3-factors structure proposed by authors.
Results: Items have good discrimination indexes (range=0,34-0,67). Global
scale presents high internal consistency (0,95) and also subscales: Social
Resources (n=22; alpha=0,92; Expl.Variance=19,96%), Personal Resources
(n=25; alpha=0,92; Expl.Variance=15,57%) and Religiousness (n=3;
alpha=0,89; Expl.Variance=6,45).
Conclusion: The Spanish version of the SRGS reflects the latent 3-factors
structure that was not found by the original authors. However, the coping factor doesn’t exactly match, since it includes only items referring religiosity.
Therefore, it is necessary to confirm this factorial structure in later studies, as
well as the concurrent validity of the scale using the Spanish version of PTGI.
CONFIRMATORY FACTOR ANALYSIS OF A SPANISH VERSION OF THE REVISED ILLNESS PERCEPTION QUESTIONNAIRE (IPQ-R)
QUALITY OF LIFE AFTER MYOCARDIAL INFARCTION:
TRANSLATION AND VALIDATION OF THE MACNEW
QUESTIONNAIRE
FOR
A
DUTCH
POPULATION
BELÉNDEZ, M., GARCÍA-AYALA, M.D* & BERMEJO, R.M*
DEP. SOCIOLOGÍA II, PSICOLOGÍA, COMUNICACIÓN Y DIDÁCTICA.
UNIVERSITY OF ALICANTE. SPAIN
* DEP. PERSONALIDAD, EVALUACIÓN Y TRATAMIENTO
PSICOLÓGICOS. UNIVERSITY OF MURCIA. SPAIN
De Gucht*, V., van Elderen*, T., van der Kamp*, L., Oldridge**, N.
* Leiden University (Netherlands); ** Center for Urban Population Health,
University of Wisconsin-Milwaukee (USA)
The Revised Illness Perception Questionnaire -IPQ-R- (Moss-Morris et al.,
2002) was designed to assess the cognitive and emotional domains of illness
representations in the common-sense model of self-regulation (Leventhal et al.,
1997). The IPQ-R contains three sections. Two scales measuring identity and
causal dimensions and a remaining section assessing the following seven
dimensions: timeline acute/chronic, timeline cyclical, consequences, personal
control, treatment control, illness coherence and emotional representations.
The main purpose of the present study was to use confirmatory factor analysis
(CFA) to determine if these latter seven dimensions are clearly identified.
A spanish version of the IPQ-R was administered to 204 patients with hypertension (27-87 yrs old).
Two potential factor models were tested. The data were analyzed through confirmatory factor analysis (CFA) using AMOS (Arbuckle, 1997) in order to
determine which of the models best fits the data.
Results indicated that the five-factor model consisting of control, coherence,
timeline cyclical, timeline acute/chronic and emotion dimensions had the best
fit indexes.
118
Background: A wide range of instruments have been used in health-related
quality of life (HRQL) assessment of subjects with coronary artery disease. The
MacNew heart disease health-related quality of life questionnaire (MacNew) is
a disease-specific measure of HRQL, that has been found to have both good
discriminative and evaluative properties.
Purpose: The objective of the present study was to translate the MacNew for a
Dutch population, and assess its reliability and validity. Methods: Three hundred and thirty-nine cardiac patients, admitted to the hospital after a cardiac
event, participated in the study. Questionnaires were filled out at baseline, at
three months, and at 12 months.
Results: A clinically relevant three-factor solution, reflecting an emotional,
physical, and social domain of HRQL, allowed us to explain 55% of variance.
The presence of angina pectoris was consistently found to have a negative
impact on HRQL. Given the clinical relevance of the three MacNew domains,
convergent and discriminant validity were found to be satisfactory. The internal consistency was found to be good (ranging between .78 and .95). Finally,
the Dutch MacNew was demonstrated to be substantially more responsive than
two other instruments measuring physical and psychological well-being.
Conclusion: The Dutch MacNew is demonstrated to be a valid and reliable
instrument for both screening and evaluative purposes in a clinical setting.
Posters
VALIDATION OF THE GOAL IMPORTANCE FACILITATION
SCALE (GIFS - MAES & AL., 2003) AMONG FRENCH POPULATION
Muller Laurent, Roudiere Julien, Spitz Elisabeth
Universite de Metz
Background : Nowadays, the causes of most chronic diseases and accidents are
to a large extent due to habitual unhealthy behaviours. Many theories of social
cognition have been applied to the adoption of health-enhancing behaviours.
These models, which include personal beliefs, values and expectations, can be
regarded as rudimentary self-regulation models. However, self-regulation can
be defined as a sequence of actions and/or steering processes intended to attain
a personal goal. Any model of self-directed behavior should include an adequate representation of the concept of personal goals. Thus, Maes and Gebhardt
(2000) have developed the Health Behavior Goal Model and the Goal
Importance Facilitation Scale.
Objective : The aim of this study is to translate the GIFS and validate it among
a French population.
Method : We finalised a set of questions about health and health behaviours, as
well as the General Health Questionnaire GHQ-12 (Goldberg, 1972), the
Hassles Scale (Lazarus & al., 1986), and the GIFS (Maes & al., forthcoming).
A sample of the population of Metz City has completed this book.
CROSS-LANGUAGE EQUIVALENCE OF THE LEIDEN
QUALITY OF WORK QUESTIONNAIRE (LQWQ)
Johnny R. J. Fontaine, Véronique De Gucht, Margot van der Doef, &
Benjamin Fischler
Katholieke Universiteit Leuven & Ghent University, University of Leiden,
University of Leiden, Katholieke Universiteit Leuven
The cross-cultural and cross-language comparability of psychological measurement instruments is seldom being investigated in the domain of health psychology. However, cultural and language bias can have serious effects on the
results. In the present research, it is investigated to what extent the 12 scales of
the LQWQ are comparable across a Dutch-speaking (N=1754) and a Frenchspeaking sample of workers (N=1104). Three types of equivalence have been
investigated, namely structural, metric and full score equivalence. Structural
equivalence was investigated by means of orthogonal Procrustes rotation of the
French factor structure towards the Dutch factor structure. Congruence measures indicated substantial congruence for 10 of the 12 scales (Tucker’s phi
ranging from .93 to .99). Although the congruence measure for the two remaining scales did not reach the cut-off value of .90 (they were .81 and .82 respectively), most of the predicted items had their highest loading on the predicted
factor. Thus, structural equivalence could be demonstrated. Metric and fullscore equivalence was investigated by means of regression analyses, and indicated full-score equivalence for most of the items. It will be further demonstrated how these analyses can help to remove biased items and improve conclusions drawn from cross-cultural and cross-language studies.
Results : To determine the latent structure of the GIFS we use both exploratory and confirmatory factor analytic techniques. Moreover, we test the impact of
goal importance and goal conflict on health behaviour, perceived stress and
quality of life.
Conclusion : In further research, this validation will allow to study the relationship between health behaviour and personal goals. It is an important issue
because personal goals give purpose to specific health goals
INCREASES IN SELF-EFFICACY FOR PAIN OVER ONE
YEAR AMONGST PATIENTS WITH RHEUMATOID
ARTHRITIS ONLY OCCUR FOR FEMALES: AN OBSERVATIONAL STUDY
Gareth J. Treharne (1), Antonia C. Lyons (2), David A. Booth (1) George D.
Kitas (3)
1) School of psychology, Univ. of Birmingham, UK, 2) School of psychology,
Massey University, New Zealand, 3) Dept. of Rheumatology, Dudley Group of
Hospitals NHS Trust, UK
Rheumatoid arthritis (RA) is a common chronic inflammatory illness that causes considerable pain and swelling of the joint and general fatigue. People with
RA are often functionally disabled and also suffer from depression more frequently than the general population. Self-efficacy over symptoms relates crosssectionally to lower depression for people with RA but there has been little longitudinal research observing the course of self-efficacy and depression.
Changes over one year were assessed for a sample of 134 Caucasian outpatients with RA (101 female) receiving standard care. The mean age was 55.44
years and mean RA duration was 7.26 years. Severity of pain and fatigue were
recorded on 100mm visual analogue scales, depression was assessed with the
Hospital Anxiety and Depression scale and self-efficacy was measured using
the British version of the Arthritis Self-Efficacy Scales pain and other symptoms (fatigue and mood) subscales. Over the year, pain, fatigue, depression and
self-efficacy for other symptoms were stable whilst self-efficacy for pain
increased significantly. These changes did not differ by age or disease duration,
but self-efficacy for pain actually increased amongst male participants and
decreased amongst female patients. This pattern has important implications for
understanding the psychology of living with RA and for planning interventions. All people with RA could benefit from self-management programmes to
improve self-efficacy and hence mood and symptoms. These interventions
need to place emphasis on self-efficacy for mood, which appears to be stable
otherwise, and need to be tailored to meet the needs of men and other cultural
groups.
A QUALITATIVE STUDY OF A TRAINING AND SUPPORT
PROGRAMME FOR PARENTS OF CHILDREN WITH CEREBRAL PALSY
A Cheshire, LA Cullen & JH Barlow
Coventry Universit
Background: The aim of this study was to describe the experiences of parents
of children with cerebral palsy (CP), as they progressed through a Training and
Support Programme (TSP).
Method: The TSP consists of eight weekly one-hour sessions of instruction in
gentle massage, delivered by qualified therapists. A sample of parents (n=26)
of children with CP completed the TSP. Data were collected by record sheets
completed by parents the week following each TSP session and open questions
on a questionnaire mailed to parents before and after the TSP. Content analysis
identified themes within the categories of before, during and after the TSP.
Findings: Before the TSP parents expected that the programme would help
their child to relax and have a positive effect on the child’s health. Four parents
did not have any expectations of the TSP.
During the programme 57% of parents reported that they felt calmer after giving gentle massage. 45% of parents reported improvements in their child’s
mobility, calmness and happiness, 29% reported improvements in their child’s
bowel movements, musculoskeletal problems, sleep, relaxation and their relationship with their child, and 12% reported improvements in their child’s bladder control and feeding/digestion.
Post-programme, parents reported that they had enjoyed the TSP, gained
confidence to give massage to their child and found it relaxing for them and
their child. Five parents would have liked the programme to be longer than 8weeks.
Discussion: Training parents in the art of gentle massage in a supportive environment appears to have the potential to have a positive effect for parent and
child. Further quantitative studies are needed.
119
Posters
WHY MODERN PHONIATRY NEED A PSYCHOLOGIST?
PSYCHOLOGICAL PROBLEMS OF DYSPHONIC PATIENTS
AND WAYS TO OVERCOME THEM
COGNITIVE BEHAVIOUR THERAPY TO REDUCE FATIGUE
AND IMPAIRMENT IN CANCER SURVIVORS, A RANDOMISED CONTROLLED TRIAL
Merecz Dorota, Marta Fisher
Institute of Occupational Medicine, Lodz, Poland
Marieke Gielissen, Stans Verhagen, Gijs Bleijenberg
Netherlands Fatigue Research Group, University Medical Centre Nijmegen,
the Netherlands
AIMS of the study:
1. diagnosis of psychological problems of dysphonic patents.
2. development of short psychological intervention supporting traditional
treatment of phoniatric disorders.
3. evaluation of intervention.
HYPOTHESES: Stress can be seen as one of the risk factors in development of
vocal disorders especially dysphonia. We assumed that psychological intervention focused on stress management would be important tool in the process
of vocal rehabilitation increasing the effectiveness of treatment.
METHODS:Patients addmited in the Phoniatrics and Audiology Centre were
asked to fill in GHQ-28 to assess their mental health status. The patients high
scored on GHQ-28 and these ones with diagnosis of dysphonia were reffered
to a clinical psychologist for additional treatment (short 6 sessions voluntary
based intervention). The intervention was evaluated by comparing mental
helath status and vocal parameters of patients participated in the programme,
those ones who received only traditional treatment, and no-treatment group.
RESULTS: The effects of an additional psychological intervention for dysphonic patients are promissing. The mental health status of participants
improved and the improvement in some vocal parameters was the greatest in
the group of patients received both traditional treatment and psychological
help.
Recent studies in our institute have shown that 20-40% of disease-free cancer
patients mention invalidating fatigue as a frequent complaint 1-6 years after
curative treatment for cancer has ended. No relations were found between
fatigue long after treatment for cancer and initial disease- and treatment variables. Somatic treatment for these complaints of fatigue is lacking.
The purpose of this RCT is to evaluate whether Cognitive Behaviour Therapy
(CBT) is effective in reducing chronic fatigue complaints in disease-free cancer patients. CBT for fatigue in disease-free cancer patients is directed at
change of cognitions and behaviour related to fatigue and impairment.
Previous research indicates that perpetuating factors of fatigue are among others low sense of control, anxiety and impairment in role functioning.
Severely fatigued disease-free cancer patients, who finished treatment for cancer at least one year ago, participate in this study. Patients are randomly allocated to one of two parallel groups, the intervention condition (CBT) or a waiting list condition of 6 months. The intervention condition consists of 15 individual sessions in six months.
Preliminary data show a favourable effect of CBT in severely fatigued diseasefree cancer patients on fatigue, functional impairment and psychological wellbeing, compared to patients waiting for this treatment.
CBT for fatigue in cancer survivors seems a promising treatment.
CONCLUSIONS: short psychological intervention increases the effectiveness
of dysphonic patients treatment.
A PILOT STUDY ON A BODY ORIENTED PSYCHOLOGICAL INTERVENTION IN PARKINSON’S DISEASE
Lorena Candini, Manuela Carlini, Pio Enrico Ricci Bitti.
Department of Psychology, University of Bologna
Objectives: Our study aimed to evaluate the effects of a short body oriented
psychological intervention (Dance/Movement Therapy or DMT) on a group of
Parkinson’s Disease patients
Methods: We considered a group of 6 Parkinson’s patients who took part in
a 5 session body oriented psychological intervention (DMT) and a group of
6 Parkinson’s patients who didn’t take part in the intervention. Patients
were similar in age, age of illness outbreak, duration of illness, severity
of illness and autonomy level.
We used the following measures pre and post intervention:
LMA/KMP Observation Scale for the observation of movement features related to psychological features; Zung SDS to evaluate depression; BELA to evaluate stress; PDQ39 to evaluate quality of life; Hoehn and Yahr; Schwab and
England neurological scales to evaluate neurological features.
We compared the groups pre and post intervention to state the differences
concerning movement, psychological and neurological features and quality
of life.
Results: We found some differences concerning movement and emotional
aspects according to pre and post evaluations in patients who took part in the
body oriented intervention. After the intervention, we also found some
improvements in communication, a reduction of physical impairment and
stress and a better autonomy level in patients who took part in the sessions. We
can state that a short body oriented psychological intervention promotes a more
systematic treatment aimed to cope with the disease symptoms.
120
REHABILITATION OF DRUG ADDICTS IN THERAPEUTIC
COMMUNITIES IN HUNGARY: FOCUS ON POSITIVE PSYCHOLOGICAL CHANGES
DEMETROVICS, Zsolt (1) - KOKONYEI, Gyongyi (1) - KARDOS, Edina
(2) 1) Eotvos Lorand University, Institute of Psychology, Department of
Personality and Health Psychology, Budapest (2) Dr. Farkasinszky Terezia
Youth Drug-Centrum, Szeged
Background: Both in Hungary and in the world, research on the effectiveness
of therapeutical interventions has gained growing interest recently. However,
most of the studies concentrate on the elimination of negative symptoms, while
no or little attention has been paid to the positive changes.
Aims: In our research we have examined the effectiveness of three therapeutic
communities
in
Hungary
(Deszk,
Nagyszénás,
Pécsvárad), through concentrating on the positive changes occurring during the rehabilitation process. Sample: 111 opiate addicts (males
62.7%) attending to therapeutic communities in Hungary between August 200
and April 2002. Method: In our research we have followed up patients at the
therapeutic communities. Data collection took place three times in each case (at
entrance in the system, 3 to 4 months later and when leaving the program).
Tools: At each checking point we have examined the value system (Rokeach,
1973), system of personal strivings (Emmons, 1986), satisfaction with life
(Pavot and Diener, 1993; Campbell et al, 1976), and psychological Immune
System (Olah, 1996) of the patients. Results: Addicts showed significant
improvement at all psychological measures during the rehabilitation process.
Results confirmed our hypotheses that the process of rehabilitation is accompanied with fundamental changes in these systems and in personality characteristics and that these changes can contribute significantly to the maintenance
of abstinence and the avoidance of relapse. According to the results value system showed a more conventional picture in the latter phase of rehabilitation,
and those who completed their treatment were more successful in achieving
their personal strivings. Patients, when leaving therapeutic communities, were
also more satisfied with their lives and also significantly more effective in
terms of their coping mechanisms.
Posters
A GROUP STRESS- MANAGEMENT PROGRAMME
UNIVERSITY STUDENTS
FOR
Anastasia Kalantzi-Azizi, Evangelos C. Karademas
Department of Psychology, University of Athens
Stress in university students is related to significant problems, such as negative self-image, psychological and adaptation difficulties, physiological problems. The application of stress-management techniques could help students
deal effectively with these problems. In the Counselling Centre for Students at
the University of Athens we have tried to form a stress-management group programme. The aim was three-fold: (a) to equip students with more effective
skills and strategies in order to cope better with their stress and its sources; (b)
to enhance students’ self-efficacy expectations regarding their abilities to confront stressful situations; (c) to improve their psychological health. The orientation of the programme was cognitive-behavioural. Therefore, behavioural
and cognitive techniques were included in the programme (i.e., relaxation techniques, problem solving, time management, dealing with anger, distraction, as
well as introduction to the process of identifying and modifying negative automatic thoughts and dysfunctional schemata). Basic self-awareness exercises
were also included in the programme. The purpose of this was to help participants gain a better understanding of the ways that they use in order to cope with
everyday stress. According to the first preliminary results from 12 students who
completed the programme until now, our programme seems to be effective,
since a significant improvement was noticed in both the indices of psychological health assessed and self-efficacy expectations. The improvement in these
aspects was maintained six months later (in the follow-up assessment)
PSYCHOSOCIAL INTERVENTIONS IN CANCER PAIN
PAXINOS I, AMMARI,M
GENERAL HOSPITAL PATISSION
There is a lot of lip service pain to the importance of the psychosocial and spiritual aspects of pain. Cancer pain has an emotional as well as a physical dimension to it and both of these dimensions are interrelated and insperable affecting
one another. If we do tend to forget the emotional aspect, perhaps we should
look for some underlying reason. The same reason makes health professionalsto forget patients’ names, referring to them only by their room and bed number.
In many cases the health carers puts up psychological defences or score higher
on anxiety and depression scales than their patients themselves.
We are aware of how cancer patients and their families get very attached to
their doctor whom they expect so much from.
Finally we will present the inerventions of the Pain Unit of the General
Hospital of Patision-Greece.
A PILOT QUALITATIVE STUDY OF THE SELF DISCOVERY PROGRAMME
PATIENTS EDUCATION IN PARKINSON’S DISEASE
EDUPARK
JK BAGH; L CULLEN & PROF. J BARLOW
Interdisciplinary Research Centre in Health, Coventry University
Noëlle Spliethoff-Kamminga; Janny de Vreugd
Heiner Ellgring; Michael Macht ; Àngels Bayés Rusiñol; Pio Enrico Ricci
Bitti; Marcia Smith Pasqualini; Pille Taba; Bi Virta;
Edupark is funded by the European Committee
(QLRT 2001-02674)
Background: Children with special needs often face difficulties with academic performance. They may also experience increased anxiety throughout
school life, which may affect their self-confidence, social competence, attention skills and general well-being, preventing them
from reaching their personal potential. The Self Discovery Programme (SDP)
aims to address these issues by providing a range of techniques and skills to
cope with general life issues, such as self-awareness and relaxation exercises.
It was hypothesised, that through SDP children’s self-confidence and social
competence may be enhanced.
Methods: A pilot qualitative study was conducted involving 18 boys and 12
girls with special educational needs (aged 8-13 years). The children received
six, weekly 1-hour sessions of SDP, which comprised activities based around
themes of relaxation, (e.g. visualisation and simple hand massage). Teachers
conducted
behaviour
profiles
through
observations
of
the
children before and after the study. Independent observations were made during the SDP course.
Findings: The researcher’s observations suggest that children’s self-confidence
had increased. Furthermore, improvements in participation in activities, attention skills and eye contact were noted. Fidgeting and self-stimulating behaviours had reduced and positive emotional expressions were displayed verbally
and through facial expressions. The children enjoyed the hand massage and
were happy to participate in the SDP. The post SDP profiles and reviews from
the teachers confirm these findings.
Discussion: The SDP appears to offer children strategies that may assist them
in achieving personal potential, enhancing their self-confidence, social competence, attention skills, which may improve their quality of life. Further investigation into the SDP are needed.
Objective:
The objective of this research project is to improve the quality of life in people
with a chronic progressive disease, specifically Parkinson’s disease (PD) and
their carers through patient education and non-medical psychosocial treatment.
A Patient Education Program (PEP), which is not available yet, will be developed, and evaluated for feasibility in seven European countries. The newly
developed program will provide education materials which can be used
throughout the different European countries taking into account the specific
cultural backgrounds and local health care conditions.
The patient education program is aiming at the empowerment of patients suffering from PD, as well as their carers. It is objected to the major goals of:
transmission of knowledge; teaching of instrumental skills; integration of
knowledge and skills for self management of the chronic disease.
Expected achievements:
Development of an innovative patient education program with seven key components: 1. Information. 2. Self-monitoring. 3. Health empowerment. 4 Stress
management; 5. Anxiety and Depression; 6. Assertiveness; 7. Social support.
Application of PEP in order to show the feasibility in each of the participating
countries.
Provision of the patient education manual, including education materials, in
seven European languages
Adoption of this cultural-sensitive program in the varying frameworks within
national health care systems.
121
Posters
ADOLESCENT WORK: HOW RISKY IS IT?
Tezan Bildik*, Türkan Yilmaz Irmak**, Müge Tamar***, Feyda Aksel****
*Assistant Professor, Ege University Medical School, Department of Child
Psychiatry
**Research Assistant, Ege University, Faculty of Letters, Department of
Psychology
***Associate Professor, Ege University Medical School, Department of Child
Psychiatry
****Professor, Ege University, Faculty of Letters, Department of Psychology
Starting to work at an earlier age is an important psychosocial risk for adolescents. It is known that about 1/3 rd of adolescent below the age of eighteen in
Turkey are in a workforce.
Aim of the study is to investigate the relationship between mental health and
expectations, needs and work relationships of apprentices. Method: The
research consisted of two studies. A total of 620 apprentices participated in the
study. In the first study, the Brief Symptom Inventory(BSI) were administered
to 620 apprentices. In the second stage of analysis, the subjects were divided
into high and low risk groups based on their BSI scores. Cuttoff points of high
and low risk groups were determined according to 1 standart deviations above
and below the mean value of transformed BSI scores. The second study consisted of high risk group. There were 74 subjects in the second study. They
were evaluated for diagnosis of psychopathology according to DSM-IV criteria by a child psychiatrists. 29.7 % of the subjects fulfilled the DSM-IV criteria for a psychiatric disorder. 14.9% of the subjects didn’t fulfill the DSM-IV
criteria completely. In 55.4 % of the subjects no psychopathology was found.
In the present study, apprentices with psychiatric problems were compared with
healthy subjects in respect to life expectations, needs and work relationships
HOW DO PARENTING PRACTICES INFLUENCE
SUBSTANCE USE IN ADOLESCENT BOYS AND GIRLS?
Engels, T., Lambrecht, P., & Andries, C.
Vrije Universiteit Brussel
Background As a follow-up on epidemiological research carried
out in 1994 and 1998 in Flanders-Belgium, this study examines the
prevalence and incidence of licit and illicit substance use among 2.068
adolescents between the age of 12 and 22.
Aim The primary aim of the research is to monitor trends in adolescent
substance use in Flanders-Belgium. The secondary aim is to study the
relationship of substance use in adolescent boys and girls with parenting
practices. This presentation focuses on the secondary aim.
Methods
Data were collected by a structured questionnaire in March 2001. The sample
was representative of school going adolescents. Under supervision of a
researcher, the pupils completed the anonymous questionnaire in class.
Prevalence and incidence of use of alcohol, tobacco, pharmaceutical and
illicit substances were enquired after, together with perceived parenting
practices by mothers and fathers.
Results
Significant negative correlations were found with positive reinforcement,
parental involvement and parental discipline for the use of cigarettes,
alcohol, painkillers and cannabis. Correlations tend to be stronger in
girls. Also, correlations were found for more individual products in girls.
Regression analysis using parenting practices as predictive variables
indicate limited predictive power. Use of energy drinks, spirits, cocktails
and painkillers can be best predicted. In boys the use of cigarettes, wine,
spirits, cocktails and painkillers can be best predicted, whereas in girls
the use of beer, wine and spirits were best predicted.
Conclusions Parenting practices appear to have differential influence on
male and female adolescent substance use.
122
FIT: A FAMILY SUPPORT PROGRAMME TO PREVENT
EARLY ADOLESCENT RISK BEHAVIOUR
Engels, T., Lambrecht, P., & Andries, C.
Vrije Universiteit Brussel
Current preventative activities mostly target either parents or pupils in a classroom setting. Seldom activities focus on the family, although parents and family factors appear to have significant influence on adolescent substance use.
The primary aim of the research is to develop a family support programme
where both parents and adolescents are involved. A four-round Delphi survey
is conducted November 2002 till June 2003 to establish the characteristics of
the programme. The Delphi panel (N = 60) consists of parents, adolescents and
professionals of different background.
In rounds 1, 2 and 3 participants completed a self-reported questionnaire. In
round 4 participants will discuss a resolution text in two round-table conferences. This qualitative research method allows the integration of the different
ideas and expectations of the participants.
Participants choose to name the programme Families in Transition (FIT). Mean
topics to include are parenting styles, parenting practices, communication,
puberty and adolescent risk behaviour. These topics will be addressed using a
bottom-up strategy, i.e. taking questions raised by parents and adolescents as a
starting point. To allow participation of
parents and adolescents, parallel and joint sessions will be organized. The programme will be for universal access to reflect societal diversity. However, local
social societies will guarantee at-risk groups' participation.Delphi survey participants are developing a family support programme targeting families with
early adolescents to prevent uncontrolled risk behaviour.
GENDER DIFFERENCES IN THE SEXUAL ATTITUDES OF
ADOLESCENTS: A CASE FOR THE PROVISION OF GENDER SENSITIVE SEX EDUCATION
Newby, K and Wallace, L
Division of Health Psychology
Background: This UK study investigated the sexual behavior of adolescents
and their attitudes towards sexual relationships.
Methods: A cross-sectional survey of 444 adolescents aged 13 to 16 years old
examined reported sexual activity and contraceptive use. Four single-sex focus
groups comprising of between 4 and 6 adolescents further explored issues relating to motivations for sexual intercourse/condom use, and trusted sources of
information, advice and support.
Findings: There was no difference in level of sexual experience according to
gender (c2(1) = 0.461, p = 0.497). Female adolescents were found to be significantly more likely to report use of condoms during sex (c2(1) = 5.835, p =
0.016). Focus groups revealed that both male and female adolescents understood that condoms provided protection from STI’s and pregnancy. Decisions
regarding their use/non-use were however made differently and reflected the
differing motivations of these groups. For male adolescents, the primary motivation for sex was personal gratification whereas for females, motivations were
far more complex and reflected romanticized attitudes towards sex and relationships. Both male and female adolescents had a general mistrust of adults
and reported that they were unlikely to discuss sexual matters with them.
Unlike male adolescents, female adolescents reported their peer group as a primary source of information, advice and support. The male peer-led culture of
bravado appeared to totally restrict opportunities for supportive relationships
amongst boys.
Discussion: On the basis of these findings, it was suggested that interventions
to reduce the rates of STI’s and unwanted pregnancy should reflect the differing motivations that lie behind the decisions of male and female adolescents to
engage in sex and use condoms. It was also suggested that the mistrust of adults
must also be addressed as this creates a barrier to important sources of information, advice and support.
Posters
GROUP IDENTITY, PERCEIVED GROUP BEHAVIOUR AND
SMOKING AMONG DANISH ADOLESCENTS
WHO IS MOST AT RISK? RELATIONSHIP BETWEEN DIFFERENT HEALTH RISK AND PROTECTION BEHAVIOURS
IN YOUNG PEOPLE
Kirsten Verkooijen*; Gert A. Nielsen**; Hans Chr. Petersen***
*Department of Health Promotion Research, University of Southern Denmark;
**Danish Cancer Society, Copenhagen; ***Department of Statistics and
Department of Health Promotion Research, University of Southern Denmark
Introduction: Adolescence is a time when group behaviour is very apparent. It
is also a period in which engagement in smoking tends to start off. The present
study examined how group identification, perceived group behaviour and personal smoking behaviour are interlinked.
Instrument: Data was gathered as part of a larger national survey on health and
health behaviour among 16 to 20 year old Danes (N=3956) carried out by the
Danish Cancer Society and The Danish Board of Health in November 2002.
Subgroup identification was assessed by the question: ‘would you agree if a
friend called you a...[group name]’. Perceived group behaviour was assessed
by the question: ‘How likely is a member of ...[group name] to be a smoker?’
Nine group names, based on prior group discussions with representatives of the
target population, were provided. Answers were given on 5-point scales.
Respondents were also asked about their personal smoking behaviour.
Data-analysis: Risk ratios for smoking by group identification and by perceived
group behaviour were calculated for each subgroup.
Results: For all except one subgroup, identification with the group was related
to either a significantly higher or a significantly lower risk of being a smoker.
Within five subgroups, the relative risk of being a smoker was significantly
higher for ‘identifiers’ who perceived group members as smokers compared to
‘identifiers’ who perceived group members not to be smokers.
Conclusion: Group identity seems to play an important role in Danish adolescents’ smoking behaviour with perceived group behaviour as a mediating factor
Luísa Barros e Fernando Fradique
Faculdade de Psicologia e de Ciências da Educação
In the last decade, several studies have investigated health risk and protection
behaviours in school-aged children. Most agree that the majority of children
and adolescents have relatively healthy life-styles, but show that a small percentage of young people are at high risk for developing health problems in the
short term (alcohol consumption, unprotected sexual activity), or have health
habits that jeopardise their future health (smoking, poor eating habits).
Some authors have defended that the adoption of unhealthy life-styles is related to others psychological risks or areas of disturbance in the child’s developmental course. Others emphasise the importance of culture, structure and environment, and family variables.
In this study we wanted to gain a better understanding of who are the young
people who have more risk and less protection behaviours, how the several risk
and protection behaviours associate, and what is the relationship between
school failure and poor health habits.
We studied about 2500 students (9-21 years) attending schools in a suburban
region nearby Lisbon, using the “Health Behaviours Questionnaire” from the
European Health and Behaviour Survey (portuguese adaptation, McIntyre ,
Soares e Silva, 1977).
In this poster we analyse the association between different risk behaviours and
protection behaviors, and between these behaviours and other variables (sex,
age, parents education, school failure).The results are discussed in terms of
some possible implications for health education in schools.
PATTERNS OF SEXUAL ACTIVITY AMONG FEMALE
TEENAGERS IN OSASCO- BRAZIL
NEGATIVE MOOD AND RELATIONSHIP WITH PEERS PREDICTS SUBSTANCE USE IN ADOLESCENTS AT RISK
Dr. Faisal-Cury,A .; Dr Quayle, J.
Sao Paulo, Brazil
Gebhard Huesler
University of Fribourg , Dept. of Psychology Switzerland
Objectives: To investigate patterns of sexual activity among teenagers in
Osasco, Sao Paulo, and to verify if there are significant differences between
those who live with their partners and those who live with their parents.
Methodology: Semi-structured interviews conducted with 109 sexually active
female adolescents, recruited among those looking for gynaecological-obstetrical care in a private clinic from July 1998 to September 2000. Participation was
voluntary.
Results: Patients were divided into 3 groups, according to pregnancy and marital status. Group 1 was constituted of 48 adolescents (44%) living with their
partners (M), either pregnant (34) or with a previous pregnancy(14). Among
those living with their parents, 12(11%) were single and pregnant (SP) and
49(45%) were single and not pregnant (SNP). There were no significant differences among the 3 groups in age, menarche, age of first intercourse and number of partners. Most knew contraceptive methods at the time of the first intercourse and although 40% of them said they could foresee the possibility, many
didn’t take contraceptive precautions (44% M; 45% SP. 12% SNP). The aspect
where the 3 groups differed most was the frequency of sexual
intercourse(Kruskal-Wallis p=0,0001) where group 1 (M) had intercourse more
frequently.
Conclusion: Intimacy favours frequency of intercourse. Knowledge about contraceptive techniques is not enough to avoid unplanned pregnancies, suggesting the importance of investigating other psychosocial aspects of motherhood
and maternal identity among female teenagers
There is a multitude of variables which influence substance use such as individual and environ-mental risk and protective factors. We believe that in adolescents at risk negative mood plays an important role for direct and indirect
influence on substance use.
Method: We used a sample of 1000 adolescents at risk for substance use with
an age range from 11-20 for testing a structural model of mood and substance
use. Variables included in the model were mood, self esteem, relationship with
parents and peers, relationship with substance consuming peers and substance
use (cigarettes, alcohol and cannabis).
Conclusion: The model shows a direct negative influence on relations with parents and a positive relationship with substance consuming peers. The consuming peers influence (.63) positively the substance use of the adolescents. On
the other hand the relationship with parents (-.12) influences negatively (protect) the substance use. There is no direct influence of mood and age. But the
model is different for boys and girls.
123
Posters
HEALTH RELATED OUTCOMES IN ADOLESCENTS AT
RISK
AN EVALUATION OF A SCHOOL-BASED INTERVENTION
FOR THE PREVENTION OF TEENAGE PREGNANCIES
Gebhard Huesler
University of Fribourg , Dept. of Psychology Switzerlan
Ingri Myklestad and Jostein Rise
Norwegian Institute of Public Health, Oslo
Physical complaints and psychological impairment are not independent factors.
In a sample of adolescents at risk for desintegration, we studied the influence
of self-esteem and self efficacy on the one side and anxiety and depression on
the other side, on health outcomes such as complaints, doctor and psychologist
visits. We used path analysis to find direct and indirect influences on these
health measures.
The aims of this study are to evaluate a school-based intervention for the prevention of teenage pregnancies.
The participants were students age 13-15 year at 3 different schools in Oslo
(N=119).
Two of the schools received a school-based intervention of 16 sessions at 9th
grade and 8 sessions at 10th grade.
The other school was a control-group and received no intervention. Both the
intervention and the control group
received questionnaires before and after the interventions. Based on what has
been found to be effective in
earlier studies, the intervention consisted of the following aspects: (1) building
of social and personal skills,
(2) sex education, and basic information about contraceptives and the risks of
unprotected intercourse,
(3) visits to the local health clinic for young people, (4) focusing on social
influence processes,
(5) teaching methods designed to activate the students. The presentation will
focus on evaluation of the school-based
intervention using the theory of planned behaviour (TBP). Outcomes will be
measured in terms of behavioural beliefs,
normative beliefs, and control beliefs. In addition, behavioural intention, condom use and contraceptive pill use
will be addressed. Practical and theoretical implications will be considered.
Method: We used a sample of 1100 adolescents at risk for substance use with
an age range from 11-20 for testing a structural model of factors which influence health. Variables included in the model to predict health outcomes were
mood (depression, anxiety), secure (self esteem, self-efficacy), relationship
with parents, suicidal thinking, and substance use (cigarettes, alcohol and
cannabis).
Conclusion: The model is slightly different for girls and boys and the different
age groups. It seems that mood as a risk factor influences directly suicidal
thinking and health outcomes. But secure influences directly the relationship
with parents but does not have a direct influence on health outcomes.
PSYCHOSOCIAL PREDICTORS OF HIV-RELATED SEXUAL
RISK BEHAVIOR IN HETEROSEXUAL PORTUGUESE
WOMEN
Eleonora Costa, Teresa McIntyre & Stevan Hobfoll
University of Minho, Department of Psychology
The purpose of this study is to investigate the psychosocial factors related with
sexual risk behaviours in terms of HIV infection in a sample of Portuguese
women with specific risk criteria.
Among the psychosocial predictors considered are self esteem, the sense of
self-efficacy, social support, depression, post traumatic stress disorder,
resources, sexual knowledge, present and past sexual practices, as well as physical and sexual abuse and STD history. The sexual behaviours assessed are
risky sexual behaviours during the last two weeks, two months and six months.
A sample of 150 women between the ages of 16 and 29 were selected from
gynaecological consults. Risk status is defined by: (1)seeking treatment for a
suspected STD (such as AIDS, herpes), (2)having sex with more than one person in the last six months, (3)having sex with someone who has other sexual
partners, and (4)she or her partner being IV drug users. Instruments and procedure from Women’s Health Study Questionnaire (Hobfoll, 2002) were administered individually.
The results will be interpreted in terms of determining the most important proximal and distal predictors of sexual risk behaviour in high risk Portuguese
women.
124
AFFECTIVE MOTIVATIONS AND EMOTION REGULATION
IN YOUNG ADULTS’ RISKY BEHAVIORS
Rosanna Trentin, *Maria Grazia Monaci and Luca Scacchi
Department of Developmental Psychology and Socialization University of
Padova *University of Aosta
Italy
This research study focused on the affective motivations and emotion regulation mechanisms that significantly affect young adults who adopt risky behaviors (tabagism, excessive drinking, drug taking, etc.). The study was done
through questionnaires and aimed at:
1) outlining the profile of risky behaviors in students attending their first years
at University;
2) exploring the affective-motivational patterns linked to the adoption of risky
behaviors, examining emotion regulation strategies and peer influence, as well
as sensation seeking and health locus of control;
3) supplying information for strategies directed at modifying emotion regulation malfunctioning linked to the most widespread harmful behaviors, such as
the emotional ambivalence associated to tabagism, and overturning the positive
affectivity associated to excessive drinking.
Preliminary results show: a) that in this population it is the high arousal emotions that increase the frequency of risky behaviors (positive ones in risky sex,
negative ones in tabagism, both in alcohol consumption); b) that there is a
strong peer influence on alcohol consumption, which is greater in female students; c) that female students smoke very much, but have negative feeling
toward smoking; d) the importance of individual beliefs on health and sensations in risky sex, where peer influence is greater in male students.
Posters
PROMOTING SAFE SEXUAL BEHAVIOR IN HIGH
SCHOOLS: CAN MEDICAL STUDENTS ACT AS ROLE
MODELS?
BALIAKAS P., KAVAKA N., POURNARAS D., MITSAKIS M.,
PANAGOPOULOU E., BENOS A.
ARISTOLE UNIVERSITY THESSALONIKI, MEDICAL SCHOOL
The aim of this study was to explore the effects of a peer-led psychosocial
intervention on knowledge, attitudes and sexual behavior of high school students, in Greece. The intervention consisted of two parts: Part one involved a
semi-structured group discussion. The discussion was led by medical students
who had previously attended a training program on health-promotion and sexual behavior. Part two involved the demonstration and practice of the correct
use of a condom. The intervention was delivered in two high schools of different socioeconomic and geographical backgrounds. A total number of 400
teenagers(N=400) aged between 15-17 years old, participated in the intervention. Effects of the intervention were evaluated in a quantitative and a qualitative way: A questionnaite assessing kwnowledge, attitudes and behavior was
administered before, and one month after the intervention. The questionnaire
was constructed for the study,based on the Theory of Planned Behavior. In
addition, the impact of the intervention was assessed qualitatively, through
open-ended questions which were transcribed, and coded, by two independent
raters.
Results will compare the impact of the intervention as assessed in both ways,
in the two participating high-shools
SOCIAL INEQUALITIES IN HEALTH FROM THE VIEWPOINT OF HEALTH CARE CONSUMERS AND PROVIDERS
Vladimir Kebza, Iva Solcova
National Institute of Public Health, Prague, Czech Republic; Institute of
Psychology, Prague, Czech Republic
Aims of the study: Inequalities in health exist in all countries. Many studies
have already documented the influence of social conditions, and the reflection
of these conditions on quality of life and health status. Our study compares both
crucial relevant points of view: consumers’(citizens), and providers’ (physicians) of health care. In addition, the relation of stress-buffering factors to selfreported health is discussed.
Hypotheses tested: We assumed that both mentioned points of view will be
either the same, or similar, and the role of social gradient in self-reported health
will be confirmed using Czech national statistical data.
Methods used: The method of standardized guided interview concerning the
views, opinions, and attitudes towards inequalities in health was implemented
in a representative sample of Czech citizens (N=1500), and Czech physicians
(N=1100). Another representative sample of the Czech adult population
(N=2680) was surveyed by another standardized guided interview focused on
age, gender, education, social class, occupation, employment status, income,
and subjective health status.
Results and conclusions: The viewpoints of consumers (citizens) and providers
(physicians)of health care concerning inequalities in health do not differ
markedly: only about 1/3 of citizens and physicians assume that there exist
inequalities in health. Among citizens there were no significant differences in
the views of men and women as regards existing inequalities in the health status. The evaluation of the problem however differs significantly in relation to
education. The analysis of possible reasons of these findings will be presented
in association with statistical data on work incapacity, unemployment, and
income.
Theoreticalissues
DIFFERENCES AND SIMILARITIES BETWEEN FRENCH
AND GERMAN MEDICAL PRACTICES
V. Chateaux ; E. Spitz; C. Tarquinio; GN. Fischer.
Universite de Metz - Laboratoire de Psychologie
Objective : The aim of this study was to notice differences and similarities
about medical practices on both sides of frontier between Saarland and
Lorraine.
Method : General physicians ( 43 French, 40 German) answered to a questionnaire which was on the understanding of patients; the relation between patient
and physicians and the time of consultation.
Results : - Therapeutic observance : French physicians think more, in average,
that patients respect their prescriptions. But German physicians think that they
have more a way to fight against the non-observance.
- The understanding of patient : German physicians think more, in average, that
“a patient is always ill”; “people are master of their health” and “we have to
take the patient’s representations of his disease into account”.
Criterians about quality of care : German physicians think more, in average,
that cares “treat in priority the pain”; “improve the patient’s quality of life”;
“are focused on patient’s request”.
Interpretation :
French and German general physicians don’t have the same approach of
therapeutic observance. French physicians seem more utopian than their colleagues because they believe more in their patient’s observance and say having
less way to fight against the non-observance.
In the understanding of patient, German physicians would have an approach
focused on patient in which this one is responsible for his health.
There are differences between criterians about quality of care too : for German
physicians, the criterians about improvement of quality of life rise up in priority.
INFLUENCE OF PATIENT-PRACTITIONER INTERACTIONS ON HEALTH OUTCOMES: A SYSTEMATIC REVIEW
OF CONTEXT EFFECTS
Zelda Di Blasi, Elaine Harkness, Edzard Ernst, Amanda Georgiou, AND Jos
Kleijnen
Zelda Di Blasi (Department of Health Sciences, University of York)
Elaine Harkness & Edzard Ernst (Department of Complementary Medicine,
University of Exeter),
Amanda Georgiou (University of Leeds, Division of Public Health),
Jos Kleijnen (NHS Centre for Reviews and Dissemination)
Background: Throughout history, doctor-patient relationships have been
acknowledged as having an important therapeutic effect, irrespective of any
prescribed drug or treatment. We did a systematic review to determine whether
there was any empirical evidence to support this theory.
Methods: A comprehensive search strategy was developed to include 11 medical, psychological, and sociological electronic databases. Based on
Leventhal’s Self-Regulatory theory, the type of non-treatment care given in
each trial was categorised as cognitive or emotional. Cognitive care aims to
influence patients’ expectations about the illness or the treatment, whereas
emotional care refers to the style of the consultation (eg, warm, empathic), and
aims to reduce negative feelings such as anxiety and fear.
Findings: We identified 25 eligible randomised controlled trials. 19 examined
the effects of influencing patients’ expectations about treatment, half of which
found significant effects. None of the studies examined the effects of emotional care alone, but four trials assessed a combination of both cognitive and emotional care. Three of these studies showed that enhancing patients’ expectations
through positive information about the treatment or the illness, while providing
support or reassurance, significantly influenced health outcomes. These findings were published in the Lancet.
Conclusion: There is much inconsistency regarding emotional and cognitive
care, although one relatively consistent finding is that physicians who adopt a
warm, friendly, and reassuring manner are more effective than those who keep
consultations formal and do not offer reassurance.
125
Posters
WHAT TYPE OF DATA HELP PATIENTS TO DECIDE TO WHICH
HOSPITAL THEY SHOULD GO?
PATIENT SATISFACTION IN AN ACADEMIC HOSPITAL IN
THE NETHERLANDS
Mira JJ, Tirado S, Pérez-Jover V., Rodríguez-Marín J.
Universidad Miguel Hernández, Spain
Coby de Boer & Sandra Boersma
Health Psychology
Introduction: Nowadays Spaniards can only choose hospital in a restrictive form.
However, there is an open debate about the advantages of the free choice of hospital.
The hospital eligibility must be based on the patients’ accessibility to relevant information about hospitals’ outcomes. In turn, sometimes, their choices could be based on hazards more than in a responsible decision.
Objective: To identify what data are more salient for patients to make a hospital choice.
Methods: A correlational study was conducted. In this case a Factor Analysis was used
to resume data. Outcomes of three fictitious hospitals were presented to experimental
subjects. Outcomes regarded three diseases: cataract, breast cancer, and prostate benign
hypertrophy. Each disease was presented to a sample of subjects. Hazards determined
the adscription to one or the other disease. The following instructions were given to the
subjects: if you need a treatment for (specific disease) which hospital will you chose?
Given some outcomes of the last three years of each hospital in the specific disease, subjects chose where they wanted to go to receive medical treatment.
Outcomes selection regarded: therapeutic efficacy, relapse probability, mean length of
stay, side-effects, patients’ satisfaction, number of patients who recommend the hospital, relatives’ satisfaction, reclaims against health professionals or hospitals.
Subjects assessed by means of a 10-points-scale if each presented data was salient for
them to choose hospital.
Saint Philip Neri Hospital had the best therapeutic efficacy, Saint John of the Cross
Hospital the higher patient’s satisfaction scores, and Saint Margaret Hospital the lower
number of reclaims against health providers and hospital.
Subjects: 751 subjects (35% health providers, the rest without health university education).
Results: Saint John of the Cross Hospital was chosen by 21,3% of the subjects; Saint
Philip Neri Hospital by 67,6%; Saint Margaret Hospital by 11,1%.
Varimax rotation of the Factor Analysis in the case of breast cancer resume data in three
factors (S2explained=78,03%). Patients’ and relatives’ satisfaction characterized the
first factor, the second was characterized by therapeutic efficacy, side-effects and relapses probability; and the third was characterized by reclaims against hospital.
In the case of prostate benign hypertrophy and cataract Factor Analysis resume data in
two factors (S2explained=64,68%). First factor included patients’ and relatives’ satisfaction, and the second factor medical outcomes in term of therapeutic efficacy.
The more salient outcomes for health providers were therapeutic efficacy, relapses probability, days of hospital stay, and side-effects (p<0,01). For the other subjects patients’
and relatives’ satisfaction and reclaims against hospital are more salient to make a
choice (p<0,01).
Background To assess patient satisfaction a core questionnaire has been
developed, allowing cross-site comparisons in the Netherlands. In a final part
of the questionnaire each hospital could add their ‘aspects of particular
importance’. For the ‘Leiden University Medical Center (LUMC)’ the core
questionnaire, containing the aspects Admission, Nursing care, Medical care,
Information, Autonomy and Discharge & aftercare, was extended with
Informed consent & access to files, Support, Kindliness, Organization, Hotel
aspects and Complaints.
Aim The aim of the study is to assess the psychometric properties of the 33item LUMC-questionnaire and to relate patient satisfaction to perceived health
at admission to the hospital and perceived health when completing the questionnaire. Patient satisfaction will also be related to patients’ overall rating of
care, intention to recommend the LUMC and intention to return to the LUMC
upon future need. Furthermore patients were invited to give their suggestions
for the improvement of care or an explanation on their evaluation of each
aspect. These comments will be used to develop an extended questionnaire for
the assessment of patient satisfaction.
Method The questionnaire was sent to 5175 inpatients and 5482 outpatients of
the LUMC. The response rates were 55% and 53% respectively.
Preliminary Results For inpatients the Factor Analysis revealed 6 underlying
dimensions: Autonomy, Nursing care, Medical care, Discharge & aftercare,
Hotel aspects and Organization, with alpha’s for the scales ranging from .72 to
.88. The patients’ comments are currently being categorized. On the conference
the results the evaluation of the questionnaire will be presented.373
Conclusions: Severity of disease and health education received are two decisive variables to take into account when patients need to be informed to make a choice of the
hospital where medical treatment is going to be received.
ADVANCED HOME CARE: PATIENTS´ AND FAMILY MEMBERS´
QUALITY PERCEPTIONS
Bodil Wilde Larsson & Gerry Larsson
Karlstad University & Swedish National Defence College
Aim of the study. To explore the correspondence between patients´and family
members´perception of the quality of care, in a context of advanced home care.
Problem addressed. Many patients receiving qualified home care have problems to
respond to questionnaires due to high age, mulitple illnesses, etc. Can patients´
responses be replaced by the opinions of close family members? Previous research indicate that family members tend to be more critical than patients. However, these studies
have been done in hospital environments were the family member visit the patient, and
not in the home setting where family members and the patient share the same everyday
experiences.
Method. The sample consisted of 59 Swedish matched pairs of patientes-family members where the patients received advanced medical home care, with cancer as the dominat diagnosis. Patients and family members responded to questions about the quality of
care independently of each other. An internationally well established instrument, the
Quality from the Patient´s Perspective questionnaire, was used.
Results. A high degree of agreement was found in the opinions of the patients and their
family members. However, in a subsample where the family member did not live with
the patient but only visited him or her once a week, the traditional picture was found more critical family members.
Conclusions. Results were interpreted using empathic precision theory. In advanced
home care, patients´ views on the quality of care can be replaced by the opinions
of family members if, but only if, they actually live together.
126
ASSESSING HEALTH SERVICES FROM THE PATIENTS’
POINT OF VIEW: CULTURAL COMPARISONS
Paddison, C., Hoera, J., Nikora, K., Faimalie, M., Vae’au, F., Flett, R., &
Alpass, F.
School of Psychology, Massey University, New Zealand
Aims: Previous research has highlighted the importance of assessing health
service quality from the patients’ perspective. The present study aimed to
explore patient experiences and perceptions of diabetes health services in New
Zealand. Specific attention was given to examining cultural differences within this context.
Method: A questionnaire survey was the primary mode of data collection
(N=225). This questionnaire included a multi-dimensional measure of patient
experiences and perceptions of diabetes health services. Three parallel studies
were run to enable cross- cultural comparisons among people with type 2 diabetes in New Zealand, (a) general population (N=75), (b) Maori (N=75), (c)
Pacific people (N=75).
Results: Research findings were used to evaluate health services for people
with diabetes across 8 dimensions; specifically identifying (a) current areas of
strength, and (b) targets for future improvement. Results provided evidence
of cultural differences in use of health services, experiences with health professionals, and preferred modes of delivery.
Conclusion: The patient’s point of view can be a useful tool to guide improvements in health service quality. Cross-cultural comparisons suggest the need to
improve cultural responsiveness within existing health services, and provide
targeted services to meet the needs of particular sub-groups within the diabetes
population. At a theoretical level research findings highlight the need to
include both patients’ experiences per se, and cognitive appraisal of their experiences (satisfaction), when measuring health service quality from the patients’
point of view.
Posters
EMOTIONAL IMPACT OF PREDICTIVE GENETIC TESTING FOR INHERITED THROMBOPHILIA AT 12 AND 18
MONTHS FOLLOW_UP
Razzaboni E., Gremigni P., Ricci Bitti P.E.*, Legnani C., Palareti G.**
* Dept. Psychology Bologna University (I) **URCT “M. Golinelli”, S.OrsolaMalpighi Policlinic, Bologna (I)
Communication of results of genetic testing (GT) has been questioned as
regards its possible negative impact on individual’s psychological adjustment.
This is particularly the case of GT related to specific predispositions not implying an immediate severe risk of illness, such as Thrombophilia Susceptibility
(TS). A previous study showed that communication of positive results of GT
for TS has not an immediate negative emotional effect. The aim of this study
was to investigate the long term emotional impact of communication of positive results of GT for TS. We assessed this emotional impact among people
with TS using an ANOVA for repeated measures at 4 different periods of time.
Twenty adults completed a questionnaire assessing emotional state and perceived well-being before attending the GT (Time 1), 20 days after having
received the GT result (Time 2), and at 12- and 18-months follow-ups (Times
3 & 4). We found no significant harmful emotional effect of communication of
positive results of GT for TS. Psychological variables didn’t change significantly neither from Time 1 to Time 2, or from Time 2 to Times 3 & 4. Subjects
didn’t show any significant difference, along the 4-time measurements, compared to the Italian Norms for healthy people. Our results confirm that communication of positive results at GT for TS doesn’t produce any negative effect
on emotional status of people, either immediately or in the long period. Further
studies could be done to evaluate the impact of GT results on quality of life and
attitude towards preventive behaviours among people who carry a mutation for
TS.
ATTITUDES TOWARDS ADVANCES IN GENETIC SCIENCE
TITLE SYMPOSIUM
Richard Shepherd, Julie Barnett, Helen Cooper, Adrian Coyle,
Chris Fife-Schaw, Jo Moran-Ellis, Victoria Senior and Patrick Sturgis
University of Surrey
Advances in genetic science in recent years have led to substantial
developments in medicine and pharmaceuticals, whereas applications
in food and agriculture have met with negative public reactions
across Europe. Some potential medical applications, such as cloning,
pre-implantation genetic diagnosis and stem cell technology, may
also present major issues of public concern in the future. It is therefore important to understand what influences reactions from the public to advances in genetic science. The factors underlying attitudes in
this area are explored, examining the role of knowledge, context and
personal relevance and self interest. These form some of the research
questions addressed in a major new UK project on public attitudes to
genomics combining quantitative and qualitative methods across a
series of studies. The initial study is a national baseline survey conducted on about 3,500 people in association with the British Social
Attitudes Survey. This will be complemented by an intervention
study examining the effects of information provision with a sub-sample from the original survey, focus groups and interviews analysed
using discourse analysis and other qualitative methods,
a textual analysis of representations of genomics, and a series of
experimental vignette studies. This will provide an in-depth understanding of current UK public views on applications of genetic science.
MAKING SENSE OF BRCA1/2 MUTATIONS: PSYCHOLOGICAL ASPECTS
Razzaboni E.¹, Cortesi L.², Calò S. ¹, Federico M. ², Ricci Bitti
P.E. ¹
¹
Department
of
Psychology,
University
of
Bologna
² Familiar Breast and Ovarian Cancer Study Centre, Oncology and
Haematology Department University of Modena and Reggio Emilia
Knowing BRCA1/2 test result could be psychologically challenging because
mutation carriers carriers can do little to control this situation.
The aim of this work was to evaluate how BRCA1/2 mutation carriers represented their risk status and how they described their conditions.
33 people carrying a BRCA1/2 mutation were enrolled in the study, and were
divided in two groups: 14 were patients (13 women and 1 man) and 19 were
healthy people (14 women and 5 men).
Semi-structured interviews were conducted and tape recorded. The covered
topics were: motivations influencing on the decision of having the test,
impact of result communication, representation of predisposition, impact
of mutation condition on daily life, communication with others, risk perception,
attitude about surveillance programs and preventions. Transcripts of semistructured interviews where analysed, using interpretative phenomenological
analysis (IPA). Both groups referred that family history was the major factor
influencing on their decision, and healthy people seemed to wait for their result
with more anxiety than patients. Both groups reported different kind of emotions related to the result communication, e.g. any particular emotion, fear and
resignation. For patients, discovering the mutation meant: having found a cause
of their illness, while for healthy people it meant mostly:
living with something that you couldn’t prevent completely, and they tried
to cope with it by empowering their trust and compliance into surveillance
programs. We can conclude that, patients and healthy people give a different
meaning to BRCA1/2 mutation, according to their illness experience.
A QUALITATIVE STUDY OF THE EMOTIONAL IMPACT OF
CANCER GENETIC RISK ASSESSMENT AND THE ACCEPTABILITY OF A DISTRACTION-BASED COPING INTERVENTION.
Ceri Phelps (1); Rachel Iredale (1); Sally Anstey (2); Jonathon Gray (2); Paul
Bennett (3)
1 University of Wales College of Medicine.
2 Cancer Genetics Service Wales, Institute of Medical Genetics
3 Universities of Plymouth and Exeter
The aims of this exploratory focus group study were to 1) identify the range of
positive and negative emotions experienced by women upon referral for cancer
genetic risk assessment 2) explore the range of coping strategies used and 3)
assess the acceptability of a written distraction-based coping intervention.
Fifteen women took part in two focus groups. Eight participants had a personal history of cancer. Participants were split into 2 groups: each group met
twice. Participants were given the distraction leaflet at the end of the first focus
group and asked to discuss it at the second focus group.
A thematic analysis of the data revealed that women experienced more positive
than negative emotions upon referral, primarily in the form of hope and relief.
Whilst the referral itself did not cause increased distress, many participants had
pre-existing concerns which were not reduced upon referral, and the subsequent completion of the family history questionnaire caused some anxiety in a
sub-sample of individuals
Participants engaged predominantly in emotion-focused coping strategies,
including distraction and positive reappraisal. All found the distraction leaflet
to be reassuring and believed it would help them cope with any intrusive worries. In conclusion, the results suggest that a sub-sample of women may be in
need of additional psychological support as a result of being referred for cancer genetic risk assessment. There is a need therefore for an effective and
appropriate coping intervention which can be easily implemented into existing
genetic services. A distraction-based coping leaflet may prove to be such an
intervention.
127
Posters
CHANGING HEALTH BEHAVIOURS IN HARD TO REACH
GROUPS
FINDING BENEFITS IN CANCER: POST-SURGICAL
ADJUSTMENT
Natasha de Meric; Dr Susan Michie; Dr Fiona Adshead
University College London
Nihal E. Mohamed & Sonja Boehmer
Freie Universitaet Berlin, Department for Health Psychology
In response to the poor health of low income and ethnic minority groups, the
UK government has set health targets that depend on changing health
behaviours, e.g. smoking, diet, activity, health screening. To achieve
these, one London Primary Care Trust has developed a new type of health care
practitioner, Public Health Assistants (PHAs). They are drawn from, and
based in, the local community with the aim of targeting hard to reach
groups.
Aims
1.To develop the behaviour change interventions to be delivered by the PHAs
2.To develop and conduct the training of PHAs in behaviour change techniques
3.To evaluate the process and outcome of the PHA intervention
Method
This two year pilot study is led by a health psychology team.
7The intervention was developed on the basis of a review of relevant
evidence and theories of changing health behaviours.
7A multidisciplinary team designed the training of the six PHAs, which
included behaviour change techniques, fieldwork application, and community
and primary care knowledge.
7Evaluation includes the assessment of health needs of hard to reach groups,
process (interviewing key health care staff, patients and senior managers)
and outcome (pre- and post-measures of target behaviours and associated
cognitions).
Discussion
This innovative project demonstrates:
7The possibility of training lay persons to work within their own community
to change health behaviours of hard to reach groups
7A model of applying health psychology theory and evidence within a primary
care setting.
7A method of evaluating a novel community based intervention.
There is a considerable amount of research concerning the relationship
between stress, benefit finding and general adjustment in cancer patients.
However, few studies focused on the role of finding benefits and provided
social support in cancer and adjusting to it. According to the literature, finding benefit reflects the pursuit for the “silver lining” of adversities , that is the
ability to focus on and strive for positives.
The aim of the study was to analyze finding benefits in cancer patients and its
association to provided social support, depression, quality of life, pain, and
impairment due to illness.
Benefit finding was measured at 6 months after surgery (Benefit Finding
Scale; Antoni et al., 2001). Provided social support was measured one week
before surgery by an 11-item scale (BSSS; Schwarzer & Schulz, 2000 ). A
depression scale (CSD-D; Radloff, 1977), a quality of life questionnaire
(EORTC-QLQ-C30; Aaronson et al., 1993), a visual analogue scale to measure
subjective health, and a coping scale (Brief COPE; Carver, 1997) were applied
at one week pre-surgery and 6 months post-surgery.
Seventy two cancer patients (29.2% women), with a mean age of 61.7 years
(SD = 10.7) participated in this study.
Results indicate that reports of finding benefit in cancer at 6 months post-surgery is not associated with adjustment at this point in time. However, finding
benefit was associated with provided support which reflects that patients are
able to strive for positives if they receive some level of support.
ILLNESS PERCEPTION, COPING, AND QUALITY OF LIFE
FOR PATIENTS WITH CANCER
HEALTH IMPLICATIONS OF CARING FOR FAMILY MEMBERS WITH CANCER
Charis Foerster, Steffen Taubert, Sonja Boehmer, Nihal Mohamed, Annerose
Wohlgemuth
Free University of Berlin, Germany
M. FOTIADOU, T. CASSIDY
COVENTRY UNIVERSITY
The aim of this poster is to assess the role of illness representation in coping
and quality of life for patients with gastrointestinal and lung cancer. Nearly
150 patients undergoing surgery for gastrointestinal or lung cancer were studied at four measurement points; three days before surgery, then one week, one
month and six months after surgery. While causal attributions do not change
significantly over time, they have a significant influence on coping and quality of life. Prior to surgery, patients expect the duration of their illness to be
shorter than after surgery. Control beliefs differ significantly over time, and
have a substantial influence on coping and quality of life.
128
Purpose: To investigate the relationship between psychological burden, social
support, perceived control and health in caregivers of cancer patients.
Methods: A survey design using a structured interview data collection technique. A sample of 65 caregivers (31 males and 34 females) of cancer patients
were assessed using a scale which combining the Zarit Burden Interview, the
Clinical Anxiety Scale, and questions to assess the amount of information supplied by health professionals. The scale was administered as a structured interview.
Results: Principal component analysis of the scale produced six factors which
were labelled psychological burden, mental health, physical health, social support, information received and relationship with the doctor. Hierarchical multiple regression analysis shows that psychological burden is a predictor of poorer physical and mental health and that this effect is mediated by perceived control. Income, education and time since diagnosis also have an effect on mental
health.
Discussion: The results support the relationship between psychological burden
and the mental and physical health of carers with the effect being mediated by
control. Those caregivers who had higher levels of perceived control reported
few health effects of caring in spite of the level of burden.
Posters
INFORMING ABOUT CANCER DISEASE AND HEALTH
RELATED QUALITY OF LIFE
Zygfryd Juczynski, Nina Oginska-Bulik
Institute of Psychology, University of Lodz, Poland
The aim of the study was to identify different effects of having enough information about of one’s own cancer diagnosis, treatment and prognosis on
adjustment to cancer and health-related quality of life.
Method A group of 100 women after mastectomy and 60 men with lung and
prostata cancer participated in the study. Examined subjects were assessed with
structured interview designed to evaluate obtained information and coping
with illness (MAC) and subjective well-being (QOL C-30).
Results Information giving in oncological patients can influence the coping
with illness and quality of life. The subjects well completely informed about
their diagnosis, treatment and prognosis are better adjusted to cancer and use
more adaptive coping strategies, as fighting spirit. If patients do not have
enough information about their illness they use mostly such strategies as helplessness and anxious preoccupation. More informing about disease is important
for perceived better well-being and higher level of physical and social functioning of cancer patients.
PSYCHOLOGICAL IMPACT OF MALE BREAST CANCER
Buddug Williams, Kate Brain, Rachel Iredale, Liz France, Jonathan Gray
University of Wales College of Medicine and University Hospital of Wales
Background: Approximately 300 cases of male breast cancer are diagnosed
every year in the UK, although the psychological impact of the condition is
unknown. It is estimated that around one quarter of female breast cancer
patients exhibit significant psychological distress in the first year after diagnosis.
Aims: To examine the prevalence of psychological morbidity, and factors associated with general distress, cancer-related distress and body image in a sample of men with breast cancer.
Methods: Preliminary data are reported from an ongoing cross-sectional questionnaire survey of 50 men with breast cancer recruited from breast clinics
across the UK.
Results: Average age of the sample was 65 years (SD 12.378, range 31–86) and
mean time since diagnosis was 36 months (SD 29.05, range 2–120). Prevalence
of HADS caseness was 4% for anxiety and 2% for depression, while 38% of
men reported moderate to high Impact of Event Scale scores. Factors associated with increased cancer-related distress included younger age at diagnosis
(p<.05), more recent cancer diagnosis (p<.05), and current side effects of treatment (p<.05). Men who were experiencing side effects had significantly poorer body image (p<.05). There was a non-significant trend towards poorer body
image in younger men and those diagnosed more recently.
Conclusion: Prevalence of psychological morbidity appears to be low in male
breast cancer patients, although cancer-specific measures are more sensitive to
men’s concerns. These results suggest that men at greatest risk of traumatic
stress symptoms may include those who are younger, recently diagnosed, and
experiencing treatment side effects.
MEANING IN LIFE AFTER THE TRAUMA OF CANCER: A
QUALITATIVE STUDY
QUALITATIVE INVESTIGATION INTO HELP SEEKING
BEHAVIOUR FOR SYMPTOMS OF ORAL CANCER
T.A. Jaarsma, G. Jonker-Pool
Northern Centre for Healthcare Research Groningen Netherlands
S.E. Scott, E. Grunfeld, M. McGurk
King’s College, London
Research on the adaptation to cancer has paid much attention to coping activities and especially to coping with the negative consequences of being diagnosed with cancer. However, it is known that cancer patients can also experience positive consequences. For example, patients have reported that life
became more satisfying for them after their cancer experience.
Unfortunately, little is known about why some cancer patients report only negative experiences, while others report positive experiences as a consequence of
their disease as well. The aim of this study is to explore the underlying mechanisms that can explain these differences among cancer patients. The central
question is:
“How do cancer patients experience their illness and what positive and/ or negative changes in their life regard do they report?”
Qualitative-in-depth interviews were held with nineteen women with different
forms of cancer. They were recorded on tape and analysed by repeatedly reading the verbalised transcripts, comparing them, and dividing them into themes.
The results show that the cancer experience varies across the women, but that
almost everyone reports some positive changes in life regard. However, the
degree of positive changes varies greatly and seems to depend on the interpretation of the meaning of the cancer.
The poster will consist of the results of these interviews.
Background: Previous research suggests that a significant proportion of
patients delay seeking help from a health care professional (HCP) after self-discovery of a symptom of oral cancer. There appears to be no association
between duration of this delay and sociodemographic variables, however, as
with other illnesses there may be an association between psychosocial variables
and help-seeking behaviour. The aim of the present study was to investigate
patients’ initial experiences of oral cancer, to ascertain their interpretations of
symptoms and identify factors influencing decisions to consult a HCP.
Method: Semi-structured interviews were undertaken with 20 participants who
had received a histological diagnosis of squamous cell carcinoma of the oral
cavity but had yet to start treatment. Participants were asked about their symptoms, expectations, emotional reactions, knowledge of oral cancer, and helpseeking behaviour. Qualitative analysis of responses was conducted.
Findings: Oral symptoms were rarely attributed to cancer and were frequently
regarded to be trivial mouth problems, even after being present for a long duration. For some participants, their original concept of oral cancer did not match
their experience and this subsequently deterred them from seeking help. The
degree of interference of symptoms on the participants’ lifestyle was an important factor in seeking help, as was absence of previous negative experiences
with HCP’s.
Discussion: This study has documented that an individual’s interpretation of
oral cancer symptoms may be misguided and this can adversely affect subsequent help-seeking behaviour. The potential for encouraging early presentation
of oral cancer is discussed.
129
Posters
SOCIAL COMPARISON AND CANCER PATIENTS: A
REVIEW
LOPEZ-ROIG S.,TEROL M.C.,NEIPP M.C.,RODRIGUEZ-MARIN J.,PASTOR M.A.,ARAGON M., LURI, M.
The study of social comparison and its application to cancer patients has been
incresed during the last decades. However some authors have pointed out
methodological weakness in the research about cancer patients. Health outcomes results are not always clear because they depend on upward or downward comparison process.
Aim: To review the empirical studies with cancer patients that have assessed
the social comparison process. We focus on the instruments used to quantify
social comparison, and their suitability in health contexts as well as examining
the influence of the social comparison process on health outcomes.
Method: A search of databases (Medline, Psychoinfo) was conducted for relevant articles published between 1980 and 2003 using key words related to cancer (i.e., cancer, oncology, and neoplasm) and social comparison construct (i.e.,
social comparison, upward comparison and downward comparison). Although
51 studies were found only 17 were empirical studies with adult cancer patient
and were written either in Spanish or English.
Results: The reviewed literature points out the important role of cognitive
strategies in coping with the illness process with both downward comparison
(the patient compares their own situation with another patient in a worse situation) and upward comparison (the patient compares with another one in a better situation) both being important. Studies generally found that the social comparison process had an impact on patients’ subjective well-being. Future investigations are required to assess the frequency, the reference point and the type
of social comparison. The literature also demonstrated the need for the adaptation of the Social Comparison instruments for a Spanish sample.
WHAT AND HOW DO THEY THINK ABOUT THEIR ILLNESS? RESULTS FROM A QUALITATIVE STUDY ON
BREAST CANCER WOMEN’S SIGNIFICATIONS USING A
COGNITIVE-DEVELOPMENTAL FRAMEWORK.
Luzia TRAVADO (Hospital S. Jose, Lisbon, Portugal)*;
Joaquim REIS (Independent University of Lisbon)
International Psycho-Oncology Society (IPOS);
Portuguese Academy of Psycho-Oncology
European Health Psychology Society (EHPS) in process
PURPOSE. Significations about illness are the core of subjective illness representation and influence the type and intensity of emotional reactions. Patient’s
illness representation has five major attributes as proposed by Leventhal and
col. namely, identity, causes, duration, consequences and controllability or
cure. In this study we intended to assess breast cancer women’s significations
of their illness and integrate them into a cognitive-developmental framework.
This perspective suggests that these significations can be ordered in five different levels of openness, flexibility, inclusiveness and autonomy, for each major
attribute of illness representation, hierarchically sequenced.
METHOD. Fifty-two breast cancer outpatient women from a Breast Surgery
Multidisciplinary Team Consultation at Hospital S. Jose, Lisbon, Portugal,
were randomly selected and submitted to a semi-structured interview to obtain
their illness significations and also filled out standard clinical scales to evaluate anxiety, depression and quality of life. The interview material was submitted to a thematic and developmental content analysis using socio-cognitive
developmental criteria. The data went through a statistical analysis to get correspondences between the qualitative data and quantitative variables.
RESULTS AND CONCLUSIONS. A typical profile of breast cancer representation is presented. It was possible to order patients’ illness significations into
different developmental levels, and present hierarchical developmental
sequences for each of breast cancer major attributes of patients’ representation,
verifying that the majority of our sample use mainly low and intermediate levels (i.e., 2 e 3). Implications for clinical practice are discussed.
130
WHAT ABOUT US? FACTORS AFFECTING CANCER
SCREENING UPTAKE AMONG PEOPLE WITH A FAMILY
HISTORY OF COLORECTAL CANCER. A CROSS-NATIONAL PERSPECTIVE.
Fichtinger, A. & Sparks, P.
Department of Psychology, University of Sussex, UK
Background: Colorectal Cancer (CRC) is a major cause of cancer morbidity
and mortality in both men and women. A family history (FHist) of CRC is a
well established risk factor for this disease, being associated with a two-to
threefold risk. Although effective screening methodologies for CRC are available, screening rates remain low, even among people with a FHist of CRC.
Little information exists explaining why CRC screening is underused among
this population. The present study aims to explore cognitive, emotional and
practical barriers to screening activity, knowledge about CRC and screening
options, patterns of perceived risk for CRC, facilitators to screening, and past
cancer related experiences in order to suggest possible directions for CRC prevention efforts in a population with a FHist of this disease.
Method: A set of pilot interviews were conducted to both identify important
themes and investigate how best to elicit the information required. These interviews in combination with constructs of the TPB and PMT were used to generate an interview schedule related to the stated aims. Semi-structured interviews will be conducted with 40 people in two countries (20 in the UK & 20 in
Austria). The interviews will be tape recorded and fully transcribed. Transcripts
will be coded, entered on appropriate software (NUD*IST) and qualitatively
analysed.
Results: Preliminary analysis of the pilot interviews indicated that interviewees
expressed weak knowledge, fear, feelings of invulnerability, and strong interest
when asked about their beliefs and emotions in respect to CRC and screening
methodologies. Key findings of the semi-structured interviews (to be conducted in June to August 2003) will be presented.
Conclusions: Findings of the present qualitative study will inform the next
quantitative stage of this research by providing a better understanding of beliefs
and emotions involved in the risk management strategies of people with a FHist
of CRC. Furthermore, results from two countries will shed some light on the
influence of external barriers (e.g. cost, availability, accessibility, role of GP) to
screening uptake.
CONSEQUENCES OF ILLNESS AND TREATMENT ON SELFCONCEPT IN PATIENTS WITH HEAD AND NECK CANCER: A
QUALITATIVE PILOT STUDY
CD LLEWELLYN, M MCGURK*, J WEINMAN
Unit of Psychology, Guy’s, King’s & St Thomas’ School of
Medicine, Guy’s Campus, London, SE1 9RT *Department of Oral &
Maxillofacial
Surgery, Guy’s Hospital, London SE1 9RT
Background: Patients with carcinoma of the head and neck (HNC) often require
radical surgical treatment. Excluding anxiety and depression, little is known
about the psychological consequences of HNC and its treatment, in particular, to
a person’s self-concept. The wider aim of this study was to investigate patients
views regarding their cancer,
treatment and recovery. The implications of this for patients’ self-concept
emerged from this study as a master theme.
Methods: Semi-structured interviews were conducted with an opportune sample of
16 participants with head and neck cancer (71% female). Ages ranged from 38 to
75 years and time since diagnosis ranged from 2 to 548 days. Data were analysed
using a framework analysis approach (Ritchie & Spencer, 1994). This technique
involved identifying recurring and important themes based on a combination of a
priori issues, emergent themes and recurring attitudes or experiences.
Findings: Four interconnected subordinate themes emerged from the master
theme of ‘self-concept’. Fulfilment of social roles, comparisons with other
patients, situations (whether downwards) or past-self all had implications for a person’s self-esteem. Low self-esteem appeared related to upward social comparisons,
an inability to resume social roles/ occupations and constant comparison with pastself. Altered appearance/ speech and uncertainty regarding the future were also
related to a decrease in self-confidence.
Discussion: Health professionals need to be aware of these issues when responding to the needs of patients diagnosed with HNC in order to provide patients with
the support to maintain positive self-esteem. As it has been shown that HNC has a
profound impact on a person’s self-concept, further research is needed to further
our understanding of the relationship between self-concept and subsequent quality
of life.
Posters
THE RELATION BETWEEN MINDFULNESS AND CANCER
Paneras Alta Ph.D. (cand.) Liza Varvogli, Ph.D.
Centre for Counseling and Psychological Support Aristotle University of
Thessaloniki
Panteio University of Athens
Purpose of the review: Cancer patients often use mindfulness techniques such
as meditation, relaxation, imagery and yoga to cope with cancer. The purpose
of this presentation is to provide an overview of the findings regarding the relation between these techniques and cancer.
Method used: Research and review articles were identified through a computer search of Medline 1966 – 2003 and Heal databases using appropriate words.
Summary of important findings: Research findings suggest the elicitation of a
relaxation response, as a result of the use of mindfulness techniques, influences
affective and physiological states relevant to cancer and may benefit cancer
patients, mentally and physically. Specifically, the use of mindfulness techniques improves a number of aspects of cancer patients’ mental well-being and
contributes to the better management of cancer symptoms and treatment sideeffects. Also, in conjunction with traditional treatments, the use of these techniques results in physical benefits regarding the rate of the cancer progression,
the response to treatment and the function of the immune system. Finally, their
use has also been associated with decreased mortality and a life prolonging
effect in cancer patients.
Conclusions: Studies indicate the use of mindfulness techniques results in a
number of benefits for cancer patients. It is not clear if the identified benefits
are direct via physiological processes or indirect, via modifications of behaviors related to health. It is important to conduct more systematic studies aiming to identify the function of moderating and mediating variables and the
mechanism of the relation between the use of mindfulness techniques and cancer.
PSYCHOLOGICAL SUPPORT PROGRAMME FOR CANCER
PATIENTS UNDERGOING RADIATION THERAPY
Doulgeraki Dora, Kakari Ioanna
401 General Military Hospital of Athens
This exploratory program was based on the collaboration between the
Consultation – Liaison Psychiatry Department and the Radiation Therapy
Department of the 401 General Military Hospital of Athens.
The aim of the project was the psychological support of patients and their families after evaluation of their psychological situation and collaboration within
group meetings with the Radiation Therapy Department, who referred the
patients to us. Those weekly group meetings also functioned as a group of emotional self-expression and personnel release against professional burnout. The
sample consisted of 43 cancer patients, 26 male and 17 female, 53.5% of whom
had a poor prognosis. 48.8% of patients had 2-4 sessions of psychological
intervention, whereas 34.9% had more than 5 sessions. The method of intervention involved individual psychotherapy sessions on which notes were taken and
analysed afterwards, following 11 categories of content analysis.
Results indicate that:
1.Following psychological support, most patients assumed a more positive attitude towards it, despite their initial cautious or neutral attitude, which was
mainly due to prejudice against psychological treatment. 60.5% of patients, as
well as 80% of their family members with whom we had the opportunity to
meet, appeared satisfied with the support programme.
2.Therapeutic intervention with patients required a certain amount of flexibility and smooth collaboration among all members of personnel, as more than half
patients were not aware of their diagnosis (53.5% had little or no information
about thei
THEORY OF PLANNED BEHAVIOUR AS A PREDICTOR OF
INTENTION TO UNDERGO GENETIC TESTING FOR
BREAST CANCER (BRCA1/2) AMONG FEMALE BREAST
CANCER PATIENTS AND FIRST DEGREE RELATIVES
KARVELI Spyridoula, SUTTON Stephen & ANAGNOSTOPOULOS Fotios,
DIVISION OF PSYCHIATRY & PSYCHOLOGY
KING’S COLLEGE LONDON & PANTEION UNIVERSITY
INTRODUCTION: There have been very limited theory-driven efforts to motivate breast cancer patients and/or first-degree relatives to uptake BRCA1/2
gene testing. The purpose of this study was to explore the predictors of intention to undergo genetic testing for breast/ovarian cancer susceptibility.
METHODS: Theory of Planned Behavior (TPB) was applied to identify the
best predictors of intention to have gene testing among 63 female breast cancer
patients and 51 female first-degree relatives of patients suffering from breast or
ovarian
cancer.
RESULTS: Overall, 69.8% of breast cancer patients reported a high intention
to uptake gene tasting, compared to 43.1% of first-degree relatives. The results
of Stepwise Multiple Regression Analysis indicated that for breast cancer
patients intention was predicted by younger age, family history, attitude and
subjective norm (adjusted R2= .51). Concerning first-degree relatives, intention was predicted by attitude, subjective norm and perceived behavioral control (adjusted R2= .75). The components of Theory of Planned Behavior have
been proven to be successful in explaining a high proportion of the variance in
intention to undergo genetic testing.
DISCUSSION: The findings of the study suggest that intention to have genetic testing is higher among breast cancer patients than first-degree relatives and
that these two groups should be treated differently. These findings offer useful
information for genetic counselors concerning the design of successful genetic
counseling sessions and the strategies that need to be used.
THE IMPACT OF ANXIETY AND DEPRESSION AND MEDICATION FOR THESE CONDITIONS ON HEALTH AND
SAFETY IN THE WORKPLACE
Haslam, C., Brown, S., Atkinson, S. and Haslam, R.
Nottingham University and Loughborough University
The prevalence of stress related disorders such as depression and anxiety has
increased considerably in recent years. This has led to a sharp increase in the
number of prescriptions for psychotropic medication to treat these conditions.
But we know little of how the symptoms and the drug treatments impact on
health and safety at work. This research, funded by the UK Health and Safety
Executive, investigated how the symptoms and the medication influence working life.
Twelve focus groups were conducted. Three groups comprised staff from
human resources, personnel, occupational health and health and safety departments, to explore the organisational perspectives on mental health at work.
Nine groups were conducted with employees (drawn from a wide range of
occupational sectors) who had suffered anxiety or depression and were prescribed medication.
Workers were not well informed about their medication and compliance was
poor. Many people stopped taking their medication due to unpleasant side
effects, which included: nausea, headaches and shaking hands. Work performance was thought to suffer due to both the symptoms and medication. Workers
described a range of accidents, which they attributed to their condition or medication, including: falls, minor injuries and accidents while driving. Those
with responsibility for others (health care workers, teachers, managers) presented a particular risk to safety. Health care workers acknowledged that, as
well as placing themselves at risk, they also posed a risk to patients. This
study has provided detailed data on health in the workplace and the results will
inform guidelines for employers and employees.
131
Posters
RESPONSE SHIFT IN QUALITY OF LIFE IN PALLIATIVE
TREATMENT OF SMALL CELL LUNG CANCER PATIENTS
EMPLOYEES ON SICKNESS LEAVE - A SMALL, BUT NOT
STABLE GROUP
M.J. Westerman, T. Hak, B.A.M. The, H. Groen, G. van der Wal
Dept of Social Medicine, EMGO, VU University Medical Center, Van der
Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
Tveito, T.H. and Eriksen, H.R.
Department of Biological and Medical Psychology, University of Bergen
Quality of Life (QoL) is now considered as a necessary end point in clinical trials in cancer patients, and is particularly relevant in small cell lung cancer
(SCLC) patients, who receive in almost all cases only life-prolonging and “palliative” therapy. As yet there is sufficient evidence that changes in QoL scores
do not only represent actual change but also an as yet unknown degree of socalled response shift, caused by the changes in the patients’ standards, values
and concepts regarding QoL.
In our study of “Response shift in Quality of Life in palliative treatment of
small cell lung cancer patients”, a qualitative exploratory longitudinal multiple
case-study with 30 patients (cases), each patient is interviewed five times at
equivalent “assessment points” in their illness trajectory, resulting into a data
base of 150 interviews. Part of this study is an exploration of SEIQoL-DW as
instrument for measuring response shift. SEIQoL-DW allows respondents to
“define” QoL by nominating the five most important aspects of their lives at
that moment (“elicited cues”) and by indicating the relative contribution
(“weight”) of each cue to their overall QoL. Inspection of our data shows indications of different weighting when patients were consistently able to elicited
five cues in their interviews, which could indica
Background: In a previous study we concluded that a group of 10% of the
employees was “responsible” for 82% of the sickness leave (Tveito et al.,
2002). These employees were characterised by heavy physical work, lower
education, and high levels of many health risk factors, such as smoking, low
job satisfaction, sleeping badly, job stress, low levels of physical exercise, and
many subjective health complaints.
The aim of this study was to repeat the survey 2½ years later. Is it still a small
group of workers who is “responsible” for the majority of the sickness leave,
and what characterise these workers? Are they the same workers that were
“responsible” for the sickness leave 2½ years earlier? Is it possible to predict
sickness leave in 2002 from the screening data in 1999?
Method: A survey was done in 13 Norwegian power companies in 1999. 2435
employees (73%) participated. The employees were asked to fill in questionnaires about sickness leave, physical work environment, stress, coping, psychological demands, control, and subjective health complaints. The survey was
repeated in 2002 (n=1168).
Results: Preliminary analysis of the data show that there is still a small group
of employees “responsible” for the majority of sickness compensation, but they
are not the same employees as in the previous survey. Data on characteristics
of these workers will be reported. In addition, data on prediction of sickness
leave in 2002 from the screening data in 1999 will be presented.
THE ROLE OF PSYCHOSOCIAL VARIABLES IN SELF-REPORTED
SYMPTOMS IN THE WORKPLACE
Gail Kinman and Miriam Griffin
University of Luton
Objectives: Research has linked the indoor environment to a cluster of
symptoms that typically grow worse when the individual is in the workplace,
and disappear or diminish when they leave. WThese symptoms are sometimes known as “sick building syndrome” Whilst the label implies that environmental factors cause the symptoms, some studies have highlighted a
strong relationship between demographic and psychological variables and the
reporting of symptoms typical of SBS. Although perceived control at work
and negative affectivity have commonly been linked with self reported health
status in general, little is known about their relationship with self reported
SBS symptoms.
Design: A cross-sectional design was utilised.
Methods: 112 office workers (47% female), working for 3 separate organisations in different buildings, completed a checklist of perceived symptoms typical of SBS. Job satisfaction, job control, job-related mood and negative affectivity were also assessed.
Results: SBS Symptoms were negatively correlated with intrinsic and extrinsic job satisfaction, perceived job control, and job-related enthusiasm and
contentment (all significant at <0.01). Multiple regression analysis showed
that anxiety, low job control, negative affectivity, and young age were significant independent predictors of self reported SBS symptoms. Contrary to previous findings that symptom prevalence is higher in females, no such gender
difference was found. Gender differences in predictors of symptomatology
are explored.
Conclusion: The results of this study suggest that psychological factors, as
well as the objective physical environment, should be considered when investigating SBS. Future research should employ a larger sample and a prospective design in order to further investigate the role of psychological variables
in symptom reporting.
132
GENDER, SOCIO-ECONOMIC CHARACTERISTICS AND WORKING CONDITIONS, WHAT MAKES THE DIFFERENCE ON HEALTH
IN A LONGITUDINAL PERSPECTIVE? THE SOMSTRESS STUDY
Godin I., Fontaine J., Mascagni T., Kittel F.
Ecole de Sante Publique, Universite Libre de Bruxelles, Brussels. Katholiek
Universiteit Leuven, Leuven
Purpose: To study the potential predictive role of gender, socio-economic characteristics and work stress on health.
Background: Numerous studies have shown the importance of health differences according socio-economic and socio-demographic characteristics,
among which gender plays a key role. Besides this corpus of independent variables, we wanted to identify, in a set of prospective data of Belgian workers,
which are the most significant predictors.
Methods: Repeated measures of a survey conducted in Belgium in 2000 and
2001 (Somstress study). Self administered questionnaires were sent to workers,
in a one-year interval. Questionnaires included socio-demographic characteristics, health information, and two models of stress at work, the JDC -S
(Karasek) and the ERI (Siegrist). Paired sample data are available for 1030
workers.
Results: Data from the first measure show clear differences between men and
women for work conditions, stress at- and outside work, as for health. Those
differences are always in women’s disfavour. Same comments can be drawn
from the second measure, but globally gender differences have been narrowed
in a one-year interval.
Logistic regressions on repeated measures indicate that after controlling for
professional and non professional environment variables, gender remains a
powerful predictor for well-being. Women are at higher risk for depression
(O.R.: 1.7, C.I. 95%: 1.0-2.8), anxiety (O.R.: 2.6, C.I. 95%:1.2-5.3), somatisation (O.R.:1.6, C.I. 95%: 1.0-2.7) and chronic fatigue (O.R.:2.2, C.I. 95%: 1.43.7).
Conclusion: Our cross-sectional results indicate important gender variations
in health status, and, in a prospective view, that being a woman is an important predictor of mental-related health problems.
Posters
RELATIVE PREDICTIVE POWER OF PHYSICAL, PSYCHOSOCIAL AND PSYCHOLOGICAL FACTORS IN
DETERMINING LOW BACK PAIN, WORK-RELATED DISABILITY AND SICK LEAVE
Gheldof, E.L.M., Vinck, J., Crombez, G.
Limburgs Universitair Centrum
While there is accumulating evidence that biomechanical or ergonomical
work aspects may trigger initial back injuries, it is widely accepted that psychosocial and psychological factors get the upperhand in predicting and
explaining prolonged back pain (BP), disability, and related work absenteeism.
Objective To determine the relative predictive power of physical exertions,
psychosocial job characteristics and psychological factors (such as pain-related fear) in determining the occurrence of BP, work-related disability and sick
leave in a working population.
Methods The present cross-sectional analyses are part of a larger prospective
cohort-study (Euro Back Unit project) on risk factors for low back pain (LBP)
and prolonged sick leave. 1.325 employees from 10 companies, located
throughout Belgium and the Netherlands, completed the baseline questionnaire. Cases of LBP were defined as workers who reported episodes of BP in
the past and having had at least 7 days of back pain in the previous 12 months.
Results An increased risk of LBP was observed for workers reporting substantial physical risk factors in their job (OR 1.1, 95% CI 1.0-1.1 ), high psychological job demands (OR 1.0, 95% CI 1.0-1.1 ), little opportunities taking training or extra courses (OR 1.5, 95% CI 1.1-2.2), or characterized by high negative affectivity (OR 1.0, 95% CI 0.9-1.0). Employees reporting fear for injury
due to movement and fear for work-related activities seem to constitute a highrisk group for experiencing work-related disability (OR 1.1, 95% CI 1.0-1.1
and OR 1.1, 95% CI 1.0-1.1) and prolonged sick leave (>30 days previous 12
months, OR 1.1, 95% CI 1.1-1.2 and OR 1.2, 95% CI 1.1-1.2 respectively)
Conclusions The occurrence of LBP seems to be influenced by biomechanical,
psychosocial and psychological factors, while work-related disability and prolonged sick leave are mainly determined by factors referring to pain-related
fear. This is consistent with the overall assumption that biomechanical factors
are relatively more important in the initial phases of problematic LBP, while
psychosocial variables are more important in determining the further course of
the problem.
LEVELS OF JOB SATISFACTION, WORK STRESS AGENTS
AND COPING MECHANISMS EXPERIENCED BY GREEK
LAWYERS
*ANTONIOU, A.-S., **LOUMAKOU, M, ***POLYMERI-THEODOSI, K.
& ****SINTZANAKI, K.
*UNIVERSITY OF MANCHESTER & SCIENTIFIC ASSOCIATION FOR
REGIONAL DEVELOPMENT AND MENTAL HEALTH - **UNIVERSITY OF THESSALY- ***UNIVERSITY OF MIDLESSEX - ***UNIVERSITY OF ATHENS
Objectives: The underlying purpose of this study was to identify the main jobrelated stressors in a random sample of lawyers practicing in a big city of
Greece.
Participants: 103 lawyers were randomly selected, 51 (49,5%) male and 52
(50,5%) female, between 22 - 68 years old. The sample consisted of articled
clerks, lawyers in the Court of First Instance, lawyers in the Court of Appeals
and lawyers in the Supreme Court.
Measures and Design: A questionnaire was constructed after personal interviews with the participants consisting of four distributing scales: a) physical
symptoms, b) occupational stress, c) job satisfaction and d) coping strategies.
The questionnaire also included a detailed demographic scale.
Results: The responsibility of protecting the client’s lawful rights, the frequency and the pressure of deadlines, being undermined by senior colleagues and
the relative neglect of personal life were the most frequently reported stressors.
Marital status proved to be a less determining variable while gender was related to particular stressors. Job satisfaction was related to the recognition of quality performance and the variety of cases in women, while in men it was related to professional opportunity and job security. Significant relationships
between job status and job satisfaction were also reported.
Conclusions: More variables likely to affect job related stress and job satisfaction must be considered in order to draw more reliable conclusions and make
more accurate predictions. For this reason, the use of supplementary measures
and the comparison of findings to international corresponding data will be beneficial.
COMPREHENSIBLE, MEANINGFUL AND MANAGEABLE?
- THE ROLE OF SENSE OF COHERENCE IN WELL-BEING
AT WORK
SOCIAL HINDRANCE, SOCIAL SKILLS AND SOCIAL
GOALS FACILITATION: DIRECT AND MODERATING
EFFECTS ON WELL-BEING
Gail Kinman
University of Luton
Simone Akerboom, Stan Maes
Clinical & Health Psychology Section, Leiden University, The Netherlands
Background
Sense of Coherence (SOC) has been described as a generalised resistance
resource for coping with life stress and remaining healthy. It is thought to function in two ways: a) the stronger the SOC the greater the well-being (main
effects); and b) SOC buffers the impact of stressors on well-being (stress moderator) As yet, however, little research has investigated the moderating role of
the SOC in an occupational setting.
Aims
The aim of this study was to explore the role played by the SOC in the relationship between work-related stressors and health.
Methods
465 lecturers working in Colleges and Universities in the UK (60% male) completed measures of perceived work-related stressors, SOC, physical health and
psychological health (context-free and work-related).
Results
SOC was inversely related to perceived stressors, and positively related to psychological and physical health. In general, SOC moderated the relationship
between stressors and health: however, respondents with a strong SOC seemed
better protected from the adverse effects of some stressful work characteristics
but not others. Many of these relationships were gender related, e.g. males with
a high SOC were better protected from the negative impact of time management stressors, whilst females suffered less ill-effects from work-home conflict.
Background. In studies modeling the effect of workplace social interactions
attention has been restricted to the positive social interactions at work: social
support. As a result, the extent to which negative social interactions at work
(that may in itself be a powerful stressor), and individual characteristics (that
may help or hamper social interactions) moderate the effect of job demands,
control and social support on well-being, has not been determined.
Objective. The aims of the study were twofold: First, to examine the extent to
which social hindrance has an adverse effect on well-being and a moderating
effect on the relation between the JDCS-constructs and well-being. Second, to
examine the extent to which social skills and social goals facilitation has a beneficial effect on well-being and a moderating effect on the relation between
social support/hindrance and outcomes.
Method. A cross-sectional self-report questionnaire study completed by 1113
health care workers measuring (1) the JDCS-constructs based on Karasek’s
(1985) Job Content Instrument; (2) social hindrance with the scale Social
Hindrance of the Organizational Risk Factors Questionnaire (Akerboom &
Maes, 2003); social goals facilitation with the scales Social Approach Goals
and Social Avoidance Goals of the Goal Facilitation Inventory (Maes et al.,
2002); social skills with the scale Self-assertion derived from the Scale for
Interpersonal Behavior (Arrindel et al., 1988); job satisfaction; burnout (MBINL); and (psycho)somatic complaints (SCL-90).
Results. The data indicated that both social hindrance, social skills and social
goals facilitation were directly linked to wellness-health outcomes, and had
moderating effects on the relationship between JDCS-constructs and outcomes.
133
Posters
MENTAL HEALTH, JOB SATISFACTION AND COPING
STRATEGIES OF GREEK TEACHERS IN SECONDARY EDUCATION
JOB DISSATISFACTION, PHYSICAL SYMPTOMS AND
COPING STRATEGIES OF GREEK DENTISTS PRACTICING PRIVATE DENTISTRY
ANTONIOU, A.-S., GIACHNAKIS, E., ANTONODIMITRAKIS, P. &
KONTOS, CHR.
UNIVERSITY OF MANCHESTER & SCIENTIFIC ASSOCIATION FOR
REGIONAL DEVELOPMENT AND MENTAL HEALTH, UNIVERSITY
OF CRETE
*ANTONIOU, A.-S., **KOBOLI, D., **ORFANIDOU, A., & **MANTZAVINOS, Z.
REGIONAL DEVELOPMENT AND MENTAL HEALTH - **UNIVERSITY OF ATHENS
Objectives: This study investigates the occupational stressors and coping
strategies in relation to the job satisfaction and mental ill-health of a sample of
Greek teachers. The relevant literature indicates that teachers serve one of the
most demanding professions. In studies conducted in the US, the UK and
Australia, teachers characterised their profession as particularly stressful.
Methods: The sample consisted of 517 teachers (288 male and 229 female)
working in schools of secondary education. In order to explore the above
parameters, they completed the Teachers’ Occupational Stress Scale
(Antoniou, 1998) and the Occupational Stress Indicator (OSI), including the
dependent variables of job satisfaction, mental and physical ill-health, and the
independent variables of sources of stress in the job, stress coping mechanisms,
demographics and attitudinal variables.
Results: According to the results, the serious occupational stressors for teachers were student discipline, lack of educational materials and technical support,
together with the low status of the profession. Bivariate analysis revealed that
there were significant differences between the two genders on certain aspects
of the OSI. Multivariate analysis showed that job satisfaction was predicted by
the demands of the profession, great volume of work and lack of power and
influence. Mental ill-health were predicted by the demands of the profession.
Conclusions: Overall, Greek teachers presented significantly lower levels of
job satisfaction and significantly higher levels of mental ill-health and sources
of pressure than the normative population and other relevant samples. The findings are discussed and recommendations for stress prevention in the teachers’
profession are given.
Objectives: The underlying purpose of this study was to determine job dissatisfaction and physical symptoms experienced by Greek dentists practicing private surgery and, furthermore, to identify their coping strategies.
Participants: The sample included 124 dentists working in the greater area of
Athens, practicing private surgery. It was randomly selected and consisted of
50 (40,3%) male and 74 (59,7%) female dentists aged between 25 - 68 years
old.
Measures and Design: The study was based on a questionnaire, which consisted four distributing scales: a) work related sources of stress, b) job dissatisfaction, c) physical symptoms and d) coping strategies. Prior to the original study,
a pilot study was conducted with a sample of 10 dentists in order to make
changes to the questionnaire. The questionnaire also included a detailed demographic scale.
Results: Opportunity to demonstrate competency, low pay rates, difficulty in
communicating with colleagues, recognition of good performance and working
conditions, were among the most important factors for dentists’ job dissatisfaction. The most frequently reported physical symptoms were tiredness and
headaches, tobacco, alcohol and food over consumption, and sleeping difficulties. The commonest coping strategies were listening to music, excursions,
sharing the problem and communicating with colleagues. Men were more job
dissatisfied than women, whereas women were experiencing significantly more
physical symptoms than men.
Conclusions: Differences in the way stress is experienced in Greek dentists are
noted as compared with the international literature. The results of this study
will help shed light to the particular stressors that Greek dentists experience
and examine ways that these stressors can be alleviated.
LEVELS OF MENTAL AND PHYSICAL HEALTH AND JOB
SATISFACTION AMONGST GREEK POST EMPLOYEES
MENTAL HEALTH AND THE WORKPLACE FOR HIV-POSITIVE PEOPLE
ANTONIOU, A.-S., **ORFANIDOU, N., ***POLYMERI-THEODOSI, K.
& ****LOUMAKOU, M.
REGIONAL DEVELOPMENT AND MENTAL HEALTH - **UNIVERSITY OF ATHENS - ***UNIVERSITY OF MIDLESSEX - ****UNIVERSITY OF THESSALY
Ch. Papathanasiou
Scientific Assistant, Department of Sociology, National School of Public
Health, Greece
Objectives: The main aim of this study was to investigate the levels of psychosomatic health of Greek postal employees and their job satisfaction deriving
from the general job conditions. Several European and US studies in the past
have indicated that psychiatric and psychological problems in this population
were related to the difficult working conditions and a number of risk factors.
Design: In accordance with other research in the area, standardised questionnaires were administered to a sample of Greek Post Office employees in different positions in order to explore certain parameters of their mental and physical health as well as the levels of their job satisfaction.
Method: Along with a demographical questionnaire data was also obtained by
administering the following specific scales in order to assess the above variables: a) the Crown-Crisp Experimenatl Index (Crown & Crisp, 1979) and b)
the Job Satisfaction Scale (Warr et al., 1979). The sample consisted of 414
employees (271 males and 143 females) who worked in the delivery service
and administration.
Results: Statistical analyses showed that the majority of postal employees who
participated in this study demonstrated high levels of anxiety and depression as
indicated by the above measurements. In addition, they were satisfied from his
job especially concerning the interpersonal relationships with their colleagues
and supervisors. Conversely, they reported dissatisfied from the general conditions of their work and the security issues.
Conclusion: The findings are discussed in comparison with the existing international literature and recommendations for stress prevention techniques in the
postal services are given.
134
AIMS: To identify the changes occurring in the professional life of HIV-positive people, the possible actions of exclusion from their workplace and the
impact in their mental health.
METHODS: The research was carried out in France and Greece in 2001. It was
based on semi-directed interviews with HIV-positive individuals as well as
activists of non-governmental organizations against AIDS.
RESULTS: The main findings indicate that people from the moment they are
infected by HIV, are faced with the dilemma of whether to conceal or reveal the
fact of their contamination. There are a few people who choose to risk their
position by revealing their HIV-positive status. Most of them appear to be
reserved and they keep their contamination secret, mainly due to social discrimination. They always have to be careful in the way they talk or act, which
apparently causes them a great deal of stress and as a result it has a negative
effect on their health.
CONCLUSION: The development of campaigns focused on a model of solidarity towards HIV-positive people in the workplace, seems to play an important role in the formation of attitudes on behalf of the professional entourage of
an HIV-positive employee.
Posters
COMPARISON OF THE STRESS LEVELS IN NURSES
WORKING IN THREE DIFFERENT SANITARY CONTEXTS
CAREGIVER DISTRESS IN STROKE: A LONGITUDINAL
EVALUATION OF KARASEK’S JOB STRAIN MODEL.
Chiambretto Paola#, Beltrami Silvia**, Cauteruccio Maria Antonella*,
D’Alisa Simonetta°
Health Psychologist;#Psychology unit, Vitaresidence Nursing Home.
Guanzate. Italy**Psychology unit, ASO “Maggiore della Carità” Novara. Italy*Cardiology Rehabilitative. Mormanno Hospital. Italy
°Department of Neurology and Neurorehabilitation. Istituto Auxologico
Italiano IRCCS, Piancavallo (VB), Italy-
Molloy, GJ1; Johnston, DW2; Johnston, M2; Morrison, V3; Pollard, B1;
Bonetti, D1; Joice, S1; McWalter, R4.
University of St Andrews1, University of Aberdeen2, University of Wales3,
University of Dundee4.
Literature regarding the risk for the mental health nurses, highlights the importance of factors related, to their professional role, their responsibilities, and to
the style of organisation; clarity of objectives and sense of belonging. This situations can lead to increased risk of accident, high levels of burn out, or
increase frequency of absenteeism, higher turn over, lack of motivation. The
aims of this study were: to assess the burn out levels in a sample of nurses, and
to verify the relationship of burn out levels are significantly linked to age, gender, years of experience and quality of team work.
Maslach Burnout Inventory questionnaire, (MBI, Maslach and Jackson, 1986)
and the Team Climate Inventory (TCI, Anderson and West 1994), a facet specific measure of the level and quality of team work, were administered to 21
nurses working in coronary unit, 10 in a rehabilitation department, 21 in a long
stay unit.
Twenty-six percent of the subject showed definitely high MBI score; gender,
time occupational, and working context did not show significant different in
MBI subscales. MBI score was mildly related to age (rho= .32 p<.05). TCI
scores are still under analysis
JOB-RELATED STRESS FACTORS, JOB SATISFACTION
AND COPING STRATEGIES OF GREEK JUDGES
ANTONIOU, A.-S., LOUMAKOU, M., KIRILLIDOU, V. & POLYMERITHEODOSI, K.
*SCIENTIFIC ASSOCIATION FOR REGIONAL DEVELOPMENT AND
MENTAL HEALTH- **UNIVERSITY OF THESSALY- ***UNIVERSITY
OF ATHENS- ****UNIVERSITY OF MIDLESSEX
Objectives: The underlying purpose of this study was to identify the sources of
job-related stress and the levels of job satisfaction experienced by Greek
Judges. This study also aims to describe the coping strategies ?f Greek judges
and examine the relationship of stressors with personality, general behaviour
and physical health.
Participants: 81 Judges in civil and criminal courts from Athens and
Thessalonica were randomly selected, 53 (65,4%) male and 28 (34,6%) female,
between 36-68 years old.
Measures and Design: A questionnaire was constructed after personal interviews with the participants consisting of four distributing scales: a) physical
symptoms, b) occupational stress, c) job satisfaction and d) coping strategies.
The questionnaire also included a detailed demographic scale.
Results: The number and difficulty of cases, constant preoccupation with cases
at home and relationships with colleagues were among the most serious jobrelated stressors. Job satisfaction was related to working conditions, freedom of
communication and recognition of quality performance. The most frequent
coping strategies were dealing with the problems themselves and the recognition of personal limits. Job satisfaction and job stressors were related to professional experience, while there were no significant differences concerning gender and age.
Conclusions: More than 50% of the sample of the study reported experiencing
high levels of occupational stress during the previous months of the study. It is
envisaged that the findings of this study will heighten awareness of the stressors that Greek judge’s experience and provide suggestions for improvement of
working conditions and reduction of stress levels.
Objectives: A specific occupational theory of stress, Karasek’s Job Strain
model, and novel measurement of predictor variables (Demand and Control)
were used in an attempt to extend previous work examining the psychological
impact of informal caregiving in stroke.
Design: Cross-sectional and longitudinal analysis of change in Demand and
Control were used to predict emotional distress in stroke caregivers over a period of 3 months.
Method: 172 informal caregivers of stroke survivors were interviewed at two
time points: 2 weeks (Time 1), 8 Weeks (Time 2) following patient’s discharge
from hospital. The dependent variables were the caregiver’s anxiety and
depression (Hospital Anxiety and Depression scale). The predictor variables
were caregiver Demand (stroke survivor’s assessment of their physical and
psychosocial functional limitations) and Control (caregiver’s perceived control
over stroke survivor’s recovery).
Results: In cross-sectional analysis of Time 1 and Time 2 data, demand and
control related as predicted to anxiety and depression, but the interactions predicted by the theory were not found. In analysis of change between time 1 and
time 2, it was found that decreasing control along with increasing demand was
associated with reduced distress.
Conclusion: The predictor variables in the Karasek model were successful in
predicting emotional distress. However this study highlights the complexity of
the relationship between perceived situational control and emotional distress in
caregiving. The results are discussed in terms of the goodness of fit between
control cognitions and the controllability of the situation and potential interventions to reduce emotional distress in stroke caregivers.
INVESTIGATION OF OCCUPATIONAL STRESS FACTORS
AND LEVELS OF JOB SATISFACTION EXPERIENCED BY
GREEK NURSING STAFF
ANTONIOU, A.-S., GIACHNAKIS, E., ANTONODIMITRAKIS, P. &
KONTOS, A.
UNIVERSITY OF MANCHESTER & SCIENTIFIC ASSOCIATION FOR
REGIONAL DEVELOPMENT AND MENTAL HEALTH, UNIVERSITY
OF CRETE
Objectives: The main purpose of this study is to investigate the occupational
stress factors and the levels of job satisfaction experienced by Greek hospital
nurses and assistant nurses.
Methods and Materials: The present study included 425 nurses and assistant
nurses (response rate 87%), who worked outside the prefecture of Attica. The
Nurse Stress Index (NSI, a=0,9) and the Job Satisfaction Scale (Warr et al.,
1979) were used for the date collection which took place during April 2001.
Results: Descriptive and inferential statistics (t-test, ANOVA) were used, and
the level of statistical significance was defined at p= .05. “The lack of organizational support”, “not being able to participate in decision-making”, “managing overload” and “dealing with patients and their relatives” were the most significant occupational stress factors reported by the participants. In specific,
females and married nurses appeared to experience significantly increased levels of occupational stress. Generally, the overall job satisfaction of this sample
showed to be at moderate levels. Females presented higher levels of job satisfaction than their male colleagues. Job satisfaction was related to interpersonal
relationships, organizational procedures, personal achievements and development and the nature of the profession.
Conclusions: The relatively high levels of stress experienced by nurses and
assistant nurses can affect their efficiency, having adverse effects on the quality of nursing care they provide. As regards the moderate levels of job satisfaction experienced by them, hospitals’ management should be targeted towards
the improvement of the general working conditions
e
135
Posters
PREDICTORS OF HEALTH STATUS IN POLICE OFFICERS
Nina Oginska-Bulik, Zygfryd Juczynski
Institute of Psychology, University of Lodz, Poland
AIM The purpose of the study was to establish:
1. the raltionship between work stress, burnout syndrome and general health
status in police officers
2. the impact of interaction of perceived job stress and burnout syndrome on
health status
3. predictors of health status in examined group of policemen.
METHOD The sample consists of 277 policemen (mean age was 35.6). The
following techniques were used in the study: * The Perception of Work
Characteristics (Dudek et al.) to determine level of work-related stress *
Maslach Burnout Inventory (MBI by Maslach, Jackson) to measure three
symptoms of burnout syndrome: emotiomal exhaustion, depersonalization and
lack of personal accomplishment * General Health Questionnaire (GHQ-28 by
Goldberg) to assess general health status and its four dimensions.
RESULTS The results obtained indicate for significant relationship between
perceived job stress, burnout syndrome and health state in examined group.
Emotional exhaustion, lack of personal accomplishment and two factors related to stress appeared predictors of general health status in polcemen.
STRESS, STRESSORS AND COPING IN PORTUGUESE
HEALTH PROFESSIONAL - CONSTRUCTIVIST-DEVELOPMENTALIST APPROACH
Santos, Margarida; Barros, Luisa
Lisbon University
The most recent approaches conceptualize occupational stress as the result of a
transaction between professional demands and a worker’s cognitions and coping abilities.
The constructivist-developmentalist perspective defends that these individual
cognitions (significations) can be structured in levels that, similar to Piaget
conceptualization, are progressively more complex, flexible and integrative.
Stress and coping strategies are then perceived differently in each level of
development.
OBJECTIVE: The central objectives of this study are: (1) to identify levels of
perceived stress and self-efficacy; and, (2) to analyse, under the constructivistdevelopmentalist perspective, the significations of 150 Portuguese Health
Professionals ( 54 Pharmacists; 55 Physiotherapists; 41 Radiotherapists), about
three potential stressful situations (dilemmas) at work, namely: an interpersonal conflict; overload; and dealing with a terminally ill patient.
METHOD: The participants (1) were asked to answer a demographic questionnaire that included two subjective scales on stress and self-efficacy and (2)
were given the three dilemmas and asked to write about their perceptions of
those situations, and their ways of dealing with them. The significations were
then analysed by means of a developmental sequence (Joyce-Moniz, 1993)
already used in several similar studies (Barros, 1992; Grilo, 1999; Nordeste,
1997; Santos, 1997).
RESULTS: The results showed that different occupational groups used different levels of significations in the three dilemmas. These differences may be due
to occupational characteristics and cultural as well as professional education
issues, and can be responsible for different ways of perceiving and reacting to
stressful situations at work.
136
OCCUPATIONAL STRESS IN A PORTUGUESE SAMPLE OF
HEALTH PROFESSIONALS — STRESS, STRESSORS AND
COPING IN PHARMACISTS, PHYSIOTHERAPIST AND
RADIOTHERAPIST
Santos, Margarida; Barros, Luisa
Lisbon University
BACKGROUND: In recent years a large number of studies have pointed out
the effects of occupational stress both on the health of health professionals, and
on the quality of patient care (Caplan, 1994; Firth-Cozens and Greenhalgh,
1997; Wall et al, 1997). Occupational stress is also recognised as having serious costs for Health Organizations (Hackett, and Bycio,1996). The majority of
these studies have identified sources of stress and coping resources in health
professionals and its results emphasised differences in the individual appraisal
of stressores which, to some extent, may be due to demographic cultural and
professional issues. These results, may be of importance in the development of
more effective interventions to reduce stress among these professionals
OBJECTIVE: The main purposes of the present research are to identify levels
of perceived stress; self-efficacy and job satisfaction, as well as to identify
sources of stress and coping resources on a sample of Portuguese health professionals.
METHOD: A convenience sample of 150 participants ( 54 Pharmacists; 55
Physiotherapists; 41 Radiotherapists) answered a questionnaire including:
demographic variables; three subjective scales (for stress; self-efficacy and job
satisfaction); a occupacional stressors inventory; and the Coping Resources
Inventory for Stress (Matheny, Curlette, Aycoc, Pugh e Taylor, 1987, adapted
to the Portuguese population by McIntyre, Silverio e Figueiredo,1995)
RESULTS: The results show that differences in professional occupation, as
well as in some demographic variables, may influence subject’s identification
of sources of occupational stress. As for the coping resources, the results reinforce the conclusions of other similar Portuguese studies (McInthyre, 1999)
that suggested the importance of cultural issues.
HOUSEWIFE BURNOUT
RODRIGUEZ M;N, J.; PASCUAL GOMEZ, E.; MARTIN ARAGON, M.T.,
y LLEDO, A.
Department of Health Psychology, “Miguel Hernandez” University. Centro
“Dr. Esquerdo”. Diputacin de Alicante.
Burnout has been described as a dysfunctional response to chronic stress in
human-service professions . Since caring for the family can be considered
a human-service profession, burnout is associated to a number of adverse
health conditions and over 9 million Spanish women are housewives,
researching housewife burnout becomes interesting.
HYPOTHESIS
Some women with paid job consider themselves housewives. Housewives
present burnout..
No differences in burnout symptoms between full-time and part-time housewives. Burnout associates to work conditions. Burnout symptoms relate to
adverse health and family function 1726 questionnaires housewife-addressed
were distributed in school and community centres. 364 voluntary and anonymous women composed study sample. Aged 21-74, lived in Alicante, average
aged 43, 75% married. Measure instruments included an Ad-Hoc questionnaire for sociodemographic and housework data, GHQ-28 (Goldberg 1972-79)
and CAGE (Leckman et al, 1984) for health status, anxiety and depression,
APGAR (Smilstein et al, 1988) for family function, and MBI (Maslach,
Jackson, 1986) for Burnout. Data treatment through SPSS included
Descriptive, Difference, Correlation and Regression Analysis between fulltime and part-time housewives.
RESULTS
47% spent <6 hours daily in housework ,36% rarely disposed of economic
independence;71% without house-help, 40% overloaded. Scarce significant
differences between groups in housework tasks. In family function, health
and burnout symptoms, fulltime housewives, higher anxiety.. Burnout symptoms relate to work conditions and presence of health problems. 1.9% of the
study sample present burnout syndrome
CONCLUSIONS.
It is necessary to revise traditional housewife concept and pursuit researching
housewife burnout.
Posters
A STRESS MANAGEMENT PREVENTION PROGRAM FOR
TEACHERS AND HEALTH PROFESSIONALS
JESUS, S. N., & PACHECO, J. E.
UNIVERSITY OF ALGARVE
Previous research show that teachers and health professionals presented high
levels of stress and burnout.
This study describes a stress-management program that was prepared and
implemented in an attempt to reduce professional stress.
The 30-hour program was divided into ten sessions that included thematic exercises on a variety of topics: sharing professional experiences with colleagues,
identifying specific stress factors and possible coping strategies, replacing irrational beliefs with more appropriate beliefs, and practising assertiveness and
relaxation.
This program was implemented in some groups of teachers and health professionals.
Some indicators of stress levels was assessed in the beginning and at the end of
the training program. Following the course, participants showed a significant
decrease in their irrational beliefs and professional distress, as well as an
increase in professional motivation and the perception of well being.
JOB STRESS IN THE NURSING PROFESSION
Tanya Gelsema, Stan Maes, Simone Akerboom
Clinical- and Health Psychology
Objectives:
The purpose of this study was to discover the most important occupational
determinants of job stress in the nursing profession.
Methods:
Participants are recruited from a large academic hospital in the
Netherlands. The sample consists of 900 nurses in different functions and
disciplines. Job satisfaction, burnout (MBI; Schaufeli & Dierendonck, 1997)
and health complaints (SCL-90; Arrindel & Ettema, 1986) are measured as
outcome variables. To gain insight in the specific sources of stress a
tailor-made and comprehensive instrument is developed and used. The
following work characteristics are measured: personnel resources, workload,
social support supervisor, social support co-workers, decision authority,
communication, skill discretion, material resources, financial reward,
physical exertion, home/ work conflict, procedures, cooperation with
doctors.
Results:
Correlation and regression analysis are performed to determine the factors
associated with nurses job satisfaction, burnout and health complaints. Most
variance is explained in job satisfaction, least variance is explained in
health complaints.
Conclusions:
For more “emotional” outcome measures like emotional exhaustion, mental
well-being and general health, work-home conflict was the most important
determinant. For work related outcome measures like job satisfaction, skill
discretion was the most important determinant. Other occupational factors
related to outcomes of job stress, were social support of supervisors,
physical exertion, workload, financial reward, communication, personnel
resources, social support colleagues, and cooperation with doctors.
EXPLORATION OF STRESSFUL AGENTS IN THE WORKPLACE AND JOB DISSATISFACTION OF GREEK NURSING
STAFF
WOMEN IN MEDICINE: A PILOT STUDY EXPLORING
PREGNANCY
COMPLICATIONS
AND
OUTCOMES
AMONGST FEMALE PHYSICIANS IN HUNGARY
ANTONIOU, A.-S., GIACHNAKIS, E., ANTONODIMITRAKIS, P., KONTOS, A.
& THEODOSI-POLYMERI, K.
Zsuzsa Gyorffy and Szilvia Adam
Women in Medicine: A Pilot Study Exploring Pregnancy Complications and
Outcomes amongst Female Physicians in Hungary
Objectives: The main purpose of this study is to investigate the occupational
stress factors and the levels of job satisfaction experienced by Greek hospital
nurses and assistant nurses.
Methods and Materials: The present study included 425 nurses and assistant
nurses (response rate 87%), who worked outside the prefecture of Attica. The
Nurse Stress Index (NSI, a=0,9) and the Job Satisfaction Scale (Warr et al.,
1979) were used for the date collection which took place during April 2001.
Results: Descriptive and inferential statistics (t–test, ANOVA) were used, and
the level of statistical significance was defined at p= .05. “The lack of organizational support”, “not being able to participate in decision–making”, “managing overload” and “dealing with patients and their relatives” were the most significant occupational stress factors reported by the participants. In specific,
females and married nurses appeared to experience significantly increased levels of occupational stress. Generally, the overall job satisfaction of this sample
showed to be at moderate levels. Females presented higher levels of job satisfaction than their male colleagues. Job satisfaction was related to interpersonal
relationships, organizational procedures, personal achievements and development and the nature of the profession.
Conclusions: The relatively high levels of stress experienced by nurses and
assistant nurses can affect their efficiency, having adverse effects on the quality of nursing care they provide. As regards the moderate levels of job satisfaction experienced by them, hospitals’ management should be targeted towards
the improvement of the general working conditions.
BACKGROUND: Half of deceased female physicians in Hungary die before
retirement age. High prevalence of role conflict may be causally linked to
increased morbidity and mortality. Reconciling profession with the role a
woman has to fulfil in the family has special significance in life of female
physicians.
AIM: The central questions of the present study are the prominent amount of
medical and obstetrical complications between female physicians.
STUDY DESIGN: The basis of present study is a qualitative survey. In 2002,
a structured in-depth interviews was conducted amongst 43 female physicians
and 59 female chemists. The interview asked for information on personal and
professional demographics, career satisfaction, childbearing and child-rearing.
RESULTS: Physicians reported high level of role conflict, stress, anxiety and
exhaustion. Problems related to pregnancy or childbirth occured in 74% of
cases. 47% of had particular pregnancy complications: diabetes, pregnancyinduced hypertension, toxaemia. 27% had problems between pregnancies or
during childbirth (prematurity, spontaneous and therapeutic abortions, dead
foetus syndrome, extrauterine pregnancy). We have to emphasize the fact that
most interviewees attached the same importance to harms at workplace (roentgen rays, infections, stress and physical strain) as the organic diseases.
Primigravida women who delivered during the residency training had higher
percentages of low birthweight infants who showed intrauterine growth retardation.
CONCLUSION: We identified among our survey increased risk of pregnancy
complications. The authors conclude that engagement, depression and distress
besides the difficulties in starting career may engender the insecure condition
of female physicians during pregnancy.
137
Posters
EVOLUTION OF ALCOHOL DEPENDENT PATIENTS IN
POST -CURE
EVALUATION OF DRUG PREVENTION PROGRAMS IN
HUNGARY
J.BROCKLY, B.DROUET, A. WOLKE-LENTZ, L.D’APOTE, E.SPITZ
Université de Metz
DEMETROVICS, Zsolt (1) - PAKSI, Borbala (2) - CZAKO, Agnes (3)
The aim of this research is to study the importance of goals and health behavior goal change among alcohol dependent patients.
The sample consisted of forty men following a post-cure after an alcoholic
weaning in hospital.
Personal goals assesment constructed by Maes, Sweeney and Gebhart (1998)
from human goals taxonomy of Fords and Nichols (1991) and General Health
Questionnaire, GHQ-28 of Goldberg and Williams (1988) was proposed during
first week of their post-cure (T1) and after two at three month of care (T2).
The results showed that towards self assertive social relationship goals and
wish organize efficaciously their activities. Their general health improve. They
feel physicaly and psychicaly better.
For future researches, it would be interesting to include studies about thrapeutic interventions.
PSYCHOTHERAPY OF SOBER ALCOHOLICS - FAMILY
VIOLENCE OFFENDERS AND CHANGES IN THEIR FAMILY
SYSTEM
Lucyna Golinska, Dorota Dyjakon
University Of Lodz
Theoretical base of the research is McMaster’s system theory of the family
modified by Cierpka. In this theory family system is described by 7 factors,
such as task performance, roles, communication, control, emotionality, emotional relationships, values and norms. It was hypothesised that violence caused
by an alcoholic during his drinking phase had fixed consequences for relationships within the family. A change in the system requires that an offender stops
performing violent acts, but also works through his guilt feelings and compensates for injuries and suffering of his relatives.
Twenty men, sober alcoholics, were included in the study. They finished their
therapy of addiction and have been sober for at least 8-10 months. Before the
therapy they were family violence offenders. Wives and children over 14 years
of age also took part in the research.
There were three phases of the study: before the psychotherapy programme,
immediately after the programme and three months later.
Research method included: Questionnaire of family by Cierpka and Frevert,
consisting of a description of relationships within the family from the subject’s
perspective, self-description of one’s own functioning in the system and a
description of the way a subject’s functioning was perceived by other family
members.
Psychotherapy programme included the phase when an offender identified
himself with his violence (breaking of the denial) and took over responsibility for its consequences.
Several important changes in the family system were found, namely in task performance, family roles, control and emotionality. These will be described and
discussed in details.
138
1) Eotvos Lorand University, Institute of Psychology, Department of
Personality and Health Psychology; (2)Budapest University of Economic
Sciences and Public Administration, Behaviour Research Centre; (3) Budapest
University of Economic Sciences and Public Administration, Sociology and
Social Policy Department
Background: While several drug prevention programs - based on different theories, approaches and methods, offered to different target groups - have been
established in Hungary in the past 10-15 years, no evaluation has happened on
this field yet.
Goal: The aim of our work was to analyze and evaluate school prevention programs operating in Budapest, targeted directly at students (5-12 grade).
Process: When defining the main stages of the research and selecting the appropriate methods we applied the evaluation recommendations for drug prevention programs issued by the European Monitoring Centre for Drugs and Drug
Addiction and took the national experience gained in other non-profit fields
into consideration.
Subjects: We involved the leaders of the organizations, the animators, and the
target population. Data was collected of 44 different programs, while process
and outcome evaluation was carried out in the case of seven programs. Method:
We evaluated the theoretical background of the programs based on structured
information sheets. The organizational evaluation was based on the interviews
with the program leaders and the analysis of other documents. During the
process evaluation we applied different methods such as structured monitoring,
short survey of the animators to test subjective ndicators, post-questionnaires
for the students to follow the reactions. The outcome evaluation was based on
the pre- and post-questionnaires of the students which contained questions to
the final and specific objectives of the programs as well. We completed the
quantitative results with the qualitative information of the focus-group interviews among the students. Results, consequences: Beyond collecting and
describing the programs to the registry our research highlighted that the different evaluation aspects complete each other. If we take them out of the context
and try to apply individually we can only receive partial information about the
program. The survey also pointed out that it is of great importance to know the
target population when evaluating the effective intervention.
REMISSION OF DEPRESSION IN DRUG ADDICTS’
PATIENTS’ MOTHERS: ROLE OF SPIRITUAL BEILIEF
Anna Grazia Lecca
University of Southampton
The effects of religious belief and religious practice on the remission of drug
addicts’ patients’ mothers diagnosed with depressive disorder were assessed at
admission and treated with 25 sessions of weekly group-therapy.
One group of 20 drug-addicts’ mothers of which 13 maintained a form of spiritual belief and religious practice and 7 without, participated extensive in-depth
interviews and answered questionnaires during their rehabilitation programme
in a residential community for remission from drug misuse.
In a wide range of issues addressed, participants were asked to describe their
belief, their personal experience of God, their closeness to Him and their commitment in faith. Secondly, interviewees were asked to fill in questionnaires
related to their psychological well-being.
Case reports show a positive association between religious experience as
source of serenity, peace, hope for the future and psychological well-being in
those mothers with spiritual belief. On the contrary those without spiritual
belief displayed much more a sense of anger, hopelessness, despair, sorrow,
resentment and desolation with a higher level of emotional distress
Posters
WHAT PROTECTS WOMEN FROM BECOMING ADDICTIVE?
Alexa Franke
University of Dortmund
Objective: Based on Antonovskys model of salutogenesis we conducted two
studies that focused on the comparison of women with either an insignificant
or a significant consumption of alcohol and medicaments (prescribed medicines).Research questions were: 1.Under which conditions do women use alcohol or medicaments “adequately”, without harmful, but rather positive effects?
2. Which conditions enhance the risks of the development of addictions?
Methods: We constructed a questionnaire that focused on the living conditions
of women - resistance resources, stress, load balances, areas of participation
etc. A representative sample of 1777 German women aged between 20 and 65
years could be compared regarding sociodemographic parameters, their living
conditions, social and psychological variables, sense of coherence, substance
expectancies and motivations for consumption, coping and the consumption of
alcohol and medicaments.
Results: The results showed numerous differences between female consumers
of either alcohol or medicaments, which enhanced according to the amount of
substances taken. From a salutogenic viewpoint the following variables could
be identified as being protective against the development of an addiction:
Being married and living in a partnership, Load balance of stress and resources,
especially concerning social burdens, Strong Sense of Coherence, Positive attitudes towards the pleasures of life, Competent coping with emotions, Little
expectancies in the capabilities of substances to change emotions and/or feelings, Subjective contentment with own mental health.
SOCIAL SUPPORT IN SUBSTANCE DETOXIFICATION
AMONG YOUNG PEOPLE: TOWARDS AN INTEGRATIVE
MODEL OF ADDICTION
Cedric E.Ginestet, Sarah Heke & Tony Cassidy
Purpose: To qualitatively evaluate the current utilisation and potential use of
social support by young people undergoing outpatient substance detoxification
treatment.
Design: An unfolding design incorporated the content analysis of semi-structured interviews in order to evaluate the impact of social support upon selfreported qualitative evaluation of treatment services.
Methods: Interviews were conducted with 14 young adults who were undergoing an outpatient detoxification treatment programme but were not yet discharged at the moment of the study. Demographic data in conjunction with
qualitative measures of psychological functioning and utilisation of social support throughout treatment were content analysed o identify the significance of
this variable in terms of treatment outcome, treatment evaluation, attitude
towards staff and relapse prevention.
Results: Content analysis of the participants’ comments revealed that social
support was related to a more positive evaluation of service provision. Social
support also indicated more recognition of staff efforts and appeared to act as
a protecting factor against further relapse.
Conclusion: These outcomes stress the need to move away from the medical
conceptualisation of addiction in order to adopt a more integrated model of
addiction, incorporating social support among others socio-economic variables.
Such a model will allow the division of multilevel interventions, which are
required to fully exploit protective factors such as family and spouse support
throughout and after treatment.
PERSONAL RESOURCES OF ALCOHOL DEPENDENT
PATIENTS AND THEIR ABSTINENCE AFTER PSYCHOTHERAPY
Barbara Mroziak
Institute of Psychiatry and Neurology, Warsaw, Poland
The aim of the study was to check for psychological variables important for
maintaining abstinence after psychotherapy of alcoholism. The theoretical
frame of reference was the model of stress by Lazarus and Folkman, including
sense of coherence, primary appraisal of stressful situations, coping styles, and
psychopathological symptoms severity.
A 6-week inpatient psychotherapy program had been completed by 219 alcoholics examined before and immediately after therapy with a set of questionnaires. At 1-year follow-up 101 alcoholics responded to the questionnaires
mailed to all the therapy completers, and 70% of the respondents declared
maintaining abstinence over the year. Pre-and post-treatment scores of the 70
abstainers (55 men, 15 women) were compared with these of 118 patients who
had completed therapy but failed to participate in the follow-up (presumably
due to a relapse of drinking).
The sense of coherence was measured using Antonovsky’s SOC-29
Questionnaire, primary appraisal - the CTL (Challenge-Threat-Loss) Scale by
Sęk and Szaładziński, coping styles - the CISS scale by
Endler and Parker, and symptom severity - the Hopkins Symptom Checklist
(HSCL) by Derogatis, adapted by Siwiak-Kobayashi.
Statistical analyses inticate that primary appraisal of stress was the only variable signifcantly differentiating between these groups, both before and after
therapy: abstainers tended to perceive stressful situations significantly more as
a challenge and significantly less as a threat or loss than did therapy completers
who presumably relapsed. None of the remaining variables under study was
significantly related to abstinence maintenance.
THE IMPACT OF SELF-AFFIRMATION ON ALCOHOLRELATED RISK PERCEPTIONS AND INTENTIONS
Lucy Napper and Dr. Peter Harris
Self-affirmation is activated by threats to the perceived integrity of the self and
functions to re-establish an experience of the self as adaptive, competent and
morally adequate (Steele, 1988). Very few studies have investigated self-affirmation in relation to health, with self-affirmation being found to reduce the
defensive processing of health-related messages in the few that have (Reed &
Aspinwall, 1998; Sherman, Nelson & Steele, 2000). This study extends previous findings by looking at the impact of self-affirmation on intentions, and risk
perceptions and optimistic bias over time. Female students (N=74), divided
into low and high alcohol consumption groups, took part in what they were told
were two separate studies. First, participants were randomly assigned to either
self-affirm an important value or to a control condition, which involved writing about an unimportant value. Subsequently, participants read information
highlighting the link between drinking alcohol and breast cancer. High alcohol
consuming self-affirmed participants were found to make significantly higher
risk judgments than those who were not affirmed. This difference persisted
over a 1-month period. Self-affirmation did not reduce high alcohol consuming
participants’ optimistic bias. Self-affirmed high alcohol consumers were also
found to have greater intentions to reduce their alcohol consumption, than were
their non-affirmed counterparts. These results suggest that self-affirmation can
have a prolonged impact on participants’ risk perceptions and increase the
intentions to reduce drinking behaviour in those most at risk of developing
breast cancer as a result of their drinking behaviour.
139
Posters
SOCIAL AND PSYCHOLOGICAL CHARACTERISTICS
ASSOCIATED WITH THE HIGH FREQUENCY-LOW
QUANTITY DRINKING PATTERN
SUBSTANCE ABUSE CONSULTATION IN THE ACUTE
CARE HOSPITAL: A TRAINING OPPORTUNITY FOR
HEALTH PSYCHOLOGISTS
Jensen, H.H., Mortensen, E.L., Sanders, S.A. & Reinisch, J.M.
Department of Health Psychology, University of Copenhagen; Danish
Epidemiology Science Center; the Kinsey Institute, University of Indiana
Brenda Chabon, Ph.D.; Salaheddine Ziadeh, M.A; Evy Cathrine Strugstad,
M.A.; Pejman Sehatpour, M.D.
Department of Psychiatry and Behavioral Sciences, Division of Addiction
Medicine
Albert Einstein College of Medicine/Montefiore Medical Center
Several studies suggest that potential health beneficial effects of alcohol are
associated with frequent consumption of low quantities. We addressed the issue
of drinking patterns in a sample of 694 young Danes, 29-34 years of age. Based
on typical weekly alcohol consumption, the sample was split with respect to
frequency (F) and quantity (Q). After median splits, low F-low Q and high Fhigh Q drinkers were excluded, leaving 151 male and 114 female social
drinkers in the present study. 52 males and 57 females were low F-high Q,
while 99 males and 57 females were high F-low Q. The data showed a number
of expected sex differences with respect to drinking patterns, but for each sex,
the total weekly volume of consumption was identical for high F-low Q and
low F-high Q drinking patterns. Socioeconomic status, education, IQ, personality, and health related behaviours were analyzed. High F-low Q was significantly associated with a preference for wine, high education, high verbal IQ,
low disinhibition, low exhibition, and low affiliation (among
women, also with higher parental social status). A significantly larger proportion was living with a partner, was physically active, and was less likely to have
tried marijuana or other illicit drugs. Although psychological crises were more
often reported among high F-low Q, and high
F-low Q women obtained higher mean scores on neuroticism, our overall interpretation is that the high F-low Q drinking pattern in Denmark is associated
with more optimal social and psychological functioning.
Acute care hospitalizations for persons with substance abuse disorders represent a substantial burden on the health care system accounting for 20 50% of
hospital admissions in the U.S.. The hospital admission provides an opportunity to engage patients in substance abuse treatment at a moment of potentially high motivation. Because of their training in how biological, psychological,
and social factors affect health and illness, and their interest in helping people
to make changes in their health behaviors, health psychologists have expertise
that is well suited to the treatment of addiction. In 1999, the Department of
Psychiatry at Montefiore Medical Center in the Bronx, NY formed an inpatient
Substance Abuse Consultation and Referral Service (SACRS) to improve the
quality of patient care for substance abusers admitted to the acute care hospital
with medical conditions. SACRS is staffed by an attending clinical health psychologist, a social worker, and a physician. SACRS has provided clinical services to over 1,500 medical inpatients with substance abuse disorders. SACRS
has also developed clinical training programs for psychologists, psychiatry and
family medicine residents. The inpatient SACRS experience offers psychology and medical trainees the opportunity to provide hospitalized patients with
psychosocial care specifically related to their drug use and ongoing medical
problems, provide consultation services to hospital inpatient staff, and facilitate entry into substance abuse treatment. Multidisciplinary training in a clinical and academic setting is needed to provide exposure to the medical and psychosocial consequences of drug addiction, and should be incorporated into the
mainstream educational curriculum for psychologists.
PARENTAL INFLUENCES INSTEAD OF PEER INFLUENCES AS PREDICTORS OF SMOKING ONSET; THE
RESULTS OF SIX EUROPEAN COUNTRIES
SOCIOECONOMIC DIFFERENCES AND STRESS PREDICT
SMOKING IN A REPRESENTATIVE SAMPLE OF HUNGARIAN POPULATION
Hein de Vries (1); Ph.D.; Math Candel (1) , Ph.D; Stef Kremers,
Ph.D., (1), Aart Mudde, Ph.D (1); Rutger Engels, Ph.D. (2)
1; Maastricht University; 2; Nijmegen University
Robert Urban and Bela Marian
Eotvos Lorand University and Marketing Centrum
An alternative to peer pressure as an explanation for similarities between adolescent and peer smoking is the selection of smoking friends by a (smoking)
adolescent and parental influences. The goal of this study is to examine
whether smoking onset in young adolescents is predicted by peer or parental
smoking.
Questionnaires were distributed to schools during the autumns of 1998 (t1) and
1999 (t2). In total 7927 adolescents from six European countries (Finland,
Denmark, the United Kingdom, the Netherlands, Spain, Portugal) were followed in a multi-centre two-wave prospective study. The complete case analysis, consisting of a total sample of 7242, was used for the structural equation
analysis using AMOS 4.0. The participating samples were recruited in Finland
(N = 1228), Denmark (N = 560), the Netherlands (N = 2057), Portugal (N =
918), Spain (N = 668) and the United Kingdom (N = 1814).
Several models were tested and will be discussed; the model with the lowest
Bayes information criterion (Bic) score was chosen, since this is the best indicator to compare non-nested designs.
The resuls showed no support for peer smoking as an important predictor of
smoking onset in all six countries in our sample. The best fitting models suggested support for the selection paradigm, suggesting that adolescents choose
their own behaviour, and then select their (smoking) friends. Support for the
impact of parents on adolescent behaviour and the choice of friends was also
found.
In conclusion, our results suggest that the social influence paradigm needs revision. More attention should be paid to the impact of parental influences and
self-selection mechanisms. The implications for innovations for smoking prevention approaches will be discussed.
140
Objectives: The smoking behavior has a major impact on the health of the society. Our research was designed to analyze the socioeconomic determinants of
smoking behavior in a representative sample of Hungarian population.
Methods: In the cross-sectional research design, we collected data related to
smoking behavior, indicators of socioeconomic status, and an indicator of
stress in a representative sample (N=1987, age over 18 years) of Hungarian
population.
Results: In this sample, the rate of smoking was 38 %, and the rate of ex-smoker was 17 %. We examined the significant predictors of smoking as a dichotomous variable with a logistic regression analysis. The model shows that being
male, younger age,lower education, self-rated lower income, place of residence
in the capital versus countryside, and high level of stress are significant risk for
smoking (R2=0,15).
Applying a multinomial logistic regression in order to predict heavy smoking,
light smoking, being an ex-smoker shows that these different types of smokers
have different patterns of socioeconomic and psychological stress factors.
The model increases its power to predict smoking status (R2=0,20), showing
the strong effects of socioeconomic variables on smoking.
Conclusion: In the prevention strategies of smoking, it is important to take the
socioeconomic differences into the consideration.
Posters
FETAL HEALTH LOCUS OF CONTROL, SMOKING AND
OTHER
HEALTH
BEHAVIOUR
IN
PREGNANCY
REDUCING SMOKING IN SMOKERS NON INTENDED TO
QUIT
Lawrence, W. and Haslam, C.
University of Southampton and University of Nottingham
Gremigni P., Rothlin U.M.*, Sommaruga M.**
Faculty of Psychology, University of Bologna; *EOSS-Ecce Omnibus
Sanitas, Como-Roma; **Maugeri Clinical Foundation, Tradate, Italy
Maternal smoking is associated with infant mortality and morbidity and is most
prevalent among younger women of low social class and low educational
attainment. But it is unclear whether maternal smoking is associated with
other health compromising behavior and health beliefs. A survey of 1203
pregnant women in the UK assessed smoking status, smoking stage of change,
fetal health locus of control, alcohol consumption, folic acid intake, and use of
vitamin and iron supplements.
Compared to ex and never-smokers, smokers were more likely to: be unmarried (p<0.001); be living with someone who smokes (p<0.001); be of lower
social class (p<0.001); have high external FHLC scores (p<0.05) and have finished education by 16 years of age (p<0.001). Pregnant smokers (especially
those in the precontemplative stage) were less likely to increase folic acid
intake, less likely to take vitamin and iron supplements (p<0.001) and less likely to feel personally responsible for the health of the fetus (p<0.005).
These findings suggest that infants of smokers may be placed at an intrauterine
disadvantage, not only in terms of smoking, but also in terms of nutrition. This
supports the argument that pregnant smokers should be targeted with information during antenatal care that both educates them about the dangers of maternal smoking and addresses their health beliefs. The results also suggest that
pregnant smokers need advice on adequate nutrition during pregnancy.
OBJECTIVE: Although the acquitted smoking related damages to the individuals’ health, about one third of the population do smoke and half of the smokers have not any intention to quit. The general objective of this study was to
promote a reduction of smoking in those who do not intend to quit, in order to
make them aware of the benefits of reducing their habit and to promote their
progression to the intention stage. The more specific objective was to verify the
efficacy of a food integrator as adjuvant in smoking reduction among healthy
smokers not determined to quit.
METHOD: Fifty healthy regular smokers, 17 men and 33 women, mean aged
39.24 years, participated in a single blind experimental study. Twenty-seven of
them were randomly assigned to the experimental group (EG) and 23 to the
control group (CG). The EG used the oral spray food integrator as an adjuvant
in smoking reduction, while the CG used a placebo. 70.4 percent of smokers in
EG reduced their smoking at the end of the 14 days treatment, while 52.2 percent in CG showed similar results. This reduction involved the men more than
the women in both the groups.
CONCLUSION: Results of this study seem encouraging, as they showed the
possibility of helping smokers not determined to quit to reduce the number of
cigarettes, without experiencing those symptoms that usually discourage any
attempt to quit. A follow up study has been designed to assess both maintenance of reduction and progression towards intention to quit.
SMOKING INTENTION IN MALE AND FEMALE YOUNG
ADULTS
LEVEL OF SELF-DETERMINATION IN ADULTS QUITTING
SMOKING
NERINI, A., NOCCHI, F., STEFANILE, C.
DEPARTMENT OF PSYCHOLOGY - UNIVERSITY OF FLORENCE
Marina Guerra, Marina Lemos, Cristina Queirs, Manuel Rosas
Oporto University, Faculty of Psychology and Educational Sciences; Pedro
Hispano Hospital
Cigarette smoking seem to be one of the primary preventable cause of mortality and morbidity (Crawford, 2001).These findings increased the development
of smoking prevention and health promotion programs (Biener, McCallum,
Keeler and Nyman, 2000). A better comprehension of the determinants of
smoking intention seems to be important to increase the efficacy of these intervention programs (Nguyet et al., 1998).
The aim of the present study was to identify the predictors of smoking intention in male and female young adults. This research wants to analyse
whether the intention to adopt this risk behavior was associated with the variables from the Theory of Planned Behavior (TPB) (attitudes toward behavior,
subjective norms, perceived behavioral control), risk perception, self-efficacy
and self-esteem.
Method
A sample of about 300 young smokers completed the Italian version of a questionnaire based on Ajzen’s TPB (1991), the Rosenberg Self-Esteem Scale
(Rosenberg, 1965) and the General Self-efficacy Scale (Sibilia, Schwarzer and
Jerusalem, 1995). The data have been subjected to multiple regression analysis.
Results
Risk perception and subjective norms (family influences) emerge as significant
predictors of smoking intention (p<.05). Self-esteem influences the intention
to quit smoking (p<.05). Perceived behavioral control seems to be a significant
predictor of smoking behavior (p<.01). Gender differences will be presented.
Conclusions
A better comprehension of smoking intention determinants in young males and
females could contribute to increase the efficacy of smoking prevention and
health promotion programs. Further research is needed to lend additional support to our findings.
Self-Determination Theory (SDT) assumes that psychological health and wellbeing are intimately related to individual’s autonomy or self-determination
(Deci & Ryan, 2000; Ryan & Deci, 2000). In particular, individual’s self-determination has been associated with health care behaviors, such as “quit smoking”. In an ongoing research project, we have tried to understand smoking cessation by examining the degree to which the individual shows an autonomous
(intrinsic and internalized reasons) versus controlled (extrinsic and coercive
reasons) regulation of behavior in this domain. The aim of the present study
was to characterize the motivational orientation (in particular the degree of
autonomy) of a group of smokers entering a clinical cessation program. The
degree to which a person’s motivation for not smoking is relatively
autonomous, will bear important implications for planning intervention, with
high
levels
of
autonomy
facilitating
optimal
outcomes.
We evaluated self-determination for not smoking using TSRQ ( Williams, Cox,
Kouides, & Deci, 1999; Ryan & Connell, 1989) sub-scales: autonomous orientation, controlled orientation, and a motivation applied in a sample of adults in
a clinic trial for smoking cessation. Perceived competence, which is also
emphasized by this theory, (SDT) was also assessed using related questionnaires (the PCS). We constructed Portuguese versions of these instruments, and
analyzed alpha reliabilities. Moreover we examined differences in initial motivations, related to social, physical and psychological individual characteristics,
such as sex, age, fargerstom test, number of cigarettes per day, number of years
smoking.
Results will be discussed in light of SDT theoretical framework.
141
Posters
AN ANALYSIS OF THE INTENTION-BEHAVIOUR RELATIONSHIP AMONG DAILY SMOKING UNIVERSITY STUDENTS
EXPLORING CROSS-CULTURAL DIFFERENCES IN ATTITUDES TOWARDS SMOKING: THE CASE OF UK AND
HELLAS. RESEARCH REPORT
Inger Synnøve Moan & Jostein Rise
National Institute for Alcohol and Drug Research - Norway
Christina Gramandani, Alexandra Leontiadou, Aikaterini Kourea, Eleni Louki,
Efrosini Mpoutou, Elsa Koppasi & Marina Economou,
University Mental Health Research Institute
In this study we want to explore the intention-behaviour relationship among
daily smoking students using an extended version of the Theory of Planned
Behaviour. Firstly to explore two potential self-regulating strategies: (1) implementation intentions and (2) negative anticipated emotions. The idea is that
those who furnish their quitting intentions with implementation intentions, will
exhibit greater intention-behaviour consistency. Likewise, those who intend to
quit and anticipate experiencing negative emotions if they do not succeed quitting, will exhibit higher intention-behaviour consistency. Secondly to attempt
to discern the sources of both consistency and discrepancy between intentions
and subsequent action by identifying four subgroups: inclined actors, inclined
abstainers, disinclined actors and disinclined abstainers. We will also assess
which available predictors discriminate best between the four subgroups using
discriminant analysis.
The data collection is currently being finalised. The first questionnaire survey
was sent to students via e-mail in November 2002, and the follow-up questionnaire survey was sent 6 months later, in the end of May (the respondents had
agreed to participate in a second questionnaire when the first survey was conducted). We have received 698 filled in questionnaires from 245 women (mean
age = 26.68, SD = 7.43) and 453 men (mean age = 26.77, SD = 7.28). The TPBvariables was measured in November 2002, and the second questionnaire contained the following measures: some control questions to test whether the participants were consistent (e.g. gender, age, smoking history and earlier quit
attempts) and actual behaviour.
A survey about lifestyles within the European Union conducted by Eurostat
confirms differences in smoking behaviour between UK and Hellas with the
Hellenic population having the worst smoking record among all the European
countries . This research report demonstrates the findings of a pilot study within a group of 16-18 adolescents from UK and Hellas in order to explore potential cross-cultural differences in attitudes towards smoking . The theory that
provides the most appropriate context without the limitations of a specific culture is George Kelly’s (1955) personal construct theory . Kelly’s repertory test
is applied for eliciting personal constructs about smoking from smokers, non
smokers and ex-smokers in both countries , by using pictures of smoking situations as common sets of photo -elements . The qualitative analysis of the result
suggests that there are some limited cross-cultural differences in attitudes adolescents have. However, these differences do not represent a different way of
construing about smoking, but they reflect the absence of social policy in
Hellas compared to the growing anti-smoking policy in UK , on the other hand
. Additionally , the adolescents in both countries have construed in a similar
way about smoking , irrespective of their smoking status which suggests that
they are psychological similar in a Kellyian sense. Nevertheless, they have different indiosyncrasies hence explore the word in a , perhaps , different way and
they cannot be viewed as a homogenous group. Finally this study suggests that
blaming adolescents for their smoking behaviour or trying to protect them in an
unrealistic way is not productive . It would be more fruitful for educators to
apply Kelly’s approach to health promotion in order to explore individual differences and place the emphasis on personal growth, development and empowerment of the individual
COGNITIVE ASPECTS OF ANOREXIA NERVOSA
USING PROBABILISTIC NEURAL NETWORKS TO PREDICT EATING DISORDER OUTCOME.
Aurora Szentagotai Tatar
Member of European Health Psychology Society
There is growing evidence that since the changes in popular culture, former
socialist countries have followed the Western tendency to over evaluate thinness as desirable and equivalent to feminine attractiveness. Altogether
research suggests that after the political changes, the vulnerability for eating
disorders has spread from certain segments in society (the student population)
to other segments, and eating disorders may be as common in the reform
countries as in Western Europe. Thus, there is an increasing need in these
countries for developing research focused on the important health problem of
eating disorders.
Cognitive theories of anorexia emphasize the importance of specific cognitive
schemata, representing the nucleus, and possibly, playing a causal role in the
etiology of the disorder. The functioning of these schemata produces systematic errors in information processing.
The objective of this research was to assess the characteristics of the intentional forgetting effect for food related stimuli in a group of anorexics, compared to a control group. Verbal and imagistic stimuli were used, in order to
ensure a higher ecological validity. Our main hypothesis was that there would
be no intentional forgetting effect for food material, in the case of anorexic
subjects.
Variance analysis, as well as between and within group comparisons, were used
in order to analyze the data. Results confirmed our hypothesis, and can be interpreted in terms of a low inhibitory capacity for food related stimuli in anorexics, or in terms of a higher level of activation of the material representing a central preoccupation of anorexic subjects.
142
Emma Vince, Dr Sarah Milne, Dr Ian Walker
University of Bath
Eating disorders are complex multi-factorial disorders, which still have no substantial explanation for their cause. Any explanation that attempts this will have
to take into account not only the large number of individual risk factors, but
also the interactions between these factors. Most of the research in the risk factor domain has only taken a handful of these factors at any one time to investigate their impact on eating disorder outcome. This paper presents work using a
new technique in health psychology, probabilistic neural networks
Once these have been trained on a data set, the can predict the most likely outcomes from novel data. This research trained a network on a large set of data
and then presented hypothetical cases to explore the links between the risk factors and the outcomes in the data set. Several interesting findings emerged from
this analysis. For example, the impact of average to extreme weight and shape
issues lead to a different eating disorder classification than the impact of
extreme family issues. In addition, regarding substance use, it was found that
very extreme substance use lead to a specific eating disorder outcome.
However, very low substance use lead to a more unspecific eating disorder outcome, and an average level of use predicted a non disordered outcome, suggesting that there seems to be an average level of substance use seen in adolescents
that is not pathological.
The paper concludes with a discussion on the implications and benefits of
applying neural networks to health promotion and the prediction of health
behaviour.
Posters
THE IDENTIFICATION OF EMOTIONS IN TWO DIFFERENT
POPULATIONS: ANORECTIC AND NON ANORECTIC GIRLS
Sandra Torres*, Marina Prista Guerra*, Leonor Lencastre*, Roma Torres** & Isabel
Brandão**
*Faculdade de Psicologia e de Ciências da Educação da Universidade do Porto
** Hospital de S. João- Porto
TRANSVERSAL AND LONGITUDINAL TRENDS AMONG
SOME PSYCHOPHYSIOLOGICAL MEASURES IN SUBJECTS WITH EATING DISORDERS UNDER COGNITIVE
BEHAVIOURAL THERAPY
Fiori E., Frassi F.N., Pruneti C.A.
Universita degli studi di Parma
Objectives: The main objective of this study was to analyze: a) the ability of feeling and
identifying emotions and, b) the variability of emotions felt in the anorectic and non
anorectic girls.
Methods: Participants The experimental group was formed by 70 Anorexia Nervosa
(AN; DSM-IV criteria) female patients, aged between 12 and 34 y.o, with an average
age of 19.07. The control group was constituted by 100 female subjects without AN
diagnosis, aged between 13 and 34 y.o, with an average age of 18.86.
Procedures and measures The part II of the Emotional Evaluation Questionnaire for
Anorexia Nervosa (QAE-AN), developed by Torres & Guerra, was applied to both
groups. The part II of this questionnaire includes 11 questions describing common situations in AN. Each situation was developed to stimulate one of the 11 primary emotions
defined by Izard (1991): interest, joy, surprise (these are considered positive emotions),
anguish, anger, disgust, contempt, fear, shame, sadness and guilty (these are considered
negative emotions). In each situation, subjects must identify: a) if they feel any emotion
or not, b) in case of an affirmative answer, which one is the main primary emotion.
Results: The Pearson Chi-Square Test (independency test) was applied to analyze the
differences between anorectic and control groups in relation to the signalized emotions
on the 11 questions. The results indicated significative statistically differences in questions referring to these emotions: interest (sig.,002), anger (sig.,000), surprise (sig.,000),
anguish (sig. ,004), disgust (sig.,000), fear (sig. ,000) and guilty (sig. ,000). In these
cases, Adjusted Residual were compared and analyzed in order to identify the specific
emotions witch present significative differences between anorectic and non anorectic
girls.
Conclusions: In a significant number of questions we can conclude the tendency of
anorectic subjects to indicate negative emotions, even in those that might stimulate positive emotions, like interest and surprise. In contrast to what we expected we observed
a high frequency of “I do not feel anything” as answers in the control group, probably
because the stimulus were chosen thinking in problems of anorectic girls. These observations suggest the anorectics’ ability of feeling and identifying emotions. Nevertheless
the type of emotions felt seem to be different from the normal population.
In order to use information which is becoming more and more objective regarding the variables involved in psychotherapeutic change, this preliminary study
has compared some psychophysiological responses measured by the psychophysiological profile (PPP) in 13 subjects during cognitive-behavioural
treatment. The three sessions of PPP were recorded in two groups of subjects:
5 Bulimia Nervosa patients (5 F; mean age 29±10,29), 8 Anorexia Nervosa
patients (1 M, 7 F; mean age 22,8±3,48) during the “assessment” phase, after
4 months and again after 8-10 months from the beginning of therapy. The following parameters were continuously monitored: the electromyogram of the
frontal muscles (EMG), the skin conductance response (SCR), the peripheral
temperature (PT) and the heart rate (HR). The PPP was registered for a period
of 16 minutes divided into Baseline phase (6 min), Stress presentation (4 min)
and Recovery (6 min), after a short adaptation phase (3-4 minutes). The first
PPP recorded was compared with the two subsequent control records by means
of the “paired sample t test”, both in a longitudinal sense (before-after), in
order to evaluate the three PPP phases mean differences, and in a transversal
sense in order to evaluate the internal parameter configuration of the same
PPP. The implications of the present findings for clinical practice and treatment verification are discussed.
EATING ATTITUDES OF ELITE, FEMALE ATHLETES AND
NON-ATHLETES.
DIET CONCERNS AND WEIGHT CONTROL STRATEGIES
IN ELITE, FEMALE ATHLETES AND CONTROLS.
Anastasia Soureti, Pavlo Kanellakis
City University & Royal Free Hospital, Eating Disorders Unit.
Anastasia Soureti, Pavlo Kanellakis
City University & Royal Free Hospital, Eating Disorders Unit.
Aim
To compare top athletes (elites) competing within different sports and non-athletes on psychological and behavioural indices of disordered eating and to identify those participants who showed symptoms of anorexia nervosa (AN).
Design
Between-groups comparison of eating attitudes and weight concerns among a
group of elite athletes competing in (a) aesthetic sports (gymnasts, ballet
dancers), (b) ballgames (basketball players) and (c) a control group.
Methods
One hundred and four female, Greek athletes (elites) and 70 female, high
school students (controls) participated. The Drive for Thinness (DT) sub-scale
of the Eating Disorders Inventory, the Eating Attitude Test 26 (EAT-26) and
several demographic indices were administered to athletes and their non-athletic counterparts. Between-subject factor MANOVA was used to test the differences on eating attitudes and weight concerns between athletes in aesthetic
sports, ballgames and the control group.
Results
Group participation had a significant effect on the EAT-26, its sub-scales and
the DT. Elite basketball players appeared to have the healthiest eating attitudes.
From athletes participating in aesthetic sports, gymnasts scored significantly
higher than basketball players and the control group in most psychological
indices, whereas ballet dancers only scored significantly higher than their nonlean athletic counterparts. When cut-off points on the EAT-26 and DT were
considered, Chi-Square suggested that a high proportion of athletes in lean
sports, especially gymnasts, scored at the range indicative of AN.
Conclusion
Counselling should be targeted at those athletes, especially gymnasts, identified in this study as being at high risk of developing disordered eating patterns.
Aim
To identify differences in body mass index (BMI), diet concerns and weight
control strategies between elite, female athletes competing in aesthetic sports
(ballet dancers, gymnasts), athletes competing in ballgames (basketball players) and a control group.
Design
A Chi-Square was used to compare differences between group participation,
BMI and diet concerns and a between-subject factor ANOVA to investigate differences in weight control strategies between athletes in different sports and
their non-athletic counterparts.
Methods
A hundred and four female, Greek athletes (elites) and 70 high school students
(controls) participated in the present study. A questionnaire was administered,
which included three questions on dieting concerns and a weight control questionnaire created by the first author for the purpose of this study (Alpha = 0.83).
Results
BMI scores indicated that most athletes and non-athletes were underweight or
of normal weight with gymnasts being the slimmest. The majority of young
female athletes and controls wanted to lose weight. However, only a small proportion of the control group and basketball players had tried to lose weight in
the last 6 months in contrast to about 60% of ballet dancers and gymnasts.
ANOVA also suggested that athletes in aesthetic sports reported the highest frequency of the total number of weight control strategies with exercise being the
most frequently reported method to lose weight by all groups.
Conclusion
Nutritional counselling should be targeted at those athletes competing in aesthetic sports so that their present diet patterns do not lead to more extreme
weight control strategies.
143
Posters
ANXIETY AND EATING BEHAVIOUR: RISK FACTORS FOR
EATING DISORDERS IN A SAMPLE OF PROFESSIONAL
DANCERS
CASTELLI E., FIORI E., AND PRUNETI C.
THE EFFECT OF MULTIPLE MEDIA EXPOSURE ON PEOPLE’S BODY IMAGE.
Alicja Glebocka
University of Opole
Purpose: Taking into consideration the aesthetic similarities between anorexics
and professional dancers, this study aims to identify possible analogies
between these two groups.
Methods: With this aim in mind, a sample group of 32 dancers was recruited
along with a clinical group of 14 patients diagnosed with anorexia nervosa
(following the DSMIV criteria, American Psychiatric Association, 1994).
The following tests were administered to both “groups”: 16-Personality
Factors, form A (16-PF), Pisa Stress Questionnaire (PSQ), Symptom
Questionnaire (SQ) e Pisa Survey for Eating Disorders (PSED), in order to
observe personality traits, life styles with a high risk of stress-correlated physical disorders, present symptomatological state and common components such
as anxiety, depression, somatic disorders, hostility, self perception of bodily
form and eating habits.
The mean values and the relative standard deviations were calculated for both
the experimental and clinical groups. Successively the Mann-Whitney statistic
test was used in order to compare the experimental sample (the dancers) with
the control group (the patients); furthermore, thanks to a preliminary factorial
analysis, Kendall’s Tau b and Spearman’s Rho were calculated, for those scales
which were able to differentiate between the two groups examined.
Conclusions: Potential analogies relative to personality traits, life style, somatic symptoms and all the factors which can raise the “risk” of an eating disorder
pathology are discussed.
The purpose of this study was to examine the relation between media exposure
and dissatisfaction with physical attractiveness, occurred in young women and
men. Many researches confirm the contrast effect resulting in lower self-esteem
with respect to physical attractiveness among girls watching ideal body standards in tv-programs. The assimilation effect was also noticed among girls who
perceived similarities between their owns appearances and the appearances of
ad’s models. Although the comparison of ideal body standard and dissatisfaction with body image impacts more frequently women, men are not free from
the influence of media exposures embodying the male ideal-body image. While
preparing this study we selected four blocks of 20-minutes long programs, presenting: TV-ads, video clips, fashion, and fragments of movies. Each of these
programs showed a number of physically attractive women and men.
IDEAL BODY IMAGES OF FEMALE BODY SHAPE IN
NORMAL AND PATHOLOGICAL GROUPS.
A NEW THEORETICAL APPROACH TO THE COGNITIVE
INFORMATION PROCESSING IN EATING DISORDERS AND
BODY DYSMORPHIC DISORDER
Alicja Glebocka, Jaroslaw Kulbat
University of Opole
The purpose of this study was to indicate the similarities and differences of
ideal body images possessed by normal and pathological female groups. We
were also interested in the discrepancy between the evaluation of individual
and ideal body images and in the level of knowledge of owns body size. This
research was conducted in Poland and included several groups of participants,
e.g.: 13-14 years old pupils, university students, obese people attempting to
reduce their weight by undergoing a low calorie treatment, and young girls suffering from anorexia. Using two sets of 9 figure drawings arranged from very
thin to very heavy body shape we collected data supported women’s dissatisfaction with their body image and different ideal body images among female
groups. The results seem to be very important for explanation the mechanism
of development of eating disorders.
144
After the exposure several measure was taken, e.g.: own attractiveness, body
parts satisfaction, effectiveness of body shape control methods and needs to
improve own physical appearances, self-esteem, mood, and anxiety.
Not only effects of single exposure were analyzed but also cumulative effects
of multiple presentation of all blocks.
Liza Lukács, Ferenc Túry
Semmelweis University, Institute of Behavioural Sciences
A new theoretical cognitive model is introduced in eating disorders – summerizing the main causes and processes of typical symptoms. This theoretical
approach represents a health psychological view and based on system theory. It
discusses the general areas of cognitive functioning, coping strategies, self discrepancies, explicit and implicit memory, the functioning and the contents of
self-schemas, self-evaluating deficits relation to eating and body-dysmorphic
disorders. The background of these processes may be understood only on the
basis of coordinated mental activity. We are also going to emphasize the procedural knowledge like action-based memories in the form of motoric skills,
habits, rules, and strategies for making judgements relevant to body image disturbance. Present theoretical methods cannot handle all these aspect of eating
and body dysmorphic disorders.
A clearer understanding of the role cognitions and information processing play
in the development and maintenance of eating disorders will hopefully allow
for more focused treatment interventions, and help to predict individuals who
are at risk for eating problems.
Posters
HEALTH RISKS IN YOUNG MEN: BODY IMAGE DISORDERS AND MUSCLE DYSMORPHIA AMONG HUNGARIAN
MILITARY COLLEGE STUDENTS
Ferenc Túry, Liza Lukács, Attila Argalász, István Murányi
Semmelweis University; Bolyai Military High School; Institute of Sociology,
University of Debrecen
Aim. Health risks of young men are only seldom analyzed, although they have
certain risk factors. Muscle dysmorphia, a specific disorder of body builders is
a new form of body image disorders. So far, no epidemiological assessment of
muscle dysmorphia was published in Central-East Europe in a college population.
The aim of the study was to detect body image disorders and muscle dysmorphia among military college students in Hungary. Our hypothesis was that body
building and related body image disorders are more prevalent in a population
where the physical strength is a usual requirement.
Method. A questionnaire screening was performed including demographic
data about eating and physical activity, eating attitudes, gender role, and personality inventories.
Results. The total number of students was 838, while the study population contained 550 students (the response rate was 65.6%). The body mass index of the
total population was 23.23 kg/m2. There were no anorectic or bulimic subject
in the study group. 34% of the subjects are actually engaged in body building,
and 22.4% has already stopped it. 18 subjects (3.3%) took or are actually taking anabolic steroids. The prevalence of muscle dysmorphia was 0.7% among
males (4 subjects among 550).
Discussion. The proportion of body building is very high in this population,
and it seems to be an important risk factor of body image disorders among
young males. The prevalence of body dysmorphia reveals that this new phenomenon can be found also in Central-East Europe in young male populations
CONNECTIONS OF SPEED, POSITION OF THE POINT, EYE
CONTACT AND HEAD MOVEMENTS IN HUMAN SPEAKING
Maria Barra
Assistant Professor (College of Communication, Budapest), 2nd year
Ph.D.student (Semmelweis University, Budapest, Institute of Behavioral
Sciencis)
According to my research there are some constant and well differentiable relations between different features of human speaking and nonverbal behavioral
signs. This poster is to show what we can find when comparing the speed of
speech as a constant with the position of points, eye contact and head movements. A videotaped sample was made of 50 adults all taking a 3 minutes
speach in front of a small audiance. Selecting the 2nd minute of all performances,the speed of speech was defined by syllables/minute and three categories
were set up: slow, normal and quick speakers. The speed of speech as a constant was then compared with the position of the full-stops - which can be left
high, floated or down. Then the eye contact was observed: number and direction of breaking in the same interval. At last the movements of the persons head
were examined, also by number and direction. Statistical analysis is still in
progress but early results show some important relations between these different features of nonverbal communication.
CROSS CULTURAL DIFFERENCES IN HEALTH AND OPTIMISM
Franziska S. Reschke (University of Halle-Wittenberg), Alevtina SiniakovaSonn (University of Leipzig), Dr. Konrad Reschke (University of Leipzig)
University of Leipzig, University of Halle
Objective: The attitude towards future events and the results of ones own
behaviour are closely linked to the level of psychological adaptation to demand
and achievement related situations. In the past empirical studies were able to
prove the influence of contructs like dispositional optimism, self efficacy and
sense of coherence on health and performance relevant variables.
Method: The aim of the present study was to investigate the connections among
measures of positive affect and future cognition and their relation to physical
and mental health. To investigate culture specific aspects of the measured constructs two samples (German students n=346, Russian students n=330) were
examinated using the following scales: LOT (Scheier & Carver, 1985),
Generalized Self Efficacy Scale (Schwarzer & Jerusalem, 1986), SOC-L9
Scale (Antonovsky, 1983; Schumacher & Brähler, 2000), STAI
(Spielberger et al., 1981), Hopelessness Scale (Beck, 1974; Krampen, 1994),
SF-12 Health Survey (Bullinger & Kirchberger, 1998) and scales measuring
academic success and perceived social security.
Results: The results confirmed the expected connections between mental health
and several of the measured contructs (dispositional optimism, generalized self
efficacy, sense of coherence). Gender differences were observable regarding
dispositional optimism, generalized self efficacy, sense of coherence and mental health. The cross cultural comparison showed similarities in the cluster
structures of the German and the Russian sample, indicating that the assumption of a culturally stable trait as an underlying basis of the measured contructs
may be appropriate. From the results of the Russian sample one can draw the
conclusion that there is hope in the main part of the Russian youth, which can
be seen as a good sign for the future.
OPTIMISM AND LIFE EVENTS
Mate Szondy
Eotvos Lorand University, Budapest, Hungary
This study examines the effects of optimism on objective life events. Although
much research has showed the connection between optimism and life events,
there has been little research examining the possible ways between the two
phenomenon.
The goals of my 2 - year long longitudinal study are (a) to test the possible links
between optimism and life events, (b) to test the connection between optimism
and subjective well being and (c) to improve new methods of optimism assessment. Data collection is ongoing.
I assume that the following mechanisms will explain the connection between
optimism and life events:
1. The optimistic explanatory style (which is associated with positive emotional state) improves the functions of immunsystem. This will decrease the possibility of illness.
2. In the face of disappoinments, optimism is associated with perseverance,
which leads greater success.
3. Optimists have more numerous and more satisfaying social relationship.
4. Optimists use special forms of coping in the time of adversity.
Hypothesis of this research is that a human behavioral scale exists with three
basic behavioral types (submissive,agressive and assertive) and easily recognizible nonverbal signs belong to each of them. Using this scale makes easy to
teach developing nonverbal behavior in human communication and can be useful in conflict-solving trainigs as well.
145
Posters
DIFFERENT STATES OF EMOTIONS AND RELATED PROBLEM SOLVING STRATEGIES
Sonia Amado, Mehmet Koyuncu, Omer Erdogan
Amado Ege University, Department of Psychology Izmir
Our strategies of coping with stress, a continual hazard for our health in a
contemporary world, and our ability to solve the problems we are faced with
are constantly tested and contested on a daily basis. Understanding the relationship between stress and problem-solving strategies, or the ability to cope
with stress, is therefore of vital importance for our personal health and social
activities. This paper claims that different emotional states have different
effects on our problem solving strategies. We are specifically concentrated
on students, their experience of anxiety as a stressful emotion during the
exams, and the relationship between different levels of anxiety and problem
solving strategies employed to overcome these emotions.
A factorial experimental design of Success Motivation (low or high) X
Feedback (positive, negative, neutral) was used to assess the correlation
between subjects’ emotions and their problem solving strategies. 120 highschool students that had been preparing for the University Entrance Exam
(UEE) participated in this experimental study where they had to answer the
questions in the success motivation scale first. This scale helped to divide students into two groups of high success motivation and low success motivation.
These two groups were further divided into three groups (each group comprising 10 male and 10 female students) representing three different feedbacks:
positive, negative, and neutral. Each student individually took a 20-questionexam similar to the University Entrance Exam presented on a computer. After
every 4-qustion-trial each student was given the feedback of the group he/she
belonged to; either positive or negative. The control group did not take the
questions in the first part of the experiment and directly started from the second stage. After the first stage of the experiment, students were presented with
the Tower of Hanoi problem and their problem solving strategies were compared on the basis of subgoals and response latency and the number of moves
for solving the problem. The computations of the results are still continued.
ATTACHMENT, EMOTION AND WELLBEING IN EVERYDAY SOCIAL INTERACTIONS: A CROSS-CULTURAL PERSPECTIVE
K.Kafetsios & J.B.Nezlek
APU-Cambridge (UK) and Colllege of William & Mary (US)
The study is based on previous work on attachment, social support and wellbeing in Greece that found a limited connection between social support and wellbeing across the life-span (Kafetsios, 2002). Hence, it aimed to test hypotheses
concerning the emotional and social support processes at the level of interpersonal interaction as mediators between attachment and wellbeing outcomes in
Greece and the UK. Participants in the two countries kept a structured diary
(Rochester Interaction Record) to record positive and negative emotions, mood
and satisfaction with social support for a period of one week. They also completed several one-off measures of wellbeing. The multiple response methodology and the measurement of cultural differences directly (using the self-construal scale, Singelis, 1995) allowed to examine links between variables at the
individual (attachment, emotion, wellbeing), relational (interactions) and cultural levels. Initial analyses demonstrated direct cultural differences in the
experience of positive and negative emotion, and social support in the two
groups, but not mood. The paper will present further, multilevel analyses under
way. The discussion will focus in particular on the relationship between attachment orientations and emotion from an interactionist-cultural perspective and
the role of social support in the Greek social context.
THE EFFECT OF PERSONALITY FACTORS UPON JOB
SATISFACTION AND OCCUPATIONAL STRESS.
DIMENSIONS OF HOSTILITY IN JAPANESE UNIVERSITY
STUDENTS
Sirigatti, S., & Michelacci, R.
Universita di Firenze
Izawa, S. & Nomura, S.
Waseda University
Objectives: Personality or cognitive traits - such as the Type A Behavior
Pattern
and
Locus
of
Control
may
mediate
between occupational sources of stress and a variety of job outcomes,
like physical condition and satisfaction. The present study addressed
itself to consider the relationship between the interactive typology of the
A/B behavioral pattern and internal/external locus of control, and the
subjectively perceived job stress, heath, and job satisfaction, in several
types of occupational groups. Method: The Occupational Stress Indicator
(OSI), by Cooper, Sloan, & Williams (1988) was administered to 855 workers,
males and females, from different Italian companies engaged in different
types of job. The education ranged from 8 years to university degree, and
the average age was 35 years (± 13). Four group ( Type A externals [AE],
Type A internals [AI], Type B externals [BE], and Type B internals [BI]
were obtained by means of a median-split; participants were assigned to
one of the four categories. In order to analyse differences between the
four groups multiple discriminant analysis (MDA) was used. Results:
Participants included in the BI group resulted least sensitive to job
stress, the opposite was true for the AE group (MDA: Wilks’ lambda: .92,
F(18, 2393)=3,82 p<.001). The BE group expressed the least job satisfaction
(MDA: Wilks’ lambda: .93, F(15, 2338)=4,11 p<.001). The BI group
resulted the most healthy in both measures (MDA: Wilks’ lambda: .9, F(6,
1700)=14,42 p<.001).
Discussion: According with some other previous researches, the combination
of personality factors, such as Type A and Locus of Control, seemed to
discriminate the different levels of stress, health, and job satisfaction.
In addition, such an effect appeared not limited to managers, but relevant
for other types of occupational groups.
The purpose of this study was to identify the dimensions of hostility
in Japanese university student. 512 university students were asked to
complete four hostility questionnaires: Aggression Questionnaire, StateTrait Anger Expression Inventory, Muller Anger Coping Questionnaire,
and Cynicism Questionnaire, which include 13 subscales in totality.
Factor analysis for 13 subscales revealed four factors solution;
“Expressive Hostility” (Anger Out, Aggression, Anger, Trait Anger),
“Suppressive Hostility” (Anger Control, Anger In, Social Inhibition,
Guilt), “Assertion” (Verbal Aggression, Controlled Affect), “Hostile
Cognition” (Cynicism, Hostility, Physical Aggression). In the next
analysis, we attempted two factors solution because a lot of prior
study suggested “Expression” and “Experience” dimensions of hostility.
However, the result showed a different pattern: “Expressive Hostility”,
which was conjoined by “Expressive Hostility” factor and “Hostile
Cognition” factor, and “Suppressive Hostility” dimensions. These
results indicated a possibility that the dimensions of hostility in
Japanese differ from those in American and European and implied the
characteristics of Japanese society in which it is emphasized to behave
cooperatively and not to express their angry emotions. These results
are important and we should consider the differences in the dimensions
of hostility when we examine the relationship between hostility and
health outcomes, especially coronary heart disease, in Japan
146
Posters
MMPI CHARACTERISTICS OF THE HUNGARIAN HOMELESS POPULATION: A PILOT STUDY
THE REASSURANCE OF TOUCH. THE COMMUNICATION
EXPRESSED THROUGH TOUCH
JUDIT PAP**, ILDIKO KOVACS*, ILDIKO GYERGYOI*, GYORGY
BODOR*, CSABA LEVAY*, ROBERT BODIZS**
INSTITUTE OF BEHAVIORAL SCIENCIES, SEMMELWEIS UNIVERSITY BUDAPEST**, NONPROFIT FOUNDATION*
M. FOTIADOU, L. A. CULLEN, J. H. BARLOW
COVENTRY UNIVERSITY
Introduction
The estimated number of homeless people is between 30 and 60 thousand in
Hungary. The aim of our work was to study the psychological and social background of homelessness.
Methods
Here we report data obtained from 160 homeless people, taking part in the
rehabilitation process provided by Nonprofit Foundation. We focused on social
support, and administered Minnesota Multiphasic Personality Inventory
(MMPI). In our sample we studied MMPI profile characteristic to this population. In addition, we analyzed the effect of educational level and sex on MMPI
clinical scales by means of ANOVA.
Results
The highest values were characteristic for psychopathic deviate (mean = 62;
SD = 9.05), paranoia (mean = 61; SD = 10.08), and schizophrenia (mean = 59;
SD = 12.03) scales. Twenty eight of the persons had >70 points on Pp scale.
The same values for Pa and Sc were 39 and 27 respectively. 40.6% of the sample had >70 points on at least one clinical scale. Age correlated positively with
depression (r = .21861, p< .006). Persons with college/university degree had
significantly lower values on depression, hysteria and schizophrenia scales.
Males had significantly higher values on hypochondria, depression, hysteria
and psychasthenia scales than females. Negative changes in the quality of
familiar relationships served as a starting point of homelessness.
Conclusions
MMPI profile analysis revealed attitudes especially characteristic for this population. We found that high educational level is protective in some psychopathological dimensions among homeless people. Males seem to be more
vulnerable than females according to our results.
NEUROPSYCHOLOGICAL METHODS IN THE ASSESSMENT OF ATTENTION DEFICIT AND HYPERACTIVITY
DISORDER
Sonia Amado, Mehmet Koyuncu, Ercan E., Tunay I.
Ege University
Attention deficit and hyperactivity disorder that is affecting 3-10 % of schoolchildren, posing behavioral problems due to lack of attention in school and
social life, have been of vital concern for the clinicians and reserchers in the
recent years (Barkley 1996). Although various attempts to define the disorder
have been made in the last 20 years, lack of attention, impulsivity and hyperactivity are the three factors that characterize it (APA, 1980, 1987, 1994).
However, how these sub types would be differentiated from each other still
varies.
In many clinics abroad and in Turkey the diagnosis of Hyperactivity and
Attention Deficiency and the classification of the subtypes are made by parentteacher questionnaires and clinical interviews. These evaluations, however,
are, more or less, biased because of the different perceptions and expectations
of the parents. Loeber, Green and Lahey (1989) claimed that depending only
on the questionnaires filled by the parents without a careful observation of the
child with an attention deficiency might cause enormous problems. Moreover,
Achenbach (1995) stated that clinical observation should be supported by laboratory assessing equipments in order to differentiate the symptoms of the disorder from other disorders and to prevent false diagnosis. In order to increase
the reliability of the diagnosis, therefore, using neuropsychological tests in
addition to the questionnaires filled by parents and teachers is of vital importance.
In that sense, the research presented here is based on Allen Mirsky’s (1991)
attention model which conceives attention as four elements; focus/execute, sustain, shift and encode. Two experimental groups, ADD and control, were
compared on the basis of this model with attention and working memory tests.
Preliminary findings show significant differences on focus, sustain, and encoding elements of attention between the experimental groups.
Background: Therapeutic massage can be a helpful intervention for people with
a disability or a chronic condition, and their families. The aim of this study was
to explore the experience of the Training and Support Programme (TSP) for
caregivers of children with disabilities.
Methods: The TSP comprises eight weekly one-hour sessions in which caregivers are instructed in gentle massage. A total of 139 caregivers of children
(age range: 0-16 yrs) with disabilities participated in the study and completed
Home Record Sheets to monitor their own and their children’s progress through
TSP. Content analysis was used to analyse the data.
Findings: The majority of caregivers were mothers (81%). Children had a range
of disabilities including cerebral palsy, autism, epilepsy, musculoskeletal problems and chromosome disorders. After attending the TSP, nearly a third (30%)
of caregivers reported increased feelings of happiness and enjoyment and over
half of them (53%) were more relaxed. Approximately half of the parents
reported positive effects on children’s bowel movement (40%), mobility (42%)
and sleep patterns (50%). Potential positive effects for the carers comprise a
sense of security and confidence (12%), developing a closer relationship with
their child (52%) and a better tolerance for child’s problems (20%). Caregivers
also found the TSP to be effective, natural and relaxing, providing them with
the opportunity to improve and maintain their psychological well-being.
Discussion: Further quantitative studies are necessary to assess caregiver’s
well-being.
ADDICTION IN THE FAMILY: MOTHER, FATHER & BABY!
Wouldes, T. A.
University of Auckland - Faculty of Medical and Health Sciences Health
Psychology
Auckland, New Zealand
Objective: To examine the development of infants born to families where the
mothers were receiving daily methadone maintenance treatment for opioid
dependence.
Method: A sample of 59 infants, 25 born to mothers receiving daily
methadone maintenance treatment and their partners and 34 comparison infants
born to non-drug dependent mothers and their partners participated in the study.
Mothers and fathers were enrolled in the study during the third trimester of
pregnancy. At that time, demographic data, as well as, data concerning maternal and paternal drug use, past criminal activity, and physical and psychological well-being were collected. Infant body dimensions, severity of Neonatal
Abstinence, and length of stay in hospital were collected at birth. At 67-69
weeks corrected gestational age visual novelty preference, which assesses the
cognitive domains of attention and memory, was measured with the Fagan Test
of Infant Intelligence.
Results: Maternal methadone maintenance treatment, obstetric history and
smoking explained the variability in neonatal outcomes. Although, a number
of maternal and paternal factors were related to early cognitive development at
7 months corrected gestational age, when a regression equation was constructed from these variables, only two factors contributed significantly to the prediction of novelty preference. These included, paternal history of violent
crime and the paternal personality measure of Reward Dependence.
Conclusion: Although maternal factors related to substance dependence were
related to neonatal outcomes, paternal factors later in the postnatal environment
were more predictive of early cognitive development.
147
Posters
INFANT BED-SHARING AMONG PACIFIC FAMILIES IN
NEW ZEALAND
CHILDREN’S BEHAVIOUR DURING HOSPITALIZATION
AND PSYCHOLOGICAL INTERNVENTION
Dr Janis Paterson
Co-director, Pacific Islands Families Study, Research Co-ordinator, Division
of Public Health and Psychosocial Studies
Michopoulou Alexandra*, Karagianni Aikaterini**, Evangelopoulou Eva**,
Nikolaou Angeliki**.
Aim: Overall there has been a substantial reduction in the rate of Sudden
Infant Death Syndrome (SIDS) mortality in New Zealand. However there is
concern that Pacific SIDS mortality rates may either be remaining constant or
increasing. Infant bed-sharing has been indetified as a pontential SIDS risk
factor, particularly if the mother is a smoker, and for infants under 4 months
of age.The aim of this presentation is to describe infant bed-sharing among
Pacific families in New Zealand.
Method: The data were gathered as part of the Pacific Islands Families: First
Two Years of Life (PIF)Study in which 1376 mothers were interviewed when
their infants were six weeks of age. Maternal reports of infant bed-sharing practices were assessed by questions about infant sleep location and the number of
people who usually shared a mattress with the infant.
* Head of the Psychological Department of Penteli Childrens Hospital
** External associates of the Psychological Department of Penteli Children’s
Hospital.
Previous research conducted at Penteli Children’s Hospital has indicated that
during hospitalization children usually present reactive behaviour that can
influence the progress of their treatment. Moreover, it was observed that
though play – therapy stress can be reduced and this can be beneficial for the
child and his/her treatment.
In the present study the child plays with toys and puppets and draws to express
his/her feelings related to hospitalization as well as feelings concerning problems related to his/her family.
Children’s concerns and fears are expressed, permitting the therapists to understand emotions and conflicts so as to clarify feelings, reduce anger and stress
and develop positive feelings.
Results:Over half the mothers(54%)reported that their infants shared a mattress
with other people, 44.2% sharing with one other person, the remainder sharing
with two or more people. Of the bed-sharing infamnts, 4.7% slept on a mattress
on top of the bed, and 4.7% only slept part of the night in a shared bed.
Conclusions: Maternal and environmental factors associated with infant bedsharing will be discussed and recommendations for effective information delivery of infant care and health promotion programmesfo Pacific families will be
made.
VERY-LOW-BIRTH-WEIGHT AND HYPERACTIVITY IN
THE BEGINNING OF OBLIGATORY SCHOOL ATTENDANCE
Palazón I, Rodríguez-Marín J.
Miguel Hernández University
Introduction: The survival rate of very-low-birth-weight (VLBW) has
increased in recent years. While the mortality outcome has decreased the morbidity has increased. Hyperactivity has been associated to VLBW.
Objective: To determine if VLBW show more hyperactivity behaviour than
other children when they are beginning obligatory school attendance.
Setting: General hospital in Spain.
Methods: Teachers of VLBW or control children responded to the Conner’s
Scales in order to identify hyperactivity behaviours. T-test was calculated. The
following variables were considered: behaviour problems, performance, integration in classroom, inattention, and aggressiveness. A measure of cognitive
performance was also realised.
Subjects: 225 VLBW and 110 control children from different schools at the
same city.
Results: VLBW cognitive performance was normal. T-test showed significant
differences between scores of VLBW and control children in all measures of
the Conners’ Scales with the exception of aggressiveness (behaviour problems
t=2,28, p=0,02; performance, t=3,31, p=0,001; integration, t=2,61, p=0,009;
inattention, t=2,64, p=0,009).
Conclusions: VLBW showed a worst adaptation to school than other children.
VLBW showed higher prevalence of hyperactivity behaviour than control.
Analysis of data yielded the suspect that lower performance in school of the
VLBW could be attributed to hyperactivity.
148
CHILDREN’S ONCOLOGIC DISEASE: QUALITY OF LIFE
AND ITS IMPACT ON THE FAMILY
Pereira M.G. & Campanhã M. L.
Both the diagnosis and the treatment of children with cancer are very stressful
experiences that cause psychological after-effects that can persist for a long
time, even after the end of the treatment for both the child and the family.
Purpose: Assessment of the relationship between parents’ psychological morbility, post-traumatic stress symptoms, family functionality and quality of life
versus psychological symptomatology, behaviour and quality of life of their
children.
Method: Sample - A group of 70 children, patients of the IPO-FG Porto, with
a cancer diagnosis, aged between 8 and 12 years old participated in the study.
Their parents were also included. The children were in treatment for cancer or
follow-up (one year after treatment)
Instruments - Child Behaviour Check List (CBCL – Achenback, 1991); State,
Trait, Anxiety Inventory for Children (STAIC – Spielberger et al., 1973);
Children’s Depression Inventory (CDI – Kovacks, 1992) and the Inventory of
Children´s Quality of Life (Peds-QL – Varnui, 1999). Parents were also submitted to: Brief Symptom Inventory (BSI – Derogatis, 1993); Family Adaptation
and Cohesion Scales (FACES II – Olson, Portner & Bell, 1991) and the Impact
of Events Scale Revised (IES-R – Wiss & Marmar, 1997).
Results: A relationship between parents’ psychological morbility and children’
behaviour was found as well as a relationship between parents’ symptomatology, family functionality and children’s quality of life. Implications for psychological intervention with this population are presented and emphasized.
Posters
QUALITY OF LIFE AND PARENTAL COPING IN CHILDHOOD ASTHMA
Pereira, M.G.; Almeida, P.; Vaz, L.; & Tavares, L.
University of Minho - Department of Psychology; Hospital S. Joao do Porto
& ISCS – Norte
PREVALENCE AND CORRELATES OF DEPRESSION IN
CHILDREN AND ADOLESCENTS WITH INSULIN
DEPENDENT DIABETES MELLITUS (IDDM)
Jigna Modha, Helen Pattison, Tim Barrett
Goals:
This presentation describes a study that assessed the impact of childhood asthma on quality of life in children and on parents coping.
Methods
Sample: Sixty children between 8 e 12 years old, who receive care from a paediatric department of a central hospital participated in this study. The instruments answered by the parents were: Child Health Questionnaire (Landgraf &
Ware, 1996), Coping Health Inventory for Parents (McCubbin, Mccubbin,
Nevin & Cauble, 1991); Paediatric Quality of Life - parent’s version (Varni,
1999) and a socio-demographic questionnaire developed for the research purposes. The instruments answered by children were: Self-Perception Profile of
Children (Harter, 1987) and the Paediatric Quality of Life - child version. Both
parents and children answered the questionnaires separately while waiting for
the child’s medical appointment.
Results: We found significant relationships between:
1) Asthma severity and children’s mental health/behaviour as measured by the
CHQ
2) Parents perception of children´s quality of life and children general health.
3) Parental coping and children’s quality of life. There were no gender differences in all dependent variables
Conclusions
Asthma has a great impact on children’ quality of life especially on their emotional functioning. Parents perceive children’s health as having an impact in
almost all domains of children’ quality of life. Finally, asthma severity has a
great impact on behavioural and mental health of children.
Implications for health psychologists and for family intervention on chronic illness, in particular, are discussed.
The aims of this study were to measure the prevalence of depression in 7-17
year olds with IDDM and to identify risk factors. Depression was measured
using the Children’s Depression Inventory (CDI). A Parents completed a
questionnaire
designed
for
this
study
to
assess
socio-demographic variables, perceived severity, understanding of diabetic
control and depressive symptoms in the child. Medical records were
consulted to obtain clinical data e.g. diabetic control (HbA1c level).
Children and their parents were approached while waiting for routine
outpatient clinic appointments in two hospitals. Of the 77 children in the
target age group with clinic appointments, 12 did not attend, and 6 declined
to take part, giving a response rate of 91.4% for those approached. The
sample represented 26.2% of the IDDM patients of the 2 hospitals in this age
group
The prevalence of depression was 18.8%, much higher than estimates for the
general population (2-6%). Linear regression revealed that high CDI scores
were predicted by: poor diabetic control; high BMI for age; non-white
ethnicity; parental belief that a cure for diabetes is unlikely; low support
levels at home; parents noticing symptoms in the child (F8,55=10.85,
p<0,001; adjusted R2=0.556).
This study suggests that depression in the population with IDDM is
influenced by diabetes related factors but also parental beliefs. The link
between poor diabetic control and depression is unlikely to be a simple
causal relationship. Our results can help parents and clinicians identify
children who are at greater risk of depression so that appropriate support
can be offered.
FAMILY ILLNESS REPRESENTATIONS
BEHAVIOURAL PROBLEMS IN RELATION TO IMPAIRMENT AND TREATMENT STATUS AMONG DUTCH,
MOROCCAN, TURKISH AND SURINAMESE CHILDREN
ACCORDING TO TEACHER- RATINGS.
Christel Salewski
University of Greifswald, Germany
Purpose: Both patients and family members develop representations of a
patient’s chronic illness. There is some evidence that close relatives’ illness
representations have an impact on patients’ illness-related behaviour and wellbeing, but little is known about the role of family representations, i.e. the similarity between patients’ and family members’ illness representations. In family stress theory, a shared representation or “family paradigm” of a stressor is
regarded as an indicator of family cohesion. Family cohesion has proofed to be
a predictor of successful family coping efforts. In the present study, data on the
impact of family illness representations and family cohesion on patients’ wellbeing, and perceived strain is reported.
Method: 30 adolescents with a chronic skin disease and their parents were
interviewed about five categories of illness representations (causes, control,
timeline, curability, and effective treatments). Questionnaires assessed patients’
well-being and strain and perceived family cohesion of all family members.
Results: 1. Comparisons between illness representations revealed some differences between family members. 2. Scores indicating the similarity of family illness representations showed no significant correlations with patients’ wellbeing. 3. Perceived family cohesion was a good predictor of adolescents’ wellbeing and strain. 4. In families with high similarity between parents’ illness
representations, the adolescents reported more well-being, but no reduced
strain.
Conclusions: Results are discussed with regard to developmental characteristics of adolescence, nature of outcome variables, and methodological problems
B.W.C. Zwirs1, J.K. Buitelaar2, H. Burger1, T.W.J. Schulpen1
University Medical Center Utrecht1 and University Medical Center Nijmegen2
Introduction
Attention-deficit hyperactivity disorder (ADHD) is the most common psychiatric disorder in children (3-5%). Also comorbid psychiatric disorders like
oppositional defiant disorder (ODD) and conduct disorder (CD) have been
reported in these children. At present, there is substantial evidence that accurate detection of ADHD, ODD and CD is lacking. Overdiagnosis and overtreatment seem to occur mainly in western children and underdiagnosis and undertreatment in non-western children. The aim of this study was to describe this
discrepancy in treatment status between western and non-western children in
the Netherlands.
Methods
Procedure: The sample population consisted of children aged 6 to 8 years
attending mainstream schools in Utrecht and the surrounding area.
Participants: 269 Dutch, 387 Moroccan, 225 Turkish and 33 Surinamese children (93% participation).
Instrument: Teachers completed the UMC Utrecht Behaviour Questionnaire
(UBQ). This scale consists of all 25 items of the teacher version of the Dutch
Strengths and Difficulties Questionnaire, 5 DSM-IV items on ADHD, CD and
ODD and 11 items regarding impairment and the treatment status of the child.
The UBQ includes 15 items on problem behaviour. These items were summed
to generate a Problem Score (Min=15, max=45)
Conclusion
Teachers reported more problem behaviour among Moroccan children than
among Dutch or Turkish children. Despite the fact that problem behaviour
impaired all ethnic groups equally, Moroccan and Turkish children received
less treatment and were considered less often in need of help than Dutch children.
149
Posters
STRESS IN CHILDREN - A CROSS CULTURAL STUDY
BETWEEN GERMAN, SYRIAN & JORDANIAN CHILDREn
THE NEUROBEHAVIORAL CHANGES IN CHILDREN
ENVIRONMENTALY EXPOSED TO PCBS.
Ismail Tanjour & Konrad Reschke
University of Leipzig
Eva Sovcikova, Tomas Trnovec, Anton Kocan, Ladislava Wsolova
Institute of Preventive and Clinical Medicine, Bratislava, Slovak Republic
Problem:
Stress is not only a problem of the adults and person in a working
environment. In the last decade in
Germany and other high industrialized countries the study of
stress in children was improved and many new and interesting results
about the conditions of the development of stress in children could
be found.
The aim of this study was to show gender and cultural differences in stress in
a German, Syrian and Jordanian sample of school children and to make proposals for the development of health promotion in the Arabic culture.
Methods and sample: Two widely used questionnaires were used to examine
the experiences of stress in the sample.
SKK: Perceived stress questionnaire for children (Klein-He?ling, Lohaus,
1996) KINDL: Health related Quality of Life-Questionnaire of children
(Bullinger, 1994) Furthermore measures for neuroticism, depression and anxiety were used to show personality constraints of stress in the samples.
185 German and 20 Arabic children (100 from Syria and 100 from)
Jordanian) in the age of 8 to 14 years were answering the questionnaires.
Results: The results demonstrate, that children in different living conditions
in different cultures are suffering from stress. Girls have especially in the
Arabic samples higher degree of stress. The results show clearly that children
in Arabic countries are perceiving and suffering higher stress and have lower
stress management capabilities. There are gender differences between and
within the cultures, which let us draw conclusions for health promotion especially for the children in Arabic countries. The overview about all results
support the conclusion that efforts are important to improve the
role of a clinical health psychology for the Arabic countries. Some suggestions
are made to show directions for the future development of stress
management programmes in the Arabic culture.
Neurobehavioral disturbances by polychlorinated biphenyls (PCBs) have been
reported in both children and animals. The aim of this study was to investigate
the relations between blood PCBs level, cognitive development and medical
examination and social background in children environmentally exposed to the
PCBs.
In school children aged 8-9 years (n = 237, 121 boys and 116 girls) born and
living in the polluted area, and similarly 242 children (119 boys, 116 girls) in
the background area, the blood PCBs, selected heavy metals, hormones and
biomarkers and other medical (thyroid, hearing and dental examinations) were
realized. By the neurobehavioral tests we examined the sensomotor reactivity,
eye-hand coordination, attention, memory and complex mental processes.
Mothers were examined by the same intelligence test as children (adult version) and completed the questionnaire about medico-social situation of children and family. In descriptive statistical evaluation of the sums of congeners
without LODs [ng/g lipi] significantly more children were with sum of PCBs
over the median in exposed area (Min 808.440, Max 6513.1, Me 520.218). The
in the control group were opposite significant proportions (Min 120.4, Max
1967.2, Me 336.663). Statistical evaluation of neurobehavioral parameters and
the sums of congeners showed significantly longer reaction times, lower short
memory performances and lower eye-hand coordination tests than in control
group.
The quality of psychic functioning in these children are in connection with the
level of congeners (153, 136, 170) sums of PCBs. Multifactor analysis of the
examinations, social factors and these measured parameters can show the new
relations between children.
NEUROPSYCHOLOGICAL METHODS IN THE DIAGNOSIS
OF HYPERACTIVITY AND ATTENTION DEFICIENCY
COUPLES COPING WITH BEHAVIORAL PROBLEMS OF A
CHILD WITH ANGELMAN SYNDROME: THE MODERATOR
ROLE OF THE ADULT ATTACHMENT STYLE
Sonia Amado, Mehmet Koyuncu
Ege University, Izmir, Turkey
Hyperactivity and Attention Deficiency that are affecting 3-10 % of schoolchildren, posing behavioral problems due to lack of attention in school and
social life, have been of vital concern for the clinicians and reserchers in the
recent years (Barkley 1996). Although various attempts to define the disorder
have been made in the last 20 years, lack of attention, instinctiveness and
hyperactivity are the three factors that characterize it (APA, 1980, 1987, 1994).
However, how these sub types would be differentiated from each other still
varies.
In many clinics abroad and in Turkey the diagnosis of Hyperactivity and
Attention Deficiency and the classification of the subtypes are made by parentteacher questionnaires and clinical interviews. These evaluations, however,
are, more or less, biased because of the different perceptions and expectations
of the parents. Loeber, Green and Lahey (1989) claimed that depending only
on the questionnaires filled by the parents without a careful observation of the
child with an attention deficiency might cause enormous problems. Moreover,
Achenbach (1995) stated that clinical observation should be supported by laboratory assessing equipments in order to differentiate the symptoms of the disorder from other disorders and to prevent false diagnosis. In order to increase
the reliability of the diagnosis, therefore, using neuropsychological tests in
addition to the questionnaires filled by parents and teachers is of vital importance.
In that sense, the research presented here is based on Allen Mirsky’s (1991)
attention model which conceives attention as four basic processes of “focus,”
“sustain,” “shift” and “encode” that are coordinated. Two experimental
groups, hyperactivity and attention deficiency and control, were compared to
see if there was any variation between the groups and if there was any relationship between attention and variables such as age and gender .
150
Angelo Compare
Catholic University, Milan, Italy.
OBJECTIVES: Children with Angelman syndrome (AS) manifest ADHD
behaviors, of insomnia, epileptic crisis, permanent movement problems, in
communication and in autonomy. Having a child with neurophysiological disability can greatly affect parents: depression, anxiety and emotional problems
are common. A good relationship, characterized by intense communication,
sharing of experiences, physical and psychological proximity and mutual support, contributes to family well-being. This paper describes couples coping
with their AS childs behavioral problems and, in particular, explores whether
adult attachment plays a mediating role.
METHODS: The adult attachment style of 54 couples with children with AS
was assessed, as was parental perception of the gravity of the childs problem.
Additional measures include: State-Trait Anxiety Inventory, Beck Depression
Inventory, a Problem Solving Inventory to assess ability to cope with childs’
behaviour, Rosenberg Self-Esteem Staircases, and the Psychological General
Well Being Index.
RESULTS: 1) mothers had higher anxiety (p<.05) and depression (p<.05) and
lower levels of quality of life (p<.05) than fathers; 2) partners with secure
attachment style perceived their childs problems as less serious than partners
with fearful attachment style (ANOVA: F=3,964; gl=3; p<.05); 3) partner’s
secure attachment style has a moderator role on the perception of child problematic behavior if the other partner has a dismissing attachment style. In particular couples with secure-secure attachment style perceive the childs behavioral problems as less serious than couples with insecure-insecure attachment
style (ANOVA: F=10,287; gl=4; p<.001).
CONCLUSION: Results are discussed considering the implications for the
psychological counseling of parents with AS children or other rare syndromes.
Psychosocial Aspects of Chronic Disease.
Posters
STRESS APPRAISAL AND POSITIVE EMOTIONS IN MIDDLE-AGED MALE WITHIN SIX MONTHS AFTER HEART
ATTACK
ATTRIBUTES OF SELF-EGO PICTURES AND EMOTIONAL
CONTROL IN PATIENTS WITH CORONARY HEART DISEASE, WHO ARE TYPE A BEHAVIOR PATTERN
DOROTA WLODARCZYK
WARSAW MEDICAL ACADEMY
Monika Kowalska, Jan Tylka, Iwona Korzeniowska - Kubacka, Kinga
Leszczynska, Monika Stepnowska
Clinic and Department of Cardiac Rehabilitation National
Institute of Cardiology, Warsaw, Poland
The study was designed to analyze the relations between stress appraisal(SA)
and changes in positive emotions during six months adaptation after MI. Two
aspects of SA were taken into account: dispositional (DSA treated as a personality tendency) and situational (SSA determined by specific situation). Subjects
in the study were 75 male, who participated in three weeks cardiac rehabilitation. They were tested three times: before, at the end of stay in the rehabilitation center and about six months after MI. Stress appraisal (both aspects) was
measured with the SAQ by Wrzesniewski et al. Positive emotions were determined through vigor-activity scale of POMS by McNaire et al. Results showed
statistical increase of vigor-activity level within six months.72%of cases were
qualified with rise, whereas 28% with drop in vigor-activity. Correlation analyses conducted on each stage of the study revealed weak positive relations
between challenge-activity DSA and vigor-activity. Stronger correlations were
observed between positive emotions and SSA, mainly challenge-activity, challenge-passivity and threat. Further analyses allowed to state that decrease of
vigor-activity within six months after MI is connected with high level of challenge-passivity SSA on every stage of the study. There was no significant relations between changes in positive emotions and challenge-activity SA, which
were expected. Possible explanations of these results will be discussed.e
The aim of study: The aim of study is an assessment of dependence between
intensity of symptoms characterised Type A behavior (life under time pressure,
competition, aggression and enmity), attributes of self ego picture described by
Gough and Heilbrun (definite as a psychological needs), indications of emotional control formulated by Brzeziński Material and methods: Patients
(man) treated in Department of Cardiac Rehabilitation National Institute of
Cardiology in Warsaw, with coronary heart disease, after first heart infarction
and PTCA or CAB (by-pass operation) were included into the study. According
to medical criterion all patients belong to the first group of NYHA.
Methods used in investigation: 1. Adjective Check List (ACL) - H.G. Gough
and A.B. Heilbrun; 2. Questionnaire of Emotional Control - J.
Brzeziński 3. Jenkins Activity Survey - C. D. Jenkins, R.H. Rosenman,
S. J. Zyzansky Twice were examined 32 men with coronary heart disease, after
heart infarction and PTCA or by-pass operation (CAB) different on score of
Type A behavior. Examined patients were described as people with Type A
behavior using JAS Questionnaire.
Results: During one-year investigation attitudes of Behavior Type were constant features. For Type of behavior significant are psychological needs achievement, dominance, nurturance, affiliation, heterosexuality, exhibition,
autonomy, aggression, change, succorance, abasement, deference.
Conclusion: 1. Type A behavior coexists with specifically features of personality and attitudes of emotional control among patients with coronary heart disease. This pattern of behavior is manifested by: * features of personality like:
tenacity of purpose, refusing emotional support, being selfsufficient, independent from other * attitudes of emotional reactivity - impulsiveness, difficulty with emotional control. 2. In therapeutic practice: psychologists should to
concern on these attitudes of self ego pictures, which are constant and possible
for expressive manifest. Other attitudes should to definite as supplementary
variable for example: emotional tension, anxiety.
THE DIFFERENCES BETWEEN MEN AND WOMEN IN
EMOTIONAL EXPRESSION BEFORE CARDIAC SURGERY
COPING, DENIAL AND PATIENTS’ FEARS BEFORE CORONARY ARTERIOGRAPHY
Mariola Wojcicka, Jan Tylka, Monika Kowalska, Monika Stepnowska,
Kinga Leszczynska
Clinic and Department of Cardiac Rehabilitation National Institute of
Cardiology, Warsaw, Poland
HELL MC, MULLER L, KHALIFE K, SPITZ E
UNIVERSITY OF METZ, HOSPITAL BON SECOURS OF METZ
Aim of study: The main goal of our study is assessing of differences between
emotional reaction manifested by men and women before their cardiac surgery.
Material and methods: 34 men,aged 25-79 years (x=58) and 15 women, aged
49-75 years (x=63), this is follow - up study The following, psychological
methods were used: Beck Depression Inventory. The Scale of Anxiety D.
Schailling Initially elaborated results of our study indicated that:
1. there are valuable differences concerning gender and emotional reactivity;
2. women presented higher than men level of anxiety and depression before
cardiac surgery;
3. results of the study should be good basis for preparing of rehab strategy
Aim: to measure the intensity of patients fears related to coronary arteriography, and to determine coping strategies used by the patien just before and just
after the coronary arteriography.
Method: Population: 111 patients undergoing scheduled coronary arteriography (with stated or suspected ischemic heart disease) at the cardiology intensive care unit of Metz’s Hospital.
Material: CISS (coping’s scale), NEO PI-R (personality inventory), denial’s
scale of Hackett and Cassem, and a purpose-designed instrument which listed
24 objects of fear on a 5-point Lickert-type scale (this instrument was given to
us at fist time and to nurses at a second time).
Results: Many patients used emotive coping strategies; they are anxious, hostile, are seeking sensations, but aren’t depressive; and more have a high denial
level. These patients have fears both before and after coronarography and the
intensity of fear varied depending upon the object of fear. The hightest intensity was recorded for fear of coronary artery bypass surgery and the incertainly
about the illness. On average, women reported significantly intense fears more
frequently than men across time. It was interessant to note that the results about
patients fear’s intensity were different according on us or nurses gived the
fears’ scale. For example when the patients answered to us, the fears’intensity
changed into the two moments “before” and “after” coronary arteriography. We
think that our psychological support allow them to deny less in their responses.
Conclusion: Gender differences in fear and coping strategies deserve closer
attention. The implication for nursing practice is discussed.
151
Posters
THE DIFFERENCES BETWEEN MEN AND WOMEN IN
EMOTIONAL EXPRESSION
BEFORE CARDIAC SURGERY
Mariola Wojcicka, Jan Tylka, Monika Kowalska, Monika Stepnowska,
Kinga Leszczynska Clinic and Department of Cardiac Rehabilitation National
Institute of Cardiology, Warsaw, Poland
Aim of study: The main goal of our study is assessing of differences between
emotional reaction manifested by men and women before their cardiac surgery.
Material and methods: 34 men,aged 25-79 years (x=58) and 15 women, aged
49-75 years (x=63), this is follow - up study The following, psychological
methods were used: Beck Depression Inventory. The Scale of Anxiety D.
Schailling Initially elaborated results of our study indicated that:
1. there are valuable differences concerning gender and emotional reactivity;
2. women presented higher than men level of anxiety and depression before
cardiac surgery;
3. results of the study should be good basis for preparing of rehab strategy
COPING, DENIAL AND PATIENTS’ FEARS BEFORE CORONARY ARTERIOGRAPHY
HELL MC, MULLER L, KHALIFE K, SPITZ E
UNIVERSITY OF METZ, HOSPITAL BON SECOURS OF METZ
Aim: to measure the intensity of patients fears related to coronary arteriography, and to determine coping strategies used by the patien just before and just
after the coronary arteriography.
Method: Population: 111 patients undergoing scheduled coronary arteriography (with stated or suspected ischemic heart disease) at the cardiology intensive care unit of Metz’s Hospital.
Material: CISS (coping’s scale), NEO PI-R (personality inventory), denial’s
scale of Hackett and Cassem, and a purpose-designed instrument which listed
24 objects of fear on a 5-point Lickert-type scale (this instrument was given to
us at fist time and to nurses at a second time).
Results: Many patients used emotive coping strategies; they are anxious, hostile, are seeking sensations, but aren’t depressive; and more have a high denial
level. These patients have fears both before and after coronarography and the
intensity of fear varied depending upon the object of fear. The hightest intensity was recorded for fear of coronary artery bypass surgery and the incertainly
about the illness. On average, women reported significantly intense fears more
frequently than men across time. It was interessant to note that the results about
patients fear’s intensity were different according on us or nurses gived the
fears’ scale. For example when the patients answered to us, the fears’intensity
changed into the two moments “before” and “after” coronary arteriography. We
think that our psychological support allow them to deny less in their responses.
Conclusion: Gender differences in fear and coping strategies deserve closer
attention. The implication for nursing practice is discussed.
TYPE D PERSONALITY AND DISTRESS IN CORONARY
HEART DISEASES: AN ITALIAN STUDY
A MODEL OF PSYCHOLOGICAL TREATMENT IN CARDIAC REHABILITATION: SHORT-ERM OUTCOME
Sommaruga M.,Gremigni P.*, Bettinardi O.**, Cauteruccio M. A.***, De
Donno A. Denollet J****
Fondazione Salvatore Maugeri, IRCCS, Tradate (Va), Servizio di Psicologia,
*Faculty of Psychology, Bologna University; **S.Giacomo Hospital,
Pontedell’Olio (PC); ***Mormanno Hospital, OU of Internal Medicine and
Cardiac Rehabilitation(CS) , Italy, **** Clinical Health Psychology, Tilburg
University , Netherlands.
Giorgi I.*, Negri M.*, Andreoli A.*, Riera D.**, Calsamiglia
G.**, Sommaruga M.***
Psychology Unit Pavia, **Cardiac Rehabilitation Unit Pavia, ***Psychology
Unit Tradate (VA)
OBJECTIVE: There is strong evidence of an association between psychosocial
risk factors and occurrence/outcome of coronary heart disease (CHD). The
combination of negative affectivity (NA) and social inhibition (SI), referred to
as Type D, was found an important determinant of psychological distress and a
major predictor of cardiac events in coronary patients. This study was aimed at
verifying the association between Type D, indicators of psychological distress
such as anxiety and depression, and other personality traits, such as neuroticism
and extraversion.
METHOD: 145 CHD patients recruited among three Clinics located in different parts of Italy completed DS14 (Type D), STAI X2 (anxiety), QD (depression) and EPQ (Eysenck’s Neuroticism and Intraversion-Extraversion scales,
short-form).
RESULTS: Analysis of variance between Type D and non Type D subjects
(median split) showed significant differences on both depression (p < 0.0001)
and anxiety (p < 0.0001). Significant correlation were found between NA and
neuroticism (r = 0.69, p<0.0001) and between SI and extraversion (r = 0.66,
p<0.0001).
CONCLUSION: Type D is a good predictor of anxiety and depression. These
results encourage the use of DS14 scale for the psychological screening in cardiac rehabilitation programs among Italian patients. To verify the predictive
value of this scale as regards adverse health outcomes, longitudinal studies
should be designed
152
Cardiac rehabilitation has been shown to be effective when a multidisciplinary,
patient-centred approach is used. The goal of this study was to evaluate the
short-term outcome of a psychological program on a sample of cardiac patients
admitted to a Day Hospital Unit (DH) 15± 5 days after cardiac surgery/valve
repair or myocardial revascularization. The four-week program provided health
education meetings, Jacobson progressive relaxation training and
individual psychological counseling. 40 patients (30M ,10F) admitted consecutively to DH, were tested at the beginning and at the end of the program using
an Anxiety and Depression scale(AD), taken from the Cognitive Behavioural
Assessment 2.0; a questionnaire for measuring self-efficacy (General Perceived
Self-Efficacy Scale-GSES) and aù questionnaire focused on the patient’s
knowledge of secondary prevention of coronary heart disease (MaugerI
CaRdiac preventiOn-Questionnaire). The subjects (mean age = 60±8.28)
showed, at the end of the program, improvement in their distress indicated by
the clinical evaluation and by significant reduction in the mean scores of the
AD (t =3.397, p =0.002; t=4.921, p=0.00). Results also showed a significant
increase in the level of knowledge concerning secondary cardiac prevention,
independent of the educational level (t=6.784, p=0.00). No significant change
was found in the GSES scores. This approach seems to be efficacious in reducing distress and improving level of knowledge necessary to change lifestyle
and to follow medical prescriptions. The one-year follow-up will allow us to
verify these preliminary results.
Posters
STRESS-CORRELATED PSYCHOLOGICAL ASPECTS IN
CARDIOVASCULAR PATIENT IN ACUTE PHASE.
F. Giaroli, F. N. Frassi, E. Fiori e C. Pruneti.
Department of Psychology, University of Parma
Considering the relevance of the psychological and emotional aspects on the
genesis and continuation of certain cardiovascular disorders, this study has
aimed at offering a further contribution to understanding the psychological
variables which have the greatest influence on their causes and symptoms.
With this aim in mind, 25 subjects, who had been diagnosed with acute
myocardial coronary, were evaluated. Whilst still in the coronary intensive care
unit (UTIC), the following psycho-diagnostic tests were administered: Illness
Behaviour Questionnaire (IBQ), Pisa Stress Questionnaire (PSQ) and
Symptom Questionnaire (SQ). Successively, during the first days of rehabilitation, 10 -12 days after the coronary, Cognitve Behavioural Assessment (CBA
2.0) battery was administered, to highlight the presence of any possible psychopathological inclinations and personality traits which the patients in the
subject sample may have in common. At this stage a second SQ was administered with the aim of highlighting any possible variations in the symptomatological state of the patients. The analysis of the results was carried out also by
comparing the mean score from the sample group with the scores from other
cardiopaths. The evaluation of the differences between the scores recorded in
the two SQ administrations, was carried out using Student’s statistic test “t”
for sample pairs. The Bravais-Pearson r coefficient. was used on all the psychodiagnostic tools used. Characteristic associations were recorded between some
of the variables which were considered to have a significant relationship
between personality traits, psychopatologic syndromes, dysfunctional forms of
behaviour and typical styles of response in the sample of cardiovascular
patients taken into consideration.
PSYCHOBIOLOGICAL APPROACH TO PERSONALITY IN
CARDIOLOGY
A RANDOMISED CONTROLLED TRIAL OF A WRITTEN
EMOTIONAL DISCLOSURE INTERVENTION FOLLOWING
FIRST MYOCARDIAL INFARCTION
Lynn Wilmott1, Peter Harris2 & Rob Horne1
1Centre for Health care Research, University of Brighton, Brighton UK
2 Department of Psychology University of Sheffield, UK
The technique of written disclosure appears to offer considerable promise for
an intervention suitable for first MI patients. Written anonymous disclosure
offers patients the opportunity to disclose views they cannot discuss openly, to
modify and develop their beliefs and understanding and, given the instructions
typically employed, encourages them to work towards resolution and progress.
The present study was a randomised controlled experiment comparing the
effects of written disclosure (writing about innermost thought and feelings
about the MI) against a writing control (writing about emotionally bland, trivial topics.
One hundred and fifty seven first-MI patients were randomly assigned to write
for up to 20 minutes on three consecutive days about either their thoughts and
feelings regarding their MI (emotional disclosure) or about trivial daily activities (control). The intervention took place in patients’ homes at 3 weeks post
MI and the impact was assessed at 2, 3 and 6 months post MI. Compared to the
control at follow up the emotional writing group had fewer hospital and GP visits and were less ill overall, had lower blood pressure, fewer prescribed medicines, greater risk factor modification and attendance at the cardiac rehabilitation course. The emotional writing group also reported a higher quality of life
on some indices.
The possible mechanisms underpinning the observed effects will be discussed
including the potential role of writing in self-regulation.
EFFECTS OF HEALTH EDUCATION AND STRESS MANAGEMENT FOR HIGH-RISK CORONARY HEART
PATIENTS
S. Grandi, C. Magelli, N. Duca, L. Sirri, S. Fabbri, E. Tossani
INTRODUCTION - Cloninger’s psychobiological model of personality is
based on three basic dimensions of temperament which are genetically independent and heritable. These dimensions appear to be predictable and adaptive
patterns of interaction in response to specific external stimuli.
The aim of the present study was to explore Cloninger’s dimensions of personality in a group of heart transplanted outpatients and to determine if these
dimensions may be statistical predictors of compliance.
MATERIALS AND METHODS - 100 consecutive outpatients (72 males and
28 females, mean age = 59.2 years) evaluated a year after heart transplantation
who were stable under a cardiovascular profile were compared with 100
healthy controls matched for socio-demographic variables.
Assessment methods included the Italian version of the SCID-IV, Cloninger’s
Tridimensional Personality Questionnaire (TPQ) and Grandi’s Compliance
Questionnaire (CQ).
RESULTS AND CONCLUSIONS - Transplanted patients showed higher
scores on NA (p£ 0.05) and RD (p£0.05) scales of TPQ than the control group.
Patients with high compliance, compared to the ones with low compliance, displayed lower scores on the NS scale (p£0.05) and higher scores on the HA scale
(p£0.006) of TPQ - These preliminary results suggest that Cloninger’s dimensional approach to personality entails important information about compliance.
Consequently, it would be worthy to replicate these findings in different clinical settings.
J de Vreugd, MMW van Boekel, G Lamboo, Th van Elderen
Clinical and Health psychology
Background: In a recent meta-analyses on the effects of health education and
stressmanagement programmes for coronary heart patients (v.Elderen
1999)positive effects were found concerning mortality, morbidity, risk-factors
and lifestyles. No effect were found, however, on quality of life variables. In a
previous research project funded by the Netherlands Heart Foundation we
found neither positive effects on quality of life variables, nor on smoking cessation and physical exercise. There were positive effects on eating habits . On
an international level several suggestions are made to improve the effectiveness
of cardiac rehabilitation services: 1. More training for health professionals
offering the programmes; 2. Screening for ‘high-risk’ patients; 3. A focus on
personal goals of the patients.
Hypothesis: Improvements mentioned will lead to positive effects of health
education and stress management programmes on quality of life variables and
healthy lifestyles.
Study objectives: Evaluation of the effects of improved health-education and
stressmanagement-programmes for high-risk coronary patients on quality of
life and lifestyles.
Methods: In a randomised pre-test post-test control group design, on the basis
of high-risk scores on quality of life variables and/or lifestyles, patients will be
selected for the experimental condition (N=90)(standard cardiac care, physical
training, health education and psycho-educational prevention programs)or for
the control condition(N=90)(standard cardiac care and physical training).
Expected results: Incremental effects in the experimental condition on quality
of life and life-style variables.
153
Posters
DEVELOPMENT OF TASK, SCHEDULING AND COPING
SELF-EFFICACY FOR EXERCISE OVER TIME
MOTIVATION IN PHYSIOTHERAPY - EXERCISES AND
BACK FRIENDLY POSTURE
Wendy M. Rodgers & Terra C. Murray
University of Alberta
Wiebke Goehner
The role of self-efficacy (SE) in the production of exercise behavior has been
well supported (e.g., Bandura, 1997; McAuley, 1992). SE has been purported
to be behavior specific and research has supported the idea that there are different types of exercise SE. Recently, Rodgers & Sullivan (2001) provided support for task, scheduling and coping exercise SE, each relating to a different set
of behaviors relevant to physical activity. We wanted to examine the temporal
unfolding of different types of exercise SE in a women’s strength training program. Two 12 week studies were conducted and included a 4 week supervised
period followed by an 8 week unsupervised period. SE was assessed at the outset, after week 4 and at the end of each program. Strength was assessed at the
beginning and end of each program. MANOVA with repeated measures
revealed significant increases in task, scheduling and coping SE over time
(Eta2 = .43, study 1, Eta2 = .33, study 2). Follow up univariate analyses
revealed that all three variables increased significantly with the largest change
observed for coping SE in both studies and the smallest for scheduling in study
1 and task in study 2.
Task did not change significantly in study 2. These results suggest that the different types of SE develop at different rates, supporting the idea that they are
differentially produced by experience with the behavior.
Objective. For long-term treatment effects and therefore the prevention of
chronic pain, physiotherapy patients need to adhere to an exercise regimen
beyond the prescribed treatment. Because adherence rates are as low as 30%, a
motivation training was developed to positively influence patients’ self-efficacy, perceived barriers and severity. For the first time, the exercise regimen consisted not only of physiotherapy exercises but also of the correct everyday posture (back-friendly sitting, standing and bending position).
Method. A two-factor experiment with repeated measures on one factor was
applied. 47 patients with back pain were randomly assigned to an experimental group (physiotherapy treatment plus 3-hour motivation training) as well as
a control group (physiotherapy treatment). Questionnaires were completed preand post-treatment, and at three and six months follow-up. Dependent variables
were self-efficacy, severity, barriers, intention, behaviour.
Results. Univariate analyses revealed significant main and interaction effects
(p<.01), the treatment group reported higher scores for the dependent variables
(lower scores for barriers). However, the adherence could only be improved
regarding the exercises (t4: treatment group: 56%, control group: 9%, t<.01).
Unexpectedly, there were no significant changes regarding the everyday posture behaviour.
Conclusion. Physiotherapists need to become aware of the fact that back pain
patients not only need adequate treatment but also adequate motivation to be
able to follow the exercise regimen in the long run. Further research is necessary to improve the adherence to back friendly everyday posture; suggestions
are given for the development of practicable interventions
DOES EXERCISE MOTIVATION PREDICT EXERCISE
ACTIVITY?
Robert Urban
Eotvos Lorand University
Objectives: This research was designed to investigate which factors of exercise
motivation predict the exercise activity among regular exercisers in younger
population.
Methods: The Hungarian version of Exercise Motivation Inventory (EMI2,
Markland ?s Ingledew, 1997) was applied to 311 younger regular exercisers
with wide range of exercise activity.
The characteristics of exercise activity were also measured including weekly
frequency, average length of exercise, commitment to regular exercise activity,
and types of exercise activity.
A weekly activity measure was designed by multiplication of weekly frequency with the average length of exercise.
Results: In the development of Hungarian version of Exercise Motivation
Inventory, a confirmatory and exploratory factor analyses were performed supporting a similar, but not identical factorial structure compared to the original
version.
The final hierarchical regression model shows that the motivation of
Competition (?=0.26), Strength (?=0.19), and Health (?=-0.12) predicted the
weekly exercise activity (R2=0.14).
The sample was divided into two groups: one group consisted of those people
who do exercise for less than 1 year (“beginner”) and those who do it for more
than 1 year ?
(“already committed”). The logistic regression analysis shows that Enjoyment
(?=1.04) and Physical appearance (?=-0.37) predicted (R2=0,12) the longer
commitment to regular exercise.
Conclusion: It is clear that only certain types of motivation can predict
significantly the exercise activity. The predictive power of motivation is quite
moderate. More research is needed to show what other factors beside or in
interaction with motivations can predict exercise activity more fully.
This knowledge would be very important for designing effective messages in
any health promotion programs to enhance physical activity.
154
MISCONCEPTIONS ABOUT PHYSICAL ACTIVITY
Smeets, T; Vries de, H
Maastricht University
Introduction Physical activity is considered important for a healthy lifestyle.
In the Netherlands, just as in other European countries, a growing part of the
population does not meet the standard recommendation of 30 minutes of
moderate physical activity on preferably all days but at least 5 days a
week. Little is known about the reasons why Dutch adults engage in physical
activity and may decide to increase their activity level. The overall aim of
the present study is to illuminate the reasons of the Dutch adult population
to (not) engage in physical activity.
Method A random sample of addresses was obtained through the Dutch national Telephone Company. These addresses were sent a questionnaire.
Respondents had to be between 18 and 65 years. The questionnaire assessed
objective and subjective physical activity, cognitive pros and cons, affective
pros and cons, social influence of partner, family and friends, self-efficacy,
implementation intentions, stages of change and sociodemographic variables.
Results The guideline for physical activity was met by 40% of the respondents.
Differences were found between stages of change in affective pros, cognitive
pros and cons and self-efficacy. Most profound differences were found
between adults in the unaware precontemplation and aware precontemplation
stage. Discussion It is important to identify misconceptions. As long as adults
do not know what they are doing wrong, they are not motivated to change. For
respondents unaware of their low activity level, the first step is to provide tailored feedback on their actual activity level, and their beliefs about physical
activity.
Posters
EXAMINING EXERCISE IN GREEK ADULTS AND COLLEGE STUDENTS: A COMPARISON AND VALIDATION OF
THE TRANSTHEORETICAL MODEL
Kara L. Hall*, Milena D. Anatchkova*, Polina Kontogianni**, Joseph S.
Rossi*, Konstantinos Karteroliotis**, Nelly Kontogianni**
*University of Rhode Island, US; **National and Kapodistrian University of
Athens, Greece
The Transtheoretical Model (TTM) of behavior change has been applied to
over 50 health behaviors, primarily with US and Western European populations. The current study examines the validity of the TTM in physical activity (PA) for two Greek populations. College students (N = 270) and a community sample of adults (N = 139) completed assessments including three TTM
constructs (stage of change, decisional balance, and self-efficacy), measures of
PA and demographic variables. Both samples demonstrated psychometric
properties similar to those seen in other populations: a one-factor solution for
self-efficacy and a two-factor solution (pros and cons) for decisional balance.
Alpha coefficients of the pros, cons, and self-efficacy scales were
between .68 and .87. A MANOVA showed significant differences between the
two populations, stage of change, and the interaction between the two groups
and stage of change. There were no significant gender differences. Results
suggest that college students engage in more PA (p < .001). and have greater
self-efficacy towards PA (p = .002) than adults. All constructs differed significantly by stage (p < .001). PA, self-efficacy and pros increased linearly and
cons decreased linearly across the stages from precontemplation to maintenance. Finally a group by stage interaction was found for
self-efficacy. This relationship showed that while the groups increased in a similar pattern in the pre-action stages, during the action and maintenance stage
college students’ self efficacy scores were higher. The results demonstrate differences in exercise behaviors between two samples and support the application of the TTM to Greek populations.
WAYS OF COPING AND COMPETITIVE STATE ANXIETY:
AN INVESTIGATION BASED ON THE TIME-TO-EVENT
PARADIGM
Nektarios A. Stavrou, Maria Psychountaki & Yannis Zervas
Laboratory of Motor Behavior & Sport Psychology, Department of Physical
Education & Sport Science, University of Athens, Greece
Recent studies have indicated that the ways of coping (WoC) in sports use are
crucial regarding the level of competitive anxiety experienced by athletes, as
well as the way they estimate their anxiety level, either facilitative or debilitative. The purpose of the present study was to examine the relationship between
WoC and competitive state anxiety. The subjects of the study were 381 athletes
(221 males, 160 females) with a mean age of 19.7 years old (SD = 4.12) and a
mean competitive experience of 6.7 years, participating in 10 individual sports.
The athletes completed one hour before the competition the Competitive State
Anxiety Inventory-2 (CSAI-2) measuring the intensity and the direction (facilitative-debilitative) of anxiety (cognitive anxiety, somatic anxiety, and selfconfidence) and the Ways of Coping Inventory (WoCI) to estimate the ways
athletes use to manage their anxiety (cognitive appraisal, active coping, passive
coping, and seeking social support). Thirty minutes after the competition the
athletes completed the CSAI-2 based on how they felt during the competition.
The results indicated that active coping was positively correlated with self-confidence, whereas passive coping and seeking social support revealed negative
correlation with self-confidence and positive correlation with cognitive and
somatic anxiety. Additionally, athletes with high cognitive appraisal revealed
more facilitative interpretation of cognitive and somatic anxiety, whereas the
athletes who where seeking for social support estimated anxiety as more debilitative to their upcoming performance. The findings of the present study support the important role of WoC the athletes use to manage the competitive anxiety prior and during competition.
EFFECTS OF A SINGLE BOUT OF AEROBIC EXERCISE
ON MOOD AND COGNITIVE FUNCTIONING
Koutsis, G., Asimakopoulou, K., Payne, N
University of Hertfordshire, University of Surrey Roehampton, Middlesex
University)
The long-term health benefits of aerobic exercise are well known. However, the
short-term effects of a single session of exercise are less clear. The present
study explored the effects of a single, brief session of moderate exercise on
mood and cognitive performance. It was predicted that moderate exercise
would affect complex cognitive processes and mood, but given the inconsistencies reported in the literature, the direction of this effect was not determined.
In a counterbalanced within participants design, 25 undergraduate volunteers
(M age = 21.28 years, SD =1.28) completed a battery of cognitive function tests
measuring ability to remember logical sequences (WAIS Logical Memory A
and B), simple and complex visuo-motor coordination (Trail Making A and B)
and mental flexibility (Serial Subtraction of 7s). Mood was measured by the
Profile of Mood States and the State Anxiety Inventory. Measurements were
obtained after a 20-minute session of moderate aerobic activity and after a 20minute session of rest, with an interval of two days between measurements.
Repeated measures t-tests suggested cognitive function enhancement in short
term logical memory (t (24) = 3.48, p<.003) and mental flexibility (t (24) = 2.15, p<.02). State anxiety (t (24) = -2.07, p= 0.05) and mood (t (24) = -1.41,
p>.05) were not affected. The results suggested that a short bout of moderate
exercise may enhance memory and mental flexibility but not mood.
LEISURE SATISFACTION, HEALTH AND LEISURE COPING
STRATEGIES
Santos, L.1 2 & Pais-Ribeiro, J.1
1 Universidade do Porto
2 Instituto Politécnico de Viana do Castelo
Portugal
OBJECTIVES: To understand the relationship between: (1)leisure satisfaction
and health; (2) leisure satisfaction and leisure coping believes.
METHOD: Sample design: A sample of 426 students was studied, 63.6%
females; aged between 17 and 23.
Procedure: Participants answered to an Inventory of Leisure Activities, with six
categories of leisure: Sport, Social and Outdoor Activities, Cultural Events,
Hobbies and Mass Media.
Measures: The Leisure Coping Belief Scale (LCBS), and the SF36.
RESULTS: Results suggest that General Health was positively related Social
Activities (r(422)=.15; p<.01), Sport Activities (r(394)=.16; p<.01), Cultural
Events (r (327)=.12; p<. 05), Outdoor Activities (r (420)=.17; p<.01); and that
Mental Health was positively related with Social Activities (r (418)=.17;
p<.001), Sport Activities (r (390)=.18;p<.001), and Mass Media (r (418)=.20;
p<.001).
Results suggest also that Leisure Belief Self-determination was positively related with Social Activities (r(423)=.23; p<.001), Sport Activities (r(394)=.27;
p<.001), Outdoor Activities (r (420)=.18; p<.001), Hobbies (r (425)=.18;
p<.001) and Mass Media (r (423)=.17; p<.01); Leisure Belief Empowerment
was positively related with Social Activities (r(423)=.28; p<.001), Sport
Activities (r(394)=.27; p<.001), Outdoor Activities (r (420)=.17; p<.01),
Hobbies (r (425)=.17; p<.001) and Mass Media (r (423)=.19; p<.001); and
Leisure Belief Friendship was positively related with Social Activities
(r(423)=.34; p<.001), Sport Activities (r(394)=.21; p<.001), Outdoor Activities
(r (420)=.21; p<.001), Hobbies (r (425)=.16; p<.01) and Mass Media (r
(423)=.25; p<.001).
CONCLUSION: The study suggests that some categories of leisure activities
were positively related with general health and mental health and with different dimensions of leisure coping beliefs of university students.
155
Posters
LEISURE PARTICIPATION, HEALTH AND GENDER
Santos, L.1 2 & Pais-Ribeiro, J.1
1 Universidade do Porto
2 Instituto Politécnico de Viana do Castelo
Portugal
OBJECTIVES: The objective was to understand the relation between leisure
participation and perceived health, and to analyse gender differences.
METHOD: Sample design: A cohort of 426 first year university students,
63.6% of which were females; aged between 17 and 23; 99.6% unmarried was
studied;
Procedure: Participants answered to an Inventory of Leisure Activities, six categories of leisure were utilised: Sport Activities, Social Activities, Cultural
Events, Outdoor Activities, Hobbies and Mass Media, and two scales in classroom context.
Measures: Inventory of Leisure Activities and Health Scale - SF36.
RESULTS: Results suggest that for male students participate more frequently
in Sport Activities (t(422)=4.94; p<.001), in Social Activities (t(421)=2.29;
p<.05) and in Cultural Events (t(422)=2.52; p<.05); Female students participate
more frequently in Hobbies (t(422)=5.10; p<.001).
Results also suggest that for male students General Health was positively related with Social Activities (r(152)=.17; p<.05), Sport Activities (r(153)=.17;
p<.05), and Mass Media (r (152)=.18; p<.05); and for female students General
Health was positively related with Outdoor Activities (r (269)=.21; p<.001) and
Hobbies (r(269)=.12; p<.05).
And that for male students Mental Health was positively related with Social
Activities (r(150)=.21; p<.05), Sport Activities (r(151)=.18; p<.05), and Mass
Media (r (150)=.22; p<.01); and for female students Mental Health was positively related with Outdoor Activities (r (267)=.17; p<.01), Hobbies (r
(267)=.14; p<.05), and Mass Media (r (267)=.22; p<.001).
CONCLUSION: The study suggests some gender differences concerning the
leisure activity participation and also between health and leisure relations.
156
HEALTH BEHAVIOUR OF MIGRANTS IN THE NETHERLANDS: PHYSICAL ACTIVITY AND ITS DETERMINANTS
AMONG YOUNG TURKS AND MOROCCANS
K. Hosper, C.J. van Oel, K. Stronks
Academical Medical Center (AMC) - University of Amsterdam, The
Netherlands
Department of Social Medicine Amsterdam, The Netherlands.
Background
There are indications that health-related behaviour of non-Western migrants in
the Netherlands differs from that of the native Dutch population. It has also
been suggested that health behaviour in some migrant groups is influenced by
specific cultural and religious attitudes. Health promotion activities mainly
based on the outcome of studies among Western groups might be less effective
for non-Western migrants. Physical activity for instance may deserve special
attention, because overweight is an increasing problem especially among Turks
and Moroccans in the Netherlands.
Aim
To gather information about specific determinants of physical activity among
Turks and Moroccans in the Netherlands.
Methods
A qualitative study is carried out, consisting of focus group interviews with
Turkish and Moroccan adolescents.
Results
From the qualitative study it appears that some determinants of physical activity might differ between ethnic groups. Moroccan and Turkish girls for example express the idea that exercise is exclusively for young people, and not for
older people like their parents. Cognitions about the benefits of physical activity seem to be more similar with those of Dutch adolescents: being physically
active is healthy, good for ones condition, and its helps to loose weight.
Conclusion
It appears to be neccesary to include culture specific attitudes in the questionnaire about determinants of physical activity. On the basis of this qualitative
study a questionnaire has been developed and tested in a pilot. At this moment
the questionnaire is used in a quantitative survey among 1500 Turks and
Moroccans (aged 10-30) in Amsterdam.

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