Optimism,self‐efficacy and information processing of threat‐ and well‐being‐related stimuli

The purpose of this study was to examine whether information bias associated with dispositional optimism and generalized self‐efficacy can account for the link between general expectations and well‐being. A modified Stroop task was used in this study. Our hypothesis was that individuals with high self‐efficacy expectations or dispositional optimism would show greater bias towards well‐being‐related stimuli, whereas individuals with low self‐efficacy or optimism would exhibit bias towards threat‐related stimuli. A secondary hypothesis was that both self‐efficacy and optimism would act as mediators of the latency, perceived distress relationship. One hundred and two undergraduate students participated in the study. After controlling for daily mood, the results showed that individuals high in optimism and self‐efficacy showed greater informational bias towards well‐being‐related stimuli. The low self‐efficacy group exhibited greater bias towards threat‐related stimuli. Also, consistent with our hypothesis, optimism and self‐efficacy mediated the relationship between the Stroop colour‐naming latencies and perceived distress. These findings suggest that associations, which refer to automatic processes, may form an additional way through which expectations are related to functioning. Copyright © 2007 John Wiley & Sons, Ltd.     

Applying a cognitive‐emotional model to nonsuicidal self‐injury

The recently proposed cognitive‐emotional model of nonsuicidal self‐injury (NSSI) draws on emotion regulation models and social cognitive theory to understand the onset, maintenance, and cessation of NSSI. We tested the prediction of the model that the relationship between emotional reactivity and NSSI is moderated by specific cognitions about self‐injury (i.e., self‐efficacy to resist NSSI, NSSI outcome expectancies), emotion regulation, and rumination. A sample of 647 university students aged 17–25 years (M = 19.92, SD = 1.78) completed self‐report measures of the constructs of interest. As expected, we found that emotional reactivity was positively related to NSSI, particularly for people who had weak self‐efficacy to resist NSSI. However, emotional reactivity was negatively related to NSSI for people who were more likely to use expressive suppression to regulate emotion. Implications for the theoretical understanding of NSSI are discussed.     

Social support,self‐efficacy and trauma in new recruits and experienced firefighters

This study compared new fire recruits in the first week of employment and following a 10‐week training period with a group of experienced firefighters. Results suggest that new firefighter recruits enter the fire service with considerable experience of exposure to critical events. Nevertheless, a significant linear relationship was found between years of experience and levels of traumatic stress and depression. Further, this study revealed that experienced firefighters had lower levels of social support and lower self‐efficacy than the new recruits. As these variables were associated with traumatic stress and depressive symptoms, it is concerning that these protective factors appear to diminish with time. Copyright © 2003 John Wiley & Sons, Ltd.     

Longitudinal relationships between self‐efficacy,post‐traumatic distress and salivary cortisol among motor vehicle accident survivors

The present study tested if post‐traumatic distress following a motor vehicle accident (MVA) and MVA‐related self‐efficacy beliefs were associated with diurnal salivary cortisol in the early post‐traumatic period. Cortisol was collected upon awakening and at 1, 4 and 12 h after waking. Collection days were 1 week, 1 month and 3 months after MVA. A total of 30 participants provided their cortisol samples across all measurement points. Two methods for computing the area under the cortisol curve were used. Higher post‐traumatic distress at 1 month predicted lower cortisol area under the curve (AUC) with respect to increase (AUC_I, reflecting changes in cortisol secretions during daytime) at 3 months. AUC with respect to ground (AUC_G, reflecting total cortisol release during daytime), measured at 1 month after trauma, predicted higher post‐traumatic distress at 3 months. The results showed that self‐efficacy at 1 week indirectly predicted 3‐month AUC_I through 1‐month post‐traumatic distress. These findings highlight the importance of self‐efficacy and post‐traumatic distress in explaining longitudinal diurnal patterns of cortisol secretion after trauma. Copyright © 2011 John Wiley & Sons, Ltd.     

Relationships between self‐efficacy,social support and stress coping strategies in Chinese primary and secondary school teachers

This study explored whether stress coping strategies could be predicted by general self‐efficacy and social support. Primary and secondary teachers (n = 530) completed measures of coping strategies, general self‐efficacy and social support. The results showed that teachers' general self‐efficacy and social support had direct and indirect predictive effects on different coping strategies, and they have more significant predictive effects on certain types of coping strategies. Teachers with higher general self‐efficacy and social support tended to adopt adaptive coping strategies or emotion‐oriented coping strategies. The study suggested that social support and self‐efficacy should be important factors to be considered when designing a prevention or intervention programme in the guidance of teachers' coping strategies and psychological counselling. Copyright © 2008 John Wiley & Sons, Ltd.     

Paravertebral block and persistent postoperative pain after breast surgery: meta‐analysis and trial sequential analysis

We examined whether paravertebral block has an effect on the prevalence of persistent postsurgical pain after breast surgery. Seven randomised, controlled trials (559 patients) which had the outcome assessor blinded were included, comparing patients who received paravertebral blocks after breast surgery with patients who did not. The risk ratio (95% CI) was 0.75 (0.48–1.15) for the incidence of postoperative pain at 3 months (four studies, 317 patients); the risk ratio (95% CI) obtained from three studies including 301 patients reporting on pain after 6 months was 0.57 (0.29–1.72), and the risk ratio (95% CI) for pain after 12 months (three trials, 237 patients) was 0.42 (0.15–1.23). Conventional meta‐analysis using the random effects model thus showed no statistically significant risk reduction for persistent postoperative pain at 3 months, 6 months or 12 months. Trial sequential analysis, used to consider the risk of type 1 and type 2 random error, showed that at 3 months, 6 months and 12 months, the number of subjects in the analyses were only 18.3%, 6.8% and 4.2% of the required information sizes at those time points, respectively. Our study is the first to evaluate data on pain 12 months postoperatively. Trial sequential analysis revealed that the current evidence is not sufficient to reach a conclusion. These findings stand in contrast to previous meta‐analyses with fewer studies that had concluded that paravertebral block effectively reduces chronic pain.     

Burnout and self‐employment: a cross‐cultural empirical study

This study examined the differences between full‐time self‐employed and organizationally employed individuals in Canada (n = 248) and Pakistan (n = 306) in terms of overall burnout and its three dimensions (emotional exhaustion, depersonalization and lack of accomplishment), turnover intentions and non‐work satisfaction. Data were collected by means of a structured questionnaire from Canadian employees in Montreal and Pakistani employees in Lahore. One‐way analysis of variance and multivariate analysis of variance were used to analyse the data. The self‐employed reported significantly higher overall burnout, emotional exhaustion, lack of accomplishment, non‐work satisfaction and turnover intention than the organizationally employed in both countries. No significant differences were found between self‐employed and organizationally employed in terms of depersonalization in both countries. Results are discussed in light of previous empirical evidence on self‐employment and the quality of work and non‐work life from cross‐cultural perspectives. Copyright © 2007 John Wiley & Sons, Ltd.     

Breakthrough pain in opioid-treated chronic non-malignant pain patients referred to a multidisciplinary pain centre: a preliminary study

BACKGROUND: Breakthrough pain (BTP) has not formerly been discussed as such in chronic non-malignant pain patients referred to pain centres and clinics. The purpose of the study was to investigate the prevalence, characteristics and mechanisms of BTP in opioid-treated chronic non-malignant pain patients referred to a pain centre and to assess the short-term effects of pain treatment. METHODS: Patients were assessed at referral (T(0)) and after a treatment period of 3 months (T(3)) using the visual analogue scale (VAS) of the brief pain inventory (BPI) within somatic nociceptive, neuropathic and/or visceral pain conditions, the mini mental state examination (MMSE) and the hospital anxiety and depression scale (HADS). The main treatment intervention from T(0) to T(3) was to convert short-acting oral opioids to long-acting oral opioids and to discontinue on demand and parenteral use of opioids. RESULTS: Thirty-three patients were assessed at T(0) and 27 at T(3). The prevalence of BTP declined significantly from T(0) (90%) to T(3) (70.4%). Worst, least, average and current pain intensities as well as duration of BTP were significantly reduced from T(0) to T(3.) The majority of BTPs were exacerbation of background pain assumed to be of the same pain mechanisms. High average pain intensity (BPI) was significantly associated with high scores for both anxiety and depression (HADS). CONCLUSION: BTP in chronic non-malignant pain patients seems to be surprisingly frequent and severe. Stabilizing the opioid regimen seems to reduce pain intensity in general as well as the intensity and duration of BTP. Average pain intensity was associated with anxiety and depression.     

Stress‐related predictors of optimism in breast cancer survivors

Optimism is a key variable for adjustment in aversive conditions. The purpose of this study was to examine whether optimism is predicted by two stress‐related variables which represent information about self and the environment (i.e. illness‐related stress and self‐efficacy), in a sample of breast cancer survivors. Ninety‐two women who had undergone a mastectomy participated in the study (minimum time elapsed since diagnosis = 3 years). Most participants (51 per cent) reported that at least one of four illness‐related concerns had been quite or very stressful in the past 6 months. Analyses showed that illness‐related stress exerted influence on optimism through coping, whereas self‐efficacy exerted influence both directly and through coping. Stress was predicted by two medical variables (time since diagnosis and time since mastectomy). These findings confirmed our hypothesis that knowledge about personal abilities, as well as about environment difficulties can predict the way a person evaluates future outcomes. This study has significant implications for clinical practice with patients. Copyright © 2007 John Wiley & Sons, Ltd.     

Illness‐related complaints in women with chronic widespread pain: importance of a contextual approach

The study, comprising 125 sick‐listed women aged 25–64 (m = 46.9 years) with widespread chronic pain, aimed at evaluating biopsychosocial problems as perceived by these women, studying such problems within a contextual framework, relating the findings to sociodemographic and medical data. Musculoskeletal complaints, fatigue, inability to work, sleep disturbances and uncertainty about the future were the problems, other than pain, most frequently reported. The women's written accounts of their musculoskeletal or somatic problems reflected being troubled by their unpaid household work and duties. Their psychological symptoms and social problems generally concerned paid work, unemployment or being on sick leave. The women's biomedical orientation appeared to be a function of their extended pharmaceutical and surgical treatment and their efforts to be recognized, particularly by insurance authorities, as clearly having a somatic disease. The study indicates the importance of a situational approach to gaining an understanding of illnesses in women with widespread pain. It is argued that, in a society accepting only medical grounds for sicklisting, physicians and other health care workers serve to reinforce a biomedical perspective in women suffering from biomedically ‘unexplained’ somatic symtoms, tending to result in medicalization, surgery and heavy use of pharmaceutical drugs. Copyright © 2005 John Wiley & Sons, Ltd.     

The association between stress,self‐esteem and childhood acceptance in nursing and pharmacy students: a comparative cross‐cultural analysis

The proposition that stress level is affected by self‐esteem development, for which acceptance from others in childhood is a key issue, was tested in two health care professions. The sample was 131 from nursing studies and 91 from pharmacy studies at a university in London, and 344 from nursing and 976 from pharmacy in Tokyo. Levels of stress were measured with the Perceived Stress Scale, self‐esteem with the Rosenberg Self‐Esteem Scale and childhood acceptance with the Parental Nurturance Scale. The data were analysed in terms of levels of and causal path between stress, self‐esteem and childhood acceptance. The proposed mechanism was supported among the nursing and pharmacy students in both British and Japanese cultures. The sample was also found to be substantially high on stress and low on self‐esteem and childhood acceptance. The results suggested that those entering the health care profession, such as nursing and pharmacy, have some additional vulnerability to stress compared with the general population. Enhancing self‐esteem was strongly recommended in stress management for health care professions. Copyright © 2008 John Wiley & Sons, Ltd.     

High self‐reported non‐adherence to antiretroviral therapy amongst adolescents living with HIV in Malawi: barriers and associated factors

Introduction : Globally adolescents and young adults account for more than 40% of new HIV infections, and HIV‐related deaths amongst adolescents increased by 50% from 2005 to 2012. Adherence to antiretroviral therapy (ART) is critical to control viral replication and preserve health; however, there is a paucity of research on adherence amongst the growing population of adolescents living with HIV/AIDS (ALHIV) in Southern Africa. We examined levels of self‐reported ART adherence, barriers to adherence, and factors associated with non‐adherence amongst ALHIV in Malawi. Methods : Cross‐sectional study of 519 ALHIV (12–18 years) attending two large HIV clinics in central and south‐eastern Malawi. Participants self‐reported missed doses (past week/month), barriers to adherence, and completed questionnaires on past traumatic events/stressors, disclosure, depression, substance use, treatment self‐efficacy, and social support. Biomedical data were retrieved from existing medical records. Multivariate logistic regression was performed to identify factors independently associated with self‐reported ART adherence (7 day recall). Results : The mean age of participants (SD) was 14.5 (2) years and 290 (56%) were female. Of the 519 participants, 153 (30%) reported having missed ART doses within the past week, and 234 (45%) in the past month. Commonly reported barriers to adherence included forgetting (39%), travel from home (14%), busy with other things (11%), feeling depressed/overwhelmed (6%), feeling stigmatized by people outside (5%) and within the home (3%). Factors found to be independently associated with missing a dose in the past week were drinking alcohol in the past month (OR 4.96, 95% CI [1.41–17.4]), missed clinic appointment in the past 6 months (OR 2.23, 95% CI [1.43–3.49]), witnessed or experienced violence in the home (OR 1.86, 95% CI [1.08–3.21]), and poor treatment self‐efficacy (OR 1.55 95% CI [1.02–2.34]). Sex and age were not associated with adherence. Conclusions : In our study, nearly half of all ALHIV reported non‐adherence to ART in the past month. Violence in the home or alcohol use in the past year as well as poor treatment self‐efficacy were associated with worse adherence. Sub‐optimal adherence is a major issue for ALHIV and compromise treatment outcomes. Programmes specifically tailored to address those challenges most pertinent to ALHIV may help improve adherence to ART.