Hypertension labelling, life events and psychological well-being

Almost all previous studies of the psychological sequelae of hypertension labelling have lacked a prospective, longitudinal design which could allow for causal interpretations. The present study relies on questionnaire data from a hypertension screening carried out on the entire adult population of a medium-sized, Norwegian county (total number of participants = 74977). 'Labelled' individuals, i.e. previously unaware hypertensives (N = 173), false positives (N = 233), and patients in need of continued BP control (N = 474) have been followed up after 1-3 years, and comparisons are made with aware hypertensives (N = 206), patients previously treated for hypertension (N = 118), and a random sample of normotensives (N = 2326). 'Pre-labelling', baseline measures of subjective well-being had been carried out on all comparison groups in connection with the screening. Changes in psychological well-being are not significantly related to labelling or BP-status. However, there is a deterioration in psychological well-being among participants who have been subjected to one or more negative life events/stresses (other than labelling) in the preceding 12 months.     

The construct validity of subjective well-being measures: An assessment via quantitative research syntheses

The construct validity of subjective well-being was assessed by quantitative research syntheses of U.S. studies of the correlates of subjective well-being appearing before 1980. The classes of evidence examined in this article include reports of reliability, estimates of correlation between different measures of subjective well-being, and estimates of correlation between measures of subjective well-being and measures of other constructs (adjustment, neuroticism, and work and family satisfaction). Generally, measures of subjective well-being showed adequate reliability (M = .80). Measures of subjective well-being were moderately associated with adjustment (M = .38), neuroticism (M = − .33), and work (M = .33) and family (M = .29) satisfaction. Although measures of subjective well-being were substantially interrelated (M = .52), validity coefficients based on two different subjective well-being measures purported to tap the construct of happiness (M = .45) were slightly lower than validity coefficients based on subjective well-being measures purported to tap the constructs of happiness and life satisfaction (M = .49). In selecting measures of subjective well-being, community psychologists are urged to consider their theoretical framework and traditional psychometric criteria.     

Life events assessment: Current practices, emerging trends

The study of stressful life events and disorder has become a prolific area of research in the past two decades, While a large literature suggests the importance and viability of this approach for studying basic stress and disease relationships, many important assessment issues require reevaluation. In particular, current assessment procedures are characterized by a wide range of varied practices. Given the lack of standardized procedures, combined with the inadequate psychometric properties of the life events instruments themselves, assessment issues may be most important for advancing knowledge of event-illness associations. Alternative approaches to assessing events, particularly taking into consideration the complex associations between events themselves, are outlined in the present paper as examples of assessment strategies that may more accurately reflect the importance of life events. Finally, the implications of such considerations for both theoretical and clinical issues are addressed.     

Relationship of hassles, uplifts, and life events to psychological well-being of freshman medical students

Hassles, uplifts, and life events were related to psychological well-being with a representative sample of 55 (of 179) freshman medical students. Students were sent measures of hassles, uplifts, and affect-moods measures for 9 consecutive months and a measure of life stress at the beginning and middle of the school year. The hassles measure was found to be a better predictor of concurrent and subsequent negative mood than was the life stress measure, whereas life stress was found to be a better predictor of subsequent positive mood than hassles. On the whole, uplifts were unrelated to mood. The relationship between life stress and hassles was also investigated. The implications of the findings for future stress and health outcome research are discussed.     

Using disablement models and clinical outcomes assessment to enable evidence-based athletic training practice, part II: clinical outcomes assessment

OBJECTIVE: To provide an overview of clinical outcomes assessment, discuss the classification of outcomes measures, present considerations for choosing outcomes scales, identify the importance of assessing clinical outcomes, and describe the critical link between the utilization of disablement models and clinical outcomes assessment. BACKGROUND: Clinical outcomes are the end result of health care services. Clinical outcomes assessment is based on the conceptual framework of disablement models and serves as the measurement method for the collection of patient-oriented evidence, a concept central to evidence-based practice. DESCRIPTION: Clinical outcomes management refers to the use of outcomes measures in the course of routine clinical care and provides athletic trainers with a mechanism to assess treatment progress and to measure the end results of the services they provide. Outcomes measures can be classified as either clinician based or patient based. Clinician-based measures, such as range of motion and strength, are taken directly by clinicians. Patient-based measures solicit a patient's perception as to health status in the form of questionnaires and survey scales. Clinician-based measures may assist with patient evaluation, but patient-based measures should always be included in clinical assessment to identify what is important to the patient. CLINICAL AND RESEARCH ADVANTAGES: Evidence-based athletic training practice depends on clinical outcomes research to provide the foundation of patient-oriented evidence. The widespread use of clinical outcomes assessment, based on the disablement model framework, will be necessary for athletic trainers to demonstrate the effectiveness of therapies and interventions, the provision of patient-centered care, and the development of evidence-based practice guidelines.     

Externalizing religious health beliefs and health and well-being outcomes

Certain religious beliefs related to perceptions of internal or external health control (including belief in the existence of miraculous healing, and beliefs deferring responsibility for health outcomes from the self and onto God) may be related to health behaviors and in turn to health outcomes. Using data from a nationally representative US survey of religion and health (N = 2948) this study evaluates a series of two structural equation models of the relationships between religious activity, externalizing religious health beliefs (belief in healing miracles and divine health deferral), health outcomes, and life satisfaction. Believing in healing miracles was related to greater divine health deferral. Greater divine health deferral was associated with poorer symptoms of physical health. Belief in miracles was related to greater life satisfaction. Comparison of coefficients across models indicated that externalizing beliefs had a significant suppressor effect on the relationship between religious activity and physical symptoms, but did not significantly mediate its relationship with life satisfaction. Religious beliefs emphasizing divine control over health outcomes may have negative consequences for health outcomes, although the same beliefs may contribute to a better sense of life satisfaction.     

长学制医学生的生活事件与幸福感

 目的 研究北京协和医学院八年制医学生的幸福感与影响最大的生活事件。方法 通过发放,自愿填写的方式进行问卷调查,包括青少年生活事件量表和总体幸福感量表。采用t检验、方差分析均值和偏相关分析得到结果。结果 发放问卷共计634份,有效问卷390份,占发放问卷的61.51%,其中男性155名,女性199名,医学预科阶段224人,基础医学阶段47人,临床医学阶段166人。总体幸福感量表医学预科阶段为74.23±12.40,基础医学阶段为72.09±12.37,临床医学阶段为79.57±10.88。生活事件量表各个年级略有不同,但总体来说得分较高的3项为人际关系2.95±0.93、学习压力2.74±0.81、丧失2.94±1.43。学习压力与幸福感总分的偏相关系数为-0.317,p<0.001。结论 基础医学阶段的学习压力最高,导致其幸福感偏低,这一问题应该为学校所重点关注。     

Goals, benefits, and outcomes of genetic counseling: client and genetic counselor assessment

Most studies of outcomes of genetic counseling have focused on client knowledge, reproductive plans and behavior, or satisfaction. Other measures of the "value" of genetic counseling are needed to guide research assessing the impact of genetic counseling on individuals and populations, as well as to improve the process of providing care. To obtain input from providers, we conducted telephone interviews with six experienced genetic counselors, and then we held a focus group with 10 additional genetic counselors from a variety of practice settings. To obtain input from consumers, telephone interviews were also conducted with 19 past clients of these participating counselors. We found that counselor goals focus on meeting clients' needs, usually educating and providing psychosocial support. Clients often had few goals going into a session because they were unaware of what would be discussed or how the session would be structured. They usually did not expect to receive "counseling," and when they did, it was a welcome surprise. Both clients and counselors commented that a positive interpersonal interaction and "connecting" are primary measures of success. All clients appreciated the large amount of time spent with the counselor, and the manner (clear, comprehensive, and unhurried) of providing information. Many clients said that genetic counseling resulted in improved communication with their partners and other family members. Clients view the counselor as an "expert" and value the counselor as an on-going resource for both information and support. These "outcomes"f genetic counseling need to be assessed, and new measures must be developed.     

Stressful events,mastery, and depression: An evaluation of crisis theory

The effect of prior stressful events and mastery on psychological distress during and following a threat to life was examined, and three competing models concerning the effect of prior stressful events on reactions to severe life crisis were compared. The stressful events model suggests that prior stressful events increase vulnerability to new threatening events. The traditional crisis model suggests no such effect of prior stressful events on crisis reaction due to the overwhelming effect of the crisis at hand. A facilitator model predicts that prior events decrease vulnerability to crisis due to a “practice effect.” Fifty-five Israeli women (not found to have cancer) were studied just prior to and 3 months following biopsy for suspected cancer. Those with greater prior stressful events were significantly more state depressed at both times than those experiencing fewer events, supporting the stressful events model. It was also found that mastery moderated the extent to which women were depressed and the period of time they remained depressed. However, mastery did not limit the stressful life event — depression relationship. Implications for research and intervention are discussed.     

Health benefits: Meta-analytically determining the impact of well-being on objective health outcomes

Abstract

This research synthesis integrates findings from 150 experimental, ambulatory and longitudinal studies that tested the impact of well-being on objective health outcomes. Results demonstrated that well-being positively impacts health outcomes (r=0.14). Well-being was found to be positively related to short-term health outcomes (r=0.15), long-term health outcomes (r=0.11), and disease or symptom control (r=0.13). Results from the experimental studies demonstrated that inductions of well-being lead to healthy functioning, and inductions of ill-being lead to compromised health at similar magnitudes. Thus, the effect of subjective well-being on health is not solely due to ill-being having a detrimental impact on health, but also to well-being having a salutary impact on health. Additionally, the impact of well-being on improving health was stronger for immune system response and pain tolerance, whereas well-being was not significantly related to increases in cardiovascular and physiological reactivity. These findings point to potential biological pathways, such that well-being can directly bolster immune functioning and buffer the impact of stress.     

Detailed analysis of skin conductance responses during a gambling task: Decision,anticipation, and outcomes

Physiological arousal is considered a key factor of gambling behavior. Hence, to understand gambling behavior it is important to study the arousal responses during gambling. Moreover, crucial mechanisms of action could be uncovered by detailing the situations that produce an arousal response. A gamble, or bet, can be partitioned into three distinct phases: (a) decision phase, during which the information concerning the gamble is presented, outcomes are appraised, and a decision is made on how to gamble; (b) anticipation phase, during which the result of the gamble is awaited; (c) outcome phase, during which the outcome of the gamble is presented. Previous research on arousal responses to gambling have mostly measured tonic changes in arousal, and when phasic responses have been measured, analyses have generally concentrated on one of the gamble phases. The aim of the present study was to map the arousal responses during gambling in more detail by measuring skin conductance responses (SCRs) during all three gamble phases of a simple card game. The anticipation phase was found to produce the largest arousal response, suggesting anticipation to be a major contributor to arousal during gambling behavior. Risk behavior during the gambling task was mirrored in self‐reported risk taking in everyday life, and risk‐takers displayed smaller SCRs compared to nonrisk‐takers during decision making, suggesting this as a possible biomarker for risk‐taking individuals.     

A preoperative assessment and education program: implementation and outcomes

A preoperative program was initiated by the nursing staff of an orthopaedic unit to prepare patients and their families by providing information about every aspect of hospitalization for total joint replacement in order to decrease length of stay (LOS) and improve patient satisfaction. This included steps to minimize complications, teaching exercises that would increase post operative function, and quality discharge planning. The program is coordinated by the Patient Care Managers (PCM) and is offered to 4 patients twice weekly. The sample consisted of 463 patients admitted for total hip and knee replacement. The average LOS during the 33-month period was 8.0 days for those patients who received the preoperative program and 8.7 days for those patients who did not. Several outliers that had extended hospitalizations were equally distributed in both groups. By providing education preoperatively, we have not only reduced costs, but we have also provided our patients with timely information and quality care.     

Repeated downsizing contact: the effects of similar and dissimilar layoff experiences on work and well-being outcomes

In this longitudinal study, the authors compared 1,244 white- and blue-collar workers who reported 0, 1, or 2 contacts with layoffs; all were employees of a large manufacturing company that had engaged in several mass waves of downsizing. Consistent with a stress-vulnerability model, workers with a greater number of exposures to both direct and indirect downsizing reported significantly lower levels of job security and higher levels of role ambiguity, intent to quit, depression, and health problems. Findings did not support the idea that workers became more resilient as they encountered more layoff events. The authors found only partial evidence that the similarity or dissimilarity of the type of repeated downsizing exposure played a role in how workers reported changes in these outcome variables.     

Interpretation of prostate cancer screening events and outcomes: a focus group study

Professional guidelines call for physicians to provide patients with information to permit informed decision making. We conducted focus groups to obtain reactions to numerical information about events and outcomes related to prostate cancer screening (prevalence, natural history, accuracy of screening, and treatment outcomes). The focus groups were used to help develop a balance sheet, a decision aid that explicitly compares likelihood and value of outcomes. In all, 90 persons participated in 12 focus groups homogeneous in ethnicity (African American, White, Hispanic) and gender. Discussions were transcribed and analyzed using qualitative methods. The view of screening derived by participants from the numerical information was less positive than initial opinions based on the media and confidence in medicine. Participants suggested shorter screening intervals, regular screening, and different treatment methods. No single topic was seen as sufficient for the screening decision. The balance sheet should cover prevalence and outcomes of screening and treatment.     

Stressful events, stress perception and treatment outcomes in patients with depressive disorders: the CRESCEND study

Background

Investigations of associations between stressful events and depression treatment outcomes have led to conflicting findings. In a prospective naturalistic study of depression treatment we sought to investigate perceived stress as a predictor of 12-week antidepressant treatment outcome.

Methods

A nationwide sample of 580 people with depressive disorders was recruited from 18 hospitals in Korea. Number of stressful events in the last 12 months and subjective perception of stress were ascertained, and were dichotomized by median values. Participants commenced on antidepressant treatment were re-evaluated at 1, 2, 4, 8, and 12 weeks later. Assessment scales for evaluating depression (HAMD), anxiety (HAMA), global severity (CGI-s), and functioning (SOFAS) were administered at baseline and at every follow-up visit. Covariates included pre-treatment socio-demographic and clinical characteristics, and treatment-related characteristics.

Results

Higher baseline perceived stress was significantly associated with worse 12-week antidepressant treatment outcomes in terms of depression, anxiety, and global severity after adjustment for all covariates. However, baseline number of stressful events was not associated with any treatment outcomes.

Limitations

The study was observational, and the treatment modality was naturalistic.

Conclusions

Depressive patients with higher level of perceived stress at the time of commencing treatment had less favorable outcomes after antidepressant treatment. This may represent a group requiring more specific assessment and more intensive management in order to improve treatment response.     

The assessment of life events: Self-administered questionnaire versus interview

Two methods of assessing life events (interview and self-administered questionnaire) were applied in a study attempting to determine the range of application of the 2 procedures. The results obtained in 55 psychiatric in-patients indicate that in a number of categories more events were detected by self-report questionnaire than by interview, while in a few categories more were reported by interview.

In the discussion it is delineated that, although both methods have their own importance, the problems of differences of events reported by interview and by self-report are likely to be mainly in the use of self-report methods. It would seem that the sensitivity of both methods differs in relation to the character of the event: acute or process-related.