The effects of gender on diagnosis of psychological disturbance

This research examines the effect of patient gender on the detection of psychological disturbance. In Study 1, primary-care patients were requested to complete the General Health Questionnaire (GHQ), a measure of nonpsychiatric psychological disturbance, prior to their consultation. The patient's GHQ score was compared with physician judgments about the level of disturbance in that patient (N=1913). Although there were a similar number of GHQ high scorers among males and females, the physicians classified significantly more females than males as disturbed. The doctors classified as disturbed a larger proportion of nondisturbed women than nondisturbed men. In order to explore the behavior of recent medical graduates, Study 2 examined the detection behavior of interns in an outpatient department with 384 of their patients. The interns behaved in a similar manner to the primary-care physicians.This study was part of two large research projects, one undertaken by the Newcastle Primary Care Research Group, funded by NH & MRC, and one looking at quality of care in interns, supported by RADGAC. The principal Investigator for both studies was R.W. Sanson-Fisher, Professor of Behavioural Science in Relation to Medicine.     

The interactive effects of counselor gender,physical attractiveness and status on client self-disclosure

Investigated client self-disclosure and client perception of counselors (as expressed in counselor evaluations) as a function of the sex, attractiveness and status of the counselor, and the sex of the client. Counselor gender and attractiveness were established by means of stimulus photographs; counselor status was defined in terms of education and experience. Ss (160 college students) first rated their counselors on intelligence and empathy; they then completed Jourard's Self-Disclosure Questionnaire while role-playing clients in therapy. A four-factor between-Ss analysis of disclosure scores revealed that clients disclosed more of themselves to male than to female counselors when the counselors were high in either status or attractiveness. Results supported the hypothesis that the effect of counselor gender on client disclosure depends on an interaction of counselor gender with other counselor variables.     

Influence of psychological and clinical factors on postoperative pain and narcotic consumption.

Demographic, psychological and clinical factors influencing postoperative pain and narcotic analgesic requirements in 162 patients undergoing elective operations under general anesthesia were studied. Eysencks Personality Questionnaire, Foulds Hostility Questionnaire, Zung's Anxiety-Depression (self-rating) Scales and the 43 Item Life Events Inventory by Holmes and Rahe were used. Clinical correlates such as surgical department, outcome of the operation, patient's knowledge of the diagnosis, were studied. Using multiple regression analysis the following results were obtained: postoperative pain levels increase with higher score of extroverted hostility (p = 0.038), abdominal surgery (p = 0.004), longer stay at hospital postoperatively (p = 0.15) and higher educational status (p = 0.13). Postoperative narcotic requirements increase with increased postoperative pain levels (p = 0.039) and preoccupation with pain postoperatively (p = 0.025), preoperative analgesic drug use (p = 0.017), abdominal surgery (p = 0.009) and longer stay at hospital preoperatively (p = 0.016). Also the department in which the patients were hospitalized influenced narcotic consumption.     

Emotional support and gender in people living with HIV: effects on psychological well-being

Current research indicates that emotional support is strongly associated with physical and psychological adjustment in persons living with HIV/AIDS. While gender-differences in health and health behaviors of HIV positive patients are well studied, less is known about how men and women living with HIV/AIDS may differentially perceive and integrate support into their lives, and how it subsequently affects their psychological well-being. This cross-sectional study examines how emotional support received from partners and family/friends and gender explains psychological well-being (i.e., stress, depression, anxiety) in a sample of 409 partnered European HIV positive individuals. We hypothesized that gender would modify the associations between support and psychological well-being such that men would benefit more from partner support whereas women would benefit more from family/friend support. Results revealed that regardless of the source of support, men’s well-being was more positively influenced by support than was women’s well-being. Women’s difficulties in receiving emotional support may have deleterious effects on their psychological well-being.     

Hypertension and pain sensitivity: effects of gender and cardiovascular reactivity.

Repeatedly, hypertensives have been found to appraise physical stressors as less aversive than normotensives. The main aim of the present study was to examine the effects of gender and cardiovascular reactivity in the relationship between hypertension and appraisal of pain. Forty-two unmedicated hypertensives and 21 normotensive controls of both genders were exposed to an electric current stimulus, while various cardiovascular parameters and prestressor anxiety were measured. In general, hypertensive women, but not men, showed diminished pain sensitivity compared to their normotensive counterparts. When the analyses were repeated with controlling for cardiovascular reactivity, the between-group effects were no longer significant. The results indicate that (i) profound gender differences exist in hypertension-related pain sensitivity and (ii) these effects seem to be mediated, at least partly, by cardiovascular reactivity.     

Mediation and moderation of psychological pain treatments: response expectancies and hypnotic suggestibility

The mediator role of response expectancies and the moderator role of hypnotic suggestibility were evaluated in the analogue treatment of pain. Approximately 1,000 participants were assessed for hypnotic suggestibility. Later, as part of a seemingly unrelated experiment, 188 of these individuals were randomly assigned to distraction, cognitive-behavioral package, hypnotic cognitive-behavioral package, hypnotic analgesia suggestion, placebo control, or no-treatment control conditions. Response expectancies partially mediated the effects of treatment on pain. Hypnotic suggestibility moderated treatment and was associated with the relief produced only by the hypnotic interventions. The results suggest that response expectancies are an important mechanism of hypnotic and cognitive-behavioral pain treatments and that hypnotic suggestibility is a trait variable that predicts hypnotic responding across situations, including hypnosis-based pain interventions.     

Investigation into the effects of music and meditation on galvanic skin response

Music and meditation are nowadays commonly used as relaxation techniques. Meditation is known to have an effect on the mental state of practitioners. It is considered to have stress-reducing capabilities. Similarly, music is believed to make a disturbed mind calm and relieved. It is used as a therapeutic agent in some countries. In this work, the authors use music and meditation as stimuli in psychophysiological experiments using galvanic skin response (GSR) as an objective method to estimate the emotional response of subjects. Results show that GSR can be used as a measure of subjective mental states during music appreciation. The effect of music on GSR is compared with that of meditation. A time-series model is developed for the response.     

The effects of psychological factors and physical trauma on recovery from oral surgery

This study evaluated the effects of several psychological factors on postsurgical recovery while controlling for and also evaluating the effects of the physical trauma induced by the surgery. Subjects were 38 patients (18 males and 20 females) who were scheduled to have four third molars surgically removed. The psychological factors measured included anxiety and expectations about recovery, trait anxiety, coping behaviors, and health locus of control. Surgical trauma was rated after surgery, and the following aspects of recovery were monitored: postoperative pain, interference with normal function, swelling, and healing. Poorer postoperative recovery was significantly predicted by each of the psychological variables and by higher levels of surgical trauma. In addition, the effects of the psychological variables on recovery were shown to be largely independent of the trauma effects. The data suggest that (a) future studies which give patients more positive expectations and reduce their anxiety about recovery may improve their recovery and (b) the types of patients most in need of preoperative psychological support would be those who have higher trait anxiety, vigilant coping behaviors, or an internal locus of control.This research was supported by NIH Research Grants DE-02668 and RR-05333 and by a Pfeiffer Foundation Fellowship.     

BDNF as an effect modifier for gender effects on pain thresholds in healthy subjects

BDNF is an important marker of neuronal plasticity. It has also been associated with pain processing. Increased BDNF levels are observed in chronic pain syndromes. In order to understand the role of BDNF associated with other factors such as gender on experimental pain we aimed to determine whether experimental heat or pressure pain threshold is correlated with brain derived neurotrophic factor (BDNF) level, gender and age. Heat pain threshold and pressure pain threshold were measured in 49 healthy volunteers (27 females). The multivariate linear regression models (on heat and pressure pain thresholds) revealed a significant effect of gender (p = 0.001 for both models), serum BDNF (p < 0.004 for both models) and interaction between BDNF and gender (<0.001 for both models). In fact, when adjusting for BDNF levels and age, heat and pressure pain thresholds were significantly reduced in women as compared to men (p < 0.001 for both models). These effects were not observed when gender was analyzed alone. These finding suggests that experimental heat and pressure pain threshold is gender-related and BDNF dependent. In fact BDNF has a facilitatory effect on pain threshold in females but has an opposite effect in males; supporting the notion that BDNF is an effect modifier of the gender effects on pain threshold in healthy subjects.     

Suicidality in chronic pain: a review of the prevalence, risk factors and psychological links

BACKGROUND: This paper reviews and integrates the growing literature concerning the prevalence of and risk factors for suicidality in chronic pain. METHOD: A series of systematic searches in MEDLINE and PsychINFO identified 12 relevant articles examining suicide, suicide attempts, and suicidal ideation in chronic pain. A selection of theoretical and empirical work identifying psychological processes that have been implicated in both the pain and suicide literature and which may be related to increased suicidality was also reviewed. RESULTS: Relative to controls, risk of death by suicide appeared to be at least doubled in chronic pain patients. The lifetime prevalence of suicide attempts was between 5% and 14% in individuals with chronic pain, with the prevalence of suicidal ideation being approximately 20%. Eight risk factors for suicidality in chronic pain were identified, including the type, intensity and duration of pain and sleep-onset insomnia co-occurring with pain, which appeared to be pain-specific. Helplessness and hopelessness about pain, the desire for escape from pain, pain catastrophizing and avoidance, and problem-solving deficits were highlighted as psychological processes relevant to the understanding of suicidality in chronic pain. CONCLUSIONS: Programmatic research is urgently required to investigate the role of both general and pain-specific risk factors for suicidality, to examine how the psychological processes mentioned above mediate or exacerbate suicidality, and to develop enhanced interventions for pain patients at risk.     

Stress-buffering effects of psychosocial resources on physiological and psychological stress response in pregnant women

Sixty healthy pregnant women (aged 21-35 years), including 30 pregnant women at the beginning of second trimester and 30 women at the beginning of third trimester underwent a psychosocial stress test. Physiological (salivary free cortisol levels, salivary alpha-amylase levels) and psychological (perceived stress, mood, anxiety) responses to standardized psychosocial stress have been brought in association with psychosocial resources (self-efficacy and daily uplifts). Predictions revealed that higher resources predict lower physiological and psychological stress responses and higher mood levels. We conclude from our data that psychosocial resources appear to dampen psychological and physiological stress response during pregnancy.     

An interactive model of pain and myocardial ischemia

The biopsychosocial model has been used to describe the intertwined factors that may act as mechanisms in cardiovascular disease, as well as those found in pain conditions. This model may also prove useful in understanding a diagnosis that overlaps these two areas, angina. This article reviews the literature related to biological, psychological, and social mechanisms of painful ischemic episodes and discusses the interactions of those variables. We propose an integrated model that incorporates the biopsychosocial mechanisms that may be responsible for the variability in pain reporting with ischemic episodes. We show how sex differences manifested in various biopsychosocial factors may interact to influence the presence of painful versus silent myocardial ischemia. We present a plan for future research to elucidate this interaction.     

The influence of sex and gender on the immune response

The immune system and its orchestrated response are affected by a multitude of endogenous and exogenous factors, modulators and challenges. One of the most frequent differences described in the immune response is its vigor and activity in females compared to males, leading to the consequent increase in autoimmune conditions seen in the female population as well as differences in the immune response to pathogens and viruses. The following review summarizes our present knowledge on sex differences in the immune response, detailing the hormonal and genetic effects that have been proposed as explanatory mechanisms. Sexual hormones, mostly estrogen but also progesterone and testosterone, affect immune cells quantitatively and qualitatively. Relevant research has focused on the impact of hormones on cytokine production by the different effector cells, as well as impact on immunoglobulin production by B lymphocytes and activity of granulocytes and NK cells. The biological aspects are complemented by research data on the possible modulatory role of the X chromosome. In addition to biological differences, the frequently neglected role of gender as an immunomodulator is introduced and explored. Gender affects all areas of human life and consequently affects the different steps of an immune response. Exposure to various types of antigens, access to health promotion programs and health care, as well as prioritization of health needs and household resource allocation all affect the different response of females and males to immunologic challenges.     

Acute and chronic pain: pain dimensions and psychological status

One hundred and ten outpatients with either acute or chronic low-back pain completed the McGill Pain Questionnaire, Beck Depression Inventory, State-Trait Anxiety Inventory, and Life Experiences Survey. Acutes and chronics did not differ on dimensions of pain, but significant correlations between pain dimensions and depression and state anxiety were found for chronics. Both groups showed elevated state anxiety; chronics also evidenced mild depression. Combined scores on depression, anxiety, and negative life change predicted sensory and affective pain for the pooled sample. These results confirm the role of psychological variables in the experience of clinical pain and underscore the highly affective nature of chronic pain.     

The effects of psychological preparation on pain and recovery after minor gynaecological surgery: a preliminary report

Investigated the effects of psychologically preparing patients for minor gynaecological surgery. A total of 59 women who were undergoing elective laparoscopy were assigned randomly to three experimental conditions: Preparation, in which an informative preoperative interview was conducted; placebo, in which a reassuring preoperative interview was held; and control, in which no contact was made prior to surgery. The women were assessed postoperatively in terms of pain, anxiety and attitudes and required to complete a follow-up questionnaire that followed a 3-week interval, which assessed subjective report of recovery rate. The results showed similar levels of pain report for all groups, although significantly fewer prepared patients requested postoperative analgesia. No differences in pain reports emerged at follow-up, although there was a tread for prepared patients to report a more rapid return to full health. The results are considered in the context of explanatory models that have been proposed to account for the effects of psychological preparation.     

Low back pain and psychological factors. A social psychiatric study of the population of working age.

The objective of the study was to find out how low back pain (LBP) and psychological factors are interrelated in the adult population. The study dealt with 220 individuals suffering from LBP and with a control group (n = 101). The method used was a psychiatric interview. Mental disorders were more prevalent in the LBP group than in the control group. A clinical disorder was diagnosed for 31% in the LBP group and they had many mild mental disturbances, too. The association between LBP and mental disorders was not as clear as found in previous studies with patient populations. The LBP group was divided according to the etiology of pain into functional and organic groups. No significant differences were found between the groups with regard to mental disturbance.     

The impact of pain on psychological well-being in rheumatoid arthritis: the mediating effects of self-esteem and adjustment to disease

The aim of this study was to determine whether self-esteem and adjustment to disease can mediate the association between pain and psychological well-being in patients with Rheumatoid Arthritis (RA). Coefficients of correlation, multiple linear regressions and Structural Equation Model (SEM) were employed in order to examine the direct and indirect relationships between pain, self-esteem, adjustment to disease and psychological well-being in a sample of 160 recently-diagnosed RA-patients. The outcomes of the analyses indicate that self-esteem and adjustment to disease are important links between pain and psychological well-being. Moreover, the results suggest the increasing importance of personality variables in mediating the relationship between pain and psychological well-being as the disease advances. The findings provide evidence for considerations that psychosocial interventions, focused on increasing the self-esteem and improving the adjustment to disease, may reduce the impact of pain on patients' psychological well-being and quality of life in general.     

Predicting occupational coping responses: the interactive effect of gender and work stressor context

This study examined whether gender and work stressor context interacted to affect reports of occupational coping strategies. Participants (N=113) were asked to indicate how they would cope with both self-focused (i.e., solitary) and interpersonal (i.e., group) work overload contexts by providing responses to the Cybernetic Coping Scale (J. Edwards & A. J. Baglioni, 1993). Consistent with the hypothesized interaction, male and female participants evidenced similar coping strategies in the self-focused work overload context, whereas female participants showed significantly higher use of coping (T(2)=.08, p<.05) and, in particular, greater emotional-expressive coping (T(2)=.07, p<.01) in the interpersonal work overload context as compared with male participants. Theoretical and practical implications were discussed.