Elucidating the relationship between negative affectivity and symptoms: The role of illness-specific affective responses

Background: More than 20 years of research confirm a positive association of trait negative affect (NA) with reports of physical symptoms. As the mechanisms underlying the association of trait NA and symptom reporting have not been identified, the meaning of the association remains unclear.Purpose: We attempted to clarify the processes underlying this association by examining the relationship of trait NA and illness-specific worry to both vague, general symptoms and illness-specific symptoms. We tested the hypothesis that trait NA has both a “biasing” effect when ambiguous symptoms are interpreted as a sign of physical illness and an “accuracy” effect on the reports of illness-specific symptoms mediated by illness-specific worry.Method: We examined the relationship of trait and state NA to symptoms reports in both cross-sectional and longitudinal data from inner-city adults with moderate and severe asthma.Results: Whereas high levels of trait NA were associated with reports of both asthma and nonasthma symptoms, only the relationship of trait NA to symptoms specific to asthma was mediated by asthma worry. In addition, these data showed that trait NA was not associated with the misattribution of symptoms to disease.Conclusions: We concluded that NA motivates individuals, through asthma worry, to be more aware of illness-specific symptoms and correctly report and attribute these symptoms to asthma. This study was funded by the Agency for Healthcare Research and Quality (RO1 HS09973) and the United Hospital Fund (010608B). Pablo A. Mora and Howard Leventhal were assisted by grant NIA AG023958 during the writing of this article. Ethan Halm was also supported by the Robert Wood Johnson Foundation Generalist Physician Faculty Scholars Program. Portions of this study were based on Pablo A. Mora’s doctoral dissertation.