Using the Millon Behavioral Medicine Diagnostic (MBMD) to Evaluate the Need for Mental Health Services in Association with Biomarkers of Disease Status Among HIV Positive Men and Women

Psychological distress states have been related to rate of disease progression among HIV-positive individuals. However, the measures that have been used in this research as well as the treatment context of the populations studied are highly variable, making it challenging for clinicians to incorporate such measures into screening batteries. The present study examined the association of two summary scales of the Millon Behavioral Medicine Diagnostic (MBMD; Millon et al., Millon Behavioral Medicine Diagnostic. NCS Assessments, Minneapolis, 2001), with markers of HIV disease status (CD4 and CD8 cell counts, viral load) among an ethnically diverse sample of 147 HIV-positive individuals (52 men who have sex with men, 34 men who have sex with women, and 51 women) who had recently initiated Highly Active Antiretroviral Therapy (HAART). After controlling for age and months since HIV diagnosis, we found that higher scores on the overall MBMD Psych Referral Summary Scale, reflecting a need for mental health treatment, were related to greater HIV viral load but did not relate to CD4 or CD8 cell counts. Subgroup analyses revealed that Psych Referral scores were related to greater HIV viral load only for the men who have sex with men (MSM) subgroup. These results suggest that the MBMD may help in identifying psychosocial characteristics associated with some markers of disease status in persons with HIV and perhaps may also be useful in identifying individual differences in response to treatment and eventual disease outcome.     

More than just body weight: The role of body image in psychological and physical functioning

The current study examined BMI and body image dissatisfaction as predictors of physical and mental health-related quality of life (HRQL) and psychosocial functioning in a sample of 414 undergraduate students (mean age = 21.5, SD = 4.9; mean BMI = 23.6, SD = 5.2). In men and women, higher BMI was correlated with body image dissatisfaction and physical HRQL, but not with any measures of psychosocial functioning, whereas higher body image dissatisfaction was associated with poorer physical HRQL and psychosocial functioning. Furthermore, body image dissatisfaction was observed to mediate the relationship between BMI and physical HRQL in men and women. Interestingly, in this model, higher BMI predicted increased self-esteem. These findings suggest that body image dissatisfaction may be an important target for health interventions.     

MBMD Coping Styles and Psychiatric Indicators and Response to a Multidisciplinary Pain Treatment Program

Psychosocial and personality factors are known to contribute to the maintenance of and recovery from chronic pain conditions but less is known about their influence on the efficacy of pain treatment programs. The purpose of the present study is to examine the ability of the Millon Behavioral Medicine Diagnostic (MBMD), a broadband measure of personality and psychosocial characteristics, to predict response to multidisciplinary pain treatment. 93 patients completed the MBMD, and ratings of current pain and average pain on an 11 point scale, prior to a multidisciplinary pain management program. Ratings of current and average pain were completed upon program completion. Participants were classified as “successful” or “unsuccessful” program completers based on pain reductions of ≥2 points. After program completion, 47 % of participants evidenced successful pain reductions. These successful participants had lower scores on depression and on coping style scales measuring introversive, inhibited, and dejected tendencies at baseline. Additionally, lower pre-treatment depression scores and lower scores on each of these coping style scales predicted lower pain ratings at discharge independent of educational level and pre-treatment pain ratings. The MBMD may be a useful tool to delineate patients who are likely to make significant treatment gains in intense, multidisciplinary pain treatment programs.     

Health-Related Quality of Life of Asylum Seekers and Refugees in Germany: a Cross-Sectional Study with Data from the German Socio-Economic Panel

The purpose of this study was to estimate the health-related quality of life (HrQoL) of asylum seekers and refugees that arrived during the European migrant and refugee crisis in Germany between 2014 and 2017. The analysis was based on the 2016 and 2017 refugee samples of the German Socio-Economic Panel (n = 6821). HrQoL was measured using a modified version of the SF-12v2 questionnaire and presented as physical (PCS) and mental (MCS) component summary scores. PCS and MCS scores for the total sample, males and females were calculated by sociodemographic characteristics. Associations between PCS and MCS scores and sociodemographic variables were examined by a linear regression with bootstrapped standard errors. The mean PCS and MCS scores of the sample were 53.4 and 47.9, respectively. Female sex was statistically significantly associated with lower PCS and MCS scores. The SF-12 subscale general health was valued highest with a score of 55.4, whereas the subscale role emotional was valued lowest with a score of 46.9. Employment was statistically significantly associated with higher PCS and MCS scores. Persons from Afghanistan had statistically significantly lower MCS scores than persons from Syria, whereas MCS scores were statistically significantly higher for persons from Eritrea. Physical and mental HrQoL of asylum seekers and refugees that arrived during the European migrant and refugee crisis in Germany between 2014 and 2017 was higher and lower than the German norm, respectively. Female sex, older age, unemployment and being separated, divorced or widowed were negatively associated with HrQoL. The three largest ethnical groups of asylum seekers and refugees, Syrians, Afghans and Eritreans, differ inherently in their HrQoL.

     

Well-being in parents of children with cancer: The impact of parental personality,coping, and the child's quality of life

The aim of the study was to investigate the impact of parental personality, coping, and the child's quality of life on the well-being of parents of children treated for cancer. The study included 99 parents (63 mothers and 36 fathers), 41 parents during child's intensive treatment, 23 parents whose child completed intensive treatment, and 25 parents of children who completed treatment at least five years ago. The results of multivariate study have confirmed the predictive role of parental personality (especially Neuroticism); emotion-focused coping styles, and the child's quality of life (especially physical functioning) on parental well-being. About 60% of the variance in parental well-being can be attributed to the predictors. Assessing parental personality functioning and coping styles can help us identify those parents who are less emotionally stable, more prone to emotionally focused coping styles, and most likely to experience poorer well-being. Improved assessment may contribute to the development of further psychological interventions.     

Social support,social integration,and health-related quality of life over time: Results from the Fitness and Arthritis in Seniors Trial (FAST)

The present study tested whether baseline perceived social support and social integration predicted baseline and follow-up measures of health-related quality of life for 364 older adults with osteoarthritis. The findings are secondary analyses of a randomized controlled trial of an exercise intervention. Multiple regression analyses indicate that perceived social support was related to baseline measures of functioning in psychological (depressive symptoms, social functioning, and life satisfaction) and physical domains (self-rated disability, observed physical function, and perceived health), after accounting for demographic and clinical status factors. At 18-month follow-up (additionally controlling for exercise intervention and baseline outcomes), social support significantly predicted changes in psychosocial functioning, but was unrelated to changes in self-reported and observed physical health. The findings indicate that social support is an important predictor of long-term psychosocial outcomes, but is less important than baseline clinical status for physical health endpoints in this cohort of older adults. In contrast, social integration was not a consistent predictor of outcomes.     

Utility of the Millon Behavioral Medicine Diagnostic to Predict Medication Adherence in Patients Diagnosed with Heart Failure

Medication non-adherence is common and a primary reason for poor medical outcomes among individuals with heart failure (HF). This study's aims were to determine whether depression, hostility, and the personality-based Millon Behavioral Medicine Diagnostic (MBMD) Medication Abuse scale were associated with medication adherence (e.g., beta-blockers, ACE inhibitors, diuretics, statins) beyond contributions of demographic, medical, and psychosocial variables in an ethnically-diverse sample of 105 men and women diagnosed with HF. In hierarchical regression, greater MBMD Medication Abuse scale scores were associated with poorer adherence above and beyond both depression (β?=?.236, t[102]?=?2.113, p?=?.037) and hostility (β?=?.244, t[102]?=?2.506, p?=?.014). The Medication Abuse scale also completely mediated the relationship between adherence and depression. These findings suggest that personality measures such as the MBMD and hostility scales might be utilized in future studies investigating predictors of adherence and also used clinically to predict medication adherence among HF patients.     

Perceptions of the roles of behaviour and genetics in disease risk: Are they associated with behaviour change attempts

Objective: We examined selected survivor characteristics to determine what factors might moderate the response to two psychosocial interventions.

Design: Seventy-one prostate cancer survivors (PCSs) were randomly assigned to either a telephone-delivered health education (THE) intervention or a telephone-delivered interpersonal counselling (TIP-C) intervention.

Measures: Psychological quality of life (QOL) outcomes included depression, negative and positive affect, and perceived stress.

Results: For three of the psychological outcomes (depression, negative affect and stress), there were distinct advantages from participating in THE. For example, more favourable depression outcomes occurred when men were older, had lower prostate specific functioning, were in active chemotherapy, had lower social support from friends and lower cancer knowledge. Participating in the TIP-C provided a more favourable outcome for positive affect when men had higher education, prostate specific functioning, social support from friends and cancer knowledge.

Conclusion: Unique survivor characteristics must be considered when recommending interventions that might improve psychological QOL in PCSs. Future research must examine who benefits most and from what components of psychosocial interventions to enable clinicians to recommend appropriate psychosocial care.     

Improving quality of life in men with prostate cancer: a randomized controlled trial of group education interventions.

Men who were recently treated for prostate cancer (N=250) were randomly assigned to a control group, a group education intervention (GE), or a group education-plus-discussion intervention (GED). Both GE and GED increased prostate cancer knowledge. In the year postintervention, men in the GED condition were less bothered by sexual problems than men in the control condition, and they were more likely to remain steadily employed (93.0%) than men in the GE (75.6%) or control (72.5%) conditions. Among noncollege graduates, GED and GE resulted in better physical functioning than the control condition, and GED resulted in more positive health behaviors than the control or GE condition. Among college graduates, controls were comparable with the GE and GED groups in physical functioning and positive health behaviors.     

Men's Adjustment to Prostate Cancer: The Role of Agency and Unmitigated Agency

We examined how two male gender-related traits, agency (focus on self) and unmitigated agency (focus on self to the exclusion of others), were related to physical and emotional functioning in 162 men (92% Caucasian) treated for prostate cancer. As predicted, unmitigated agency was associated with worse functioning and more cancer-related difficulties. By contrast, agency was associated with better functioning and fewer cancer-related difficulties. We tested whether difficulties expressing emotions explained these relations. Unmitigated agency was associated with difficulty expressing emotions, and agency was associated with the ability to express emotions. Structural equation modeling was used to show that emotional expressiveness mediated the relations of unmitigated agency and agency to adjustment to prostate cancer. The implications of these results for interventions to enhance men's adjustment to prostate cancer are discussed.     

Mental health and thinking styles in Sternberg's theory: an exploratory study

The relationship between thinking styles, as defined in Sternberg's theory of mental self-government, and mental health was investigated. 583 university students (362 women, 221 men; M age = 21.4 yr., SD = 0.9) in Guangzhou, P. R. China, were invited to fill out the Thinking Styles Inventory-Revised and the Symptom Checklist-90 on a voluntary basis. Results indicated that scores on six of Sternberg's 13 thinking styles were significantly correlated with the Mental Health Index. The hierarchical style (one Type I style) negatively predicted the General Severity Index beyond sex and age, whereas the judicial, anarchic, and internal styles did so positively. The specific ways in which the thinking styles and mental health scales were related to one another supported Zhang and Sternberg's (2006) claim that thinking styles are value-laden. Applications of thinking styles in enhancing mental health are discussed.     

Quality of Life of Children and Adolescents with Short Stature: The Twofold Contribution of Physical Growth and Adaptive Height-Related Cognitive Beliefs

This study aimed to examine the health-related quality of life (HrQoL), coping, height-related beliefs, and social support of children/adolescents with short stature, the sociodemographic, clinical, and psychosocial variables associated with HrQoL, and the moderating role of sociodemographic and clinical variables on the associations between psychosocial variables and HrQoL. 114 Portuguese children/adolescents with short stature, aged 8–18 years old, completed the Quality of Life in Short Stature Youth questionnaire and the Satisfaction with Social Support Scale. Regression analyses explained 54% of the variance of HrQoL, with significant main effects of current height deviation and height-related beliefs, and a significant interaction effect between beliefs and diagnosis. Results suggest that a multidisciplinary therapeutic approach, not only focused on hormone treatment to boost physical growth, but also including psychosocial interventions focused on the modification of height-related beliefs, may contribute to improve the HrQoL of pediatric patients with short stature.

     

Patient and Partner Quality of Life and Psychosocial Adjustment Following Radical Prostatectomy

We prospectively examined differences in quality of life and psychosocial adjustment in 80 prostate cancer patients and their partners (n = 65) beginning before radical prostatectomy and proceeding across the first year postsurgery. Both members of the couple experienced significant changes associated with the patient's cancer, however their experiences differed in some regards. Patients experienced reprieve from emotional distress and negative affect immediately following surgery despite worsened physical functioning. Partner quality of life and psychosocial adjustment scores were generally more constant from presurgery to postsurgery, with improvements noted 1 year later. For both patients and partners, cancer-specific stress symptoms declined progressively over the year. We also obtained partial support for the effectiveness of a single-session communication intervention on patient social/family wellbeing and partner general stress. Findings have implications for patient and partner adjustment following radical prostatectomy, and attest to the importance of incorporating partner evaluations into psychosocial oncology research.     

Compensatory Conscientiousness and Health in Older Couples

ABSTRACT— The present study tested the effect of conscientiousness and neuroticism on health and physical limitations in a representative sample of older couples ( N = 2,203) drawn from the Health and Retirement Study. As in past research, conscientiousness predicted better health and physical functioning, whereas neuroticism predicted worse health and physical functioning. Unique to this study was the finding that conscientiousness demonstrated a compensatory effect, such that husbands' conscientiousness predicted wives' health outcomes above and beyond wives' own personality. The same pattern held true for wives' conscientiousness as a predictor of husbands' health outcomes. Furthermore, conscientiousness and neuroticism acted synergistically, such that people who scored high for both traits were healthier than others. Finally, we found that the combination of high conscientiousness and high neuroticism was also compensatory, such that the wives of men with this combination of personality traits reported better health than other women.     

Personality and Health, Subjective Well-Being, and Longevity

ABSTRACT Personality traits can be employed to guide understanding of trajectories to health and longevity, but long-term longitudinal study and multifaceted assessment of healthy aging are crucial. Following up on the life span study initiated by Lewis Terman, we assessed 4 validated factors of personality in young adulthood in 1940, constructed a multifactor measure of participants' healthy aging in 1986, and collected death certificates through 2007 (to determine longevity) on a sample of 1,312 Terman participants (732 men). Neuroticism predicted worse physical health and subjective well-being in old age and, for women, higher mortality risk, but for men, neuroticism predicted decreased mortality risk. For both sexes, extraversion predicted old-age social competence, whereas conscientiousness predicted men's old-age productivity. Differential patterns of association between personality traits and healthy aging components are informative about individual personality characteristics and long-term health outcomes.     

Stability and predictive ability of personality traits across 9 years

In the present study, personality traits, as assessed by the Karolinska Scales of Personality (KSP) were found to be stable after 9 years, both with regard to mean level stability (absolute stability) and rank-order stability (relative or differential stability). Moreover, outcome scales were applied measuring either perceptions of satisfaction or scales measuring functioning. Personality scales (from the Eysenck Personality Questionnaire and the KSP) completed in 1986/1987 were associated with measures (completed in 1995/1996) of satisfaction and functioning of family life, emotional and physical health, and work. Specifically, neuroticism-related personality traits predicted a lack of satisfaction with health, but not functional problems due to health. In contrast, neuroticism-related personality traits predicted poor functioning but not satisfaction with family life and work.     

Utility of the Millon Behavioral Medicine Diagnostic (MBMD) to predict adherence to highly active antiretroviral therapy (HAART) medication regimens among HIV-positive men and women

Psychosocial and behavioral factors may be strong predictors of adherence to medications in a wide variety of diseases. Newly emerging antiretroviral medications for HIV have been shown to be effective but require near perfect adherence to offer clinically significant benefits. There is currently great interest in deriving patient factors that may predict optimal medication adherence in HIV-positive persons. In this study, we examined the association of psychosocial and behavioral characteristics using the Millon Behavioral Medicine Diagnostic (MBMD; Millon, Antoni, Millon, Meagher, & Grossman, 2001) and adherence to highly active antiretroviral therapy (HAART) among 117 HIV-positive individuals on HAART regimens. Specific indexes of the MBMD were associated with HAART adherence as assessed through patient interview, at baseline assessment, and at 3-month follow-up at a point after which participants had received medication adherence training. As hypothesized, the Medication Abuse scale of the MBMD was uniquely associated with overall adherence at baseline assessment and also predictive of adherence at 3-month follow-up. Additional MBMD scales were also related to overall adherence as well as specific adherence behaviors such as missed doses, following specific instructions, and overmedicating, although the Medication Abuse scale emerged as the most consistent predictor of adherence in the study. These results suggest that the MBMD can be used to predict adherence to HAART medication in a sample of HIV-positive men and women and may subsequently be used to identify those in need of adherence counseling at the point when medications are initiated.     

Adult attachment styles and psychological disease: examining the mediating role of personality traits

The aim of the present study was to examine differences in anxiety and depression related to differences in attachment models of the self and of others and whether personality traits mediate this relationship. The authors assessed attachment styles, anxiety, depression, and personality traits among 274 adult volunteers. Participants were classified into 4 attachment groups (secure, preoccupied, fearful, and dismissing-avoidant) according to K. Bartholomew's (1990) model. The present authors found significant differences among attachment groups on anxiety and depressive symptoms with attachment styles involving a negative self-model showing higher scores than attachment styles characterized by a positive self-model. The authors also found that differences between attachment styles in anxiety and depression remained significant when personality factors related to attachment prototypes were entered as covariates. Results indicate that secure attachment in adults was associated with better mental health, while insecure attachment styles characterized by negative thinking about the self were associated with higher depression and anxiety scores. Our findings seem to evidence that attachment and personality are only partly overlapping and that attachment cannot be considered as redundant with personality in the explanation of psychological disease.     

The relationship of borderline personality disorder, life events and functioning in an Australian psychiatric sample

Studies have documented poor functioning and higher rates of negative life events in association with personality disorders (PDs), in particular with borderline personality disorder (BPD). The current study investigated the impact of recent life events, daily hassles and uplifts on psychosocial functioning in patients with PDs, while extending previous research by examining the role of perceived coping effectiveness and perceived stress of recent life events. Ninety-seven participants (Axis I group, N = 30; BPD group, N = 23; Other PD group, N = 44) completed measures of functioning, recent life events, daily hassles and uplifts. Results indicated that the BPD group reported the poorest levels of functioning, especially interpersonal functioning. The BPD group also reported more negative life events, particularly in the interpersonal relationships, personal health, crime, and financial domains. The BPD group experienced less uplifts, more hassles and found employment circumstances particularly stressful and difficult to cope with. Intensity of hassles was a predictor of functioning independent of a BPD diagnosis. A greater frequency of life events was closely associated with a non-BPD diagnosis in predicting a decrease in psychosocial functioning.