Dimensions of cancer locus of control scale as predictors of psychological adjustment and survival in breast cancer patients

The Cancer Locus of Control Scale, to investigate specific beliefs of control in cancer patients, was validated previously with an English-speaking population. This study tested the construct and concurrent validity of a 17-item French version of the scale and explored its relations with psychological adjustment and with adaptation assessed two years later. In a sample of 157 women diagnosed with a first breast cancer, the French version was administered along with the Body Image Questionnaire, the State-Trait Anxiety Inventory, the Perceived Stress Scale, the Social Support Questionnaire, and the Ways of Coping Checklist. A factor analysis performed on scores identified the three original factors: internal causal attribution, control over the course of the illness, and religious control. Internal causal attribution was associated with high scores for state and trait anxiety, negative body image, emotion-focused coping, and problem-focused coping. Control over the course of the cancer was positively associated with scores on both problem- and emotion-focused coping. Religious control was negatively associated with perceived stress. Emotional adjustment and quality of life were assessed in 59 of the 157 breast cancer patients two years after diagnosis and original testing. Hierarchical regression analyses indicated that internal causal attribution significantly predicted 38.1% of the variance in rated state anxiety. None of the dimensions of the Cancer Locus of Control Scale predicted the duration of survival measured two years later in 75 of the 157 patients.     

Perceived threat and depression among patients with cancer: the moderating role of health locus of control

Illness perception was found to be a better predictor of psychological outcome among cancer patients than the objective characteristics of illness. The current study explored the association between the perceived threat of illness (a major aspect of illness perception) and depression among cancer patients. We examined the hypothesis that this association will be higher for persons with low External (others) or internal (self) Health Locus of Control (HLC) than for those with high HLC. The study took an exploratory approach regarding the role that different sources of control (external and internal) may assume. Fifty-seven cancer patients completed self-report measures of Perceived Life Threat (PLT), HLC and Depression. The possible moderating role of HLC on the relationship between PLT and Depression was examined. A significant relationship between perceived threat and depression was found only among participants reporting low levels of internal locus of control. The results support the hypothesis that perception of cancer as life threatening is important factor in determining the level of depression among cancer patients. The results also support the differentiation between internal and external HLC and suggest that internal HLC may be more relevant than external HLC in managing perceived threat. Internal locus of control can be interpreted as having a sense of agency and mastery which is important in managing the cognitive perception of the threat of illness. Further research is needed in order to determine the role of external HLC in managing perceived or actual threats.     

Reactions to AIDS and other illnesses: reported interactions in the workplace

Previous research on the public's response to AIDS has been concerned with attitudes and knowledge in relation to the disease itself. The present study investigated American students' willingness to interact in the workplace with AIDS patients and compared this with their reactions to cancer and hepatitis patients. The effects of perceived control over the cause of the disease were also examined. Exposure to the diseases was manipulated with written scenarios. Results demonstrated that the type of illness affected a willingness to interact with individuals--AIDS patients were reacted to least positively, followed by hepatitis, and cancer patients. Perceived control over the cause of the disease did not affect reactions.     

The importance of children's illness beliefs: the Children's Illness Perception Questionnaire (CIPQ) as a reliable assessment tool for eczema and asthma

A lack of information about disease in children can lead to erroneous views such as children believing that hospital admittance or the presence of a disease is a punishment for a perceived wrong. There has thus far been no standard tool available to measure children's illness conceptualizations from a Leventhalian framework. Three groups of children with eczema, asthma and eczema and asthma between the ages of 7 and 12 years of age were recruited. Children were given the Children's Illness Perception Questionnaire (CIPQ), a 26-item instrument adapted from the Illness Perception Questionnaire for adults. A Kuder - Richardson 20 test of reliability for dichotomous data was performed allowing an estimate of the internal consistency of the measurement scales. It can be seen that, for all three illness groups, internal consistency is acceptable for the timeline and consequences scale. The cure/control scale, however, was not internally consistent for any illness group. As health professionals, we need to develop the means to further understand how paediatric illness beliefs relate to specific disease types, age and psychosocial factors and the utility of this instrument is discussed within this context.     

Reactions to AIDS and Other Illnesses: Reported Interactions in the Workplace

Previous research on the public's response to AIDS has been concerned with attitudes and knowledge in relation to the disease itself. The present study investigated American students' willingness to interact in the workplace with AIDS patients and compared this with their reactions to cancer and hepatitis patients. The effects of perceived control over the cause of the disease were also examined. Exposure to the diseases was manipulated with written scenarios. Results demonstrated that the type of illness affected a willingness to interact with individuals—AIDS patients were reacted to least positively, followed by hepatitis, and cancer patients. Perceived control over the cause of the disease did not affect reactions.     

Illness representations and emotion in people with abnormal screening results

The present study examined the relationship of cognitive and emotional representations of illness specified by self-regulation theory on emotional responses of patients with abnormal screening results. Participants were 660 women who received an abnormal cervical smear and 701 men and women who received an abnormal colorectal cancer screening result. Participants completed postal questionnaires containing measures of illness representations and specific emotions. Factor analyses of cause components produced three factors for each sample, corresponding to psychological stress, biological, and behavioural causes. Regression analyses showed that, after controlling for demographic variables, perceived consequences, illness identity, and causal attributions to psychological stress explained significant variance in emotion. Emotional representations also accounted for unique variance in emotional responses. Results indicate congruence in the relationships between illness representations of an emotionally salient event and emotion in patients from the two cancer screening programmes and support the internal validity of self-regulation theory.     

Measuring Stigma Toward Mental Illness: Development and Application of the Mental Illness Stigma Scale1

Guided by theory on stigma, a Likert‐type scale was developed to measure 7 factors of attitudes toward people with mental illness: interpersonal anxiety, relationship disruption, poor hygiene, visibility, treatability, professional efficacy, and recovery. The scale was validated among college students and community members, measuring attitudes toward people with mental illness, depression, bipolar disorder, and schizophrenia. In a second application, college students completed the scale from their own perspective, then from an imagined perspective of someone with mental illness, while psychiatric patients completed the scale from their own perspective, then from an imagined viewpoint of someone without mental illness. Psychiatric patients assumed that they were stigmatized to a greater extent than was admitted by the student sample.     

The affective consequences of social comparison: either direction has its ups and downs

Research on social comparison processes has assumed that a comparison in a given direction (upward or downward) will lead to a particular affective reaction. In contrast, the present two studies proposed and found that a comparison can produce either positive or negative feelings about oneself, independent of its direction. Several factors moderated the tendency to derive positive or negative affect from upward and downward comparisons. In Study 1, cancer patients low in self-esteem and with low perceived control over their symptoms and illness were more likely to see downward comparisons as having negative implications for themselves. Those low in self-esteem were also more likely to perceive upward comparisons as negative. In Study 2, individuals with high marital dissatisfaction and those who felt uncertain about their marital relationship were more likely to experience negative affect from upward and downward comparisons. The implications of these findings for social comparison theory and for the coping and adaptation literature are discussed.     

Illness perceptions are the main predictors of depression and anxiety symptoms in patients with chronic pain

Depression and anxiety symptoms in chronic pain are associated with adverse clinical outcomes, and appear highly related to patient’s illness perceptions as well as with marital adjustment. This study aimed to investigate the predictive value of pain variables, marital adjustment and illness perceptions on depression and anxiety in patients with chronic pain. Two hundred patients were recruited from a pain unit in a public hospital in the north of Portugal. Patients completed a questionnaire that assessed illness perceptions (IPQ-Brief), marital adjustment (revised dyadic adjustment scale), depression and anxiety symptoms (hospital anxiety depression scale) and pain variables (pain intensity and pain disability index). Depression and anxiety symptoms were associated with pain intensity, pain-related disability, marital adjustment and illness perceptions. Results from hierarchical regression showed that illness perceptions contributed significantly to depression and anxiety symptoms over and above the effects of pain intensity, pain-related disability and marital adjustment, after controlling for gender. In multivariate analyses, pain intensity, pain-related disability and marital adjustment were uniquely related to depression and anxiety symptoms, whereas specific illness perceptions were uniquely related to depression symptoms (identity, treatment control, emotional response and coherence) and to anxiety symptoms (identity, emotional response and concern). Perceptions of greater symptomatology (identity) and of emotional impact, and lesser perceptions of treatment control and understanding of chronic pain (illness comprehensibility) were significantly associated with increased depression symptoms. Perceptions of greater symptomatology (identity), emotional impact and greater concern were associated with anxiety symptoms. These findings indicate that the contribution of illness perceptions was greater than that made by traditional covariates, and may therefore be a useful basis for future psychological interventions.     

Appraisals of control and predictability in adapting to a chronic disease

In a sample of 92 patients with rheumatoid arthritis, we examined interrelations among various control appraisals, illness predictability, psychosocial adjustment, mood, and illness status. Perceiving greater personal control over the disease and symptoms and perceiving greater health-care-provider control over symptoms were associated with greater illness predictability. Patients reported more personal control over their symptoms than over the course of the disease and thought that their health care providers had more control over disease course than they did themselves. Multiple regression analyses showed that perceiving greater personal control over one's medical care and treatment was associated with positive mood and psychosocial adjustment. Negative mood was also associated with the belief that providers have greater control over the patient's daily symptoms. Patients who had a more severe disease and expressed greater personal control over its course reported greater mood disturbance and were rated as exhibiting less positive adjustment, but those who had more severe daily symptoms and expressed greater personal control over their symptoms reported less mood disturbance. These findings are discussed in terms of the possible benefits of patients' active participation in their care and the implications of perceiving personal and others' control over more or less controllable aspects of the illness, especially when the illness is more severe.     

Cognitive functioning self-assessment scale (CFSS): preliminary psychometric data

The cognitive functioning is included in the concept of quality of life. Many times well-being remains incomplete because of cognitive difficulties, that people are not always able to properly recognize and explain. Nonetheless, only few instruments, specifically thought for non-clinical neurologic populations, are available to measure them. The present study is an attempt at providing a self-report instrument--cognitive functioning self-assessment scale (CFSS)--to measure the individual cognitive functioning in general population. The CFSS is itemized into18 questions to which participants answer on a five-point scale. Two hundred and eighty-two patients in a General Practitioner study have filled-in the CFSS together with a clinical and socio-demographic data form. Explorative factor analysis, using principal component analysis, suggests the consideration of the CFSS as one-dimensional; internal reliability = 0.856. Non-parametric tests have shown that women report a worse cognitive functioning than men, while no differences emerged in relation to age, manual prevalence, presence of an illness or being in pharmacological treatment. Although further verifications are necessary, the CFSS seems to be a promising self-report cognitive functioning measure.     

Evaluation of a psychosocial intervention on social support, perceived control, coping strategies, emotional distress, and quality of life of breast cancer patients

The purpose of this research was to demonstrate that a specific psychosocial intervention changes reactions to cancer and quality of life. This study was carried out on 66 patients with a first breast cancer. Patients were randomly divided into two groups: a specific intervention group (G1, 8 sessions) or a support group (G2, 8 sessions). A control group (G3) was composed of patients who refused to participate in psychological intervention. Social support, perceived control, repression of emotions, coping strategies, emotional distress, and quality of life were assessed one week before (T1) and at the end (T2) of the psychological intervention. Results showed that G1 did not have significantly modified quality of life or psychological scores. Patients of G2 had poorer emotional quality of life, use of internal causal attributions, and minimized their illness at T1 as compared to patients of G3. At Time 2 these differences were not observed.     

Cultural Adaptation,Translation and Validation of Tuberculosis Specific Health Related Quality of Life Measuring Functional Assessment of Chronic Illness Therapy Tuberculosis (FACIT-TB) Scale in Sri Lanka

The aim of the present study was to culturally adapt, translate and validate the functional assessment of chronic illness therapy tuberculosis (FACIT-TB) scale with a view to assess health related quality of life among pulmonary tuberculosis patients in Sri Lanka. The cultural adaptation was performed by Delphi method. The translation into Sinhala (the local Sri Lankan dialect) was carried out through forward–backward translation method by five translators. A multidisciplinary team of experts assessed the Sinhala FACIT-TB scale for its content validity. The construct validity, the reliability and the acceptability of the scale were determined by conducting a validation study among 225 pulmonary tuberculosis patients. The confirmatory factor analysis technique was used to assess the construct validity. The reliability was assessed through internal consistency by Cronbach’s alpha and test re- test reliability by intraclass correlation coefficient after one week of assessment. The FACIT-TB showed adequate content validity. The confirmatory factor analysis yielded high fit indices with the original five factor model of FACIT-TB: Root Mean Square Error of Approximation (RMSEA) =0.05, Standardized Root Mean Square Residual (SRMSR) =0.07, Comparative Fit Index (CFI) =0.94 and Non –Normal Fit Index (NNFI) =0.94. Reliability showed high internal consistency with Cronbach’s alpha values exceeding the Nunnally’s criteria of 0.7 and all factors of the scale showed high test-retest reliability with intra-class correlation coefficient exceeding 0.7. Overall the FACIT-TB Sinhala version showed adequate validity to assess health related quality of life among pulmonary tuberculosis patients in Sri Lanka.

     

Counterfactuals, coping strategies and psychological distress among breast cancer patients

The aim of this primary study was to predict the effect of counterfactuals, coping strategies, personal resources (age and education) and stage of the illness on psychological distress in a sample of 64 breast cancer patients. The main findings indicated that upward counterfactuals played an important role in the patients' psychological distress and coping process with the illness. Patients who used a high level of upward counterfactual thinking were found to have a high level of psychological distress. Downward counterfactual thinking, however, was not found to be related to less psychological distress.     

School Psychologists at Mid-Century Edited by Norma E. Cutts

Considerable evidence suggests that group interventions are a valuable resource for cancer patients, but few conceptual frameworks are available to guide decisions about which approaches might be most usefulforwhich patients at what phases of illness. This article presents an integrative treatment model for group services. It describes different group interventions geared toward patients at different phases of illness to accommodate the shifting needs and concerns that evolve over the course of the disease. Recommendations are offered concerning further research and model development.     

An integrated model of group treatment for cancer patients

Considerable evidence suggests that group interventions are a valuable resource for cancer patients, but few conceptual frameworks are available to guide decisions about which approaches might be most useful for which patients at what phases of illness. This article presents an integrative treatment model for group services. It describes different group interventions geared toward patients at different phases of illness to accommodate the shifting needs and concerns that evolve over the course of the disease. Recommendations are offered concerning further research and model development.     

Role of health locus of control beliefs and expectations of treatment efficacy in adjustment to cancer

We examined the effects of health locus of control beliefs (self-, doctor, and chance control) and expectations of treatment efficacy on short-term psychological adjustment in a sample of newly diagnosed cancer patients. The role of these beliefs and expectations in moderating the relation between (perceived and actual) disease severity and depression was also examined. The data were collected within one week of diagnosis. The relation between perceptions of disease severity and depression was weaker for those who believed that they could personally control their health and for those who held positive expectations about the effects of complying with medical treatment. Similar patterns were found when disease severity was defined in terms of prognosis for survival. Strong negative correlations between self-control/treatment expectations and depression were found for those who perceived that their illness was very severe. The results for chance and doctor control were less consistent. The stability of health control beliefs and treatment expectations over the course of a serious long-term illness is discussed.     

Ovarian cancer patients' psychological distress: the role of physical impairment, perceived unsupportive family and friend behaviors, perceived control, and self-esteem.

Although research has indicated that illness-related and interpersonal stress are associated with greater psychological distress among cancer patients, little empirical attention has been given to mechanisms that account for these relationships. In the present study, 2 mechanisms for the association between illness-related stress (physical impairment) and interpersonal stress (family and friend unsupportive responses) and psychological distress of 143 ovarian cancer patients were examined cross-sectionally. Separate structural equation models tested whether physical impairment impacted patients' distress via decrements in perceived control over their illness and whether unsupportive behaviors impacted patients' distress via decrements in patients' self-esteem. Results supported the proposed models and suggest that perceived control and self-esteem are 2 mechanisms for explaining how illness-related and interpersonal stress may be associated with psychological distress among women with ovarian cancer.