Integration of the pleasant events and activity restriction models: development and validation of a "PEAR" model of negative outcomes in Alzheimer's caregivers

This study examined an activity restriction/pleasurable activities mismatch model for psychosocial and health-related outcomes. A total of 108 spousal caregivers of patients with Alzheimer's Disease (AD) were assessed for their experience of social and recreational activities over the past month as well as their perception of how restricted they were for engaging in social and recreational activities. Participants were divided into three groups based on their reported activities and activity restriction: HPLR = High Pleasant Events + Low Activity Restriction (i.e., reference group; N = 28); HPHR/LPLR = Either High Pleasant Events + High Activity Restriction or Low Pleasant Events + Low Activity Restriction (N = 43); LPHR = Low Pleasant Events + High Activity Restriction (N = 37). We hypothesized that participants reporting low pleasant events combined with high activity restriction (LPHR) would demonstrate greater disturbance relative to other two groups in multiple outcome domains, including: (a) greater mood disturbance, (b) greater use of negative coping factors, (c) reduced use of positive coping strategies, (d) reduced report of psychological resource factors (e.g., personal mastery, self-efficacy), and (e) increased report of subjective health difficulties (e.g., sleep disturbance). Results generally supported our hypotheses, suggesting that assessment of both constructs is important for best predicting quality of well-being in AD caregivers, and potentially for establishing maximal effect in behavior therapy for caregivers.     

A Secondary Analysis of Perceptions of Quality of Life of Older Adults Residing in a Nursing Home and Assisted Living Setting Using an Integrated Conceptual Model of Measurement

Quality of life is difficult to measure but is fast becoming the standard for long-term care. A secondary analysis was conducted of quality-of-life perceptions of older adults residing in a nursing home and then an assisted living facility from the perspectives of older adults and their family members/friends. This study shows that using a comprehensive integrated model that incorporates six major life domains of physical well-being, social well-being, psychological well-being, cognitive well-being, spiritual well-being, and environmental well-being into the assessment process appears to be a promising approach to determining quality-of-life perceptions of older adults. Findings also suggest that healthcare and human services professionals should place more reliance on indicators of social and environmental well-being, including opportunities for choice, when striving to maximize quality of life of older adults. As the demographic composition of the United States changes, policies and services will need to be modified to accommodate the changing needs of older adults in a way that optimizes perspectives of quality of life.     

Direct versus Indirect Well-Being Measures: Using Partially Structured Stimuli to Evaluate Well-Being

Given the important limitations of direct (explicit) measures, the study of indirect (implicit) measures of psychological constructs has received increased attention of social researchers. However, in the field of well-being the measures that have traditionally been used have tried to capture people’s well-being in an explicit and direct way, with some exceptions that are based mainly on adaptations of the Implicit Association Test (IAT). Given the critics that the IAT has received, the first aim of the present research was to develop a new life satisfaction measure using partially structured stimuli (PSWBS). The second goal was to examine the relation between direct and indirect well-being measures. In the first study, PSWBS showed good internal consistency, test–retest reliability and construct validity. Factorial analyses indicated that this measure acted as an indirect measure. In addition, direct and indirect well-being showed a significant but weak relation. To explain this result, in a second study we analyzed the moderating role of social comparison orientation on the relation between direct and indirect well-being measures. As expected, more social comparison tendency implied a stronger relation. In a third study we analyzed the criterion validity of both kind of measures. The PSWBS, the Personal Wellbeing Index-Adults and the Satisfaction With Life Scale significantly correlated with a criterion validity coefficient in terms of a semi-structured interview made by an external experimenter. Finally, in a fourth experiment we analyzed the influence of social desirability on direct and indirect measures of well-being. In contexts of high desirability, partially structured stimuli seemed to be more resistant to response factors (e.g., control of impressions) than traditional direct measures.

     

Twins' responses to pleasant, unpleasant, and life events

Pairs of monozygotic (n = 41) and same-sex dizygotic (n = 29) twins were administered the Pleasant Events Schedule, the Unpleasant Events Schedule (Lewinsohn & Amenson, 1978), and the Life Experiences Survey (Sarason, Johnson, & Siegel, 1978). These provided indices of both the frequency of and the emotional response to mood-related events. Monozygotic twins resembled one another more than dizygotic twins on all subscales of these measures, and the greater similarity was statistically significant for most of the subscales. This suggests that there may be a genetic influence on affect, which is expressed through both the frequency of engagement in and the emotional response to mood-related events. The results are discussed in the context of studies of genetic influences on subclinical levels of depression and other emotions.     

Preferences and life evaluations of older adults with and without dementia: reliability, stability, and proxy knowledge

This study assessed the reliability and stability of care preferences and life evaluations among older adults with and without dementia. The study also examined spouse proxy predictions of partner responses. Test-retest reliability over 1 week, stability over 1 year, and proxy knowledge were all moderate to good, but lower for people with dementia. In all 3 areas, however, there was broad interindividual variability. People with dementia may become less reliable and stable in their self-reports, and some spouse proxies may have flawed knowledge about their partner, but dementia status alone is not sufficient to presume poor reliability or knowledge.     

Twins' Responses to Pleasant,Unpleasant, and Life Events

Pairs of monozygotic (n = 41) and same-sex dizygotic (n = 29) twins were administered the Pleasant Events Schedule, the Unpleasant Events Schedule (Lewinsohn & Amenson, 1978), and the Life Experiences Survey (Sarason, Johnson, & Siegel, 1978). These provided indices of both the frequency of and the emotional response to mood-related events. Monozygotic twins resembled one another more than dizygotic twins on all subscales of these measures, and the greater similarity was statistically significant for most of the subscales. This suggests that there may be a genetic influence on affect, which is expressed through both the frequency of engagement in and the emotional response to mood-related events. The results are discussed in the context of studies of genetic influences on subclinical levels of depression and other emotions.     

Comparability of self-report checklist and interview data in the assessment of stressful life events in young adults

The purpose of this study was to evaluate the incremental value of conducting an interview to assess stressful life events over the self-report questionnaire approach, first by examining the degree to which life events reported on a questionnaire met inclusion criteria in a detailed stress interview, and second, by comparing the magnitude of prospective associations with depression symptoms for the two different assessment procedures. Data from the Oregon Adolescent Depression Project were examined, in which 191 community-residing young adults (55% female; M age=23.6, SD=0.6) completed a mailed questionnaire assessing the frequency with which 33 life events had occurred to them or to other important people in their lives prior to the diagnostic and stress interviews. An average of 67.5% of events occurring to self met criteria for classification as a life event on the stress interview, as did 19.7% of the events occurring to others. Events having a large effect on the participant had a greater likelihood of meeting inclusion criteria on the stress interview. Contrary to expectation, stress scores from the interview assessment did not result in stronger associations with depression. Recommendations for assessment of stressful life events are offered.     

Depression and the frequency and strength of pleasant events: Exploration of the Staats-Heiby theory

An analysis derived from the paradigmatic behaviorism theory of depression was applied to the Pleasant Events Schedule. The PES combines measurement of frequency and intensity of pleasant events, while paradigmatic behavioral analysis indicates these involve different independent variables. Results showed that different subtypes could be isolated by differentiating these variables, subtypes that would differently predict for depression. The findings have implications for understanding, diagnosing, and treating depression.     

An Integrated Conceptual Model of Quality of Life for Older Adults Based on a Synthesis of the Literature

Quality of life is fast becoming a standard of measure of long-term care and gerontological service outcomes. Although the issue of quality of life has been of increasing interest in the field of aging, there has been little agreement as to the clarity and definition of the concept and how to measure it, especially as it relates to older adults. Presented here is a comprehensive, integrated model of quality of life that was developed by synthesizing existing constructs within the literature into six major life domains—(1) social well-being, (2) physical well-being, (3) psychological well-being, (4) cognitive well-being, (5) spiritual well-being, and (6) environmental well-being. Consistent with a general systems framework, this holistic model expands the predominant Health-Related Quality of Life constructs to incorporate non-physical aspects of well-being. Each of these domains was broken down into several dimensions in an effort to operationalize the concept of quality of life so that it can have some common standard of useful measurement. These major life domains and indicators are important factors in determining the perceptions of quality of life of older adults. Understanding what constitutes quality of life and how to measure it comprehensively has significant implications for social policy and practice in the field of aging.     

Social support and the course of bipolar disorder

The current study prospectively examined the impact of social support on symptom severity and recovery from episodes in bipolar disorder, both as a direct influence and as a buffer of life events. Fifty-nine individuals with Bipolar I disorder were followed longitudinally with monthly symptom severity interviews. Social support was measured by the Interpersonal Support Evaluation List and the Interview Schedule for Social Interaction, and life events were assessed using the Life Events and Difficulties Schedule. Individuals with low social support took longer to recover from episodes and were more symptomatic across a 6-month follow-up. Results suggest a polarity-specific effect, in that social support influences depression but not mania. Discussion focuses on theoretical implications of a series of polarity-specific findings within the field.     

The Environmental Reward Observation Scale (EROS): development, validity, and reliability

Researchers acknowledge a strong association between the frequency and duration of environmental reward and affective mood states, particularly in relation to the etiology, assessment, and treatment of depression. Given behavioral theories that outline environmental reward as a strong mediator of affect and the unavailability of an efficient, reliable, and valid self-report measure of environmental reward, we developed the Environmental Reward Observation Scale (EROS) and examined its psychometric properties. In Experiment 1, exploratory factor analysis supported a unidimensional 10-item measure with strong internal consistency and test-retest reliability. When administered to a replication sample, confirmatory factor analysis suggested an excellent fit to the 1-factor model and convergent/discriminant validity data supported the construct validity of the EROS. In Experiment 2, further support for the convergent validity of the EROS was obtained via moderate correlations with the Pleasant Events Schedule (PES; MacPhillamy & Lewinsohn, 1976). In Experiment 3, hierarchical regression supported the ecological validity of the EROS toward predicting daily diary reports of time spent in highly rewarding behaviors and activities. Above and beyond variance accounted for by depressive symptoms (BDI), the EROS was associated with significant incremental variance in accounting for time spent in both low and high reward behaviors. The EROS may represent a brief, reliable and valid measure of environmental reward that may improve the psychological assessment of negative mood states such as clinical depression.     

Emergent Values and the Experience of Aging

This study examined the role of values or guiding principles emerging from the life histories and reflections of 111 older adults as predictors of the experience of aging. Participants completed a detailed life history interview in which they described themselves on 10 major life dimensions. They also completed standardized questionnaires of well-being, personality traits, and intolerance of uncertainty. Participants expressed a mix of prosocial and self-interest values in their interviews. Multiple regression analyses indicated that social support and intolerance of uncertainty positively predicted the extent of values articulated in the interviews. Better quality of aging was predicted positively by extent of emergent values and greater well-being and negatively by age. The results indicate that an examination of values provides a unique contribution to the understanding of the experience of aging.     

Activity, event transactions, and quality of life in older adults

A multidimensional assessment of activity and subjective well-being based on a cognitive model of event causation was tested in a sample of 60 older adults. Activity was conceptualized as involving the occurrence of an event, the presence or absence of a response to that event, and the hedonic tone of the outcome of that transaction. Events were categorized as to whether the environment or the individual initiated them: demands or desires, respectively. Well-being was conceptualized as having two independent components, positive and negative, assessed by positive and negative mood scales and general well-being and quality-of-life scales. Analyses showed that older adults who were responsive to events reported more positive well-being, but high responding was also associated with negative aspects of well-being. Demands interacted with desire responding and outcome; affective outcomes of desired actions were significantly influenced by the occurrence of demand events. Results are interpreted in an expanded model of activity theory.     

The effect of social comparison information on the life satisfaction of frail older persons

In this study, the authors examined the effects of social comparison on the life satisfaction of 455 community-dwelling older persons. These older persons were confronted with a fictitious interview with either an upward or a downward target. After downward comparison, older persons felt more satisfied with their lives than after upward comparison, especially those who had higher levels of frailty. These effects were only found with lower levels of identification. Apparently, downward comparison only serves its self-enhancing function on life satisfaction among frail older persons when they perceive the comparison target as different from themselves.     

Femininity and work plans protect women against postpartum dysphoria

This study examined contributions of the following variables to postpartum depressive symptomatology: level of antepartum depression, loss of social reinforcement, assertiveness, sex-role orientation, and work plans. The Beck Depression Inventory (BDI), Pleasant Events Schedule (PES), Assertion Inventory, and Bem Sex Role Inventory (BSRI) were administered to 69 women during the eighth month of pregnancy. One month after delivery, subjects were administered the PES, postdelivery questionnaire, and BDI. A hierarchical regression analysis revealed that antepartum BDI scores predicted postpartum depressive symptomatology, and BSRI Femininity scores and work plans were significant negative predictors. A one-way analysis of variance of sex role orientation on postpartum BDI scores showed that undifferentiated women reported more depression than other sex role groups.     

Assessing preference in elders with dementia using multimedia and verbal pleasant events schedules

The current study compared an abbreviated oral interview version of the Pleasant Events Schedule – Alzheimer's Disease (PES‐AD) to a multimedia‐supplemented version. Both measures identified multiple preferred items and their scores were moderately correlated (r = .481). Direct observations were conducted to determine whether either of the two measures predicted subsequent engagement. For all nine individuals with dementia, items endorsed as preferred by both versions of the PES‐AD resulted in high levels of engagement and items endorsed as non‐preferred items on both measures resulted in low to moderate levels of engagement. Individuals with MMSE scores of 10 or higher had more stable and differentiated patterns of engagement than individuals with scores below 10. For individuals with higher MMSE scores, items endorsed only by the multimedia version resulted in high engagement levels (i.e., true positive) while items endorsed only on the verbal presentation resulted in low levels (i.e., false positive). Copyright © 2008 John Wiley & Sons, Ltd.     

Phenomenology of life satisfaction among elderly men: quantitative and qualitative views

Standardized measures of subjective well-being were compared with qualitative analysis of life satisfaction from 100 elderly men (70 years and older) from New Delhi, India, and London, England. 3 structured measures were used, Life Satisfaction Index (A), Cantril Self-Anchoring Ladder, and a one-item happiness question. Qualitative data were obtained from semistructured interviews covering past and present experiences. Meaning units were extracted from interview protocols, emerging themes were identified for each respondent, and overall summaries were written for English and Indian samples. Groups did not differ significantly on any of the structured measures, but showed marked differences in the qualitative analysis. Limitations of structured measures of subjective well-being are discussed in terms of "context-stripping," both in data collection and data analysis.     

Correlates of spirituality and well-being in a community sample of people living with HIV disease

While the past several years have witnessed an increase in the amount of research examining the spiritual perspectives of people living with HIV/AIDS, this literature is still insufficient to guide the conceptualization and development of spiritually based interventions to improve the life quality of people living with HIV illness. The present study assessed a community sample of 275 persons living with HIV disease to examine relationships among their spirituality, quality of life, perceptions of social support, and coping and adjustment efforts. This study found relationships between social support, active problem solving, life satisfaction, and gender and race with higher levels of spirituality among people living with HIV/AIDS. Mental health providers may need to routinely include assessments of spirituality and religious practices. Caregivers, faith communities, and mental health providers will need to assist in developing supportive environments that enhance the spiritual life and social well-being of people living with HIV infection. Additionally, caregiver training programs will need to focus on spiritual practices as a means of establishing a support system that increases the psychosocial well-being of people living with HIV/AIDS.     

An Attempt to Predict Change in Mood in Response to Velten-Like Mood Induction Procedures

College student subjects were rated high or low in cognitive and behavioral depression proneness, based on their scores on a screening battery that included the Automatic Thoughts Questionnaire (Hollon & Kendall, 1980), the Dysfunctional Attitude Scale (Weissman, 1979), the Intemality-Extemality Scale (Rotter, 1966), the Pleasant Events Schedule and the Unpleasant Events Schedule (Lewinsohn & Amenson, 1978). The students were subsequently exposed to one of two different Velten-like depressive mood inductions, one based on Beck's (1974) model of depression, and the other based on Lewinsohn's (1974) model. We hypothesized that subjects who scored higher on the cognitive measures would tend to become more depressed when exposed to the Beck statements and that those who scored higher on the behavioral measures would tend to become more depressed when exposed to the Lewinsohn statements. The hypothesis was not supported. Instead, pre-existing cognitively or behaviorally defined depression proneness appeared to be unrelated to subjects' susceptibility to one or the other model of depression as defined by the two mood inductions. However, the inductions themselves were found to produce a significant lowering of mood, and both inductions were equally effective in lowering mood.     

Social phobia in disabled workers with chronic musculoskeletal pain

The present study assessed the prevalence and impact of social phobia and other anxiety disorders in disabled workers with chronic musculoskeletal pain. Potential participants were 200 disabled workers consecutively referred to an interdisciplinary tertiary care centre. A two stage screening process was used in which: (a) a self-report battery was given during a pre-admission visit, and (b) preplanned selection criteria were applied to the self-report instruments to select patients for a structured diagnostic interview. Fifty-four of the 146 patients who provided complete responses on the self-report battery met criteria for interview. Twenty-six patients (17.8%) met DSM-IV criteria for a current anxiety disorder and, of these, 16 (11.0%) were diagnosed with social phobia. Subjects with social phobia rated themselves as having less social support than subjects with no psychiatric disorder, but the groups did not differ in pain-related life interference, personal control, or health care utilization. The results suggest that social phobia is over-represented in disabled workers with chronic musculoskeletal pain and should be noted as a comorbid condition that may compound both suffering and disability.