Cortisol changes interact with the effects of a cognitive behavioural psychological preparation for surgery on 12-month outcomes for surgical heart patients

Previous studies offer contradictory evidence regarding the effects of cortisol changes on health outcomes for surgical heart patients. Increased cortisol and inflammation have been related to psychological stress while separate studies have found an inverse relation between cortisol and inflammation. Psychological preparations for surgery can reduce stress and improve outcomes and may interact with cortisol changes. Following from these relationships, we hypothesised that a preparation for surgery will interact with changes in cortisol to affect outcomes. Measures were the SF 36 General Health and Activities, medical visits and satisfaction. Eighty-five patients were randomly assigned to standard care plus a psychological preparation or standard care alone using a single-blind methodology. Data on psychological and biological functioning were collected at admission, 1 day prior and 5 days post-surgery, and 12-months after hospital discharge. General health and activities, and medical visits were related to the interaction of cortisol change and psychological preparation in support of the hypothesis. Patients were more satisfied in the preparation group than controls. Based on these findings, some outcomes from psychological preparations may be affected by changes in levels of cortisol. These results caution against a one-size-fits-all approach to psychological preparations.     

Hypnotic discontinuation in chronic insomnia: impact of psychological distress, readiness to change, and self-efficacy.

OBJECTIVE: To compare individuals who were successful in discontinuing hypnotic medications against those who were not on measures of insomnia severity, medication withdrawal symptoms, psychological symptoms, perceived health, readiness to change and self-efficacy. DESIGN: Secondary analyses of a randomized clinical trial comparing a hypnotic taper intervention with or without self-help treatment for insomnia. MAIN OUTCOME MEASURES: Self-report measures of insomnia severity, medication withdrawal symptoms, depression and anxiety symptoms, physical and mental health, stages of change, readiness to change, decisional balance, and general and situational self-efficacy. RESULTS: There were no significant differences at baseline between medication-free individuals and those still using sleep medication at the end of a taper intervention. Group differences emerged midway through the 8-week withdrawal program and were accentuated after the intervention; participants who remained medication-free during the next six months had less severe insomnia and anxiety symptoms, a more positive perception of their health and higher self-efficacy to refrain from hypnotic use in various situations. Contrary to expectations, there were no differences between drug-free and nondrug-free participants on both readiness to change and stages of change. CONCLUSIONS: Chronic users of hypnotic medications entered a taper intervention with equal levels of psychological distress, health, self-efficacy, and readiness to change. Successful hypnotic discontinuation was associated with overall improvement of insomnia, anxiety and distress symptoms, perceived health and self-efficacy. More intensive and individualized therapeutic attention may be warranted for individuals experiencing worsening of insomnia symptoms, more withdrawal symptoms and psychological distress, and lower self-efficacy during medication discontinuation.     

Faculty Stressors, Job Satisfaction, and Psychological Distress Among University Teachers in Hong Kong: The Role of Locus of Control

The study aimed at identifying the sources of stress, and investigating their effects on job satisfaction and psychological distress among 106 university teachers (86 males, 20 females) from four tertiary institutes in Hong Kong. Another purpose of the study was to examine the moderating effect of locus of control on stressor-strain relationships. A factor analysis of the faculty stressors revealed six factors: recognition, perceived organizational practices, factors intrinsic to teaching, financial inadequacy, home/work interface, and new challenge. A series of stepwise multiple regressions demonstrated that recognition, perceived organizational practices, and financial inadequacy were best predictors of job satisfaction, whereas perceived organizational practices and home/work interface were the best predictors of psychological distress. Further, external locus of control was associated with low job satisfaction and psychological distress. A series of hierarchical moderated regressions demonstrated a moderating effect of locus of control on some of the stressor-strain relationships.     

Sleep,resilience, and psychological distress in United States military Veterans

Sleep problems are prevalent among Veterans. Left untreated, such problems may elevate psychological distress and increase risk of subsequent mental health disorders. Psychological resilience may buffer against negative psychological outcomes, yet the relationship between sleep and resilience has not been studied. This study explored poor sleep, resilience, and psychological distress using questionnaires collected as part of the Study of Post-Deployment Mental Health. Participants (N = 1,118) had served in the US military since September 11, 2001, had one or more overseas deployments, and were free from a past-month DSM-defined mental health disorder. Hierarchical linear regression was used to examine the association between poor sleep quality (Pittsburgh Sleep Quality Index total score) and psychological distress (Global Symptom Index; Symptom Checklist-90-R), controlling for demographic and health characteristics. Moderation analyses tested for a potential buffering effect of resilience (Connor-Davidson Resilience Scale). Poor sleeping Veterans had worse physical and psychological health, lower resilience, and endorsed more lifetime traumatic events. Poor sleep was associated with greater psychological distress controlling for health and demographic characteristics. Both resilience factors—adaptability and self-efficacy—had significant buffering effects on the relationship between poor sleep and psychological distress, suggesting that resilience may protect against negative outcomes in poor sleepers. Additional research is warranted to better understand the relationships between sleep, resilience, and psychological distress. Such research may inform pertinent prevention efforts, including interventions that improve sleep, enhance resilience, and protect against incident mental health diagnoses.     

Perceived control over the medical procedure and its association with adjustment to a low-control situation: the case of infertility

Illness perceptions were shown to be related to emotional and physical outcomes, as proposed by Leventhal’s self-regulation model. These perceptions include the illness identity, its timeline, consequences, causes, and controllability, which later research found to include self-control and treatment control. The current study aimed to examine the role of a third type of perceived control: Control over the treatment procedures. We hypothesized that this type of control would be important for women undergoing infertility treatments, which are characterized by high uncertainty and low personal control. The sample included 194 Israeli women who were undergoing infertility treatments, 70% recruited in hospitals and the remainder in a fertility counseling center and website. All participants were married religious Jewish women, which added to the stress inherent in infertility. Study measures included the Illness Perception Questionnaire-Revised (IPQ-R), adapted to infertility, with an additional subscale assessing control over the procedure, and infertility-specific distress and well-being scales. Exploratory and confirmatory factor analyses supported the factor structure, including the distinct new subscale. A structural equations model showed that perceived consequences were most strongly related to distress and well-being. The three types of control were positively intercorrelated but differed in their associations with distress and well-being: Self-control over the problem and treatment control were unrelated to either measure while self-control over the procedure was related to greater well-being. These findings suggest that when control over the condition or the treatment outcomes is impossible, individuals may still benefit from control over external factors such as their health care. Healthcare providers can support them by seeking ways to increase their control over their treatment procedures, which may contribute to better psychological adjustment. Future studies should examine the role of perceived control over the procedures in other low-control situations (e.g., newly diagnosed cancer; aging-related declines).     

Illness perceptions account for variation in positive outlook as well as psychological distress in rheumatoid arthritis

Psychological distress in rheumatoid arthritis (RA) is associated with adverse clinical outcomes, and appears highly related to patients' illness perceptions. This study aimed to investigate the association between illness perceptions, psychological distress, positive outlook and physical outcomes in RA. Two hundred and thirty patients aged >18 years and prescribed at least one disease-modifying anti-rheumatic drug (DMARD) were recruited from outpatient clinics across Hertfordshire (England). Patients completed a questionnaire that assessed psychological distress and positive outlook (depression, anxiety and positive outlook scale), illness perceptions (IPQ-R) and functional disability (health assessment questionnaire). Information regarding prescribed medication and disease activity [disease activity score (DAS28)] was collected from medical notes. Psychological distress, but not positive outlook, was associated with functional disability and DAS28. After controlling for sex, age and DAS28, perceptions of greater symptomatology (identity) and lesser understanding of RA (coherence) were significantly associated with increased psychological distress. Perceptions of greater treatment control were associated with greater positive outlook, but only for those with low DAS28. Coherence was also associated with positive outlook. These findings indicate that illness perceptions may influence psychological distress and positive outlook in RA patients, and may therefore be a useful basis for future psychological interventions.     

Beliefs about emotion: implications for avoidance-based emotion regulation and psychological health

People’s beliefs about their ability to control their emotions predict a range of important psychological outcomes. It is not clear, however, whether these beliefs are playing a causal role, and if so, why this might be. In the current research, we tested whether avoidance-based emotion regulation explains the link between beliefs and psychological outcomes. In Study 1 (N?=?112), a perceived lack of control over emotions predicted poorer psychological health outcomes (increased self-reported avoidance, lower well-being, and higher levels of clinical symptoms), and avoidance strategies indirectly explained these links between emotion beliefs and psychological health. In Study 2 (N?=?101), we experimentally manipulated participants’ emotion beliefs by leading participants to believe that they struggled (low regulatory self-efficacy) or did not struggle (high regulatory self-efficacy) with controlling their emotions. Participants in the low regulatory self-efficacy condition reported increased intentions to engage in avoidance strategies over the next month and were more likely to avoid seeking psychological help. When asked if they would participate in follow-up studies, these participants were also more likely to display avoidance-based emotion regulation. These findings provide initial evidence for the causal role of emotion beliefs in avoidance-based emotion regulation, and document their impact on psychological health-related outcomes.     

Facial disfigurement in patients with head and neck cancer: the role of social self-efficacy.

This study investigated the moderating role of social self-efficacy (i.e., the belief that one is capable of exercising control over the reactions and openness of other people) with respect to the link between facial disfigurement and psychological and n = 76) as well as their physicians. In line with the hypotheses, the results revealed that the degree of facial disfigurement, as judged by patients as well as their physicians, was positively related to psychological distress and distress in reaction to unpleasant behavior of others, but only when patients did not feel self-efficacious in social encounters. Furthermore, social self-efficacy mitigated the positive link between facial disfigurement as judged by patients and social isolation.     

Health Locus of Control Beliefs in Low Back Pain Patients

Abstract

Associations between health locus of control (HLC) beliefs, illness characteristics, psychological distress and self-care behaviour were studied in a group of subjects (n=459) aged 35 to 54 years suffering from chronic or recurrent low back pain (LBP). The results showed that younger subjects and men were more internal in their beliefs, and that duration and severity of LBP, psychological distress, and back care were associated with the individual's beliefs in his/her control over illness. The associations found were, however, of a low magnitude. More conclusive evidence on the development and modification of HLC beliefs are required before practical applications are possible.     

A Model for Primary Care Psychology With General Thoracic Surgical Patients

This study examined a model for brief psychological assessment for providing primary psychological care to patients within a surgical, specialty outpatient clinic to provide early and accurate detection of psychological distress in patients to increase compassionate care. Questionnaires were completed by 351 outpatients and 227 of these outpatients were provided a model of primary care (brief psychological intervention). Patients were assessed and provided coping strategies, patient education, and a brief evaluation of anxiety and depressive symptoms. Psychologists, in a brief interview (mean = 12 min) identified individuals experiencing significant psychological distress. The ratings of emotional status also predicted health quality of life and anxiety. Younger individuals presenting for medical care appear to be more vulnerable to psychological distress. Brief psychological interventions provide accurate, efficient assessment of psychological distress and can be an effective way of increasing compassionate care. The results support the use of primary care psychology and brief psychological interventions in the management of medical patient care.     

Predictors of Health Locus of Control in Older Adults

Health locus of control has been shown to influence how individuals approach their health and health-related decisions. The present study examined the variables predictive of older adults’ health locus of control. A total of 261 adults aged 54–84 years completed a questionnaire about their health, approach to health, and background information about themselves. The results revealed that demographic indicators, health-related variables, and psychological variables—particularly health risk tolerance, future time perspective, health self-efficacy, and emotional instability—were related to older adults’ health locus of control. Findings have implications for programs aimed at modifying older adults’ health locus of control.     

Discrimination and Women’s Mental Health: The Mediating Role of Control

Perceived discrimination is a stressor, related to both negative physical and mental health outcomes. Utilizing a sample of 259 undergraduate females from the northeast region of the U.S., the present study examined a model that tested the direct, indirect, and mediated relations among perceived sexist discrimination, psychological distress, self-esteem, and sense of personal control. Path analysis of the model indicated that (a) perceived sexism was related to greater psychological distress, with personal control partially mediating this link and (b) perceived sexism was not related to self-esteem. The path model accounted for 28% of the variance in self-esteem and 37% of the variance in psychological distress. Implications of the findings for women’s health are discussed.     

The adaptive effect of personal control when facing breast cancer: Cognitive and behavioural mediators

This prospective study examines the cognitive and behavioural mediators of the relation between personal control and the initial response to a breast cancer diagnosis as well as subsequent psychological adjustment. A total of 143 patients participated immediately after diagnosis (T1), after surgery (T2) and 2 months after the end of treatment (T3), of whom 92 also completed a questionnaire pre-diagnosis (T0). The buffering effect of personal control on psychological distress shortly after diagnosis was mediated by cancer-specific cognitions, i.e. threat appraisal and coping self-efficacy. Moreover, a strong sense of personal control predicted lower levels of anxiety 2 months after the end of treatment, but was unrelated to distress at T3. The adaptive effect on anxiety was mediated by threat appraisal and active engagement in social life after surgery, but not by active patient participation or coping self-efficacy. These results confirm and explain the adaptive effect of control. Apparently, women with a low sense of control appraise cancer and their personal coping skills more negatively, which makes them vulnerable to distress in response to diagnosis. Furthermore, women with a strong sense of control might regulate anxiety by remaining engaged in social life.     

THE IMPACT OF CHILDCARE RESPONSIBILITY AND SELF-EFFICACY ON THE PSYCHOLOGICAL HEALTH OF PROFESSIONAL WORKING MOTHERS

This study examined how childcare responsibility and self-efficacy to manage multiple role demands related to the psychological well-being and distress of 42 full-time professional women one month after they returned to their jobs after the birth of their first child. The results showed that greater childcare responsibility is associated with lower well-being and greater psychological distress. As predicted, perceived self-efficacy to cope with demands of occupational and familial roles appeared to mediate this relationship. A woman's belief in her capability to enlist the help of her spouse for childcare was the most consistent predictor of both well-being and distress.     

Examining maternal age,breastfeeding self-efficacy and health locus of control in psychological wellbeing of mothers

We investigated the direct and interaction influence of maternal age, breastfeeding self-efficacy (BSE), health locus of control (HLOC) on six dimensions of psychological wellbeing of breastfeeding mothers in Lagos, Nigeria. Data were collected from a convenience sample of 291 mothers attending health facilities in two suburb local government areas. The survey included socio-demographics (maternal age, marital status, ethnicity, education level and position of the baby currently breastfeeding), breastfeeding self-efficacy, health locus of control and psychological wellbeing scales. Independent variables were tested against sense of autonomy, positive relations with others, purpose in life, self-acceptance, environmental mastery and personal growth using factorial Multivariate Analysis of Variance. Results showed direct influence of BSE, HLOC and maternal age on various dimensions of psychological wellbeing. Interaction influences indicate BSE and HLOC on environmental mastery; BSE and maternal age on self-acceptance and HLOC and maternal age on sense of autonomy, positive relationship with others and self-acceptance respectively. In conclusion, maternal age, breastfeeding self-efficacy and health locus of control are vital for mothers to enjoy plenty dimensions of psychological wellbeing. Breastfeeding mothers need to be confident in their abilities to breastfeed and have control over their health-related behaviour in order to enjoy sufficient dimensions of psychological wellbeing.     

The influence of type A behaviour and locus of control upon job satisfaction and occupational health

Results from this study show that in a sample of 332 German managers a Type A personality and an External locus of control are associated with greater perceived levels of stress (particularly in terms of inter-personal relationships), lower job satisfaction and a poorer physical and mental health than that of managers with a type B personality and an Internal locus of control. The magnitude of main effect size is substantially larger than the interaction terms (Type A×Locus of Control). There is no evidence to support a significant effect of a Type A×Locus of Control interaction on either of the health outcome measures (physical and psychological health), but there is some evidence of an interaction with work satisfaction outcomes (job satisfaction and organizational satisfaction). Those with an External locus showed significantly lower levels of work satisfaction, especially when this characteristic was combined with a Type A personality. It appears that negative health consequences may outweigh the superficial attractiveness of the type A personality in a managerial position, particularly when this trait is coupled with a more external locus of control.     

Predictors of mental distress and poor physical health among homeless women

Abstract

We tested a latent variable path model in which situational, personal, and social resources predicted several mediators and the key health outcomes of mental distress and poor physical health among 871 homeless women. Mental distress was predicted by risky sexual behavior, less social support, avoidant coping, less self-esteem, client abuse history, social support from deviant sources, less drug self-efficacy and health care utilization. Poor physical health was predicted by a client abuse history, less drug self-efficacy, fewer perceived rewards for drug use, higher perceived costs for drug use, and a doctor visit. Current risky sexual behavior was predicted by a parent drug abuse history, less drug self-efficacy, and more social support from deviant sources. Current drug use was predicted by parent drug abuse history, less drug self-efficacy, more social support from deviant sources and by high perceived costs for drug use. Implications of results for intervention and theory are discussed.     

Hardy personality, self-efficacy, and general health in nursing professionals of intensive and emergency services

In this study, the predictive power of hardy personality and generalized self-efficacy on general health perception was investigated in a sample of nursing personnel working in emergency and intensive care services. A cross-sectional retrospective design was used, and the following measurement instruments were applied: a sociodemographic and work questionnaire, Goldberg's GHQ-28 Health Questionnaire, the Baessler and Schwarzer General Self-efficacy Questionnaire, and the Hardy Personality Subscale of Moreno's Nursing Burnout Questionnaire (CDPE). The results revealed a positive and statistically significant relationship between the individual variables of generalized self-efficacy and hardy personality. A canonical correlation analysis carried out on the psychological distress symptoms with self-efficacy and hardy personality as predictor variables, led us to emphasize the relevance of the construct total hardy personality as a predictor and, consequently, as a protective factor against the onset of psychological distress symptoms in the sample of professionals studied. Lastly, the implications of the results for clinical practice are discussed.     

情绪调节自我效能感与心理健康的交叉滞后研究

摘 要：对531名青少年进行为期五个月的追踪,运用交叉滞后回归分析考察积极、沮丧、生气三种情绪调节自我效能感与心理健康（问题行为、抑郁和生活满意度）间的相互影响。结果：T1积极情绪调节自我效能感不能预测T2问题行为、抑郁和生活满意度;T1沮丧情绪调节自我效能感显著预测T2抑郁水平;T1生活满意度和抑郁显著预测T2生气情绪调节自我效能感。结论：高沮丧情绪调节自我效能感能保护青少年处于“低抑郁状态”,而生气情绪调节自我效能感更容易受到个体生活满意度和抑郁水平的影响,是青少年处于不良心理状态下的易感效能。