Expanding coping goodness-of-fit: religious coping, health locus of control, and depressed affect in heart failure patients

The goodness-of-fit coping hypothesis posits that problem-focused (PF) coping is particularly helpful under high controllability conditions, while emotion-focused (EF) coping is more helpful in low controllability situations. However, little research has examined whether the goodness-of-fit hypothesis applies to religious coping, a distinct set of coping resources and efforts. Further, little goodness-of-fit research has been conducted in the context of life-threatening illness. We tested coping goodness-of-fit for PF and EF as well as religious coping resources and strategies in 202 congestive heart failure (CHF) patients. Multiple regression analyses examined the extent to which each type of coping, health locus of control (HLOC) regarding their CHF, and their interactions related to subsequent depressed affect. Neither religious coping efforts nor religious resources were related to depressed affect. However, when examined in conjunction with internal HLOC, active coping and organized religious commitment were related to less depression for those higher in internal HLOC, while daily spiritual experience was related to less depression for those lower in HLOC. These results partially support the goodness-of-fit hypothesis and indicate a need to consider the perceived controllability of situations when examining the associations of religious coping resources and activities on depressive symptoms in the context of illness.     

Trauma and autobiographical memory specificity in depressed inpatients

Research on autobiographical memory has shown that clinical depression is associated with a difficulty in retrieving specific autobiographical memories in response to cue words. This study examined the relation between lack of autobiographical memory specificity and self-reported trauma in a group of depressed adults (N = 23). In addition to the Autobiographical Memory Test (AMT; Williams & Broadbent, 1986) participants completed a number of questionnaires assessing the presence of traumatic experiences in the past, level of depression and neuroticism. The number of specific responses was not related to depression severity, but was significantly associated with the presence and severity of reported physical abuse. Participants who had been victim of physical abuse were less specific than participants who had not been confronted with such physical adversities. The results are discussed in the context of a functional hypothesis about the developmental relations between memory specificity, trauma and depression.     

Anxiety sensitivity in first-degree relatives of patients with panic disorder

Anxiety sensitivity (AS) has been proposed as a risk factor for the development of panic disorder. Strong familial-genetic influences in panic disorder (PD) have been reported. AS may be familial too. The current study therefore examined whether first-degree relatives of PD patients are more anxiety-sensitive than normals. Twenty-three first-degree relatives of PD patients, 38 PD patients and 30 normals were given the Anxiety Sensitive Index and the Body Sensations Questionnaire. It was found that the first-degree relatives were, indeed, more anxiety-sensitive than the normals, but less so than the PD patients, suggesting that AS runs in families.     

Pursuit gain and saccadic intrusions in first-degree relatives of probands with schizophrenia

Oculomotor functioning of 26 probands with schizophrenia, 12 spectrum and 46 nonspectrum first-degree relatives, and 38 nonpsychiatric control subjects was evaluated. Spectrum relatives had more anticipatory saccades (ASs) and lower pursuit gain than nonspectrum relatives, who had more ASs and lower pursuit gain than control subjects. Probands also had lower pursuit gain than nonspectrum relatives and control subjects but did not differ from other groups on AS frequency. Control subjects had more globally accurate pursuit tracking (root mean square [RMS] error deviation) than both relative groups, whereas probands had the poorest RMS scores. Square wave jerk frequency did not differentiate the groups. Attention enhancement affected the frequency of ASs but did not affect either the other intrusive saccadic event or RMS scores. These results offer evidence that eye-movement dysfunction may serve as a biological marker for schizophrenia.     

Abuse, health locus of control, and perceived health among HIV-positive women.

This study of 230 predominantly poor Hispanic and African American women aged 25 to 61 years living with HIV/AIDS in New York City revealed high levels of both sexual (39%) and physical (44%) trauma before the age of 16. Both types of early trauma were correlated with later trauma, and all forms of trauma were significantly associated with current perceived health. In multivariate analyses controlling for relevant covariates, the Powerful Others and Internal Control subscales of the Multidimensional Health Locus of Control Scales (K. A. Wallston, B. S. Wallston, & R. DeVellis, 1978) acted as independent predictors of perceived health rather than (as hypothesized) mediators of the association between trauma and perceived health. Findings underscore the importance of addressing trauma and perceptions of control over one's physical health in the provision of health services to HIV-positive women.     

Borderline psychopathology in the first-degree relatives of borderline and axis II comparison probands

The purpose of this study was to assess the prevalence of each of the nine DSM criteria for borderline personality disorder and the prevalence of the disorder itself in the first-degree relatives of borderline probands and Axis II comparison subjects. Four hundred and forty-five inpatients were interviewed about familial borderline psychopathology using the Revised Family History Questionnaire--a semistructured interview of demonstrated reliability. Of these 445 subjects, 341 met both DIB-R and DSM-III-R criteria for BPD and 104 met DSM-III-R criteria for another type of personality disorder (and neither criteria set for BPD). The psychopathology of 1,580 first-degree relatives of borderline probands and 472 relatives of Axis II comparison subjects was assessed. Both DSM-III-R and DSM-IV BPD were found to be more common among the relatives of borderline than Axis II comparison probands. However, five of the criteria for BPD (inappropriate anger, affective instability, paranoia/dissociation, general impulsivity, and intense, unstable relationships) and all four sectors of borderline psychopathology (affect, cognition, impulsivity, and interpersonal relationships) were found to be both more common and discriminating than the BPD diagnosis itself. Taken together, the results of this study suggest that the subsyndromal phenomenology of BPD may be more common than the borderline diagnosis itself.     

Personality correlates of hopelessness in depressed inpatients 50 years of age and older.

In this study we examined the relationship between scores on the Beck Hopelessness Scale and the personality traits that constitute the Five-Factor Model in a sample of 77 depressed inpatients, 50 years of age and older. Multiple regression analyses showed that Hopelessness is related to low Extraversion domain scores, and to specific facets of both Extraversion (low positive emotions) and Neuroticism (low self-consciousness, high impulsiveness). Efforts to tie Hopelessness with the motivational, affective, and interpersonal constructs subsumed under Extraversion are warranted.     

Spiritual well-being and spiritual practices in elderly depressed psychiatric inpatients

This study's aims were to describe the spirituality of depressed elderly psychiatric inpatients and to examine associations among spirituality, depression, and quality of life (QOL). Forty-five persons participated. Most reported frequent, stable spiritual practices and experiencing spiritual comfort and guidance. Some reported spiritual distress and changes in spirituality. During hospitalization, participants demonstrated increased spiritual well-being (SWB) and peacefulness, and reduced hopelessness, worthlessness, and guilt. Positive associations were found between SWB and QOL and negative associations between SWB and depression.     

The Rorschach test for predicting suicide among depressed adolescent inpatients.

With the decreasing length of psychiatric hospitalizations, identification of test indicators of suicide risk becomes critically important. This Rorschach study was designed to model a clinical decision-making scenario concerning adolescent suicide risk. Using Psychiatric Evaluation Form (PEF) scores, we selected a sample of 25 severely depressed and suicidal adolescents; 26 severely depressed, not suicidal adolescents; and 28 not suicidal, not depressed adolescent inpatients at The Sheppard and Enoch Pratt Hospital. A Rorschach Index using the Exner (1986) Comprehensive System for scoring was developed to predict group membership. Four of six of the features on this index selected 64% of suicidal subjects. This constellation included traditional affective variables (vista responses, color-shading blends, color dominated responses, and morbid content) as well as measures of cognitive distortion (inaccurately perceived human movement responses [M-] and special scores). We discuss the implications of these findings for the diagnosis and treatment of the suicidal adolescent.     

Utility of the SCL-90-R with depressed and conduct-disordered adolescent inpatients.

We assessed the diagnostic utility of the Symptom Checklist-90-Revised (SCL-90-R) in a sample of adolescent inpatients. In Part 1 (n = 79), convergent and discriminant validity were demonstrated for SCL-90-R scales measuring depression and paranoid ideation. Canonical correlation showed that SCL-90-R scales tapped two dimensions of adolescent psychopathology, a primary dimension of dysphoria and a secondary dimension of anger and mistrust. In Part 2 (n = 50), adolescents diagnosed as having major depression showed significant elevations on scales measuring depression, anxiety, and obsessive-compulsive features. Although several scales had high diagnostic specificity for major depression and conduct disorder, sensitivity was low.     

The assessment of personality characteristics in depressed and dependent psychiatric inpatients

The diagnosis and treatment of depression may be complicated by the presence of excessive dependency needs. Previous research has found stable personality traits useful in identifying depressive subtypes. This study was designed to assess the personality characteristics of 106 psychiatric inpatients. Subjects were grouped according to the presence or absence of two primary dimensions: depression and dependency. Results indicated that both depression and dependency were significantly related to various indices of psychopathology. Main effects were more useful than interactions, implying that depression and dependency both affect symptomology directly rather than interactively. Although the assessment of personality traits may be complicated by the presence of a major psychiatric disorder, results from our study suggest that the assessment of both Axis I and Axis II variables can be useful in understanding the current clinical picture.     

Expressed emotion and familial interaction: a study with agoraphobic and obsessive-compulsive patients and their relatives

Patients with panic disorder with agoraphobia (n = 40) or obsessive- compulsive disorder (n = 61) participated in a 10-min problem-solving interaction with their primary relative. Relatives were categorized as hostile or nonhostile toward the patient on the basis of a measure of expressed emotion (EE). Observed interactions between patients and their hostile relatives, relative to those of dyads with a nonhostile relative, were marked by higher rates of relatives' criticism and of patients' negativity but not by higher rates of negative reciprocity. Analyses of sequences indicated that the dyads with a hostile relative had a higher rate of sequences in which the relative was first critical and the patient then negative than was the case for dyads with nonhostile relatives. Moreover, hostile relatives were more frequently critical than nonhostile relatives whether patients' preceding behavior was positive, negative, or neutral. The findings are consistent with the stress-vulnerability model of the effect of EE on mental health, in that patients living with a high EE relative appear to be exposed to higher levels of interpersonal stress.     

Validation of health locus of control patterns in Swedish adolescents

The purpose of the present study was to investigate the relationships between Health Locus of Control (HLOC) questionnaire subscales (Internal, Powerful Others, Chance) and self-esteem in Swedish adolescents (N = 506). Results from traditional correlational analyses were compared with findings using an alternative method of clustering individuals according to their pattern of scores on the three HLOC subscales. One-way analysis of variance, with eight possible groupings of high and/or low scores on the three subscales, indicated that those with a combination of strong belief in internal control of health, high degree of belief that health is determined by powerful others, and low degree of belief that health is a function of chance/luck had better self-esteem than those with a quite opposite pattern, involving high belief in chance and low belief in internal control. The potential benefit to researchers and clinicians of using this method of combining the HLOC subscales, instead of the traditional correlational method, is discussed.     

The effect of self- vs. external-monitoring and locus of control upon the pacing and general adjustment of psychiatric inpatients

Ninety-six psychiatric inpatients with a history of problematic pacing were identified as internal or external (Rotter Internal-External Locus of Control Scale) and assigned to one of four monitoring categories: (1) self-monitoring, in which participants recorded their pacing on wrist counters, (2) external-monitoring, in which ward staff informed participants of their pacing, (3) social demand, in which participants were pressured not to pace, but without specific feedback concerning their pacing and (4) no treatment. Dependent measures included the number of cycles paced, distance paced, and staff rated general social adjustment (MACC scale). As hypothesized, internals showed greater reductions in pacing and increases in general adjustment scores in the self-monitoring condition and externals reducing pacing and improved general adjustment on the external monitoring condition. Both of the treatment conditions created greater positive change than the social demand condition.     

Parental control in child rearing and multidimensional locus of control.

272 French-Canadian adolescent boys and 286 girls took part in a study of the association between parental control in child-rearing and Levenson's locus of control dimensions. Analysis showed relations between parental control and the two external dimensions but not with the internal one. Age and gender did not contribute to the various relationships.     

Use of the Beck Depression Inventory-II with depressed geriatric inpatients

To provide information about the clinical utility of the Beck Depression Inventory-II (BDI-II) [Beck, A.T., Steer, R.A., & Brown, G.K. (1996b). Manual for the Beck Depression Inventory-II. San Antonio, TX: Psychological Corporation] with geriatric inpatients, the BDI-II was administered to 130 psychiatric inpatients who were 55 years old or above and who were diagnosed with principal DSM-IV major depressive disorders (MDD) (N = 85, 65%) or adjustment disorders with depressed mood (N = 45, 35%). The internal consistency of the BDI-II was high (coefficient alpha = 0.90), and its total score was not significantly related to sex, age, or ethnicity. An iterated maximum-likelihood factor analysis found the Cognitive and Noncognitive dimensions which have been reported for the BDI-II by Steer and co-workers (Steer R.A., Ball R., Ranieri W.F., & Beck A.T. (1999). Dimensions of the Beck Depression Inventory-II in clinically depressed outpatients. Journal of Psychopathology and Behavioral Assessment, 55, 117-128) in a younger sample of clinically depressed psychiatric outpatients. The mean BDI-II total score of the 85 geriatric inpatients with MDD was also comparable to that of 42 younger (< or = 54 years old) inpatients with MDD. The results were discussed as supporting the use of the BDI-II with clinically depressed geriatric inpatients.     

Some correlates of health locus of control among multicultural individuals

The relationship of locus of control to depression, anxiety, hostility, and physical health was assessed in a sample of multicultural college students (N = 162). Powerful Others Health Locus of Control was correlated with depression, anxiety, hostility, and recent physical symptoms while Chance Health Locus of Control (CHLC) was correlated with all of the above as well as chronic physical symptoms and major health problems. When controlling for a variety of health risk factors (viz., age, sex, body mass, exercise, smoking, salt, alcohol, and caffeine), only CHLC remained significant in the physical health models. Results support the cognitive model of mental health which emphasize the importance of adaptive beliefs. Specifically, they suggest that issues about control are related to negative affect and indicate that the often-cited relationship of an external locus of control to depression and anxiety also holds for hostility. The findings do not, however, support the view that anxiety and depression are associated with different types of external locus of control but rather suggest a unified set of locus of control beliefs underlying the three types of negative affect. In addition, evidence is provided for the external validity of the Multidimensional Health Locus of Control (MHLC) Scales with respect to mental health. Further, the results indicate that belief about one’s health may play a significant role in one’s physical health and that the health behavior model of the relationship between locus of control and physical health is insufficient to explain the relationship. As the Chance and Powerful Others MHLC scales were not related to health habits in this sample but were related to mental health (viz., depression, anxiety, and hostility), locus of control beliefs may be related to physical health via their relationship with mental health.     

A comparison of two multidimensional health locus of control instruments

This study examined the factor structure, internal consistency reliability, and construct validity of the multidimensional health locus of control (MHLC) instruments developed by K.A. Wallston, B.S. Wallston, and DeVellis (1978) and Lau (Lau, 1982; Lau & Ware, 1981). Both measures were administered to a sample of Veterans Administration (VA) medical outpatients (N = 181). Only minimal evidence of convergence was found between corresponding scales of the two MHLC instruments. Low convergent validity appears attributable to the poor internal consistency reliability of the Lau-Ware subscales. Moreover, results of factor analysis largely supported the a priori factor structure of the K.A. Wallston et al. (1978) MHLC instrument but failed to support the factor structure of the Lau-Ware instrument. Health locus of control (HLC) dimensions that emerged from simultaneous factor analysis of both instruments were most consistent with a three-dimensional typology (i.e., Personal Control, Professional Control, and Chance) rather than the four-dimensional typology proposed by Lau (Lau, 1982; Lau & Ware, 1981). Implications for HLC conceptualization and measurement are discussed.     

Spiritual health locus of control and breast cancer beliefs among urban African American women.

The present study examined the relationship between spiritual health locus of control, breast cancer beliefs, and mammography utilization among a sample of 1,227 African American women from urban public health centers. Spiritual health locus of control was conceptualized as having an active and passive dimension, empowering individuals in their health beliefs and behaviors or rendering them to rely on a higher power (e.g., God) to determine their health outcomes, respectively. The active dimension was negatively associated with perceived benefits of mammography and positively associated with perceived barriers to mammography. The active and passive spiritual dimensions are distinct from internal and external health locus of control. Further study of their associations with other health-related beliefs and behaviors is warranted.