Subjective health complaints and health related quality of life in a population of health care workers

The aim of this study was to assess whether Subjective Health Complaints (SHC), demands and coping are associated with health-related quality of life in a population of health care workers. One hundred and nineteen employees in two nursing homes for the elderly filled in a questionnaire on health, exercise, psychological factors, and work conditions. Main outcome measures were SHC and quality of life measured by SF-36. High level of SHC was associated to low health-related quality of life. Low coping and high demands were related to low scores (low quality of life), and high coping and low demands to high scores on mental health. Pseudoneurological complaints (e.g. tiredness, sadness), high demands and low coping were associated with low mental health. The expected negative association between SHC and health-related quality of life was found. There was a positive association between coping and quality of life.     

Learning subjective health complaints

Symptom episodes often show a spatio-temporal structure, that is, they occur in a specific context for a certain duration. Repeated experiences may therefore be construed as associative learning trials, in which context elements are turned into predictive cues, triggering anticipatory processes conducive to subjective health complaints. A series of experiments, using inhalations of air enriched with CO2 and external (odors) or internal (mental images) stimuli as cues, is discussed to show that subjective health complaints may occur upon presenting the cue alone. Learned symptoms may be unrelated to bodily responses and easily generalize to new related cues. Better learning occurs to cues with a negative affective valence and in participants scoring high for negative affectivity. Our findings are relevant to the understanding of medically unexplained ("functional") syndromes and the poor relationship between objective and subjective health indicators in general.     

Sensitization and subjective health complaints

Why is it that some of us have more pain, more fatigue, and more gastrointestinal trouble than others? Is it possible that there are brain mechanisms and psychological mechanisms that make some people sensitized to specific complaints? In this concluding paper we review the historical and theoretical background, discuss the evidence and theoretical positions in the contributions, and draw some conclusions. Traditional psychosomatic models had less predictive value and less therapeutic importance than what was hoped for. The main problem with these models was the lack of a pathophysiological explanation for why psychological problems could be related to somatic disease. Sustained arousal or "allostatic load" offers more plausible and acceptable mechanisms for pathology, and, to some extent, for sensitization and illness. The combination of cognitive psychology and neurophysiology offers a model for somatic pathology, and, perhaps more important, also for the understanding of subjective complaints and illness.     

Cognitive-emotional sensitization and somatic health complaints

Sensitization is conceptually related to cognitive bias in experimental psychopathology, and they share the basic mechanism of neuronal sensitization. Every strongly relevant individual concern, like fears, can yield cognitive bias or "cognitive-emotional sensitization". It might also be present for bodily and environmental information related to illness, and could be an etiological factor in medically unexplained complaints. Physiological and cognitive sensitization are theoretically compared. There is evidence for cognitive-emotional sensitization in some medically unexplained somatic complaints, and negative affect is suggested as a catalyst. Prolonged cognitive-emotional sensitization ("perseverative negative cognition" or worry, rumination) might even have demonstrable somatic pathological effects. It is concluded that sensitization may be organized at different levels, both in the organism and in the larger living system within which the organism is subsumed. This view might not only help to clarify medically unexplained pain syndromes, but virtually every subjective complaint, both with and without recognized physiopathology.     

Predicting adolescent health complaints by personality and Behaviors

Abstract

In a sample of 97 male adolescents, individual differences in health complaints were predicted by personality traits and by self-reported health/risk behaviors. Anxiety and loneliness were measured at Times 1 and 2, and health locus of control, various behaviors and health complaints were assessed at the end of the two-year study. A causal model was specified, employing anxiety and loneliness as distal predictors, health locus of control and behaviors as proximal predictors of health complaints. It turned out that anxiety was the most powerful single predictor, and that loneliness exerted a direct effect on health locus of control and behaviors and an indirect effect on health complaints. Risk behavior as well as health behavior were related to complaints. Social integration facilitated not only health behavior but also risk behavior.     

Subjective perception of health in elderly inpatients

There is evidence that subjective health is an important variable in general health outcomes. It can be an indicator of the individual's overall health status, creating a reliable and valid estimate about health. Quality of life (QoL) assessment can be associated with the individuals' subjective assessment of their own health status. The aim of the present study was to investigate variables associated with subjective perception of health in older inpatients. Ninety elderly inpatients over 60 years old were interviewed. The perception of health assessment (healthy/unhealthy) allocated elders in either of two groups. All the elders answered sociodemographic questions, the WHOQOL-100 and the Beck Depression Inventory (BDI). Comparing the group that considered themselves unhealthy to the other group, the former showed a tendency of worse QoL assessments in five out of six domains investigated. Significant differences were found for the physical and level of independence domains, as well as overall QoL. There was a significant association between health perception and lower intensity of depressive symptoms, as well as better QoL perception in the level of independence domain. This study shows the existence of an association between depressive symptoms and health assessment. It also suggests that the independence dimension is important in the elders' perception of their health status. These findings can help identify cause-effect relations between variables in aging studies involving health indicators and bring new intervention proposals for the elderly.     

The effects of a positive health priming intervention on somatic complaints

Somatic complaints are common and form a major burden. Previous studies suggested that such complaints might be increased by ‘illness-related memory’, for example due to worries about health. In this ambulatory study we tested whether we could decrease somatic complaints through enhancing the activation of health-related memory by a ‘positive health’-priming intervention. Forty-three students were randomly assigned to the ‘positive health’-group or a control group. Using online measures, participants reported negative affect (NA) and somatic complaints for a period of six days, while each morning performing the priming task. The intervention caused a decrease in somatic complaints but only for participants with low trait NA or low somatosensory amplification. These findings seem to suggest that priming or other interventions directed at activating positive health memory might reduce health complaints, but only in certain subgroups.     

The relationship between memory complaints,activity and perceived health status

Subjective memory complaints (SMC) is a possible symptom of mild cognitive impairment which may progress to dementia. The present study examines the relationship of physical activity (PA), cognitive activity (CA), social activity (SA), and perceived health status (HS) with SMC for middle age and older adults. Participants were from the MIDUS II study (Midlife in the United States) recruited in 2004–2006 (Mean age = 55.99; N = 3030). Hierarchical multiple regression was performed with SMC as the dependent variable, along with PA, CA, SA, and HS as the independent variables. The study revealed that SMC was strongly related to PA, CA, and HS, while controlling covariates. Further, HS had the strongest link with SMC among these predictors while interaction effects (PA × HS, CA × HS, and SA × HS) were insignificant. In addition, different results were achieved in younger versus older groups. Participants with more CA, PA and perception of better health had lower frequency of memory complaints.     

Workplace bullying and health complaints: the moderating role of physiological activation

Previous research has shown that workplace bullying is related to several negative outcomes. In this line of research, few studies have focused on possible moderators of the experience of bullying. The aim of the present study was to examine the moderating role of physiological activation, measured as systolic blood pressure, in the relationship between bullying and health problems. The sample was made up of 213 employees, who filled in a questionnaire about health and well being, and participated in a voluntary medical check-up that was carried out by an independent Occupational Health Service. Results revealed that physiological activation strengthened the relationship between bullying and health problems, so that those with high levels of blood pressure reported more health complaints in bullying situations. These results are in line with the allostatic load theory.     

Effects of momentary assessed stressful events and worry episodes on somatic health complaints

Somatic health complaints are extremely common and are responsible for a large part of human suffering and healthcare costs. It has been recognised that psychosocial stress can affect somatic health. According to the 'perseverative cognition hypothesis', stressful events affect somatic health because people keep on worrying about them. Worry would prolong stress-related physiological activity that can ultimately lead to health problems. In this ambulatory study we tested whether stressful events and worry predict daily somatic complaints, and whether worry mediates the effects of stressful events. In addition, it was tested whether these effects were independent from negative affect. Using electronic diaries, 69 teachers (age 21-60 years) from Dutch primary and secondary schools reported daily stressful events, worry episodes, negative affect and somatic complaints for a period of 6 days. Results showed that worry intensity predicted the number of somatic complaints and mediated the effect of stressful events on somatic complaints. Furthermore, these results were independent from biobehavioural variables and daily negative affect. These findings support the perseverative cognition hypothesis proposing that the negative somatic health effects of stressful events are largely due to the worry; that is, to the prolonged cognitive representation of stressors.     

Obsessional-compulsive complaints

A simple questionnaire was developed as an instrument for assessing the existence and extent of different obsessional-compulsive complaints. Two major types of complaint, checking and washing compulsions, and two minor types, slowness and doubting, were established. The final form of the questionnaire, and major properties, are presented.     

Depressive affect among health care seekers: how it is related to attachment style, emotional disclosure, and health complaints

The present cross-sectional questionnaire survey investigated depressive affect among persons visiting their general practitioner (GP). It examined the impact of a number of factors likely to be associated with depressive affect, including demographic variables, severity of medical condition, and personal factors such as ease in disclosing personal information, and attachment style. Results showed that among the sample of patients (N = 198) visiting their GP, depressive affect was generally quite high. In particular, those reporting more depressive affect were the elderly, those with more severe health problems, more psychological problems, and a lower level of emotional disclosure frequency. As expected, attachment style was also related to lack of well-being among patients: those with a less avoidant but more anxious attachment style reported higher levels of depressive affect. In total, 38% of the variance of depressive affect was predicted by this model. Security of attachment was also related to reasons why patients consulted their GP, with avoidant attachment related to physical problems and anxious attachment to mental problems. Theoretical relevance of the findings and implications for medical help-seeking are discussed.     

The influence of emotional awareness and expressiveness on care-giving burden and health complaints in women and men

This study was designed to investigate the role of emotional awareness and expressiveness as influences on the experience of burden and impaired health for women and men maintaining a spouse or relative at home who had been diagnosed as having dementia. One hundred and thirty-one Caucasian care givers, 41 males and 90 females, participated in the study. Multivariate analysis of variance indicated that women scored higher than men on measures of burden, health complaints, and awareness of others' emotions. Regression analysis indicated that self-awareness of emotions interacted with care-giver gender to decrease health complaints for female care givers but increased health complaints for male care givers. Self-awareness of emotions also increased feelings of burden for male care givers in general and for female care givers experiencing low levels of burden. Awareness of others' emotions tended to reduce feelings of burden. Emotional expressiveness did not influence burden or health complaint scores.This research was funded by grants from the Health Research Funds of Quebec, the Quebec Council for Social Research, and the Montreal Alzheimer Society. The authors would like to express their gratitude to Valerie Takeda, Charlene Stamegna, and Helene Fyfe for their work on the project, and to the families, patients, and staff of the various referral agencies for their cooperation with the study.To whom reprint requests should be addressed at Centre for Research in Human Development, Concordia University, 1455 de Maisonneuve Boulevard West, Montreal, Quebec, Canada, H3G 1M8.     

Subjective Reasons

In recent years, the notion of a reason has come to occupy a central place in both metaethics and normative theory more broadly. Indeed, many philosophers have come to view reasons as providing the basis of normativity itself . The common conception is that reasons are facts that count in favor of some act or attitude. More recently, philosophers have begun to appreciate a distinction between objective and subjective reasons, where (roughly) objective reasons are determined by the facts, while subjective reasons are determined by one's beliefs. My goal in this paper is to offer a plausible theory of subjective reasons. Although much attention has been focused on theories of objective reasons, very little has been offered in the literature regarding what sort of account of subjective reasons we should adopt; and what has been offered is rather perfunctory, and requires filling-out. Taking what has been said thus far as a starting point, I will consider several putative theories of subjective reasons, offering objections and amendments along the way, will settle on what I take to be a highly plausible account, and will defend that account against objections.     

Perseverative thoughts and subjective health complaints in adolescence: Mediating effects of perceived stress and negative affects

Stable tendency to perseverative thoughts such as trait rumination and worry can influence somatic health. The purpose of the study was to investigate the relationship between perseverative thoughts and somatic complaints, and the possible mediating effects of perceived stress, negative and positive affectivity in adolescence. Having an acute or a chronic condition was also assessed to be controlled for and to reveal their effects on symptom reporting. Three hundred and six adolescents from 7th to 12th grade with mean age of 16.33 (SD = 1.29) participated in the study. Mediation analysis suggested that impact of trait-like perseverative thoughts on complaints were mediated by perceived stress and negative affectivity. Having an acute condition had also an effect on symptom reporting through increased negative affectivity. Our results highlight that ruminations or worry as stable intrapersonal characteristics are relevant processes in health and can be potential targets in prevention programmes in adolescence.     

Unemployment,social support and health complaints: A longitudinal study of stress in East German refugees

Migrants have to deal with a number of stressors, among them tenacious job search and the constitution of a new social network. Prolonged unemployment and lack of social support can result in impaired health. A sample of 235 East Germans was investigated at three times during two years following their transition to West Berlin in 1989, after the breakdown of the communist system. The majority found a job during this time and succeeded to adapt psychosocially. Those, however, who remained unemployed were worse off in terms of self-reported health. This stress—health relationship was moderated, however, by social support. Within the group of migrants who suffered from long-term joblessness, social support exerted a longitudinal buffer effect. At Wave 3, frequent physical symptoms were reported only by migrants who neither held a job nor received support. In a longitudinal causal model, the employment status affected mainly health complaints, but also social support. The relationship between health and support was found to be reciprocal over time.