A secondary analysis of three types of social support in relation to self-efficacy, disease impact, and depression in fibromyalgia.

OBJECTIVE: Fibromyalgia (FM) is a chronic pain condition associated with depression. However, self-efficacy (belief in own ability to manage symptoms) and social support may be protective. This study tested three types of social support (emotional, tangible, and instrumental) for moderation of the mediating effect of self-efficacy on the relationship between FM impact and depression over time. METHODS: Six hundred participants with FM were randomly assigned to no intervention, social support group, or combined self-management and social support. The Fibromyalgia Impact Questionnaire, Norbeck Social Support Questionnaire, FM-modified Arthritis Self-Efficacy Scale, and Center for Epidemiological Studies-Depression surveys were administered at baseline, 6, 12, and 18 months. There were no significant intervention effects on the variables of interest, however, participants' scores were used to assess four longitudinal models. RESULTS: Self-efficacy showed mediation both between (b = 0.104, p < .001, 95% CI = [0.071, 0.137]) and within (b = 0.89, p < .001, 95% CI = [0.073, 0.106]) individuals. Only tangible support demonstrated moderation of the relationship between FM impact and self-efficacy, and only between individuals (b = 0.154, p = .022, 95% CI = [0.022, 0.287]). CONCLUSION: The results indicated that self-efficacy attenuated a portion of the effect of FM impact on depression over time. Additionally, higher levels of tangible support (the belief that your social network can provide you with assistance) were related to weaker influence of FM impact on self-efficacy over time. These factors may be important targets for the prevention of depression in people with FM.

The Effects of Racial/Ethnic Minority Status on Sleep, Mood Disturbance, and Depression in People with Fibromyalgia.

PURPOSE: Fibromyalgia syndrome (FMS) is a chronic musculoskeletal pain disorder that is characterized by persistent and widespread pain. FMS has been associated with sleep disturbance, mood disorders and depression. Racial/ethnic minorities are less likely to receive a diagnosis of FMS than White individuals. Although mood disorders and depression are prevalent among racial/ethnic minority groups, researchers have not examined whether there are differences between racial/ethnic minorities and White individuals with FMS. PARTICIPANTS AND METHODS: The participants were 600 people who were 18 years of age or older and who had a physician's diagnosis of FMS, which was confirmed using the 1990 American College of Rheumatology criteria. Most participants were female (95.5%) and White (85.0%). Sleep disturbance was assessed using the Pittsburgh Sleep Quality Index (PSQI), mood disturbance was assessed using the Profile of Mood States (POMS), and depression was assessed via the Center for Epidemiological Studies Depression Scale (CES-D). RESULTS: Racial/ethnic minorities reported significantly greater levels of sleep disturbance, significantly greater levels of mood disturbance, and had significantly greater levels of depression than White participants. However, racial/ethnic minorities had significantly greater reductions in mood disturbance over the one-year period than White participants. CONCLUSION: Overall, the findings from the present study indicated that racial/ethnic minorities had "worse" physical and psychological outcomes than White participants.

Vignette responses and future intentions in a health decision-making context: How well do they correlate?

INTRODUCTION: Vignettes are commonly used to assess health care decision making when it is impractical or unethical to use experimental methods. We sought to determine whether decisions made in response to hypothetical vignettes requiring medical decisions for self or parents related to reported future likelihoods of engaging in similar behaviors. METHOD: Respondents (n = 1,862) were adults recruited in person in general community settings. Individuals were assigned randomly to read 1 of a variety of vignettes that presented various medical problems being experienced either by oneself or a parent in a hypothetical context. Individuals reported their likelihoods of hiring a health care advocate to perform a variety of tasks in the context of the vignette and their likelihoods of hiring a health care advocate for themselves or their own parents in the future. Multigroup analysis was performed to estimate a latent variable path model for the vignette hiring questions and real-world future intention to hire by condition. RESULTS: The configural model was retained. Tests of invariance for the correlation between future intentions to hire and the latent variable from the vignette decision making indicated a significant difference between self and parent conditions. However, moderate relationships existed between vignette responses and future intentions in both conditions, with approximately 25% of the variance in personal, future intentions being accounted for by vignette responses. DISCUSSION: Our findings support the continued study of vignettes as a possible tool to measure behavioral intentions in the context of positive and negative health care decisions impacting self and others. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

You get used to it, or do you: symptom length predicts less fibromyalgia physical impairment, but only for those with above-average self-efficacy.

To determine whether the effects of symptom duration on fibromyalgia physical impairment are moderated by symptom self-efficacy, data from 572 female participants, who were members of a large health maintenance organization and had a diagnosis of fibromyalgia syndrome (FMS) were assessed. Age, symptom duration, history of physical, sexual, and emotional abuse, fibromyalgia-specific self-efficacy (Arthritis Self-Efficacy Scale adapted for FMS [ASES]), depression (Centers for Epidemiological Studies Depression Scale [CES-D]), fibromyalgia physical impairment (Fibromyalgia Impact Questionnaire [FIQ]), and pain (McGill Present Pain Index [PPI]) were measured five times across 18 months. Linear regressions were performed to predict baseline FIQ and PPI cross-sectionally. Of primary interest was a hypothesized interaction between ASES and symptom duration, which was significant in relation to FIQ but not PPI. Multilevel mixed models were performed to determine whether the same pattern existed longitudinally controlling for baseline symptom duration as an effect of time and ASES. The interaction was significant in the models for both FIQ and PPI. These results suggest that the effects of age and symptom duration on FMS are unique, and that self-efficacy plays a crucial role in moderating disease course (measured by symptom duration or time) in FMS.

A longitudinal analysis of pain experience and recall in fibromyalgia.

AIM: To evaluate pain experiences and memories in fibromyalgia (FM) patients over time. METHOD: Participants included 572 females who were members of a large health maintenance organization who had a diagnosis of FM syndrome (FMS) and met inclusion criteria for the study. Recruitment was for an intervention study that tested the effects of social support and education treatment arms, but there were no treatment effects. Reports of experiential pain (EP), historical peak pain (HPP), and historical valley pain (HVP) for FM were collected. Differences between HPP and EP and EP and HVP (bias) were calculated to determine whether HPP and HVP were distributed evenly around EP over time across participants. Models were performed to assess personal history and psychosocial factors that affect EP, HPP, HVP, and bias. RESULTS: There was systematic tendency for HPP to be significantly larger than EP relative to EP vs HVP. EP and HPP decreased significantly over time, but not HVP. There were significant predictors of EP, HPP, HVP, and bias, including depression, self-efficacy, and sleep quality, among others. CONCLUSION: The experiences and recollections of pain in FM appear to provide a unique means of understanding the maintenance of chronic pain-including factors that affect this process.

Factors associated with continued participation in a matched monetary incentive programme at local farmers' markets in low-income neighbourhoods in San Diego, California.

OBJECTIVE: The Farmers' Market Fresh Fund Incentive Program is a policy, systems and environmental intervention to improve access to fresh produce for participants on governmental assistance in the USA. The current study examined factors associated with ongoing participation in this matched monetary incentive programme. DESIGN: Relationship of baseline factors with number of Fresh Fund visits was assessed using Poisson regression. Mixed-effects modelling was used to explore changes in consumption of fruits and vegetables and diet quality. SETTING: San Diego, California. SUBJECTS: Recipients of Supplemental Nutrition Assistance Program (SNAP), Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and Supplemental Security Income (SSI) who attended participating farmers' markets from 2010 to 2012 (n 7298). RESULTS: Among those with participation for ≤6 months, factors associated with increased visits included reporting more daily servings of fruits and vegetables (F&V) at baseline, being Vietnamese or Asian/Pacific Islander, and eligibility because of SNAP/CalFresh or SSI (v. WIC). Among those who came for 6-12 months, being Asian/Pacific Islander, eligibility because of SNAP/CalFresh and enrolling in the autumn, winter or spring were associated with a greater number of Fresh Fund visits. Among those who came for >12 months, being male and eligibility because of SSI were associated with a greater number of visits. Overall, the odds of increasing number of servings of F&V consumed increased by 2 % per month, and the odds of improved perception of diet quality increased by 10 % per month. CONCLUSIONS: Sustaining and increasing Fresh Fund-type programme operations should be a top priority for future policy decisions concerning farmers' market use in low-income neighbourhoods.

Smoking, depression, & stress: predictors of fibromyalgia health status.

The purpose of the present study was to examine the effects of smoking, stress, and depression on fibromyalgia health status. Fibromyalgia syndrome (FMS) is a chronic musculoskeletal pain condition that negatively affects health status. Health status is not only affected by the constellation of physical symptoms, but also by mood symptoms, stress levels, and patient behaviors (e.g. smoking). Participants were 491 individuals with a physician's diagnosis of FMS. They completed self-report measures of their current levels of depression, stress, the number of cigarettes smoked per day, and health status. A linear regression analysis was conducted to determine whether these measures predicted FMS health status. All three measures predicted worse health status, predicting 51.5% of the variance in health status. However, it is important to evaluate and treat more than just the physical symptoms of FMS. Attention should also be paid to mental health status and to engagement in unhealthy behaviors in order to reduce their effects on FMS health status. Future researchers should design and evaluate interventions that target these modifiable risk factors to determine the extent to which they could improve health outcomes.

Community BMI Surveillance Using an Existing Immunization Registry in San Diego, California.

This study examines the demographic representativeness of the County of San Diego Body Mass Index (BMI) Surveillance System to determine if the BMI estimates being obtained from this convenience sample of individuals who visited their healthcare provider for outpatient services can be generalized to the general population of San Diego. Height and weight were transmitted from electronic health records systems to the San Diego Immunization Registry (SDIR). Age, gender, and race/ethnicity of this sample are compared to general population estimates by sub-regional area (SRA) (n = 41) to account for regional demographic differences. A < 10% difference (calculated as the ratio of the differences between the frequencies of a sub-group in this sample and general population estimates obtained from the U.S. Census Bureau) was used to determine representativeness. In 2011, the sample consisted of 352,924 residents aged 2-100 years. The younger age groups (2-11, 12-17 years) and the oldest age group (≥65 years) were representative in 90, 75, and 85% of SRAs, respectively. Furthermore, at least one of the five racial/ethnic groups was represented in 71% of SRAs. This BMI Surveillance System was found to demographically represent some SRAs well, suggesting that this registry-based surveillance system may be useful in estimating and monitoring neighborhood-level BMI data.

"Experience Keeps a Dear School": the Effects of Ethnicity and Caregiving Experience on Hiring a Healthcare Advocate.

In the present study, ethnic differences in evaluating the severity and associated needs of medical complications experienced by an elderly man and the likelihood of seeking professional assistance (i.e., hire a healthcare advocate [HCA]) to care for him, and for one's own family or parent should they become ill, as a function of previous caregiving experience, were investigated. The 974 participants were White, Black, Hispanic, or Asian/Pacific Islander. They read a hypothetical vignette about a 75-year-old man, Daryl, who was experiencing health problems. Participants were instructed to imagine that they were James, Daryl's son, and asked to indicate how severe his condition(s) were, how much medical assistance he would require, and how likely they would be to hire an HCA to assist him. They were also asked to report whether they previously had assisted a parent with activities of daily living (Assistance) and whether they would be likely to hire an HCA in the future if 1) a family member or 2) a parent, specifically, became ill. Two, 2 (Assistance) × 4 (Ethnicity) multivariate analyses of covariance (MANCOVA) were performed to assess differential responses among individuals of different ethnicities as a function of previous caregiver experience. A priori interaction contrasts were examined to determine whether Black, Hispanic, or Asian/Pacific Islander participants differed on the outcomes from White participants as a function of previous caregiver experience. There were no significant differences between Black or Asian/Pacific Islander and White participants, but Hispanic participants assigned significantly higher severity and need for medical assistance ratings and were significantly more likely to indicate that they would seek assistance from an HCA with respect to the vignette and for their own parents in the future if they had provided caregiving to a parent in the past, whereas White participants were less likely to seek assistance from an HCA if they had provided caregiving in the past to a parent. Although ethnic differences in evaluations of Daryl's condition and in the reported likelihoods of hiring an HCA in various contexts as a function of previous caregiving experience were limited, there are important inter-cultural differences to recognize. It may be important in future research to assess ethnic differences in the expectations and experiences of caregiving.

Assessing the Structure of the Ways of Coping Questionnaire in Fibromyalgia Patients Using Common Factor Analytic Approaches.

The Ways of Coping Questionnaire (WCQ) is a widely used measure of coping processes. Despite its use in a variety of populations, there has been concern about the stability and structure of the WCQ across different populations. This study examines the factor structure of the WCQ in a large sample of individuals diagnosed with fibromyalgia. The participants were 501 adults (478 women) who were part of a larger intervention study. Participants completed the WCQ at their 6-month assessment. Foundational factoring approaches were performed on the data (i.e., maximum likelihood factoring [MLF], iterative principal factoring [IPF], principal axis factoring (PAF), and principal components factoring [PCF]) with oblique oblimin rotation. Various criteria were evaluated to determine the number of factors to be extracted, including Kaiser's rule, Scree plot visual analysis, 5 and 10% unique variance explained, 70 and 80% communal variance explained, and Horn's parallel analysis (PA). It was concluded that the 4-factor PAF solution was the preferable solution, based on PA extraction and the fact that this solution minimizes nonvocality and multivocality. The present study highlights the need for more research focused on defining the limits of the WCQ and the degree to which population-specific and context-specific subscale adjustments are needed.

Honor Thy Parents: An Ethnic Multigroup Analysis of Filial Responsibility, Health Perceptions, and Caregiving Decisions.

The present study explores patterns of parity and disparity in the effect of filial responsibility on health-related evaluations and caregiving decisions. Participants who identified as White, Black, Hispanic, or Asian/Pacific Islander read a vignette about an older man needing medical care. They were asked to imagine that they were the man's son and answer questions regarding their likelihood of hiring a health care advocate (HCA) for services related to the father's care. A multigroup (ethnicity) path analysis was performed, and an intercept invariant multigroup model fits the data best. Direct and indirect effect estimation showed that filial responsibility mediated the relationship between both the perceived severity of the father's medical condition and the perceived need for medical assistance and the likelihood of hiring an HCA only for White and Hispanic participants, albeit differently. The findings demonstrate that culture and ethnicity affect health evaluations and caregiving decision making.

The Effects of Age, Mental Health, and Comorbidity on the Perceived Likelihood of Hiring a Healthcare Advocate.

BACKGROUND AND PURPOSE: The projected increase in chronically ill older adults may overburden the healthcare system and compromise the receipt of quality and coordinated health care services. Healthcare advocates (HCAs) may help to alleviate the burden associated with seeking and receiving appropriate health care. We examined whether having dementia or depression, along with hypertension and arthritis, or having no comorbid medical conditions, and being an older adult, affected the perceived likelihood of hiring an HCA to navigate the health care system. METHOD: Participants (N = 1,134), age 18 or older, read a vignette and imagined themselves as an older adult with either a mood or cognitive disorder, and comorbid medical conditions or as otherwise being physically healthy. They were then asked to complete a questionnaire assessing their perceived likelihood of hiring an HCA. RESULTS: Participants who imagined themselves as having dementia reported a greater likelihood of hiring an HCA than participants who imagined themselves as having depression (p < .001). CONCLUSION: It is imperative that health care professionals attend to the growing and ongoing needs of older adults living with chronic conditions, and HCAs could play an important role in meeting those needs.

Physical function and quality of well-being in fibromyalgia: the applicability of the goodness-of-fit hypothesis.

Objective: The goodness-of-fit hypothesis suggests that the effectiveness of a coping strategy depends on the match between type of strategy (problem-focused, emotion-focused) and the level of perceived control. This hypothesis was examined as a predictor of physical functioning and quality of well-being (QWB) in a large sample of women with fibromyalgia. Methods: Participants were 478 women with diagnosed fibromyalgia (Mage = 54.31, SD = 11.2), who were part of a larger intervention in which no intervention effects were found. Hierarchical, mixed selection regressions were performed to determine whether the relationship between coping and control-predicted physical functioning and QWB. Results: Participants who reported having lower levels of perceived control over their fibromyalgia syndrome and who engaged in more self-controlling coping (emotion-focused strategy) experienced greater QWB and physical functioning than those who used less self-controlling coping. Various main effects for coping and perceived control were also found. Level of physical functioning was also related to escape-avoidance, distancing, and perceived control. The level of QWB was related to social-support seeking, accepting responsibility, distancing, problem-solving, and perceived control. Conclusions: This study provides a greater understanding of the relationships among coping, perceived control, physical functioning, and well-being for women with fibromyalgia. Implications and directions for future research are discussed.

The functional implications of motor, cognitive, psychiatric, and social problem-solving states in Huntington's disease.

OBJECTIVE: Huntington's disease (HD) is a genetic, neurodegenerative disorder characterized by motor, cognitive, and psychiatric dysfunction. In HD, the inability to solve problems successfully affects not only disease coping, but also interpersonal relationships, judgment, and independent living. The aim of the present study was to examine social problem-solving (SPS) in well-characterized HD and at-risk (AR) individuals and to examine its unique and conjoint effects with motor, cognitive, and psychiatric states on functional ratings. METHOD: Sixty-three participants, 31 HD and 32 gene-positive AR, were included in the study. Participants completed the Social Problem-Solving Inventory-Revised: Long (SPSI-R:L), a 52-item, reliable, standardized measure of SPS. Items are aggregated under five scales (Positive, Negative, and Rational Problem-Solving; Impulsivity/Carelessness and Avoidance Styles). Participants also completed the Unified Huntington's Disease Rating Scale functional, behavioral, and cognitive assessments, as well as additional neuropsychological examinations and the Symptom Checklist-90-Revised (SCL-90R). A structural equation model was used to examine the effects of motor, cognitive, psychiatric, and SPS states on functionality. RESULTS: The multifactor structural model fit well descriptively. Cognitive and motor states uniquely and significantly predicted function in HD; however, neither psychiatric nor SPS states did. SPS was, however, significantly related to motor, cognitive, and psychiatric states, suggesting that it may bridge the correlative gap between psychiatric and cognitive states in HD. CONCLUSION: SPS may be worth assessing in conjunction with the standard gamut of clinical assessments in HD. Suggestions for future research and implications for patients, families, caregivers, and clinicians are discussed.

Hiring a pediatric health care advocate for advisory and support services.

In this study, factors that influence a person's likelihood of hiring a pediatric health care advocate (HCA) for support and/or advisory services were examined. Participants were asked to read vignettes in which a child's symptom severity, probability of mortality, and age were manipulated. A significantly higher likelihood of hiring an HCA for advisory services than for support services was found. A significant interaction between level of mortality and type of service indicated that when mortality was depicted as high, participants reported a greater likelihood of hiring an HCA for support services than for advisory services.

Predictors of pain and functioning over time in fibromyalgia syndrome: an autoregressive path analysis.

OBJECTIVE: Fibromyalgia is a disabling, chronic pain condition of unknown etiology. Although many factors have been recognized as important contributors to the pain experiences and functional abilities of fibromyalgia patients, the factors that are most impactful (and therefore represent optimal targets for intervention) are still unclear. The aim of the present study was to examine the pathways among depression, self-efficacy, pain, and physical functioning in a large sample of fibromyalgia patients over a 1-year timeframe. METHODS: Data from 462 participants (441 women) were analyzed using an autoregressive path analytical model with first- and second-order cross-lagged effects. RESULTS: Self-efficacy was the only significant predictor of depression, physical functioning, and pain intensity ratings across time. Physical functioning at 6 months predicted self-efficacy at 1 year; no other factors related significantly to self-efficacy in the model. CONCLUSION: Our model suggests that self-efficacy is a salient factor in fibromyalgia symptomatology. Our findings support designing interventions that use a multimodal approach, with an explicit focus on combining exercise (or other means) to improve physical functioning and psychotherapy (e.g., cognitive-behavioral therapy) with the intention of reprocessing the functional improvements and the implications of these improvements for the patients' ability to manage their fibromyalgia symptoms. By doing so, self-efficacy should be enhanced, and this would produce the greatest and broadest benefits for fibromyalgia patients.

The good life: assessing the relative importance of physical, psychological, and self-efficacy statuses on quality of well-being in osteoarthritis patients.

Background and Purpose. The purpose of the present study was to examine the interrelationships among physical dysfunction, self-efficacy, psychological distress, exercise, and quality of well-being for people with osteoarthritis. It was predicted that exercise would mediate the relationships between physical dysfunction, self-efficacy, psychological distress, and quality of well-being. Methods. Participants were 363 individuals with osteoarthritis who were 60 years of age or older. Data were collected from the baseline assessment period prior to participating in a social support and education intervention. A series of structural equation models was used to test the predicted relationships among the variables. Results. Exercise did not predict quality of well-being and was not related to self-efficacy or psychological distress; it was significantly related to physical dysfunction. When exercise was removed from the model, quality of life was significantly related to self-efficacy, physical dysfunction, and psychological distress. Conclusions. Engagement in exercise was directly related to physical functioning, but none of the other latent variables. Alternatively, treatment focused on self-efficacy and psychological distress might be the most effective way to improve quality of well-being.

Caring for a loved one with Alzheimer's disease: views from the population about hiring a health care advocate.

OBJECTIVE: Alzheimer's disease (AD) is associated with considerable caregiver and social burden. It is important to examine ways to minimize the negative effects of AD. Health care advocates (HCAs) may be one means of limiting the aversive effects of AD. METHOD: Participants completed a short survey that assessed their perceptions of the impact of comorbid AD on health status and their likelihood of hiring an HCA to assist in managing it. A mediational model was proposed: cognitive status (AD vs cognitively healthy) was the independent variable, perception of severity was the mediator, and the probability of hiring an HCA was the dependent variable. RESULTS: The results indicated that the relationship between cognitive status and probability of hiring an HCA was fully mediated by perceptions of severity. CONCLUSION: This study demonstrated that participants appreciated the impact of AD on health status, and this translated into a greater probability of hiring an HCA.

Fibromyalgia and hysterectomy: the impact on health status and health care costs.

Women account for over 80 % of the fibromyalgia syndrome (FMS) population. Some researchers have noted that a large percentage of women with FMS have had hysterectomies. The purpose of this study was to examine the relationship between FMS and hysterectomies, and to examine the impact of having a hysterectomy on health status and health care costs. A sample of 573 American women, who were members of a health maintenance organization with a confirmed diagnosis of FMS, reported whether they had a hysterectomy. Participants completed the Quality of Well-Being Scale and their annual health care costs were calculated based on their medical records. Almost half of the sample (48.3 %) reported having had a hysterectomy, with 90.7 % reporting having had the surgery before their FMS diagnosis. Those who had a hysterectomy had significantly lower general health status and incurred higher health care costs than the women with FMS who did not have a hysterectomy. The percentage of women with FMS who had a hysterectomy was considerably higher than that found in the general population. In this study, having a hysterectomy and a diagnosis of FMS was related to poorer health status and higher health care costs.

Factors that influence the likelihood of hiring a health care advocate for a chronically ill child.

INTRODUCTION: In response to the increasing complexity of the health care system, the field of health care advocacy has emerged. However, little is known about variables that may influence a person's likelihood of hiring a health care advocate (HCA) for their chronically ill child. METHODS: Severity (high or low) and probability of mortality (high or low) of a child's chronic illness and the child's age (1, 7, or 13 years) were manipulated using vignettes. The dependent variable was a composite score of the eight items used to measure the participants' likelihood of hiring an HCA. RESULTS: Participants (N = 1052) were more likely to hire an HCA for a child who was 1 year old than for a child who was 13 years old. Participants were more likely to hire an HCA for a child whose chronic illness was low rather than high in severity and whose chronic illness was high rather than low in probability of mortality. DISCUSSION: Use of an HCA may increase patient satisfaction, decrease medical errors, and enhance pediatric health outcomes.