Using the common sense model of self-regulation to understand the relationship between symptom reporting and trait negative affect.

BACKGROUND/PURPOSE: Based on the Common Sense Model of Self-Regulation, we examined if the relationship of trait NA to physical symptom reporting was moderated by life events and illness representations. METHODS: This relationship was examined using a cross-sectional dataset of 554 elderly adults. RESULTS: A significant three-way interaction demonstrated that individuals who reported the greatest severity of physical symptoms were higher in trait NA, and reported more life events and a chronic illness history. CONCLUSIONS: The results of this study are consistent with the hypothesis that individual high on trait NA who have a history of a chronic illness have illness representations with both disease specific physical symptoms and symptoms from other causes, such as emotional distress. This may complicate the care of medical conditions for these patients.

An intervention to reduce postpartum depressive symptoms: a randomized controlled trial.

Depressive symptoms and depression are a common complication of childbirth, and a growing body of literature suggests that there are modifiable factors associated with their occurrence. We developed a behavioral educational intervention targeting these factors and successfully reduced postpartum depressive symptoms in a randomized trial among low-income black and Latina women. We now report results of 540 predominantly white, high-income mothers in a second randomized trial. Mothers in the intervention arm received a two-step intervention that prepared and educated mothers about modifiable factors associated with postpartum depressive symptoms (e.g., physical symptoms, low self-efficacy), bolstered social support, and enhanced management skills. The control arm received enhanced usual care. Participants were surveyed prior to randomization, 3 weeks, 3 months, and 6 months postpartum. Depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale (EPDS of 10 or greater). Prevalence of depressive symptoms postpartum was unexpectedly low precluding detection of difference in rates of depressive symptoms among intervention versus enhanced usual care posthospitalization: 3 weeks (6.0 vs. 5.6 %, p = 0.83), 3 months (5.1 vs. 6.5 %, p = 0.53), and 6 months (3.6 vs. 4.6 %, p = 0.53).

Why do comparative assessments predict health? The role of self-assessed health in the formation of comparative health judgments.

OBJECTIVE: Research has shown that self-assessments of health are strong predictors of morbidity and mortality regardless of format (i.e., self or comparative). In this study, the authors examined the relationship between 2 of these health assessments, self-assessed health (SAH) and comparative health (CH). On the basis of social psychological theory, they hypothesized that CH is predictive of health outcomes because it is based on SAH. Additionally, the authors examined whether motivational and dispositional factors influenced CH and whether these factors were able to account for the differences between CH and SAH. METHOD: Data were obtained from 851 community-dwelling older adults (M = 73 years). Participants responded to questionnaires assessing personality characteristics (e.g., trait affectivity, dispositional optimism and pessimism), and health status (e.g., functional limitations). All-cause mortality was tracked for a 10-year period. RESULTS: Correlation and agreement analyses revealed that both judgments had a high degree of similarity. As expected, survival analysis showed that CH predicted mortality but only until SAH was added into the model. Analysis examining the factors that influence CH showed that after controlling for SAH, high levels of trait positive affectivity, low levels of functional limitations, and low levels of fatigue-lack of energy were associated with high CH ratings. Examination of CH-SAH difference scores showed that only participants' age accounted for differences between these 2 judgments. CONCLUSIONS: These data revealed that CH judgments were, to a great extent, based on SAH. Results showed that motivational factors influence CH judgments but do not explain the differences between SAH and CH.

Measurement invariance of the SF-12 across European-American, Latina, and African-American postpartum women.

PURPOSE: The purpose of this study was to determine whether a postpartum-specific version of the SF-12 was invariant across three ethnic groups. Specifically, we examined the presence of differential item functioning (DIF) among European-American, Latina, and African-American mothers. DIF refers to differential endorsement of item responses that are not due to the construct being measured. DIF can result in biased group comparisons. METHODS: We analyzed cross-sectional data of postpartum women (n = 655) who delivered at an urban hospital in the northeast region of the USA. Multiple indicators multiple causes (MIMIC) model was used to examine differential item functioning. RESULTS: The analyses revealed the presence of DIF for three items: Item 1 "self-assessed general health," item 8 "bodily pain," and item 9 "calm and peaceful." Only two DIF effects were meaningful based on odds ratios and on the percentage of the total effect accounted for by the DIF effect. Specifically, African-American women differentially endorsed item 8 "bodily pain" when compared to European-American women (OR = 2.11, CI95 = 1.20, 3.71) and Latinas were more likely to endorse item 9 "calm and peaceful" when compared to European-American women (OR = 2.62, CI95 = 1.64, 4.17). CONCLUSION: The results of this study indicate that the SF-12 is to a great degree an invariant measure for the assessment of HRQoL among postpartum ethnically diverse women. More research is needed to examine other aspects of invariance (e.g., configural and metric) and longitudinal invariance in ethnically diverse samples. To better understand ethnic differences in health, future studies need to examine the factors that may underlie DIF effects in quality of life.

Heterogeneity in depression symptoms and health status among older adults.

OBJECTIVES: We assessed whether distinct classes of depression symptoms could be identified. In addition, we determined how these classes differed in terms of health status. METHODS: Data were analyzed with latent profile analysis. MANOVA tests were used to compare the health status of the various classes. RESULTS: A four-class model had the best fit. Classes were labeled according to participants' responses to the Center for Epidemiologic Studies-Depression Scale (CES-D) items and their overall score: low depression symptoms, high depression symptoms, subthreshold with anhedonia, and subthreshold with anhedonia and negative interpersonal feelings. Cross-sectional and longitudinal analyses showed that health status differed across classes. CONCLUSIONS: The results provide support for the idea that there is heterogeneity in the presentation of depression symptoms among older adults. These data showed that about a third of our sample of older adults reported increased levels of anhedonia and that negative interpersonal feelings were uncommon.

Modern health worries, health care utilization, and symptom reporting: a cross-cultural comparison.

Perception of risk to personal health from features of modern life and technology is increasing across the globe. We investigated whether these concerns exist in the Turkish setting in the same degree and whether symptom reports mediate the relationship between modern health worries (MHWs) and health care utilization in the UK and Turkish settings. A total of 506 University of St Andrews students and a total of 424 Turkish university students in Istanbul Bilgi University participated in the study. The factor structure of the MHW scale was similar in both samples and previous literature with the addition of a new factor, "ingested toxins." Turkish sample had higher scores on all items compared to the UK sample. We also tested a moderated mediational hypothesis in both samples which showed that subjective health complaints mediated the relationship between MHWs and health care utilization in both samples.

Association between self-monitoring of blood glucose and diet among minority patients with diabetes.

BACKGROUND: Self-monitoring of blood glucose (SMBG) is used to regulate glucose control. It is unknown whether SMBG can motivate adherence to dietary recommendations. We predicted that participants who used more SMBG would also report lower fat and greater fruit and vegetable consumption. METHODS: The present study was a cross-sectional study of 401 primarily minority individuals living with diabetes in East Harlem, New York. Fat intake and fruit and vegetable consumption were measured with the Block Fruit/Vegetable/Fiber and Fat Screeners. RESULTS: Greater frequency of SMBG was associated with lower fat intake (r(s) = -0.15; P < 0.01), but not fruit and vegetable consumption. The effects of SMBG were not moderated by insulin use; thus, the relationship was significant for those individuals both on and not on insulin. A significant interaction was found between frequency of SMBG and changing one's diet in response to SMBG on total fat intake. The data suggest that participants who use SMBG to guide their diet do not have to monitor multiple times a day to benefit. CONCLUSION: The present study found that the frequency of SMBG was associated with lower fat intake. Patients are often taught to use SMBG to guide their self-management. This is one of the first studies to examine whether SMBG is associated with better dietary intake.

Factor structure and longitudinal invariance of the Medical Adherence Report Scale-Asthma.

Adequate assessment of adherence to medical treatment is critical for both research purposes and clinical practice. This study examined the factor structure and longitudinal invariance of the Medication Adherence Report Scale (MARS-A10) in a sample of asthmatic patients. We examined longitudinal data from 294 inner-city, adult participants with moderate to severe asthma. Because of ambiguous evidence regarding the dimensionality of the MARS-A10, the data was analysed with exploratory structural equation modelling. We first proceeded by determining the dimensionality of the scale at baseline and examined whether the structure, loadings, intercepts and errors were invariant over the four assessments points. Results indicated that a two-factor structure (factor 1: non-adherence based on experiential changes; factor 2: non-adherence based on intentional medication avoidance) had the best fit to the data (χ(2)(25)=37.69, p=0.05). Longitudinal analyses revealed that the nine items assessing intentional non-adherence were invariant over time. The evidence from the factor analysis suggests that intentional non-adherence is a multidimensional construct. Additionally, longitudinal data provided strong evidence that the items examining intentional non-adherence are invariant over time, indicating that changes in non-adherence scores can be validly attributed to changes in behaviour.

Lack of preparation, physical health after childbirth, and early postpartum depressive symptoms.

BACKGROUND: Prior research has not examined the association of patient expectations or preparation by providers for the postpartum experience with depressive symptoms. We investigated whether lack of preparation for the postpartum experience and physical health after uncomplicated childbirth were associated with early postpartum depressive symptoms. METHODS: We conducted a telephone survey of 720 early postpartum mothers in New York City. Mothers reported on depressive symptoms, physical symptoms, provider preparation for the postpartum experience, and other factors. RESULTS: Nearly 39% of patients reported depressive symptoms; 24% did not feel adequately prepared by their provider for the postpartum experience. Mothers reported a range of physical symptoms: 98% reported daily vaginal bleeding, 79% reported cesarean section or episiotomy site pain, 82% reported breast pain, and 32% reported urinary incontinence. Patients who reported inadequate preparation by their provider were more likely to report depressive symptoms compared with patients who reported adequate preparation (53% vs. 35%, p < 0.001). In a multivariable model predicting postpartum depressive symptoms, adjusted odds ratios (ORs) remained elevated for perceived lack of preparation for the postpartum experience, more physical symptoms, and more physical functional limitations. CONCLUSIONS: Further research is needed to investigate whether preparing patients for expected health consequences after pregnancy may reduce the incidence of early postpartum depressive symptoms.

Measurement invariance of the Mini Asthma Quality of Life Questionnaire across African-American and Latino adult asthma patients.

PURPOSE: This study tested the factorial and measurement invariance of the Mini Asthma Quality of Life Questionnaire (MiniAQLQ) in a sample of Latino and African-American asthmatic patients. METHODS: We used confirmatory factor analyses (CFA) to examine data from adult outpatients diagnosed with asthma (n = 265). We proceeded by examining the original factor structure of the MiniAQLQ in the whole sample. We then determined whether the factor structure supported by the data was invariant across African-American and Latino patients by testing a series of nested models. RESULTS: Results revealed that a three-factor structure model that combined the emotional function and symptom domains had the best fit to the whole sample (chi (2)(91) = 99.83, P = 0.08). Analysis using a MIMIC model among Latino participants indicated that survey language did not influence item functioning (chi (2)(93) = 103.29, P = 0.22). Multi-group CFA showed that both the structure and the meaning of the items were invariant across Africa-American and Latino participants. Scalar and strict measurement invariance was supported for 11 out of 15 items. CONCLUSION: These data suggest that structure of the MiniAQLQ needs to be reassessed. Additional research needs to examine whether elimination of current items or inclusion of new items can ensure that constructs are measured without bias across different ethnic groups.

Modifiable factors associated with changes in postpartum depressive symptoms.

Up to 50% of mothers report postpartum depressive symptoms yet providers do a poor job predicting and preventing their occurrence. Our goal was to identify modifiable factors (situational triggers and buffers) associated with postpartum depressive symptoms. Observational prospective cohort telephone study of 563 mothers interviewed at 2 weeks and 6 months postpartum. Mothers reported on demographic factors, physical and emotional symptoms, daily function, infant behaviors, social support, and skills in managing infant and household. Mothers were categorized into four groups based on the presence of depressive symptoms at 2 weeks and at 6 months postpartum: never, always, late onset, and remission groups. Fifty-two percent did not have depressive symptoms at 2 weeks or at 6 months (never group), 14% had symptoms at both time points (always group), 10% had late onset, and 24% had early onset of symptoms with remission. As compared with women in the never group, women in the always and late onset groups had high-risk characteristics (e.g., past history of depression), more situational triggers (e.g., physical symptoms), and less robust social and personal buffers (i.e., social support and self-efficacy). As compared with the never group, mothers in the remission group had more situational triggers and fewer buffers initially. Changes in situational triggers and buffers were different for the four groups and were correlated with group membership. Situational triggers such as physical symptoms and infant colic, and low levels of social support and self-efficacy in managing situational demands are associated with postpartum depressive symptoms. Further research is needed to investigate whether providing education about the physical consequences of childbirth, providing social support, and teaching skills to enhance self-efficacy will reduce the incidence of postpartum symptoms of depression.

Distinct trajectories of perinatal depressive symptomatology: evidence from growth mixture modeling.

Although heterogeneity in the timing and persistence of maternal depressive symptomatology has implications for screening and treatment as well as associated maternal and child health outcomes, little is known about this variability. A prospective observational study of 1,735 low-income, multiethnic, inner-city women recruited in pregnancy from 2000 to 2002 and followed prospectively until 2004 (1 prenatal and 3 postpartum interviews) was used to determine whether distinct trajectories of depressive symptomatology can be defined from pregnancy through 2 years postpartum. Analysis was carried out through general growth mixture modeling. A model with 5 trajectory classes characterized the heterogeneity seen in the timing and magnitude of depressive symptoms among the study participants from Philadelphia, Pennsylvania. These classes included the following: 1) always or chronic depressive symptomatology (7%); 2) antepartum only (6%); 3) postpartum, which resolves after the first year postpartum (9%); 4) late, present at 25 months postpartum (7%); and 5) never having depressive symptomatology (71%). Women in these trajectory classes differed in demographic (nativity, education, race, parity) health, health behavior, and psychosocial characteristics (ambivalence about pregnancy and high objective stress). This heterogeneity should be considered in maternal depression programs. Additional research is needed to determine the association of these trajectory classes with maternal and child health outcomes.

Psychological factors influencing self-assessments of health: toward an understanding of the mechanisms underlying how people rate their own health.

BACKGROUND: Research in the past 20 years has shown that self-assessed health (SAH) is a consistent and reliable predictor of health outcomes. However, it is still unclear what factors are responsible for the association of SAH with mortality and other objective health indicators. PURPOSE: This study examined the impact of trait positive affect, trait negative affect, and functional limitations (FL) on SAH cross-sectionally and longitudinally. We hypothesized that changes in SAH ratings would be mainly influenced by FL, whereas affective information would have a biasing effect on SAH ratings cross-sectionally. METHODS: We analyzed longitudinal data obtained from five successive annual interviews conducted with over 800 elderly respondents (mean age = 73 years) using latent growth curve modeling. RESULTS: Results revealed that SAH judgments were related to FL and to trait affects in each of the five waves (cross-sectional data), but only changes in FL were related to changes in SAH over time. These data also showed that changes in SAH were predictive of mortality above and beyond its initial levels. CONCLUSIONS: The results suggest that the temporal trajectory of FL is a source of information that allows an individual's SAH to predict objective health measures of both morbidity and mortality.

Using the common sense model to design interventions for the prevention and management of chronic illness threats: from description to process.

In this article, we discuss how one might use the common sense model of self-regulation (CSM) for developing interventions for improving chronic illness management. We argue that features of that CSM such as its dynamic, self-regulative (feedback) control feature and its system structure provide an important basis for patient-centered interventions. We describe two separate, ongoing interventions with patients with diabetes and asthma to demonstrate the adaptability of the CSM. Finally, we discuss three additional factors that need to be addressed before planning and implementing interventions: (1) the use of top-down versus bottom-up intervention strategies; (2) health care interventions involving multidisciplinary teams; and (3) fidelity of implementation for tailored interventions.

Elucidating the relationship between negative affectivity and symptoms: the role of illness-specific affective responses.

BACKGROUND: More than 20 years of research confirm a positive association of trait negative affect (NA) with reports of physical symptoms. As the mechanisms underlying the association of trait NA and symptom reporting have not been identified, the meaning of the association remains unclear. PURPOSE: We attempted to clarify the processes underlying this association by examining the relationship of trait NA and illness-specific worry to both vague, general symptoms and illness-specific symptoms. We tested the hypothesis that trait NA has both a "biasing" effect when ambiguous symptoms are interpreted as a sign of physical illness and an "accuracy" effect on the reports of illness-specific symptoms mediated by illness-specific worry. METHOD: We examined the relationship of trait and state NA to symptoms reports in both cross-sectional and longitudinal data from inner-city adults with moderate and severe asthma. RESULTS: Whereas high levels of trait NA were associated with reports of both asthma and nonasthma symptoms, only the relationship of trait NA to symptoms specific to asthma was mediated by asthma worry. In addition, these data showed that trait NA was not associated with the misattribution of symptoms to disease. CONCLUSIONS: We concluded that NA motivates individuals, through asthma worry, to be more aware of illness-specific symptoms and correctly report and attribute these symptoms to asthma.

Depression as a predictor of perceived social support and demand: a componential approach using a prospective sample of older adults.

This study examined the relationship of the cognitive, mood, and somatic components of depression on perceptions of social support and social demand among older adults (n = 851) over two years. Factor-analyses confirmed the factor structure of our multicomponential model of depression. Results supported our proposal that interpersonal specificity, as measured by depressive cognition about self and others, is important to predicting changes in perceived support and demand over time. Each component of depression was related to social support and social demand cross-sectionally, whereas only the cognitive component of depression predicted changes in support and demand prospectively. Future research should consider the pathways linking depressive cognition to perceived support and demand.

Racial and ethnic differences in factors associated with early postpartum depressive symptoms.

OBJECTIVE: To explore racial differences in reporting of early postpartum depressive symptoms. To explore whether racial differences in early postpartum experience (such as mother's health status and social context) might account for racial differences in reported postpartum depressive symptoms. METHODS: This was a telephone survey of 655 white, African-American, and Hispanic mothers between 2 and 6 weeks postpartum. Mothers reported on demographic factors, physical symptoms, daily function, infant behaviors, social support, skills in managing infant and household, access, and trust in the medical system. We explored racial differences in report of early postpartum depressive symptoms using bivariate and multivariate statistics. RESULTS: African-American and Hispanic women more commonly reported postpartum depressive symptoms (43.9% and 46.8%, respectively) than white women (31.3%, P < .001). Similar factors (physical symptom burden, lack of social support, and lack of self-efficacy) were associated with early postpartum depressive symptoms in white, African-American, and Hispanic mothers. In a comprehensive model including other demographic factors, history of depression, physical symptoms, daily function, infant behavior, social support, skills in managing infant and household, access, and trust, the adjusted odds ratio for reported postpartum depressive symptoms remained elevated for African-American women at 2.16 (95% confidence interval 1.26-3.70) and Hispanic women at 1.89 (95% confidence interval 1.19-3.01) as compared with white women. CONCLUSION: African-American and Hispanic mothers are at higher risk for reporting early postpartum depressive symptoms as compared with white mothers. Factors associated with these symptoms are similar among African-American, Hispanic, and white mothers.

Trait negative affect relates to prior-week symptoms, but not to reports of illness episodes, illness symptoms, and care seeking among older persons.

OBJECTIVE: Use the commonsense model of self-regulation to generate and test hypotheses about the relationships of trait negative affect (NA) and self-assessed health (SAH) to reports of current symptoms (acute and chronic), episodes of illness, and use of health care during illness in a sample of elderly, community-dwelling respondents. Trait NA and SAH were compared with the properties of the illness episodes in models predicting the use of medical care. METHODS: Data were obtained from two successive annual interviews (N = 790 and 719, respectively) conducted with elderly respondents (mean age = 73 years). RESULTS: Both NA and SAH correlated (positively and negatively, respectively) with reports of prior-week acute and chronic symptoms at each of the two interviews. Trait NA and SAH also predicted changes in prior-week symptoms 1 year later. Neither trait NA nor SAH was related to reports of acute illness episodes, but each showed a very small relationship to reports of chronic illness episodes. Neither trait NA nor SAH predicted the average number of symptoms reported during acute or chronic episodes. The use of medical care during acute and chronic illness episodes was related to the properties of the episode: reported duration, novelty, and severity. Neither NA nor SAH predicted use of care for acute episodes; SAH was related to use of care for chronic episodes. Worry about the illness episode, but not trait NA, was related to care seeking for participants interviewed during a chronic episode. CONCLUSIONS: Trait NA does not bias elderly adults' reports of symptoms, illness episodes, symptom reports for episodes, or the use of health care. Both NA and SAH reflect independent sources of common sense and self-knowledge, and each contributes valid information about the elderly individuals' perceptions of their somatic states.