Assessing depressive symptoms in multiple sclerosis: is it necessary to omit items from the original Beck Depression Inventory?

Overlap between depression scale item content and medical symptoms may exaggerate depression estimates for patients with multiple sclerosis (MS). We reconsider Mohr and co-workers' (1997) recommendation to omit Beck Depression Inventory (BDI) items assessing work ability (item 15), fatigue (17), and health concerns (20) for MS patients. Subjects were medical patients with either MS (n = 105) or a medical disorder for which the BDI is empirically supported [diabetes mellitus (DM), n = 71; chronic pain (CP), n = 80], psychiatric patients with depressive disorder (MDD; n = 37), and healthy controls (HC; n = 80). Relative scores for the eight "somatic" BDI items were analyzed by multivariate analysis of variance with demographic variables and BDI total as covariates. The only significant difference was MS > HC (item 15). On raw scores, MS patients exceeded HCs on items 15 and 21 (sexual disinterest), but this was attributable to the low HC item endorsement. There were no other differences on somatic items or item-total correlations. Scale consistency was good across groups, regardless of item omission. Somatic items were unassociated with major MS parameters. We thus encourage continued application of the full BDI for assessing depressive symptoms in patients with MS.

Assessment of irrational health beliefs: relation to health practices and medical regimen adherence.

The purpose of the present research was to provide initial validation of the 20-item Irrational Health Belief Scale (IHBS). Study 1 included 392 undergraduate psychology students. Results from Study 1 suggested that the IHBS total score is internally consistent and stable over an 18-month time period. Greater health-related cognitive distortion (higher IHBS scores) was associated with weaker internal health locus of control beliefs, lower positive affectivity, stronger chance health locus of control beliefs, and greater negative affectivity. Most important, greater cognitive distortion was uniquely and significantly associated with a less positive pattern of health practices. Study 2 involved 107 individuals with Type I diabetes mellitus. Results indicated that higher IHBS scores were significantly associated with both objective (hemoglobin HbA1) and self-reported diabetic regimen adherence independent of trait neuroticism and conscientiousness.

Cerebral blood flow and personality: a positron emission tomography study.

OBJECTIVE: This study sought to describe brain regions associated with the personality dimension of introversion/extraversion. METHOD: Measures of cerebral blood flow (CBF) were obtained from 18 healthy subjects by means of [150]H20 positron emission tomography. Correlations of regional CBF with introversion/extraversion were calculated, and a three-dimensional map of those correlations was generated. RESULTS: Overall, introversion was associated with increased blood flow in the frontal lobes and in the anterior thalamus. Regions in the anterior cingulate gyrus, the temporal lobes, and the posterior thalamus were found to be correlated with extraversion. CONCLUSIONS: The findings of the study lend support to the notion that introversion is associated with increased activity in frontal lobe regions. Moreover, the study suggests that individual differences in introversion and extraversion are related to differences in a fronto-striato-thalamic circuit.

Cynical hostility, powerful others control expectancies, and patient adherence in hemodialysis.

OBJECTIVE: The present study examined the joint role of cynical hostility and powerful others health locus of control expectancies in predicting regimen adherence in a sample of center hemodialysis patients. METHOD: Forty-eight hemodialysis patients completed the Cook-Medley Hostility (Ho) Scale and the Powerful Others Health Locus of Control (PHLC) scale. Adherence to the fluid-restriction and phosphorus reduction components of the treatment regimen was assessed by examining patients' interdialysis session weight gains and serum phosphorus (P) levels. RESULTS: In a hierarchical regression analysis, higher hostility was associated with significantly higher serum P levels indicating poorer dietary and medication adherence. The main effect for hostility was qualified by the interaction of hostility and PHLC. This pattern indicated that the deleterious effect of hostility on adherence was most pronounced among patients possessing the expectancy that positive health outcomes are not strongly contingent on the actions or advice of powerful others (eg. health care providers). Similar analyses failed to show significant effects for hostility or PHLC in the prediction of interdialytic weight gain. CONCLUSIONS: The present findings suggest that jointly assessing hostility and health-related expectancies may be useful in identifying chronically ill patients who are potentially at risk for difficulties in performing a prescribed regimen.

Health beliefs, personality, and adherence in hemodialysis patients: an interactional perspective.

Research examining the main effects of health beliefs and personality on medical regimen adherence has yielded inconsistent results. This study tested the hypothesis that health beliefs and personality predict adherence in an interactive manner. Components of the Health Beliefs Model, Conscientiousness (C) from the NEO-Five Factor Inventory, and regimen adherence were assessed in a sample of 70 in-center hemodialysis patients. In a hierarchical regression analysis, the interaction of health beliefs and C failed to explain a significant portion of the variance in interdialysis weight gain, a measure of adherence to fluid restrictions, after controlling for demographic characteristics. The interaction did significantly predict individual differences in serum phosphorus levels, a measure of diet and medication adherence. The effect was primarily attributable to the interaction of C and perceived severity. However, the combination of high C and high perceived severity was associated with poorer patient adherence. Such a pattern may be the result of defective coping patterns associated with high levels of anxious arousal and has implications for therapeutic interventions targeted at modifying health beliefs among chronically ill patients following prescribed medical regimens.

Patient adherence in chronic illness: personality and coping in context.

Previous reviews have concluded that there is no evidence for a predictable association between person factors and regimen adherence in chronic illness. The brief current review of the literature reveals that past work has been limited by the lack of a common structural theory of personality and the failure to consider the interaction of person factors with disease and treatment context. Application of the five-factor model of personality to adherence research will reduce divergence in the field and aid in the orientation and interpretation of future work. Evidence suggests that an interactive perspective recognizing the moderating influence of contextual factors on the behavioral expression of personality traits will contribute to the prediction of adherence behavior.

Effect of verbal self-disclosure on natural killer cell activity: moderating influence of cynical hostility.

One objective of the present research was to examine the immunological effects of self-disclosing personal information regarding a traumatic or stressful experience. A second objective was to examine the hypothesis that the effect of self-disclosure on immune function is moderated by individual differences in cynical hostility. Forty-three male college undergraduates, classified as high or low on the Cook-Medley Hostility scale were randomly assigned to either a verbal self-disclosure or a nondisclosure discussion condition. Task-induced change in natural killer (NK) cell activity (i.e., cytotoxicity) served as the dependent variable. As predicted, a significant interaction between discussion condition and hostility was obtained. Among subjects in the self-disclosure condition, high hostility subjects exhibited a significantly greater increase in NK cell cytotoxicity than low hostility subjects. The effect of self-disclosure on NK cell activity is moderated by an individual's level of cynical hostility. The greater short term enhancement in NK cell activity observed for hostile persons is a likely correlate of a more pronounced acute arousal response elicited by the self-disclosure task.

Body consciousness, illness-related impairment, and patient adherence in hemodialysis.

Recent theory and evidence suggests that bodily self-focusing tendencies (e.g. private body consciousness) may be associated with medical regimen adherence among chronically ill patients. The present study examined the joint effects of private body consciousness and degree of illness-related physical impairment on treatment regimen adherence in a sample of 52 hemodialysis patients. It was predicted that the effect of PBC on adherence would vary as a function of patients' level of illness-related physical impairment. For patients experiencing more severe impairment, higher PBC scores were associated with poorer adherence to the prescribed medication and dietary regimen. In contrast, for patients experiencing a relatively low degree of disease-related physical impairment, higher private body consciousness was associated with more favorable adherence. Results are discussed in terms of self-focused attention and behavioral self-regulation theories. Implications for future research and clinical intervention are also discussed.

Coping with treatment-related stress: effects on patient adherence in hemodialysis.

With a modified version of the Ways of Coping Checklist, the relation of coping to adherence among 57 hemodialysis patients was examined. The association of a particular type of coping to adherence was predicted to depend on the specific type of stressful encounter being considered. As predicted, coping efforts involving planful problem solving were associated with more favorable adherence when used in response to stressors involving a relatively controllable aspect of the hemodialysis context. For less controllable stressors, coping efforts involving emotional self-control were associated with more favorable adherence. The seeking of informational support in response to an uncontrollable encounter was associated with poorer fluid-intake adherence. Confrontive coping was associated with poorer adherence for both high- and low-control situations.

Predictors of survival among hemodialysis patients: effect of perceived family support.

The authors examined the role of perceived family support and symptoms of depression as predictors of survival in a sample of 78 in-center hemodialysis patients. Cox regression analysis revealed significant effects for family support (p < .005), blood urea nitrogen (p < .01), and age (p < .005). The effect for depression was not significant. The Cox model indicated that a 1-point increase on the family support measure was associated with a 13% reduction in the hazard rate (i.e., mortality). Estimated 5-year mortality rates among low family support patients were approximately 3 times higher than estimated mortality for high support patients. Differences in patient adherence to the dietary and medication regimens failed to explain the significant effect of family support.