Dimensions of Resilience and Their Predictive Utility Among Clients With Anxiety Disorders or Depressive Disorders: A Factor Analytic Study.

The Connor-Davidson Resilience Scale is a commonly used measure of resilience. However, while resilience is considered multidimensional, the specific dimensions embedded within this scale remain equivocal. The aim of this article was to contribute to this debate by analyzing responses from a large sample obtained within a mental health setting. Baseline data from 672 consecutive referrals to a publicly funded outpatient service for adults with anxiety and depression were subjected to exploratory factor analysis. Outcome data from 349 of these participants who had completed treatment were analyzed using confirmatory factor analysis. Both analytical strategies suggested that two dimensions were evident (Adaptability and Tenacity), although comparisons of Adaptability and Tenacity across sociodemographic, diagnostic, psychological distress, and functional impairment variables provided little support for their discriminability. The practical utility to mental health nurses of subcomponents of resilience remains clinically persuasive yet empirically elusive with current instrumentation.

Does Illness Behavior Contribute to the Understanding of Self-Efficacy and Quality of Life Among People With Hearing Loss? A Test of Concept.

PURPOSE: The study sought to first confirm the mediating role of self-efficacy (SE) in the link between hearing loss and reduced quality of life (QOL) and introduce the construct of illness behavior (IB) as a further correlate of self-reported QOL that may itself be mediated by SE. METHOD: Cross-sectional data were attained using a questionnaire that was completed by 61 adults with self-reported acquired hearing loss. RESULTS: Support was provided for low SE being a barrier to QOL, with hearing loss only predictive of emotional QOL when SE was an intermediary (mediating) variable. Cognitive and affective indices of IB also predicted QOL. Those participants with elevated emotional distress and, to a lesser extent, exaggerated concerns for their health, were found to have both lower SE and poorer QOL. CONCLUSIONS: Attempts to replicate these findings longitudinally and with larger and more diverse samples (e.g., congenital or illness-derived hearing loss) are encouraged. A more objective assessment of hearing loss may also reduce the potential for spurious associations that may arise from the use of self-reported data. Nevertheless, the analytical results provide encouragement for the continued consideration of IB in the evaluation of the well-being of individuals with hearing loss. It is proposed that IB could be a useful supplement to the study of motivation among this cohort, such as an addition to the commonly used Health Belief Model, to improve the predictive validity of appropriate health behaviors.

Predictive Validity of Resilience in the Treatment of Individuals With Anxiety and Depressive Disorders.

The current study sought to evaluate the predictive validity of resilience among individuals with anxiety and/or depressive disorders. Receiver operating characteristics were calculated for each of the 25-item and 10-item versions of the Connor-Davidson Resilience Scale, evaluated against psychological distress and treatment response, at screening and post-treatment. New referrals to an anxiety and related disorders clinic were recruited for this purpose (N = 672 at screening, N = 349 post-treatment). Robust cross-sectional associations between resilience and psychological distress and treatment response were noted and were strongest at post-treatment. However, the related sensitivity (63% to 66% at screening, 69% to 76% post-treatment), specificity (78% to 83% at screening, approximately 73% post-treatment), and areas under the curve (AUC; approximately 73% at screening, 78% to 82% post-treatment) were modest. Furthermore, there was minimal support for resilience as a predictor of recovery using the longitudinal data (sensitivity and specificity could not be determined, with AUC of approximately 68% for psychological distress and 56% for treatment response). Although a relatively large homogeneous sample was available for this study, analyses of specific diagnostic subgroups may offer valuable further insight. [Journal of Psychosocial Nursing and Mental Health Services, 59(7), 35-41.].

Toward an Understanding of Patients' and Their Partners' Experiences of Bladder Cancer.

BACKGROUND: Bladder cancer is characterized by recurrence and progression, ongoing surveillance and treatment, adverse effects, and complications and is associated with chronic ill health that may compromise relationships, social activities, and employment. OBJECTIVE: The aim of this study was to gain an understanding of quality of life disruptions among both those diagnosed with bladder cancer and their supportive partners (spouses or other family members). INTERVENTIONS/METHODS: Couples were recruited from a tertiary care public hospital database. Nine heterosexual couples (married/de facto) and another comprising a clinical participant and her daughter-in-law were interviewed for approximately 60 minutes. Interviews were audio recorded and transcribed, with qualitative description used to gain an in-depth understanding of participants' experiences without previous agenda or knowledge, allowing their viewpoints to be summarized in everyday terms. RESULTS: Thematic analysis highlighted 4 themes: psychical responses, cognitive and emotional reactions, survival techniques and the importance of partner support and its assistance for clinical participants acceptance of, and adaptation to their bladder cancer, surveillance, and treatment protocols. CONCLUSION: A key finding was the value of a supportive partner in dealing with the effects of bladder cancer daily. From a health service perspective, the need for clear information provision and counseling/support to assist patient management was also evident. IMPLICATIONS FOR FUTURE PRACTICE: Health professionals need to appreciate the quality of life implications for patients and partners, thus understanding the needs of couples. Greater collaboration with and by health professionals who assist in care may allow couples to move more confidently toward adaptation to bladder cancer.

Predicting wellbeing among people with epilepsy using illness cognitions.

OBJECTIVE: This study sought to examine the synergistic contribution of illness-related perceptions (stigma, severity, and threat) and illness behavior to wellbeing among people with epilepsy. Poorer wellbeing was expected among those who perceived greater stigma, illness severity, and threat and had more extreme illness behavior. METHODS: Individuals with a diagnosis of epilepsy (N=210), recruited through local and online support groups, completed a questionnaire comprising demographic and epilepsy-specific information, and validated measures of illness perceptions and behavior, epilepsy-related quality of life, and general psychological health. RESULTS: Bivariate associations among illness cognition, illness behavior, and wellbeing were all as expected. Structural equation modeling highlighted the strong, direct effect of illness threat on quality of life, with other contributions from perceived stigma and an abnormal illness behavior syndrome (i.e., maladaptive illness responses). Significant variance was accounted for in both quality of life (64%) and psychological health (34%). CONCLUSION: Preliminary evidence of the contributions of illness threat and maladaptive illness responses to wellbeing highlights the need for longitudinal research to examine the dynamic nature of such findings. Clinicians are encouraged to consider the potential value of screening for both illness threat and abnormal illness behavior to facilitate interventions.

Patterns of 'Abnormal' Illness Behavior among Healthy Individuals.

OBJECTIVES: We extend the seminal work of Professor Issy Pilowsky by presenting a contemporary re-conceptualization of abnormal illness behavior (AIB) as a general psychological phenomenon evident among healthy community members. METHODS: Participants (N = 344) completed a self- report questionnaire comprising health information and well-validated psychological measures from the field of somatization (eg, AIB, attributional style for physical symptoms, cognitive distortion of somatic information, illness likelihood, maladaptive coping). RESULTS: Cluster analysis of illness behavior responses resulted in 3 unique groupings distinguished by key health and psychological variables. Cluster 1 reflected 'normal' responses, Cluster 2 'atypical' and Cluster 3 'maladaptive'. Cluster 3 may represent a personality attribute indicative of a general style of interpreting illness in a more extreme way (trait AIB) whereas Cluster 2 may reflect a transient response to a specific illness event (state AIB). CONCLUSIONS: The construct of 'abnormal' illness behavior may usefully be extended to include individual differences in responses regardless of current health status. Furthermore, the potential to further characterize illness behavior as either dispositional (trait) or situational (state) emerges as a fruitful area for future analyses. Specifically, longitudinal studies are recommended to determine the causal links between health events and illness behavior profiles.

Predicting success in medical school: a longitudinal study of common Australian student selection tools.

BACKGROUND: Medical student selection and assessment share an underlying high stakes context with the need for valid and reliable tools. This study examined the predictive validity of three tools commonly used in Australia: previous academic performance (Grade Point Average (GPA)), cognitive aptitude (a national admissions test), and non-academic qualities of prospective medical students (interview). METHODS: A four year retrospective cohort study was conducted at Flinders University Australia involving 382 graduate entry medical students first enrolled between 2006 and 2009. The main outcomes were academic and clinical performance measures and an indicator of unimpeded progress across the four years of the course. RESULTS: A combination of the selection criteria explained between 7.1 and 29.1 % of variance in performance depending on the outcome measure. Weighted GPA consistently predicted performance across all years of the course. The national admissions test was associated with performance in Years 1 and 2 (pre-clinical) and the interview with performance in Years 3 and 4 (clinical). Those students with higher GPAs were more likely to have unimpeded progress across the entire course (OR = 2.29, 95 % CI 1.57, 3.33). CONCLUSIONS: The continued use of multiple selection criteria to graduate entry medical courses is supported, with GPA remaining the single most consistent predictor of performance across all years of the course. The national admissions test is more valuable in the pre-clinical years, and the interview in the clinical years. Future selections research should develop the fledgling research base regarding the predictive validity of the Graduate Australian Medical School Admissions Test (GAMSAT), the algorithms for how individual tools are combined in selection, and further explore the usefulness of the unimpeded progress index.

Construct validity and temporal stability of the abridged 31-item Illness Behaviour Questionnaire.

OBJECTIVE: Key psychometric information was sought for three newly derived dimensions from an abridged Illness Behaviour Questionnaire (IBQ-31): Affirmation of Illness (AI), Concern for Health (CH) and General Affective State (GAS). The construct validity of these scales was examined along with their test-retest reliability and long-term stability. DESIGN: A longitudinal, observational study was conducted with 675 participants (general community members and those with either asthma, diabetes and chronic pain or chronic fatigue syndrome) providing self-report questionnaire data at baseline, with additional information sought at three (n = 483; 71.6%) and 12 months (n = 517, 76.6%). MAIN OUTCOME MEASURES: Construct validity of the IBQ-31 was explored using well-validated psychological measures of Symptom Attributions and Symptom Experience, Cognitive Distortion of Somatic Information and Illness Likelihood. RESULTS: In general, AI, CH and GAS shared predictable empirical overlap with related psychological indices across the five samples. Adequate three-month test-retest reliability was evident, with greater score variability over 12 months. CONCLUSION: The IBQ-31 comprises three theoretically relevant dimensions which demonstrate relative short- and long-term stability for individuals with diverse illness experiences. Future investigations should explore the predictive validity of AI, CH and GAS, along with the potential value of 'cut-off' scores for clinical use.

Somatic symptom disorders and illness behaviour: current perspectives.

The behavioural aspects of somatic symptom disorders have received minimal research attention to date. The first section of this paper identifies key theoretical perspectives relevant to behavioural responses to illness. Specifically, the sociological concept of illness behaviour is offered as a general framework in which to consider the range of psychosocial factors associated with responses to perceived illness. Further, the potential relevance of the construct of abnormal illness behaviour and the cognitive behavioural conceptualization of health anxiety is explored. The second part of the paper describes various approaches to the operationalization of illness behaviour, with particular emphasis on the Illness Behaviour Questionnaire, an instrument with a rich history of application. Additional insight is provided into two contemporary instruments which aim to measure overt behavioural aspects of illness more specifically. The third and final section of the paper makes recommendations for how future research may advance the understanding of state- versus trait-based characteristics of illness behaviour. Suggestions are made for how adaptive forms of behaviour (e.g. self-management, appropriate coping) may reduce the risk of developing a somatic symptom disorder or alternatively, minimizing the potentially negative psychosocial implications of such a presentation.

New dimensions of abnormal illness behaviour derived from the Illness Behaviour Questionnaire.

The primary aim was to explore the factor structure of the Illness Behaviour Questionnaire (IBQ) and the generalisability of the derived dimensions to both general community members and four chronic illness groups. A questionnaire was administered to 675 participants, comprising 344 from the community, 80 with asthma, 95 with diabetes, 79 with chronic pain and 77 with chronic fatigue syndrome (CFS). Illness severity was calculated for all chronic illness participants (self-rated health for community members). Three IBQ scales were derived following an exploratory factor analysis for the whole sample: Affirmation of Illness (α = 0.71 (CFS)-0.79 (asthma, diabetes)), Concern for Health (α = 0.71 (asthma)-0.78 (pain)) and General Affective State (α = 0.70 (CFS)-0.80 (asthma)). Patterns of response across the five samples, and intercorrelations among the new scales and the original seven scales, were largely in accord with expectation. Long-standing criticisms of the IBQ were addressed by using systematic statistical principles to identify meaningful and psychometrically sound IBQ dimensions. The derived structure offers a more parsimonious account of possible illness responses, with the availability of a more concise yet informative index of abnormal illness behaviour having practical utility for researchers and clinicians alike.

The measurement of abnormal illness behavior: toward a new research agenda for the Illness Behavior Questionnaire.

Abnormal illness behavior (AIB) refers to a maladaptive manner of experiencing, evaluating, or acting in response to health and illness that is disproportionate to evident pathology. The construct was originally informed by the sociological notions of the sick role and illness behavior. The present article provides a comprehensive review of the conceptual and empirical development of AIB with a detailed insight into the variety of illness contexts to which it has been applied using the Illness Behavior Questionnaire (IBQ). While the relevance of AIB continues to be demonstrated within the prescribed contexts of the chronic pain and psychiatric literatures, criticisms of AIB and its measurement have arisen when researchers have attempted to move beyond these contexts. In recognition of these criticisms, this article presents a new research agenda to address key limitations that currently impede the broader development and application of AIB. Most importantly, it is proposed that greater consideration needs to be given to the definition of AIB according to type of illness and for general community members without a current illness. The article concludes with comment on the potential practical implications of any future reconceptualization of AIB, including the need to reconsider the manner in which IBQ scores are derived and interpreted, and the need for caution when applying the label "abnormal" in specific illness contexts.

The contributions of psychological disposition and risk factor status to health following treatment for coronary artery disease.

BACKGROUND: Successful adjustment following treatment for coronary artery disease is related to both psychological disposition and risk factor status. Consideration of the interplay between these variables is required to better acknowledge their relationship with health outcome. AIMS: To determine the salience of self-efficacy and locus of control to both general self-rated health and current cardiac health, relative to risk factor status. To determine whether self-efficacy is a more salient predictor of health status than locus of control. METHODS: Men (n=248) treated in the previous 3 years for either coronary artery disease alone or a myocardial infarction completed a questionnaire in which clinical, risk factor (knowledge of risk factors, current risk factors, change in risk factors), psychological (self-efficacy, locus of control) and health information were sought. RESULTS: Self-efficacy and internal locus of control had both direct and indirect influences on health in the models in which knowledge of risk factors was treated as the potential mediator. This pattern of results was not evident when either current risk factors or change in risk factors were examined as potential mediators. In the models in which self-efficacy was considered as a potential mediator of locus of control in the prediction of health status, self-efficacy was determined to be the more relevant psychological construct. CONCLUSION: The consistent positive associations obtained among self-efficacy, cognitive risk factor status and health suggest that health professionals involved in cardiac rehabilitation should be encouraged to tailor interventions that allow patients to both improve their understanding of CAD and also to develop greater self-confidence in their ability to implement the acquired knowledge.

Measuring disability with parsimony: evidence for the utility of a single item.

PURPOSE: To provide evidence for the utility of a single item measure designed to quantify disability in the past 30 days. METHOD: Australian data from studies comprising a community-dwelling elderly sample (N = 328) and a sample of chronic osteoarthritis (OA) patients (N = 119) are reported. Degree of disability was classified as 0-30 days, 0 vs. 1 or more days, and 0-9 vs. 10 or more days. Associations between disability and a range of demographic, health-related, and psychological variables were assessed. RESULTS: Participants with OA reported a significantly higher level of disability than participants from the community sample regardless of how disability was classified. Modest levels of association were noted between the number of disability days (0-30) and both health and psychological indices in both samples. The three alternative classifications of disability made little difference to the significance of associations. On balance, the comparison of 0-9 vs. 10 or more days appeared the more predictive classification of disability. CONCLUSIONS: The performance of the single item measure of disability was generally very satisfactory. Future investigations into the clinical application of the item across a range of patient groups are encouraged.

Dimensions of osteoarthritis self-management.

Our aims were to determine whether a taxonomy of self-management strategies for osteoarthritis could be identified, and whether the resultant dimensions of such a taxonomy demonstrate predictable relationships with health status indices. Participants (n = 117) from community-based self-help groups and a general rheumatology outpatient clinic completed a self-management inventory consisting of 11 items, answered for both the past 7 days and a day on which symptoms were worse than usual. Duration of symptoms, level of pain, perceived functional ability and self-rated health were recorded as indicators of health status. Three essentially identical factors were obtained for both past 7 days and worse day items. Resultant scales were labeled passive, complementary and active, respectively. Correlations with health status measures provided modest evidence for the construct validity of these self-management scales. Compared with a simple aggregate score based on the total number of strategies used, the scales provided a clearer understanding of the relationship between self-management and health. The study provided a useful extension to existing research, addressing a number of shortcomings identified by previous researchers. The identified self-management dimensions offered a greater insight into the self-management choices of patients. Suggestions for further improvements to the measurement of self-management are outlined.