Stability of a Q-sort model of optimal mental health.

This study explores clinicians' conceptions of optimal mental health as a function of target age and asks whether contemporary conceptions of optimal mental health differ from Block's (1961) earlier Q-sort model. Ten experienced clinicians from Northwestern University described the personality characteristics of optimally adjusted 25- and 50-year-old targets using the California Q-set. Item scores from these Q-sorts were aggregated to form 25-year-old, 50-year-old, and composite templates of optimal mental health. Using the Spearman-Brown formula, the reliability of the 10-judge composite was .97. The 3 templates were very highly correlated with each other and with Block's original template. Q-sort descriptions of optimal mental health are remarkably stable over 2 generations of clinicians and between young adulthood and mid-life.

Construct validity and content analysis.

We clarify points of agreement and disagreement with Schnurr, Rosenberg, and Oxman, as put forth in their article appearing this issue. Speech samples elicited under different conditions may or may not be interchangeable. This is a matter of empirical research, but it is also dependent upon the meaningfulness of the content categories. used in the analysis. We prefer a theory-driven, construct validational approach that employs well validated coding schemes to assess psychologically meaningful concepts.

On the comparison of TAT and free speech techniques in personality assessment.

Schnurr, Rosenberg, and Oxman (1992) recently compared the free speech samples and Thematic Apperception Test (TAT) responses of 95 normal adults. They concluded that the two techniques are not interchangeable, and that the TAT, which proved superior in the prediction of individual differences, may be preferable to free speech instructions for eliciting data in content analytic studies. We disagree with both conclusions. Various forms of narrative speech samples may be highly correlated, so long as psychologically meaningful, well-validated, and higher order content categories are used. The use of first-order content categories is less likely to contribute to the study of personality.

The decision to enter a medical specialty: timing and stability.

The timing and stability of the decision to enter a medical specialty were examined for one class of medical students. Students were asked to predict specialty choices for themselves on six occasions from orientation day in year 1 to January of the senior year. Choices were compared to actual National Residency Matching Programme results. Forty-five per cent predicted their ultimate specialty choice at orientation, and 69% predicted their ultimate choice by the end of the second year. Specialty choices are made early, and are more stable and accurate than the previous literature has suggested. Variations in timing among the specialties are described, and implications for medical education are discussed.

Personality profiles and specialty choices of students from two medical school classes.

Changes in the composition of medical school classes, in methods of personality assessment, and in the nature of medical specialties motivated the authors to reexamine the relationship between a student's personality and his or her chosen medical specialty. In the mid-1980s, the authors assessed two consecutive classes of medical school students (120 in each class) on 15 personality measures throughout their four years; usable data were obtained for 199 of the students. The students' specialty choices upon graduation were obtained from the results of the National Resident Matching Program, and were classified as follows: internal medicine, surgery, family practice, pediatrics, psychiatry, obstetrics-gynecology, and hospital-based specialties. The authors constructed personality profiles for the students who had chosen each of these seven specialty groupings, on the basis of t-tests and discriminant function analyses, and discuss these profiles and their associations with the students' specialty choices in the context of earlier research. The personality profiles for surgeons were remarkable for their consistency with reports from the literature from the 1950s and 1960s, while the profiles for obstetricians, psychiatrists, and pediatricians were complex and provocative. Distinctive personality profiles did not emerge for internists or family practitioners.

Vicissitudes of depressed mood during four years of medical school.

We describe the vicissitudes of depressed mood for one medical school class that was assessed repeatedly overtime, from the first day of medical school until several months short of graduation, using the Beck Depression Inventory (BDI). Using an arbitrarily defined BDI cutoff point of 14 or greater, at least 12% of the class showed considerable depressive symptoms at any assessment during the first three years; the largest fraction (25%) was symptomatic near the end of the second year. The median class BDI score increased almost threefold during the first two years. Students were likely to be in a similar class ranking at all assessments, indicating that for many students dysphoric mood was enduring. Those with BDI scores of 21 or greater were more likely to quit medical school. Students with high scores for dysphoria were not more likely to evidence a family history of major depression or concomitant substance abuse. Women medical students were not more vulnerable to depressed mood than men.

The relationship between academic performance and severity of depressed mood during medical school.

We employ a structural equation model to examine the relationship between academic performance and depressed mood over 4 years for a single medical school class. Academic performance measures included undergraduate gradepoint average, first- and second-year medical school gradepoint average, full Medical College Admissions Test (MCAT) and total National Boards Part I (NB) scores. Severity of depressed mood was assessed by administering the Beck Depression Inventory two times per year during the first 2 years, and once per year during the last 2 years. Overall there is little reason to think that depressive mood states compromise academic performance during the first 2 years of medical school for the class as a whole. Medical school grades had no direct impact on depressed mood, and mood had no direct impact on grades. There was a non-significant tendency for mood in the months preceding National Boards Part I to influence Board scores, which in turn influenced mood. Students with higher college gradepoint averages consistently reported fewer depressive symptoms throughout medical school. The latter result directs attention to a subgroup of medical students less susceptible to depression, or less prone to admit distress or symptoms. The non-susceptible and/or minimizing qualities of this subgroup merit further investigation.

Physical and psychosocial functioning in multiple sclerosis: descriptions, correlations, and a tentative typology.

Multiple sclerosis (MS) is a disease of great variety and ambiguity. It outcome is both multidimensional and uncertain. As part of an ongoing effort to describe and differentiate the various courses that MS can follow, 81 out-patients diagnosed with MS completed the California Psychological Inventory (CPI) and the Sickness Impact Profile (SIP) administered as a structured interview. Descriptive statistics for the SIP and the CPI are provided and examined as a function of age and sex. Correlations between health status and personality scales are reported. Increasing physical dysfunction is associated with lowered performance on a broad array of psychosocial dimensions but only among women. A cluster analysis of CPI factor scores is described and a very tentative typology of persons with MS is offered for further investigation.

Intimacy, power, and psychological well-being in medical students.

Numerous reports suggest that medical school has adverse psychological effects on medical students, although not all students are affected equally. The authors examined the effects of two social motives, the need for power and the need for intimacy, on measures of well-being and distress obtained throughout the undergraduate years. Medical students high in both power and intimacy motivation were more depressed, neurotic, fatalistic, and self-doubting than were their classmates. These effects began at the end of year 1, peaked in year 2, and disappeared by the end of clerkships. High intimacy-low power students had the highest levels of well-being. These effects were equally true in men and women and both support and render more precise prior role conflict explanations.

The stability and attitudinal correlates of warmth and caring in medical students.

It is often said that medical school admits students who are compassionate, nurturant and person-oriented, and transforms them into cold, impersonal graduates. These attributes describe two ends of a personality trait continuum referred to as psychological femininity. The Femininity Scale of the Personal Attributes Questionnaire was administered to a class of medical students four times over 3 years. Measures of empathy, attitudes towards doctor-patient relations and attitudes towards professional psychological help were also obtained. Femininity appears to be normally distributed, remarkably stable over a 28-month interval and predictive of attitudinal measures of empathy, readiness to make psychiatric referrals, recognition of one's own need for psychological help, and a non-cynical, person-oriented approach to patient care. Such findings suggest a different state of affairs within medical training than is usually portrayed. Rather than viewing medical school as having a universally adverse effect on student compassion, medical school has virtually no effect on self-reports of warmth, kindness, helpfulness, etc. Students at different ends of the femininity continuum may require different interventions aimed at teaching communication skills and interpersonal sensitivity.

Masculinity, femininity, and psychosocial adjustment in medical students: a 2-year follow-up.

As part of a longitudinal study of medical students, relations between masculinity and femininity and psychosocial well-being were investigated over a 21-month interval. Of a class of medical students, 82% (N = 99) completed measures of masculinity and femininity during orientation and, 21 months later, completed a broad array of measures of psychological well-being, interpersonal functioning, humanistic attitudes toward patient care, and alcohol consumption. Hierarchical multiple regression analyses with interaction terms revealed main effects of masculinity on self-esteem, extraversion, and confidence, and main effects of femininity on hedonic capacity, interpersonal satisfaction, sharing of personal problems, and alcohol consumption. Little evidence for additive or balance androgyny formulations was found. Findings for masculinity were consistent with earlier findings from this study and others, but they were weaker in magnitude. Findings for femininity were surprisingly robust and enrich the construct validity of this measure. Measures of impaired mood and of alcohol and drug impairment were also studied in relation to masculinity and femininity. Both variables contribute to the prediction of depressed mood; femininity also contributes to the prediction of drug involvement. Neither scale has sufficient sensitivity or specificity to be used by itself as a test of impairment.

Alcohol use patterns of first-year medical students: II. Psychosocial characteristics associated with drinking level.

Psychosocial characteristics that identified first-year medical students who drank more or less alcohol than their peers were examined. Subjects were 116 freshman medical students (96% of one class) who completed questionnaires about alcohol use, mood, personality, social relationships, and parental alcohol abuse on the first day of school, and 106 (88% of the class) who responded to the same questionnaires in April of the first year. Heavier drinking students (i.e., the upper 25% of the sample) were more likely to be male and single, to have drunk heavily prior to medical school, to come from larger social networks which include fewer relatives, and to demonstrate a lower interpersonal orientation. Mood, academic performance, and parental alcohol abuse were not associated with drinking level. The heaviest drinkers in this sample appear to be precisely those individuals who are most impervious to peer or other social influences.

Masculinity, femininity, type A behavior, and psychosocial adjustment in medical students.

The freshman class of a midwestern medical school completed measures of masculinity and femininity, Type A behavior, and a variety of dependent variables concerning psychological well-being, adjustment, and interpersonal satisfaction. Appropriate statistical treatment of the data revealed strong and consistent masculinity effects on neuroticism, depression, self-esteem, confidence, hedonic capacity, locus of control, and relationship satisfaction. Femininity main effects varied in number as a function of the statistical method employed and involved a more diverse group of variables than is typically reported. Additive androgyny formulations of mental health were supported; balance androgyny formulations were not. No evidence for a Type A X Masculinity effect on adjustment was found. Discussion focuses on the correct interpretation of masculinity and femininity scales, comparability of analysis of variance (ANOVA) and multiple regression statistical analyses, and the viability of the concept of androgyny.

Measuring regression in hospitalized medical patients: the BUMP scale.

This article describes the construction and initial validation of a brief rating scale designed to measure behavioral regression or upset in hospitalized medical patients (the BUMP scale). The scale consists of 32 items representing various psychologic reactions to illness. Nurses completed questionnaires on 213 hospitalized patients. Corrected item-total score correlation coefficients averaged 0.53. Factor analysis revealed four factors measuring behavioral regression, poor patient--staff relations, depression/anxiety, and passivity/withdrawal. Alpha reliabilities revealed a high degree of internal consistency of scale items for total score and the four factor subscales. Cluster analysis revealed four clinically meaningful patient groups that were discussed in terms of various typologies in the literature. Potential uses of the BUMP scale and the need for further validating studies were discussed.

Personality indicators of psychosocial adjustment in first-year medical students.

One aspect of the Rush Medical College Longitudinal Study is concerned with the identification of personality traits that predict various kinds of psychosocial adjustments and impairments among medical students and physicians. Two orthogonal traits, masculinity and femininity, were selected for study as independent variables because of their implications for mental health and their relevance to the work of physicians. Ninety percent (N = 106) of a class of first-year medical students completed measures of masculinity and femininity during orientation and, 8 months later, completed a broad array of dependent measures of psychological well-being, interpersonal satisfaction, humanistic attitudes and alcohol consumption. Analyses of the data revealed strong and consistent main effects of masculinity on depression, confidence, pleasure capacity, extraversion, locus of control, neuroticism and interpersonal satisfaction. Femininity was associated with depression, pleasure capacity, extraversion, neuroticism, interpersonal satisfaction, concern for the opinion of others and humane attitudes toward patient care. Low femininity was also associated with high alcohol consumption. These results suggest that masculinity and femininity scores may help to identify at the outset medical students at risk for impairment, and that androgynous individuals (who are high in both masculinity and femininity) may be especially well-suited to assume the demanding and varied roles that physicians are called on to play.

Physical disability, life stress, and psychosocial adjustment in multiple sclerosis.

Eighty-one outpatients with diagnosed multiple sclerosis were studied in an effort to examine the relative contributions of physical health status, life stress, duration of illness, age, sex, marital status, and social class on various aspects of personal and interpersonal functioning. Stepwise multiple regression analyses were performed to identify the most significant discriminators of the seven psychosocial measures. Physical health status exerted the broadest influence, affecting personal efficiency and well-being, capacity for independent thought and action, self-confidence, self-reliance, and number of meaningful social contacts. Life stress was associated with lowered personal efficiency and sense of well-being. Duration of illness and the demographic variables had few or no effects on psychosocial adjustment. Discussion contrasts the present findings with others in the rehabilitation literature and specifies certain limitations of the study's design.