"Learning to Live With What You Can't Rise Above": Control Beliefs, Symptom Control, and Adjustment to Tinnitus.

The relations between 3 types of perceived control, symptom severity, and 2 adaptational outcomes, depressive symptoms and psychological well-being, were examined in a sample of 319 people with tinnitus. Consistent with previous studies of control and adjustment to chronic health conditions, general health and symptom control were associated with better psychological adjustment, and retrospective control was associated with worse psychological adjustment. Only symptom control emerged as a significant moderator in the symptom severity--adjustment relationship, such that stronger beliefs in one's ability to control symptoms were most strongly associated with better adjustment among those with more severe tinnitus symptoms. These findings were consistent with coping perspectives and cognitive adaptation theory and suggest that symptom-related perceptions of control may be an effective coping resource to nurture in chronic health contexts with severe symptoms. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Interpersonal expectations, social support, and adjustment to chronic illness.

Chronic illness places considerable burdens on patients and their interpersonal relations with families. In this study, patients' perceptions of family and medical staff expectations regarding responsibility for care and routine functions were examined. The authors hypothesized that a patient's perceived inability to meet others' expectations about coping with illness would lead to poorer adjustment. Forty-two chronically ill patients were assessed prospectively for perceptions of others' expectations, social support, and psychological adjustment. Findings confirmed that expectations predicted subsequent decreases in psychological adjustment over a 3-month period, even when social support was controlled. A test of the reverse hypothesis showed that poorly adjusted patients did not misperceive others' expectations. Theoretical interpretations of the findings and their relation to social support research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social support and hostility as predictors of depressive symptoms in cardiac patients one month after hospitalization: a prospective study

OBJECTIVE: Hospitalization for cardiac disease is associated with an increased risk for depression, which itself confers a poorer prognosis. Few prospective studies have examined the determinants of depression after hospitalization in cardiac patients, and even fewer have examined depression within the weeks after hospital discharge. The present study assessed the prospective relations among perceptions of social support and trait hostility in predicting symptoms of depressive symptoms at 1 month after hospitalization for a diagnostic angiography in 506 coronary artery disease (CAD) patients. METHOD: A series of structural equation models 1) estimated the predictive relations of social support, hostility, and depressive symptoms while in the hospital to symptoms of depression 1 month after hospitalization, and 2) compared these relations across gender, predicted risk classification, and age. RESULTS: Social support assessed during hospitalization was independently negatively associated with depressive symptoms 1 month after hospitalization, after controlling for baseline symptoms of depression, gender, disease severity, and age. Hostility was an indirect predictor of postdischarge depressive symptomology by way of its negative relation with social support. This pattern of relations did not differ across gender, predicted risk classification, and age. CONCLUSIONS: Our findings suggest that a patient's perceived social support during hospitalization is a determinant of depressive symptoms 1 month later. The relation of social support and hostility to subsequent depressive symptoms was similar across a variety of populations.     

Role of health locus of control beliefs and expectations of treatment efficacy in adjustment to cancer.

Examined the effects of health locus of control beliefs (self-, doctor, and chance control) and expectations of treatment efficacy on short-term psychological adjustment in 137 18–86 yr old newly diagnosed cancer patients. The role of these beliefs and expectations in moderating the relation between perceived and actual disease severity and depression was also examined. Ss completed an intake questionnaire assessing the perceived severity of illness, the amount of pain or discomfort they were experiencing, how sad or depressed they were, and expectations about complying with medication instructions; Ss also completed items from Rotter's Internal–External Locus of Control Scale, the Multi-Dimensional Health Locus of Control Scale, and the Self-Rating Depression Scale. The relation between perceptions of disease severity and depression was weaker for Ss who believed that they could personally control their health and for those who held positive expectations about the effects of complying with medical treatment. Similar patterns were found when disease severity was defined in terms of prognosis for survival. Strong negative correlations between self-control/treatment expectations and depression were found for Ss who perceived that their illness was severe. The results for chance and doctor control were less consistent. The stability of health control beliefs and treatment expectations over the course of a serious long-term illness is discussed. (34 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Marital conflict, gender, and children's appraisals and coping efficacy as mediators of child adjustment.

The role of children's perceptions and appraisals in the impact of marital conflict was examined for 51 9- to 12-yr-olds from intact families. Gender differences were found in the cognitions and coping processes related to marital conflict and child adjustment. Appraisals of coping efficacy and the threat posed by marital conflict predicted adjustment in boys, whereas self-blame was linked with internalizing problems for girls. The appraised destructiveness of conflict was significantly related to perceived threat in boys and self-blame in girls. Boys appeared more attuned or, alternatively, less shielded from marital conflict, as reflected by the higher correlations with mothers' reports of marital conflict for boys than for girls. The significance of boys' appraisals to adjustment was suggested by the fact that boys' perceptions were better predictors of adjustment outcomes than were mothers' reports. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dynamics of support perceptions among couples coping with cardiac illness: The effect on recovery outcomes.

Objective: The current prospective study explored how male cardiac patients' perceptions of received support (i.e., active engagement, protective buffering, and overprotection) moderated the associations between female partners' perceptions of provided support and patients' recovery outcomes: psychological well-being, cholesterol levels, and smoking cessation. Methods: Couples (N = 86) completed surveys at the initial hospitalization after patients' Acute Coronary Syndrome (ACS), and 1 and 6 months later. Partners' ways of providing support and patients' concurrent perceptions of these ways were measured using the Ways of Giving Support Questionnaire; patients' depressive and anxiety symptoms were measured using the Brief Symptom Inventory (BSI). Patients' cholesterol levels were assessed during hospitalization and 6 months later, and smoking habits were reported by the patients. Results: Female partners' protective buffering was positively associated with male patients' depressive symptoms at follow-up only when male patients' own perceptions of partners' protective buffering were low. Female partners' active engagement was positively associated with better odds for male patients' cessation of smoking only when patients' own perceptions of partners' active engagement were high. Finally, female partners' overprotection was associated with higher levels of male patients' harmful blood lipids at follow-up, but only when patients' own perceptions of partners' overprotection were high. Conclusions: As hypothesized, the effect of partners' perceptions of support provided on patients' recovery was moderated by patients' own perceptions of the support received. The effect of this interaction was determined by the specific types of support provided or received and by the specific recovery outcome that was measured. The clinical and theoretical implications of the findings are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Attachment and control in family and mentoring contexts as determinants of adolescent adjustment at college.

This study examined whether adolescents' perceptions of attachment security and behavioral and psychological control as experienced in family and mentoring contexts are predictive of their adjustment to college. One hundred fifty-eight academically at-risk adolescents (63 men and 95 women, 16–20 years old) completed questionnaires twice during their first semester: before and after they participated in a mentoring program. Analyses yielded 4 findings: (a) Paternal control was predictive of adolescent adjustment to college; (b) above and beyond perceptions of parental attachment and control, perception of a secure relationship with a mentor was predictive of adolescent adjustment; (c) this relationship was found to be stronger for adolescents who reported having high levels of security in the relationship with their mother; and (d) psychological control by both parents appeared to be a significant determinant of academic achievement. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Children and terrorism-related news: Training parents in coping and media literacy.

This study examined associations between televised news regarding risk for future terrorism and youth outcomes and investigated the effects of training mothers in an empirically based approach to addressing such news with children. This approach--Coping and Media Literacy (CML)--emphasized modeling, media literacy, and contingent reinforcement and was compared via randomized design to Discussion as Usual (DAU). Ninety community youth (aged 7-13 years) and their mothers viewed a televised news clip about the risk of future terrorism, and threat perceptions and state anxiety were assessed preclip, postclip, and postdiscussion. Children responded to the clip with elevated threat perceptions and anxiety. Children of CML-trained mothers exhibited lower threat perceptions than DAU youth at postclip and at postdiscussion. Additionally, CML-trained mothers exhibited lower threat perceptions and state anxiety at postclip and postdiscussion than did DAU mothers. Moreover, older youth responded to the clip with greater societal threat perception than did younger youth. Findings document associations between terrorism-related news, threat perceptions, and anxiety and support the utility of providing parents with strategies for addressing news with children. Implications and research suggestions are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Perceived social support mediates between prior attachment and subsequent adjustment: A study of urban African American children.

The processes whereby attachment and other social and cognitive factors contribute to social and emotional adjustment were examined. Participants were 56 African American children from low-income urban families. Attachment and sociability were assessed in the strange situation when children were 4.5 years old. Two years later, children were interviewed regarding their perceptions of social support and their attributions about others' intentions. Also assessed at Time 2 were child verbal intelligence, defensive response style, children's self-reports, and parent reports of child adjustment. As expected, attachment uniquely predicted perceived social support. Insecure attachment predicted self-reports of behavior problems and parental report of internalizing problems. Perceived social support was associated positively and significantly with viewing ambiguously depicted actions as prosocial rather than aggressive. Perceived social support was found to mediate the relation between attachment and adjustment. Results suggest that behaviorally mediated strategies for relating to caregivers in early childhood predict generalized social perception, thought, and emotion at later ages. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Influence of adjustment and physical attractiveness on the employability of schizophrenic women.

Compared manifest adjustment and physical attractiveness for their effects on hirability. Employment interviewers assessed 21 18–54 yr old female psychiatric patients who had been videotaped taking part in a simulated job interview. Results indicate that (a) 43% of the interviewees were considered employable by at least 3 of 4 interviewers, although all interviewees were hospitalized with diagnoses of psychosis at the time. (b) Manifest adjustment (i.e., during the interview) related strongly to Ss' hirability. (c) Variables that had nonsignificant correlations with hirability included physical attractiveness (whether judged from videotapes or still photos) and demographic indexes such as number of previous hospitalizations and age at 1st hospitalization. The significant correlation between manifest adjustment and employability corroborates results of earlier studies that used "normal" confederates (stooges) rather than actual mental patients. (10 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Parents' influence on children's achievement-related perceptions.

Two aspects of the relation between parents' perceptions of their children and children's self- and task perceptions in math and English were investigated: (a) the mediating role of parents' perceptions between grades and adolescents' self-perceptions and (b) the gendered nature of parents' perceptions. Data for this study are part of a longitudinal investigation (the Michigan Study of Adolescent Life Transitions). Data from 914 sixth-grade adolescents and their parents are used in this article. Results showed that parents' perceptions mediate the relation between children's grades and children's self and task perceptions in both domains. Parents' perceptions had a stronger influence on children's perceptions than children's own grades. Significant but low correlations between gender and self and task perceptions were found in both math and English. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predicting young adults' health risk behavior.

A prototype model of risk behavior is described and was tested in a longitudinal study of 679 college students, beginning at the start of their freshman year. Perceptions of the prototype associated with 4 health risk behaviors (smoking, drinking, reckless driving, and ineffective contraception) were assessed along with self-reports of the same behaviors. Results indicated that prototype perception was related to risk behavior in both a reactive and a prospective manner. That is, perceptions changed as a function of change in behavior, and perceptions predicted those behavior changes as well. This prospective relation was moderated by social comparison, as the link between perception and behavior change was stronger among persons who reported frequently engaging in social comparison. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Longitudinal analysis of specific domains of internal control and depressive symptoms in patients with recurrent cancer.

The relation between perceptions of control and depressive symptoms was examined in a longitudinal study of patients with recurrent cancer. Five domains of control (self-blame, control over cancer onset, control over symptoms, control over the course of the illness, and overall control over life events) were found to be independent of one another. In cross-sectional analyses, depression symptomatology was negatively correlated with illness course control, symptom control, and overall control. Cross-lagged longitudinal analyses using structural equation modeling suggested only onset control and overall control were significantly associated with depressive symptomatology over the 8-month interval. Greater baseline onset control predicted greater follow-up depression, whereas higher baseline depression predicted lower follow-up overall control. The importance of developing and using domain-specific measures of control and investigating the association of control and adjustment in longitudinal analysis are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Young children's appraisals of interparental conflict: Measurement and links with adjustment problems.

The present study investigated 2 questions pertinent to understanding developmental aspects of children's conflict appraisals: (a) Do 7- to 9-year-old children make reliable distinctions between their perceptions of conflict and their appraisals of threat and self-blame? (b) Do threat and blame appraisals mediate the association between exposure to interparental conflict and adjustment problems in this age group? Factor analysis of a new version of the Children's Perception of Interparental Conflict Scale (CPIC-Y) designed for younger children showed that 179 7- to 9-year-old children distinguished properties of conflict from their appraisals of it. Moreover, as predicted by the cognitive-contextual framework, threat and self-blame appraisals mediated the link between conflict and internalizing problems but not externalizing problems. This study provides compelling evidence that appraisals of interparental conflict can be reliably measured at relatively young ages and suggests that perceptions of threat and self-blame function similarly in 7- to 9-year-olds as they do in older children. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Testing a Self-Determination Theory Process Model for Promoting Glycemic Control Through Diabetes Self-Management.

A longitudinal study tested the self-determination theory (SDT) process model of health behavior change for glycemic control within a randomized trial of patient activation versus passive education. Glycosylated hemoglobin for patients with Type 2 diabetes (n=159) was assessed at baseline, 6 months, and 12 months. Autonomous motivation and perceived competence were assessed at baseline and 6 months, and the autonomy supportiveness of clinical practitioners was assessed at 3 months. Perceptions of autonomy and competence were promoted by perceived autonomy support, and changes in perceptions of autonomy and competence, in turn, predicted change in glycemic control. Self-management behaviors mediated the relation between change in perceived competence and change in glycemic control. The self-determination process model fit the data well. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Emotional, cognitive, and family systems mediators of children's adjustment to interparental conflict.

Emotional, cognitive, and family systems processes have been identified as mediators of the association between interparental conflict and children's adjustment. However, little is known about how they function in relation to one another because they have not all been assessed in the same study. This investigation examined the relations among children's exposure to parental conflict, their appraisals of threat and blame, their emotional reaction, and triangulation into parental disagreements. One hundred fifty ethnically diverse 8- to 12-year-old children and both of their parents participated in the study. Comparisons of 3 models proposing different relations among these processes indicated that they function as parallel and independent mediators of children's adjustment. Specifically, children's self-blaming attributions and emotional distress were uniquely associated with both internalizing and externalizing problems, whereas perceived threat uniquely predicted internalizing problems and triangulation uniquely predicted externalizing problems. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Appraisals of marital conflict and children's adjustment, health, and physiological reactivity.

Children's appraisals of marital conflict were examined as moderators and mediators of conflict and children's adjustment, physical health, and physiological reactivity. Mothers completed measures of marital conflict and children's adjustment and physical health, and elementary school children provided information on their parents' marital conflict, appraisals of perceived threat and self-blame in relation to parents' conflicts, and their internalizing symptomatology. Children's heart rate, systolic and diastolic blood pressure, and skin conductance response and level were examined during both a baseline and an interadult argument. Higher levels of both self-blame and perceived threat functioned as robust vulnerability factors for children exposed to higher levels of marital conflict in relation to internalizing behaviors, health problems, and higher levels of cardiovascular reactivity to the argument. Further, a higher level of perceived threat was a vulnerability factor for externalizing problems associated with exposure to marital conflict. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Patient empowerment and feedback did not decrease pain in seriously ill hospitalized adults

We tested a nurse clinician-mediated intervention to relieve pain in a group of seriously ill hospitalized adults using a randomized controlled trial at five tertiary care academic centers in the US. The study included 4804 patients admitted between January 1992 and January 1994 with one or more of nine high mortality diagnoses; 2652 were allocated to the intervention and 2152 to usual care. Specially-trained nurse clinicians assessed patients' pain, educated them and their families about pain control, empowered patients to expect pain relief, informed patients' nurses and physicians about level of pain and suggested or used other pain management resources. Patients' pain was determined from hospital interviews with patients and surrogates. Pain 2 and 6 months later or after death and satisfaction with its control at all time periods were also assessed. All analyses were adjusted for baseline risk of being in pain and propensity to be in the intervention group. Overall, 50.9% of patients reported some pain. After adjustment for other variables associated with pain, comparing the intervention to the control group, there was not a statistically significant difference in level of pain (OR for higher levels of pain 1.15; CI 1.00-1.32) or satisfaction with control of pain during the hospitalization (OR for higher levels of pain 1.12; CI 0.91-1.39), 2 or 6 months after discharge, or during the last 3 days of life. A multifaceted intervention using information, empowerment, advocacy, counseling and feedback was ineffective in ameliorating pain in seriously ill patients. Control of pain in these patients remains an important problem. More intensive pain treatment strategies addressing the needs of seriously ill hospitalized adults must be evaluated.     

Teachers' perceptions of their relationships with students: Effects of child age, gender, and ethnicity of teachers and children.

This study assessed the extent to which teachers' perceptions of their relationships with young students varied as a function of child and teacher characteristics in a large, demographically diverse sample of 197 preschool and kindergarten teachers and 840 children (mean age 4 yrs 7 mo old). Children were approximately evenly divided between boys and girls. Regression analyses were conducted to examine the relation between teachers' perceptions of their relationships with students and (a) teacher ethnicity, (b) child age, ethnicity, and gender, and (c) the ethnic match between teacher and child. Child age and ethnicity and teacher–child ethnic match were consistently related to teachers perceptions, explaining up to 27% of the variance in perceptions of negative aspects of the teacher–child relationship, specifically teacher–child conflict. When child and teacher had the same ethnicity, teachers rated their relationships with children more positively. The results are discussed in terms of classroom social processes related to children's adjustment and the measurement of teacher–child relationships. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Vulnerability to postpartum depression: A prospective multivariate study.

A sample of 115 primiparous women was assessed during pregnancy and the postpartum to identify the predictors and correlates of postpartum depression. The variables considered were marital adjustment, attributional style, life stress, maternal expectations for and perceptions of infant behavior, and blues symptoms. The data obtained at each assessment were submitted to principal-components analyses to identify variable clusters or constructs, which were used to predict both depressive symptom levels and a diagnosis of depression. Concurrently, symptoms and diagnosis were related to mothers' perceptions of their infants as temperamentally difficult. Prospectively, depressive symptomatology was predicted by low marital adjustment and depressed mood during pregnancy, optimistic expectations for infants, prepartum life stress, and early postpartum symptoms of anxiety and cognitive impairment. Although diagnostic status was related to a subset of these variables, results indicate that depressive symptom levels and diagnosis are not synonymous measures of the construct "postpartum depression." (PsycINFO Database Record (c) 2010 APA, all rights reserved)