Relations between problem orientation and optimism, pessimism, and trait affectivity: a construct validation study

The effects of modified problem-solving therapy on depression, coping, and self-efficacy in elderly nursing home residents

Background

With the increasing trend of aging, the mental health problems of the elderly require urgent attention. Depression is a common psychological problem of the elderly, which affects their quality of life and physical health. Problem-solving therapy can effectively improve depression in the elderly, but there are few studies on problem-solving therapy for depression in the elderly in China. The purpose of this study was to evaluate the effects of modified problem-solving therapy (MPST) on depression, coping and self-efficacy in elderly nursing home residents.

Methods

This study was a randomized controlled trial. A total of 60 older adults from two nursing homes were recruited to participate in this study and randomly assigned to the intervention group (MPST) or the control group (usual care). The intervention lasted 8 weeks, and information on depression, coping skills, and self-efficacy was collected before the intervention, immediately after the intervention, and 3 months after the intervention. Repeated measures ANOVA was used to compare changes at multiple time points between the two groups. If the interaction effect (group * time) was significant, independent samples t-test was used to compare the differences in outcome indicators between groups at post-intervention and 3 months post-intervention.

Results

Compared to the control group, depression scores in the intervention group were significantly lower at the end of the intervention and remained significantly lower than the control group 3 months post-intervention (p < 0.05). Negative coping and self-efficacy in the intervention group also improved significantly at the end of the intervention, and 3 months post-intervention, while positive coping in the two groups did not differ significantly at 3 months post-intervention.

Conclusion

The findings of this study suggest that MPST could be beneficial in reducing depressive symptoms and enhancing positive coping and self-efficacy levels in older adults in nursing homes.

Negative Life Events Associated with COVID-19 and Psychological Distress: The Role of Irrational and Rational Beliefs

The current study examines possible mediating and moderating mechanisms in the relationship between negative life events associated with COVID-19 and psychological distress. A total of 450 adults (mean age = 22.11 years, SD = 3. 46 years) participated in this study. The participants completed measures of negative life events, psychological distress, and irrational/rational beliefs. The present findings indicated that adverse life events associated with COVID-19 predict psychological distress in adults. The findings also indicated that indirect predictive effect of adverse life events associated with COVID-19 on psychological distress via irrational beliefs varies depending on specific value of rational beliefs. The current study contributes to existing cognitive vulnerability model by documenting when and how adverse life events associated with COVID-19 influence psychological distress.

A network analysis of social problem-solving and anxiety/depression in adolescents

Social problem-solving (SPS) involves the cognitive-behavioral processes through which an individual identifies and copes with everyday problems; it is considered to contribute to anxiety and depression. The Social Problem-Solving Inventory Revised is a popular tool measuring SPS problem orientations and problem-solving styles. Only a negative problem orientation (NPO) is considered strongly related to anxiety and depression. In the present study, we investigated the detailed connections among the five components of SPS and 14 anxiety-depression symptoms and specified the role of NPO and other components in the anxiety-depression network. We employed network analysis, constructed circular and multi-dimensional scaling (MDS) networks, and calculated the network centrality, bridge centrality, and stability of centrality indices. The results were as follows: (1) the MDS network showed a clustering of anxiety and depression symptoms, with NPO and avoidance style components from SPS being close to the anxiety-depression network (demonstrated by large bridge betweenness and bridge closeness); (2) the NPO and positive problem orientation from SPS were most influential on the whole network, though with an opposite effect; (3) strength was the most stable index [correlation stability (CS) coefficient = 0.516] among the centrality indices with case-dropping bootstraps. We also discussed this network from various perspectives and commented on the clinical implications and limitations of this study.

Using the Habit App for Weight Loss Problem Solving: Development and Feasibility Study

Background

Reviews of weight loss mobile apps have revealed they include very few evidence-based features, relying mostly on self-monitoring. Unfortunately, adherence to self-monitoring is often low, especially among patients with motivational challenges. One behavioral strategy that is leveraged in virtually every visit of behavioral weight loss interventions and is specifically used to deal with adherence and motivational issues is problem solving. Problem solving has been successfully implemented in depression mobile apps, but not yet in weight loss apps.

Objective

This study describes the development and feasibility testing of the Habit app, which was designed to automate problem-solving therapy for weight loss.

Methods

Two iterative single-arm pilot studies were conducted to evaluate the feasibility and acceptability of the Habit app. In each pilot study, adults who were overweight or obese were enrolled in an 8-week intervention that included the Habit app plus support via a private Facebook group. Feasibility outcomes included retention, app usage, usability, and acceptability. Changes in problem-solving skills and weight over 8 weeks are described, as well as app usage and weight change at 16 weeks.

Results

Results from both pilots show acceptable use of the Habit app over 8 weeks with on average two to three uses per week, the recommended rate of use. Acceptability ratings were mixed such that 54% (13/24) and 73% (11/15) of participants found the diet solutions helpful and 71% (17/24) and 80% (12/15) found setting reminders for habits helpful in pilots 1 and 2, respectively. In both pilots, participants lost significant weight (P=.005 and P=.03, respectively). In neither pilot was an effect on problem-solving skills observed (P=.62 and P=.27, respectively).

Conclusions

Problem-solving therapy for weight loss is feasible to implement in a mobile app environment; however, automated delivery may not impact problem-solving skills as has been observed previously via human delivery.

Trial Registration

ClinicalTrials.gov NCT02192905; https://clinicaltrials.gov/ct2/show/NCT02192905 (Archived by WebCite at http://www.webcitation.org/6zPQmvOF2)

Problem-Solving Education to Prevent Depression Among Low-Income Mothers: A Path Mediation Analysis in a Randomized Clinical Trial

IMPORTANCE

Although problem solving has been an important component of successful depression prevention and treatment interventions, evidence to support problem solving's mechanism of action is sparse.

OBJECTIVE

To understand the mechanism of an efficacious depression prevention intervention, problem-solving education (PSE).

DESIGN, SETTING, AND PARTICIPANTS

A multivariate path analysis was embedded within a randomized efficacy trial (February 15, 2011, to May 9, 2016). Participants were mothers with depressed mood, anhedonia, or depression history (but not in current major depressive episode) at 1 of 6 Head Start agencies. Participants were followed up for 12 months with serial assessments of potential intervention mediators and depressive symptoms.

INTERVENTIONS

Problem-solving education (n = 111) and usual Head Start services (n = 119).

MAIN OUTCOMES AND MEASURES

Primary outcomes were depressive symptom elevations, which were measured bimonthly. Eight plausible intervention mediators were assessed: problem-solving ability; mastery; self-esteem; perceived stress; behavioral activation; and avoidant, problem-focused, and social coping.

RESULTS

Among 230 participants, 152 (66.1%) were Hispanic; mean (SD) age was 31.4 (7.3) years. Based on associations with either PSE participation or depressive symptom outcomes, problem-solving ability, perceived stress, behavioral activation, and problem-focused coping were included in a parsimonious, multivariate path model. In this model, only perceived stress was associated with both PSE participation and depressive symptoms. Participants in the PSE group had adjusted standardized perceived stress change scores that were 11% lower than controls (95% CI, -0.19 to -0.03), and improvement in perceived stress generated an adjusted rate ratio (aRR) of 0.42 (95% CI, 0.33-0.53) for depressive symptom elevations. Participants in the intervention group also had standardized behavioral activation change scores 15% greater than controls (95% CI, 0.01-0.30) and problem-focused coping change scores 17% greater than controls (95% CI, 0.03-0.31); however, changes in these constructs were not associated with a differential rate of depressive symptom elevations. The direct effect of PSE on depressive symptom elevations (aRR, 0.72; 95% CI, 0.52-0.97) was greater than the mediated effect explained by improvement in perceived stress (aRR, 0.91; 95% CI, 0.85-0.98).

CONCLUSIONS AND RELEVANCE

Problem-solving education is efficacious in preventing depressive symptoms and appears to work by decreasing perceived stress; however, the mechanism for much of PSE's impact on depression remains unexplained. These results can be used to simplify the intervention model in preparation for effectiveness testing.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT01298804.

Behavioural medicine and gastrointestinal disorders: the promise of positive psychology

Psychosocial risk factors linked to brain-gut dysregulation are prevalent across the spectrum of gastrointestinal disorders and are associated with poor patient outcomes. Robust and reproducible data in the areas of behavioural intervention science and the brain-gut axis have led to major advances in patient care, including the routine use of brain-gut psychotherapies to manage digestive symptoms and optimize coping. The logical next step for the emerging field of psychogastroenterology is to develop a scientific framework that enables the identification of those individual characteristics and coping styles that buffer patients against the negative psychological effects of chronic gastrointestinal disorders. A shift towards a strength-based, positive psychological science of gastrointestinal disorders could facilitate the integration of early, effective psychological care into gastroenterology practice. In this Perspective, I discuss the potential role of three human strengths with relevance to gastrointestinal health - resilience, optimism and self-regulation - and how these three constructs can be cultivated through existing or emerging brain-gut psychotherapies.

Efficacy of a Maternal Depression Prevention Strategy in Head Start: A Randomized Clinical Trial

IMPORTANCE

Low-income and minority mothers experience a disproportionate incidence of depression and lack access to treatment services. Development of prevention strategies in accessible community-based venues is a potentially important public health strategy.

OBJECTIVE

To determine the efficacy of a depression prevention strategy embedded in Head Start.

DESIGN, SETTING, AND PARTICIPANTS

This randomized clinical trial was performed from February 15, 2011, through May 9, 2016, at 6 Head Start agencies serving families at or below the federal poverty level. Participants included mothers with depressed mood, anhedonia, or depression history but who were not in a current major depressive episode. Participants were followed up for 12 months with masked outcome assessments. Final follow-up was completed on May 9, 2016.

INTERVENTIONS

Participants were randomized to a problem-solving education (PSE) intervention (n = 111) or usual Head Start services (n = 119).

MAIN OUTCOMES AND MEASURES

Primary outcomes were problem-solving skills and depressive symptoms. To capture the chronicity and intensity of symptoms, the Quick Inventory of Depressive Symptoms was administered bimonthly, and rates of clinically significant symptom elevations were compared across groups. Secondarily, the presence of a major depressive episode was assessed using the Structured Clinical Interview for DSM-IV Axis I Disorders.

RESULTS

Among the 230 participants, 152 (66.1%) were Hispanic, with a mean (SD) age of 31.4 (7.3) years. An intention-to-treat analysis among 223 participants contributing follow-up data found no differences in problem-solving skills across groups. The mean (SD) number of depressive symptom elevations among the PSE participants was 0.84 (1.39) compared with 1.12 (1.47) among the usual service participants (adjusted incident rate ratio [aIRR], 0.60; 95% CI, 0.41-0.90). In analyses stratified according to baseline depressive symptoms, PSE exerted a preventive effect among those with lower-level baseline symptoms, with a mean (SD) of 0.39 (0.84) elevations among PSE participants compared with 0.88 (1.37) among usual service participants (aIRR, 0.39; 95% CI, 0.21-0.75). However, no difference was observed among those with higher-level baseline symptoms (mean [SD] elevations, 2.06 [1.92] for PSE and 2.00 [1.91] for usual service; aIRR, 1.10; 95% CI, 0.67-1.80). Analysis of symptom scores followed the same pattern, with an adjusted mean reduction of 1.33 (95% CI, 0.36-2.29) among participants with lower-level baseline symptoms.

CONCLUSIONS AND RELEVANCE

The PSE intervention is efficacious in preventing depressive symptom episodes and performs optimally among those with initial low-level symptoms. Additional effectiveness studies in Head Start are necessary to develop meaningful public health programs.

TRIAL REGISTRATION

clinicaltrials.gov Identifier: NCT01298804.

Coping and Social Support as Mediators of the Relation of Optimism to Depressive Symptoms Among Black College Students

This investigation examines mechanisms through which optimism may influence psychological adjustment among 133 Black college students. Specifically, this study evaluates the extent to which active and avoidant coping and social support account for the association between optimism and depressive symptoms. Participants completed questionnaires that included the Life Orientation Test-Revised, the COPE, the Social Provisions Scale, and the 12-item Center for Epidemiological Studies Depression Scale. Avoidant coping and social support mediated the relation between optimism and depressive symptoms, whereas active coping did not mediate this relationship. Results partially replicate those of prior research and illustrate the need for culturally sensitive theory regarding the combined effect of personality, coping strategies, and social support on psychological adjustment to stressful situations.

Relationship Expectations and Relationship Quality

This article reviews research that examines the effects of relationship expectations on interpersonal relationships. Most of the published research suggests that positive relationship expectations are associated with better interpersonal functioning, as indicated by greater relationship persistence, more positive relationship evaluations and motivations, more prorelationship behavior, more forgiveness, and reduced contempt. Research on related constructs, such as relationship efficacy, implicit theories, trust, and insecurity dispositions, suggests a similar conclusion. However, there is some evidence that positive relationship expectations may sometimes have negative effects on healthy relationship functioning. A model of the multiple pathways through which relationship expectations may promote and threaten relationship quality is described, and several directions for future research are suggested.

The impact of childhood emotional abuse and experiential avoidance on maladaptive problem solving and intimate partner violence

The purpose of the current study was to examine the joint influences of experiential avoidance and social problem solving on the link between childhood emotional abuse (CEA) and intimate partner violence (IPV). Experiential avoidance following CEA may interfere with a person's ability to effectively problem solve in social situations, increasing risk for conflict and interpersonal violence. As part of a larger study, 232 women recruited from the community completed measures assessing childhood emotional, physical, and sexual abuse, experiential avoidance, maladaptive social problem solving, and IPV perpetration and victimization. Final trimmed models indicated that CEA was indirectly associated with IPV victimization and perpetration via experiential avoidance and Negative Problem Orientation (NPO) and Impulsivity/Carelessness Style (ICS) social problem solving strategies. Though CEA was related to an Avoidance Style (AS) social problem solving strategy, this strategy was not significantly associated with IPV victimization or perpetration. Experiential avoidance had both a direct and indirect effect, via NPO and ICS social problem solving, on IPV victimization and perpetration. Findings suggest that CEA may lead some women to avoid unwanted internal experiences, which may adversely impact their ability to effectively problem solve in social situations and increase IPV risk.

Bringing life course home: a pilot to reduce pregnancy risk through housing access and family support

Proponents of life course comment that while the theory is persuasive, translating theory to practice is daunting. This paper speaks to the challenges and possibilities of intervention based on life course theory. It describes Healthy Start in Housing (HSiH), a partnership between the Boston Public Health Commission (BPHC) and the Boston Housing Authority (BHA) to reduce stress due to housing insecurity among low-income, pregnant women. HSiH seeks improved birth outcomes and long term health of mothers and infants. BHA goals are improved quality of life for participants, greater public housing stability and enhanced impact of housing on community well-being. HSiH is a 1 year pilot offering 75 housing units to pregnant women at risk of adverse birth outcomes and homelessness. BHA provides housing and expedites processing of HSiH applications; BPHC staff oversee enrollment, guide women through the application process, and provide enhanced, long-term case management. Of 130 women referred to HSiH to date, 53 were ineligible, 59 have submitted applications, 13 are preparing applications and 5 dropped out. Nineteen women have been housed. Among eligible women, 58 % had medical conditions, 56 % mental health conditions, and 14 % prior adverse outcomes; 30 % had multiple risks. Standardized assessments reflected high levels of depressive symptoms; 41 % had symptoms consistent with post-traumatic stress disorder. Life course theory provides both the framework and the rationale for HSiH. HSiH experience confirms the salience of daily social experience to women's health and the importance of addressing stressors and stress in women's lives.

Problem-solving orientation and attributional style as predictors of depressive symptoms in Egyptian adolescents with visual impairment

The association between attributional style (AS), problem-solving orientation (PSO), and gender on depressive symptoms was investigated in Egyptian adolescents with visual impairment (VI). After being written in Braille, measures of AS, PSO, and depression were administered to 110 adolescents with VI, ages 12–17 years, from a residential school for pupils with VI. Regression analyses showed that gender, negative general (NG) attributions, and negative problem-solving orientation (NPSO) were the strongest predictors of depressive symptoms in adolescents with VI, whereas negative internal (NI) attributions and avoidant problem-solving orientation (APSO) were weak predictors. The findings are discussed in relation to different perspectives and models of depression, particularly the stress-diathesis model. The theory that these cognitive variables are core constituents of a cognitive diathesis model of depression in individuals with VI is not supported by this study.

Association between anticipatory grief and problem solving among family caregivers of persons with cognitive impairment

OBJECTIVE

Measure perceived involvement in medical decision making and determine if anticipatory grief is associated with problem solving among family caregivers of older adults with cognitive impairment.

METHOD

Retrospective analysis of baseline data from a caregiver intervention (n = 73). Multivariable regression models testing the association between caregivers' anticipatory grief, measured by the Anticipatory Grief Scale (AGS), with problem-solving abilities, measured by the social problem solving inventory-revised: short form (SPSI-R: S).

RESULTS

47/73 (64%) of caregivers reported involvement in medical decision making. Mean AGS was 70.1 (± 14.8) and mean SPSI-R: S was 107.2 (± 11.6). Higher AGS scores were associated with lower positive problem orientation (p = .041) and higher negative problem orientation scores (p = .001) but not other components of problem solving-rational problem solving, avoidance style, and impulsivity/carelessness style.

DISCUSSION

Higher anticipatory grief among family caregivers impaired problem solving, which could have negative consequences for their medical decision making responsibilities.

Specificity of problem-solving skills training in mothers of children newly diagnosed with cancer: results of a multisite randomized clinical trial

PURPOSE

Diagnosis of cancer in a child can be extremely stressful for parents. Bright IDEAS, a problem-solving skills training (PSST) intervention, has been shown to decrease negative affectivity (anxiety, depression, post-traumatic stress symptoms) in mothers of newly diagnosed patients. This study was designed to determine the specificity of PSST by examining its direct and indirect (eg, social support) effects compared with a nondirective support (NDS) intervention.

PATIENTS AND METHODS

This randomized clinical trial included 309 English- or Spanish-speaking mothers of children diagnosed 2 to 16 weeks before recruitment. Participants completed assessments prerandomization (T1), immediately postintervention (T2), and at 3-month follow-up (T3). Both PSST and NDS consisted of eight weekly 1-hour individual sessions. Outcomes included measures of problem-solving skill and negative affectivity.

RESULTS

There were no significant between-group differences at baseline (T1). Except for level of problem-solving skill, which was directly taught in the PSST arm, outcome measures improved equally in both groups immediately postintervention (T2). However, at the 3-month follow-up (T3), mothers in the PSST group continued to show significant improvements in mood, anxiety, and post-traumatic stress; mothers in the NDS group showed no further significant gains.

CONCLUSION

PSST is an effective and specific intervention whose beneficial effects continue to grow after the intervention ends. In contrast, NDS is an effective intervention while it is being administered, but its benefits plateau when active support is removed. Therefore, teaching coping skills at diagnosis has the potential to facilitate family resilience over the entire course of treatment.

Towards an idiothetic understanding of the role of social problem solving in daily event, mood and health experiences: A prospective daily diary approach

OBJECTIVES

Utilising D'Zurilla's (1986, 1990) transactional social problem solving model as the theoretical framework, the present study sought to examine the dynamics of the social problem solving process in relation to intraindividual experiences of events, mood, and physical health in daily life.

DESIGN

The study incorporated both idiographic and nomothetic strategies, combining a daily diary approach within a prospective design. As such, each individual's experience of events, mood, and health were assessed on a daily basis, and the prospective relations between social problem solving and these day-to-day experiences examined.

METHODS

Participants' (university students) completed a measure of social problem solving at baseline followed, approximately 5 weeks later, by daily self-reports of mood (positive & negative), events (hassles & uplifts), and physical health (health status & URI symptoms) for a period of 14 days. The data were analysed using multilevel hierarchical modelling.

RESULTS

Days on which individuals had greater than their average hassles were associated with higher negative and lower positive mood (i.e. domain specific & cross-over effects), whilst greater uplifts were linked to positive mood only. With regard to health, individuals reported worse status and more URI symptoms on days with greater than their average negative (hassles, negative mood) but not positive influences (uplifts, positive mood). Both social problem solving orientations and skills dimensions were associated prospectively with daily health outcomes, and these relationships were not moderated by day-to-day experiences of mood or events.

CONCLUSIONS

The data clarify the importance of social problem solving to within-person daily event, mood, and health experiences. The implications of these findings for contemporary transactional social problem solving models are discussed.

An Exploration of the Burnout Situation on Teachers in Two Schools in Macau

To explore the burnout situation of teachers in two schools in Macau and to investigate any differences made of demographic characteristics. The relation of burnout on social problem solving and holistic health of teachers is also studied. A self reported questionnaire with the Chinese Maslach Burnout Inventory (C-MBI), Chinese Social Problem Solving Inventory (C-SPSI) and the Body-Mind-Spirit Well-Being Inventory (BMSWBI) were used. Totally 138 teachers participated in the study. With Hong Kong data as a reference, Macau teachers scored in the average range of burnout in emotional exhaustion and depersonalization but scored in the low range of burnout in personal accomplishment. Significance differences were found in some dimensions of burnout in age, marital status, teaching experiences, education background and satisfaction with income. Both C-SPSI and BMSWBI were found to be significantly negative correlated with emotional exhaustion and depersonalization and positive correlated with personal achievement. The findings identified those with greater degree of burnout, to whom more attention should be paid. The study also contributed to the limited literature on the quality of life of teachers in Macau. Finally, the findings added on the data base for comparison internationally among the Chinese population.

Which thoughts can kill a boxer? naive theories about cognitive and emotional antecedents of suicide

OBJECTIVES

We investigated naive theories regarding the association among beliefs, emotions and behaviours to test Rational Emotive Behaviour Therapy's (REBT) assumption that rational cognitions and adaptive emotions lead to functional behaviours whereas irrational cognitions and maladaptive emotions trigger dysfunctional reactions.

DESIGN

We applied an experimental between-subjects design.

METHODS

Participants read newspaper articles about the defeat of a boxer. In one condition, the authentic article informed participants that he committed suicide and in the other, a fictitious article about the same defeat described the athlete as successfully continuing his career. Different question formats were employed to assess participants' assumptions about the stimulus person's defeat-related cognitions and emotions: rating scales, sentence completion and free responses.

RESULTS

Participants assumed significantly more irrational beliefs (e.g. I absolutely have to win) on the side of the boxer in the suicide scenario than in the non-suicide version. This finding was obtained by directive and non-directive assessment methods. Additionally, participants expected the suicidal stimulus person to be experiencing maladaptive emotions (e.g. depression, guilt) whereas a successful resumption of his career lead to expectations of adaptive affects (e.g. sadness, concern). Ratings of the functionality revealed that sadness, fear, annoyance and concern were expected to be more functional than depression, anxiety, rage and guilt.

CONCLUSIONS

The results show that naive psychological theories about the antecedents of dysfunctional behaviour are in accordance with theoretical assumptions of REBT: Irrational beliefs are viewed to be connected with maladaptive emotions and to result in dysfunctional behaviour, and adaptive emotions are thought to be of higher functional value than their maladaptive counterparts. The use of different question formats and a between-subject design excluded that results are due to methodological artifacts or contrast effects.

The Chinese version of the social problem-solving inventory: some initial results on reliability and validity

The development of an instrument that measures social problem solving of Chinese adolescents is reported. The Social Problem-Solving Inventory Revised (SPSI-R) was translated to Chinese, and content validity, cultural relevance, and reading level of the translated measure were reviewed by panels of experts. The Chinese version of the scale (C-SPSI-R) was then administered to a sample of 352 junior secondary-school students. Exploratory factor analyses revealed a 5-factor structure that was largely consistent with the structure of the original English-language SPSI-R. The C-SPSI-R and its subscales were found to be internally consistent and temporally stable over time. The scores of the subscales were also correlated with depression scores, a correlation that supported the convergent validity of the subscales. Adolescents with high and low Chinese Beck Depression Inventory scores had significant differences in four out of five subscales of the C-SPSI-R (except Rational Problem-Solving). On the whole, the results supported that the C-SPSI-R is a reliable and valid instrument in the assessment of social problem solving in Chinese adolescents.

Negative problem orientation (Part II): construct validity and specificity to worry

Negative problem orientation, a dysfunctional set of attitudes related to problem-solving ability, has been implicated as a process variable in several psychological disorders, notably depression and generalized anxiety disorder (GAD). The goal of the present study was two-fold: (1) to further examine the construct validity of a new measure of negative problem orientation, the negative problem orientation questionnaire (NPOQ), through its relationship to conceptually similar variables, and (2) to investigate the specificity of negative problem orientation to worry, the cardinal feature of GAD, compared to depression. The sample consisted of 148 university students who completed six questionnaires, the NPOQ and measures of worry, depression, pessimism, self-mastery, and neuroticism. Multiple hierarchical regressions revealed that when entered in the last step following demographic information and personality variables (pessimism, self-mastery, and neuroticism), the NPOQ accounted for 5.6% of the variance in worry scores compared to 1.6% of the variance in depression scores. It was concluded that the NPOQ shows evidence of construct validity, and that the process variable of negative problem orientation appears to have greater specificity to worry than depression. Implications for the understanding of worry and GAD are discussed.

Negative problem orientation (Part I): psychometric properties of a new measure

Negative problem orientation, a set of dysfunctional attitudes toward social problem-solving, has increasingly become an important construct in our understanding of deficits in problem-solving ability in daily life. Until recently, no measure was specifically constructed to assess negative problem orientation directly, other than as a subscale in a more global measure of problem-solving ability. The goal of the present study was to translate the French version of the Negative Problem Orientation Questionnaire (NPOQ), and to examine its psychometric properties. The sample consisted of 201 university students who completed five questionnaires assessing psychological distress, pessimism, components of problem-solving ability, and the NPOQ. A unitary factor structure was revealed, accounting for 54.8% of the variance. The NPOQ had excellent internal consistency, good test-retest reliability at 5 weeks, and demonstrated convergent and discriminant validity when measured against self-reported pessimism, depression, anxiety, and problem-solving ability. The findings suggest that the NPOQ is a measure with sound psychometric properties that will be a valuable tool in future research on problem orientation.

Problem-solving and distress in prostate cancer patients and their spousal caregivers

GOALS OF WORK

Prostate cancer, the most common life-threatening cancer among American men, increases risk of psychosocial distress and negatively impacts quality of life for both patients and their spouses. To date, most studies have examined the relationship between patient coping and distress; however, it is also likely that what the spouse does to cope, and ultimately how the spouse adjusts, will affect the patient's adjustment and quality of life. The present study examined the relationships of spouse problem-solving coping, distress levels and patient distress in the context of prostate cancer. The following mediational model was tested: Spouses' problem-solving coping will be significantly inversely related to patients' levels of distress, but this relationship will be mediated by spouses' distress levels.

PATIENTS AND METHODS

One hundred seventy-one patients with prostate cancer and their spousal caregivers were assessed for mood; spouses were assessed for problem-solving coping skills. Structural equation modeling was used to test model fit.

MAIN RESULTS

The model tested was a good fit to the data. Dysfunctional spousal problem-solving was a significant predictor of spouse distress level but constructive problem-solving was not. Spouse distress was significantly related to patient distress. Spouse dysfunctional problem-solving predicted patient distress, but this relationship was mediated by spouse distress. The same mediational relationship did not hold true for constructive problem-solving.

CONCLUSIONS

Spouse distress mediates the relationship between spouse dysfunctional coping and patient distress. Problem-solving interventions and supportive care for spouses of men with prostate cancer may impact not only spouses but the patients as well.

The mediating role of appraisal and coping in the relationship between optimism-pessimism and quality of life

Longitudinal data from 165 women diagnosed and treated for breast cancer were used to investigate if the relationship between optimism-pessimism and quality of life (QOL) is attributed to the appraisal and coping strategies. The women completed the Life Orientation Test-Revised (LOT-R), as a measurement of optimism-pessimism, the Mental Adjustment to Cancer (MAC) Scale, as a measure for coping, a VAS for appraisal and the EORTC QLQ-C30, as a measure for QOL at two time points: at diagnosis and 12-months after breast cancer surgery. Optimism-pessimism had both a direct and indirect influence on QOL. Two coping strategies were particularly strong mediators for the indirect influence: fighting spirit and hopeless/helpless. Optimists responded with fighting spirit, which had a positive effect on their QOL. On the other hand, pessimists responded with hopeless/helplessness, which had a negative effect on their QOL. The relationship between pessimism and QOL at time of diagnosis was also mediated by appraisal, such as threat. The two coping strategies remained fairly stable over the 12 months within the optimists and pessimists.The results suggest that the influence of optimism and pessimism on QOL appears to be mediated by coping both before and after treatment for breast cancer. Fighting spirit and hopeless/helplessness appear to reflect the characteristic coping strategies for optimists and pessimists.

History of family suicide behaviors and negative problem solving in multiple suicide attempters

This study examined the relationship between family history of suicide, negative problem solving orientation and suicide attempt status (multiple suicide attempters versus single suicide attempters). Suicide attempters with a family history of suicide were more likely to have multiple suicide attempts when compared to suicide attempters who did not have a family history of suicide. This relationship was consistent with a model in which the relationship between family history and suicide attempt status is mediated by negative problem solving. Results of this study are discussed as they pertain to the theory and treatment of suicide attempters.

A controlled, problem-solving, group-based intervention with vulnerable incarcerated young offenders

Recent research has indicated that vulnerable incarcerated young offenders--such as those at risk of suicidal behaviour, those on formal protection due to their inability to assimilate into mainstream, and those who are bullied but remain in normal circulation--display impoverished problem-solving abilities. Furthermore, deficits in their problem-solving skills are significantly correlated with levels of anxiety, depression, and hopelessness. This study evaluated the effectiveness of a time-limited, group-based problem-solving training intervention compared with a no-treatment control for vulnerable, incarcerated young offenders. A total of 46 young offenders were equally allocated to intervention or control groups. Intervention participants experienced significant reductions in their levels of anxiety, depression, and hopelessness and improvement in their self-assessed social problem-solving abilities. Gains in aspects of self-assessed problem-solving ability and mental health for the intervention group continued to be evident at 3-month follow-up. Methodological concerns in this study and directions for future research are discussed.

Problem-solving skills training for mothers of children with newly diagnosed cancer: a randomized trial

Mothers of children with serious illnesses have lower levels of well-being than mothers in the general population. Problem-solving therapy (PST), a cognitive-behavioral intervention, has been shown to be effective in treating negative affectivity (depression, anxiety) and other manifestations of reduced well-being. This report describes a problem-solving skills training (PSST) intervention, based on problem-solving therapy, for mothers of newly diagnosed pediatric cancer patients. Ninety-two mothers were randomly assigned to receive PSST or to receive standard psychosocial care (Control Group). After the 8-week intervention, mothers in the PSST Group had significantly enhanced problem-solving skills and significantly decreased negative affectivity compared with controls. Analysis revealed that changes in self-reports of problem-solving behaviors accounted for 40% of the difference in mood scores between the two groups. Interestingly, PSST had the greatest impact on improving constructive problem solving, whereas improvement in mood was most influenced by decreases in dysfunctional problem solving. The implications of these findings for refinement of the PSST intervention and for extension to other groups of children with serious illnesses are discussed.

Working with low back pain: workplace and individual psychosocial determinants of limited duty and lost time

BACKGROUND

Few studies have identified the risk factors associated with lost time in employees working with occupational low back pain (OLBP) despite the presence of pain. Such data could assist in the development of evidenced-based secondary prevention programs.

METHODS

The present investigation was a case-control study (n = 421) of demographic, health behavior, ergonomic, workplace and individual psychosocial factors hypothesized to be associated with lost time in young, full-time employees (i.e., soldiers) with OLBP. Analyses of the burden of OLBP in terms of the number of days on limited duty and lost time status were also computed.

RESULTS

Logistic regression analysis indicated that female gender, education beyond HS/GED, longer time working in military, higher levels of daily life worries, no support from others, higher levels of ergonomic exposure, stressful work, increased peer cohesion, and greater perceived effort at work placed a worker at a greater likelihood for OLBP-related lost work time. Lower levels of innovation, involvement, and supervisor support were also associated with lost time. Linear regression indicated that the number of days of lost time and limited duty was associated with lower levels of physical health and higher levels of symptom severity.

CONCLUSIONS

The results support the potential utility of interventions targeting ergonomic, workplace and individual psychosocial risk factors in secondary prevention.

Working with low back pain: problem-solving orientation and function

A number of ergonomic, workplace and individual psychosocial factors and health behaviors have been associated with the onset, exacerbation and/or maintenance of low back pain (LBP). The functional impact of these factors may be influenced by how a worker approaches problems in general. The present study was conducted to determine whether problem-solving orientation was associated with physical and mental health outcomes in fully employed workers (soldiers) reporting a history of LBP in the past year. The sample consisted of 475 soldiers (446 male, 29 female; mean age 24.5 years) who worked in jobs identified as high risk for LBP-related disability and reported LBP symptoms in the past 12 months. The Social Problem-Solving Inventory and the Standard Form-12 (SF-12) were completed by all subjects. Hierarchical multiple regression analyses were used to predict the SF-12 physical health summary scale from interactions of LBP symptoms with each of five problem-solving subscales. Low scores on positive problem-solving orientation (F(1,457)=4.49), and high scores on impulsivity/carelessness (F(1,457)=9.11) were associated with a steeper gradient in functional loss related to LBP. Among those with a longer history of low-grade LBP, an avoidant approach to problem-solving was also associated with a steeper gradient of functional loss (three-way interaction; F(1,458)=4.58). These results suggest that the prolonged impact of LBP on daily function may be reduced by assisting affected workers to conceptualize LBP as a problem that can be overcome and using strategies that promote taking an active role in reducing risks for LBP. Secondary prevention efforts may be improved by addressing these factors.

Einfluß symptombezogener vs. ablenkender Aufmerksamkeit auf die Problemorientierung subklinisch Depressiver in interpersonalen Situationen

Zusammenfassung.Theoretischer Hintergrund: Aspekte der Problemorientierung depressiver Personen gegenüber interpersonalen Problemsituationen wurden vor dem Hintergrund des Prozeßmodells von Nezu, Nezu und Perri (1989) und unter Bezugnahme auf den Reaktionsstil-Ansatz von Nolen-Hoeksema (1991) untersucht. Fragestellung: Es wurde die Annahme überprüft, daß die bei depressiven Probanden zu erwartenden Defizite in der Problemorientierung insbesondere bei ruminierendem Aufmerksamkeitsfokus auftreten und durch einen ablenkenden Aufmerksamkeitsfokus abgemildert werden können. Methode: Bei jeweils der Hälfte der subklinisch depressiven (n = 30) bzw. nicht depressiven Probanden (n = 40) wurde ein ruminierender bzw. ablenkender Aufmerksamkeitsfokus induziert. Die Probanden wurden dann aufgefordert, sich in fünf aversive/mehrdeutige interpersonale Problemsituationen hineinzuversetzen. Für jede Problemsituation wurden verschiedene Aspekte der Problemorientierung anhand eines Fragebogens erfaßt. Ergebnisse: Für Problemattribution, Problembewertung, Kontrollerwartung und Annäherungstendenz, nicht aber für subjektive Wichtigkeit, Kontrollierbarkeitserwartung und Vermeidenstendenz zeigten sich die erwarteten Unterschiede zwischen subklinisch depressiven und nicht depressiven Probanden. Entgegen den Annahmen von Nolen-Hoeksema (1991) veränderten sich die Ergebnisse nicht in Abhängigkeit von der Art der Aufmerksamkeitsfokussierung. Schlußfolgerungen: Es zeigten sich die erwarteten Defizite in der Problemorientierung depressiver Probanden. Daß sich die Ergebnisse nicht in Abhängigkeit vom induzierten Aufmerksamkeitsfokus verändern, wird u.a. darauf zurückgeführt, daß es sich bei ruminierender vs. ablenkender Aufmerksamkeitsfokussierung möglicherweise eher um habituelle Reaktionsstile handelt, die nur schwer durch kurzfristige experimentelle Manipulationen zu verändern sind.