Social comparisons and temporal comparisons after coronary artery surgery

If only… a systematic review and meta-analysis of social, temporal and counterfactual comparative thinking in PTSD

Comparative thinking is ubiquitous in human cognition. Empirical evidence is accumulating that PTSD symptomatology is linked to various changes in social, temporal and counterfactual comparative thinking. However, no systematic review and meta-analysis in this line of research have been conducted to this date. We searched titles, abstracts and subject terms of electronic records in PsycInfo and Medline from inception to January 2019 with various search terms for social, temporal and counterfactual comparative thinking as well as PTSD. Journal articles were included if they reported a quantitative association between PTSD and social, temporal and/or counterfactual comparative thinking in trauma-exposed clinical or sub-clinical samples. A total of 36 publications were included in the qualitative synthesis. The number of publications on the association between PTSD and social and temporal comparative thinking was too scarce to warrant a meta-analytic review. A narrative review of available literature suggests that PTSD is associated with distortions in social and temporal comparative thinking. A meta-analysis of 24 independent samples (n = 4423) assessing the association between PTSD and the frequency of counterfactual comparative thinking yielded a medium to large positive association of r =.464 (p <.001, 95% CI =.404; .520). Higher study quality was associated with higher magnitude of association in a meta-regression. Most studies collected data cross-sectionally, precluding conclusions regarding causality. Overall, study quality was found to be moderate. More longitudinal and experimental research with validated comparative thinking measures in clinical samples is needed to acquire a more sophisticated understanding of the role of comparative cognitions in the aetiology and maintenance of PTSD. Comparative thinking might be a fruitful avenue for a better understanding of posttraumatic reactions and improving treatment.

Standards of Comparison and Discordance in Rheumatoid Arthritis Global Assessments Between Patients and Clinicians

OBJECTIVE

Patient-physician discordance in health status ratings may arise because patients use temporal comparisons (comparing their current status with their previous status), while clinicians use social comparisons (comparing this patient's status to that of other patients, or to the full range of disease severity possible) to guide their assessments. We compared discordance between patients with rheumatoid arthritis (RA) and clinicians, using either the conventional patient global assessment (PGA) or a rating scale with 5 anchors describing different health states. We hypothesized that discordance would be smaller with the rating scale because clinicians likely used similar social comparisons when making global assessments.

METHODS

We prospectively studied 206 patients with active RA and assessed the PGA (range 0-100), rating scale (range 0-100), and evaluator global assessment (EGA; range 0-100) on each of 2 visits (total visits = 401). We compared the PGA/EGA discordance and the rating scale/EGA discordance at each visit.

RESULTS

The mean ± SD PGA/EGA discordance was 8.5 ± 22.4, and the mean ± SD rating scale/EGA discordance was 2.3 ± 24.0. The intraclass correlation, measuring agreement, was higher between the rating scale and EGA than between the PGA and EGA (0.39 versus 0.31). Agreement was larger at low levels of RA activity on both pairs of measures.

CONCLUSION

Discordance between patients' global assessments and evaluators' global assessments was smaller when patients used a social standard of comparison than when they marked the PGA, suggesting that differences in standards of comparison contribute to patient-clinician discordance when the PGA is used.

Temporal comparison theory and elderly satisfaction with their body: a preliminary study

OBJECTIVES: Studies on body satisfaction have been neglecting a possible contribution of temporal comparisons (TC) for determining people's satisfaction with their body. The purpose of this work is to provide preliminary data on the usefulness of TC theory in determining body satisfaction in elderly individuals. METHODS: Participants were 18 functionally limited elderly adults, aged 68-90 years. After receiving three theory-related stimuli (social comparison, temporal comparison, and self-schema), they completed two scales: a scale on satisfaction with body functioning and a scale on body appearance satisfaction. RESULTS: Satisfaction with body functioning and satisfaction with body appearance did not differ among theory-related stimuli. TC-related correlations were stronger than the other theory-related correlations, even when adjusted for confounding variables. CONCLUSIONS: Our results suggest that TC theory may be a useful framework for explaining body satisfaction in the elderly. Studies on this subject should be encouraged. However, further research is needed before any conclusion can be drawn.

Social comparisons and chronic illness: research synthesis and clinical implications

The chronically ill patient must adjust to new life circumstances and manage ongoing threats to personal health. Patients often make comparisons with each other, which can have effects on their psychological and physical well-being. One question is whether health psychologists can develop interventions to strategically facilitate the use of such comparisons to optimise adjustment. This paper critically reviews evidence on patients' comparisons in studies using selection, narration and reaction methods. Discussion focuses on gaps in the empirical literature and describes some new basic concepts in social comparison, which may advance knowledge about the process in medical patients. Recommendations also are provided about the kinds of studies needed to inform the future design of effective social comparison interventions.

A systematic review and meta-analysis of the incidence and severity of postoperative fatigue

OBJECTIVE

Postoperative fatigue is common following major abdominal surgery. Less is known about its prevalence in other surgical subgroups, and about its long-term prognosis. A systematic review of prospective cohort studies was conducted to clarify these issues.

METHOD

Studies were identified from an extensive literature search. Overall estimates of pre- to postoperative change in fatigue severity and the incidence of clinically significant postoperative fatigue were calculated using meta-analyses.

RESULTS

Eighty-one cohorts were identified. Type of surgery was found to be a possible predictor of fatigue severity, with major abdominal, gynaecological, cardiac and minor surgery apparently associated with greater fatigue than orthopaedic surgery. Limited data were available regarding the long-term persistence of postoperative fatigue.

CONCLUSION

Postoperative fatigue appears to be an important problem following only certain forms of surgery. Why this is so remains unclear, and further work using better fatigue questionnaires is now required to confirm these differences.

Boosting Strategies: Enhancing the Self-Esteem of Individuals With Catastrophic Illnesses and Injuries

This qualitative study used grounded theory methods to determine how individuals were able to live with catastrophic illnesses and injuries. Twenty-eight participants were interviewed for stories of how they endured their circumstances. Although several strategies were used, this article describes a strategy entitled "boosting," which outlines the affected individuals' efforts to improve their self-esteem, which helped them bear their circumstances. Boosting has some relationship to social comparison theory. Implications for nurses and the importance of awareness of this communication need for patients are discussed.

"Are you better?" A qualitative study of the meaning of recovery

PURPOSE

Research into the meaning of illness has often focused on an individual's transition into a state of being ill, for example the adoption of a sick role. The question "Are you better?" addresses the transition out of this state and is fundamental to the patient-clinician relationship, guiding decisions about treatment. However, the question assumes that all patients have the same meaning for "being better." The purpose of this study was to explore the meaning of the concept of recovery (getting better) in a group of people with upper limb musculoskeletal disorders.

METHODS

Qualitative (grounded theory) methods were used. Individual interviews were conducted with 24 workers with work-related musculoskeletal disorders of the upper limb. The audiotaped interviews were transcribed and coded for content. Categories were linked, comparisons made, and a theory built about how people respond to the question "Are you better?"

RESULTS

The perception of "being better" is highly contextualized in the experience of the individual. Being better is not only reflected in changes in the state of the disorder (resolution) but could be an adjustment of life to work around the disorder (readjustment) or an adaptation to living with the disorder (redefinition). The experience of the disorder can be influenced by factors such as the perceived legitimacy of the disorder, the comparators used to define health and illness, and coping styles, which in turn can influence being better.

CONCLUSION

Two patients could mean very different things when saying that they are better. Some may not actually have a change in disease state as measured by symptoms, impairments, or function.