Measures of self-efficacy and optimism in older adults with generalized anxiety

The Brave Patient after 80-Satisfaction with Visit and Individual Determinants of Proactive Patient Attitude among the Oldest General Practice Users

Background. A patient’s adherence to a course of treatment depends on the individual’s activation, the quality of patient–clinician relations, attitudes, self-efficacy, or positive emotions. Patient proactive attitude (PAA) is seldom researched among the oldest healthcare users. This study was designed to identify predictors of PAA toward health and treatment among community-dwelling general practice patients aged 80+, and was based on a PRACTA (PRomoting ACTive Aging) project. Methods. Patients (n = 658), aged 80+ visiting a general practitioner (GP) filled in the PRACTA attitude toward treatment and health scale and the PRACTA self-efficacy scale questionnaires. Sociodemographic factors, self-reported health status, and satisfaction with the visit were analyzed as independent factors. Results. Attitudes toward treatment and health scores were predicted by marital status, living alone or not alone, hospitalization the prior year, level of impairment, and satisfaction with visit. However, some differences were observed depending on the device’s subscale. Self-efficacy score was determined by marital status, living alone or not alone, prior hospitalization, and satisfaction with visit. We did not find an effect of age or gender on PAA. Patient satisfaction with visit was the strongest predictor of all PAA dimensions. Conclusion. Higher visit satisfaction helps to retain a PAA among seniors 80+. Screening questions about living situation, marital and functional status, emotional state, and recent history of hospitalization might help GPs additionally anticipate PAA level and adjust their actions accordingly.

The Relative Deprivation Trap: How Feeling Deprived Relates to Symptoms of Generalized Anxiety Disorder

Introduction: How income inequality associates with poorer mental health remains unclear. Personal relative deprivation (PRD) involves appraising oneself as unfairly disadvantaged relative to similar others and has been associated with poorer mental health and negative cognitive appraisals. As generalized anxiety disorder (GAD) is associated with negative cognitive appraisals, PRD may relate to the experience of GAD and its cognitive predictors, intolerance of uncertainty (IU), positive beliefs about worry (PBW), negative beliefs about worry (NBW), and experiential avoidance (EA).

Method: In two observational studies (Study 1, N = 588; Study 2, N = 301) participants completed measures of PRD, cognitive predictors and symptoms of GAD, subjective socioeconomic status (SES), self-efficacy, and self-esteem.

Results: A relationship between PRD and GAD was found across studies, which was simultaneously mediated by IU and NBW. These results remained when controlling for subjective SES but were weakened when controlling for self-concept factors.

Discussion: This research supports the possibility that the experience of deprivation may “trap” people in thinking patterns that contribute to anxious symptomology.

Evidencias psicométricas iniciales de la escala de autoeficacia para envejecer (EAEE) en adultos mayores peruanos

El estudio examina las evidencias psicométricas de la Escala de Autoeficacia para Envejecer (EAEE) en una muestra de 400 adultos mayores (75.2% mujeres y 24.8% hombres) de la ciudad de Trujillo (Perú) con una edad promedio de 73.37 años (DE = 7.86). Los participantes completaron la EAEE junto con medidas de satisfacción con la vida y depresión. El análisis factorial exploratorio (AFE), reveló que la EAEE presentaba una estructura factorial unidimensional. El análisis factorial confirmatorio (AFC), mostró que el modelo unidimensional tenía un ajuste aceptable (S-Bχ2 = 54.02, df = 345 p = .001; S-Bχ2/df = 1.54; CFI = .97; RMSEA = .052 [IC90% .021, .078]; y SRMR = .049; AIC= 118.96) y una confiabilidad adecuada (ω = .88 [IC95% .84 – .91]; α = .88 [IC95%: .84 - .91]). Los puntajes de la EAEE se correlacionaron de manera positiva con la satisfacción con la vida (r = .56, p< .01 [IC95%: .46, .79]) y negativa con la depresión (r = -.48, p< .01 [IC95%: -.37, -.73]). Los resultados sugieren que la EAEE presenta evidencias de validez basada en la estructura interna, convergente y discriminante, así como una adecuada confiabilidad.

Optimism and Well-Being Among Institutionalized Older Adults

Abstract. Institutionalization is often related to the psychologically negative outcomes of old age. Optimism could alleviate suffering, but little is known about its role in institutionalized settings. We sought to explore optimism correlates and to determine whether it predicts emotional well-being variables, after controlling for potential covariates, by assessing 66 institutionalized elderlies. Optimism was low and associated with failure to do physical exercise, urinary incontinence, increased anxiety, depressive symptoms and feelings of loneliness, and reduced satisfaction with life and positive affect. Optimism predicted emotional well-being, albeit not over and above some covariates. Given the low optimism levels and the correlates, we suggest that intrapersonal resources could be intervention targets. It is our hope that our findings will inspire research to analyze interventions promoting optimism-beneficial combinations of well-being among institutionalized older adults.

Effect of perceived stress on depression of Chinese "Ant Tribe" and the moderating role of dispositional optimism

This study examines the moderating role of dispositional optimism on the relationship between perceived stress and depression of the Chinese "Ant Tribe." A total of 427 participants from an Ant Tribe community completed the measures of perceived stress, optimism, and depression. The structural equation modeling (SEM) analysis showed that dispositional optimism moderated the association between perceived stress and depression. The Ant Tribe with high perceived stress reported higher scores in depression than those with low perceived stress at low dispositional optimism level. However, the impact of perceived stress on depression was insignificant in the high dispositional optimism group.

Predictors of change in quality of life in older adults with generalized anxiety disorder

BACKGROUND

Quality of life (QOL) is lower in older adults with generalized anxiety disorder (GAD). QOL generally improves following cognitive-behavioral treatment for GAD. Little is known, however, about additional variables predicting changes in QOL in older adults with GAD. This study examined predictors of change in QOL among older participants in a randomized clinical trial of cognitive behavioral therapy (CBT) for GAD, relative to enhanced usual care (EUC).

METHODS

Hierarchical multilevel mixed-model analyses were used to examine inter-individual and intra-individual factors that predicted QOL over time. Predictors were categorized into treatment, personal and clinical characteristics.

RESULTS

QOL improved over time, and there was significant variability between participants in change in QOL. Controlling for treatment condition, baseline general self-efficacy, baseline social support, within-person variation in worry and depression and average levels of depression across different time points predicted changes in QOL.

CONCLUSIONS

QOL has increasingly been used as an outcome measure in treatment outcome studies to focus on overall improvement in functioning. Attention to improvement in symptoms of depression and worry, along with psychosocial variables, such as social support and self-efficacy, may help improve QOL in older adults with GAD. This study was a secondary study of data from a randomized clinical trial (NCT00308724) registered with clinical.trials.gov.

The impacts of dispositional optimism and psychological resilience on the subjective well-being of burn patients: a structural equation modelling analysis

Burn wounds are severely stressful events that can have a significant impact on the mental health of patients. However, the impact of burns on individuals with different personality traits can be different. The present study aimed to investigate the impact of dispositional optimism on the subjective well-being of burn patients, and mainly focused on the confirmation of the mediator role of psychological resilience. 410 burn patients from five general hospitals in Xi'an accomplished the revised Life Orientation Test, Connor-Davidson Resilience Scale, and Subjective Well-Being (SWB) scale. The results revealed that both dispositional optimism and psychological resilience were significantly correlated with SWB. Structural equation modelling indicated that psychological resilience partially mediated the relationship between dispositional optimism and SWB. The current findings extended prior reports and shed some light on how dispositional optimism influenced SWB. Limitations of the study were considered and suggestions for future studies were also discussed.

The Pittsburgh Sleep Quality Index in older primary care patients with generalized anxiety disorder: psychometrics and outcomes following cognitive behavioral therapy

The Pittsburgh Sleep Quality Index (PSQI) is a widely used, comprehensive self-report measure of sleep quality and impairment, which has demonstrated good psychometric properties within various populations, including older adults. However, the psychometric properties of the PSQI and its component scores have not been evaluated for older adults with generalized anxiety disorder (GAD). Additionally, changes in PSQI global or component scores have not been reported following cognitive-behavioral treatment (CBT) of late-life GAD. This study examined (1) the psychometric properties of the PSQI within a sample of 216 elderly primary care patients age 60 or older with GAD who were referred for treatment of worry and/or anxiety; as well as (2) response to CBT, relative to usual care, for 134 patients with principal or coprincipal GAD. The PSQI demonstrated good internal consistency reliability and adequate evidence of construct validity. Those receiving CBT experienced greater reductions in PSQI global scores at post-treatment, relative to those receiving usual care. Further, PSQI global and component scores pertaining to sleep quality and difficulties falling asleep (i.e., sleep latency and sleep disturbances) demonstrated response to treatment over a 12-month follow-up period. Overall, results highlight the usefulness of the PSQI global and component scores for use in older adults with GAD.

Relationship of quality of life to dispositional optimism, health locus of control and self-efficacy in older subjects living in different environments

PURPOSE

To describe the relationship of dispositional optimism, health locus of control and self-efficacy to quality of life (QOL) in older subjects differing in level of disability and institutionalisation.

METHODS

The study was conducted in the three groups of subjects aged > or = 65: 110 relatively healthy community-dwelling elderly, 102 independent elders who voluntarily decided to live in veteran home and 112 inhabitants of a long-term care home. Life orientation test-revised (LOT-R), multidimensional health locus of control (MHLC) and generalised self-efficacy scale (GSES) together with a multidimensional assessment were performed with each subject. QOL was assessed using the Euroqol 5D questionnaire, the Nottingham health profile and the satisfaction with life scale (SWLS).

RESULTS

QOL generally decreased with growing level of dependence and institutionalisation. LOT-R, MHLC and GSES were important and independent correlates of QOL in all three environments of older subjects. The relationship of education, smoking habit, physical activity, strength and mobility measures to psychological characteristics was different in the three groups of elders. LOT-R, MHLC Powerful Others, MHLC Chance and GSES were the most important QOL correlates in veteran home group, while MHLC Internal was most significant in long-term care home inhabitants.

CONCLUSIONS

Data of this cross-sectional study suggests that the veteran home elderly, as a group 'in transition' between community and institution, should be the first target of psychological preventive and health-promoting measures aimed at improving QOL in older population.