A longitudinal investigation of repressive coping and ageing

OBJECTIVES

Two studies investigated the possibility that repressive coping is more prevalent in older adults and that this represents a developmental progression rather than a cohort effect. Study 1 examined repressive coping and mental health cross-sectionally in young and old adults. Study 2 examined whether there was a developmental progression of repressive coping prevalence rates in a longitudinal sample of older adults.

METHOD

Study 1 compared younger adults (mean age 27.6 years) with older adults (mean age 74.2 years) on inventories of mental health and well-being and examined the prevalence of repressive coping in both samples. Study 2 re-tested a sample of older adults previously reported following an interval of 7 years.

RESULTS AND CONCLUSION

Study 1 - in line with previous research older adults demonstrated greater psychological well-being and had a higher prevalence of repressive coping than younger adults (at 30% vs. 12% respectively). Study 2 - the data indicated that the prevalence of repressive coping rose from 41% at the first time of testing (2002) to 56.4% at the second testing interval (2009). These results suggest that repressive coping may increase across the lifespan in certain individuals and continue to increase throughout older adulthood. Furthermore, this increase in repressive coping with age appears to result in better well-being in those older adults who become repressive copers.

A cluster randomised controlled trial of the clinical and cost-effectiveness of a 'whole systems' model of self-management support for the management of long- term conditions in primary care: trial protocol

BACKGROUND

Patients with long-term conditions are increasingly the focus of quality improvement activities in health services to reduce the impact of these conditions on quality of life and to reduce the burden on care utilisation. There is significant interest in the potential for self-management support to improve health and reduce utilisation in these patient populations, but little consensus concerning the optimal model that would best provide such support. We describe the implementation and evaluation of self-management support through an evidence-based 'whole systems' model involving patient support, training for primary care teams, and service re-organisation, all integrated into routine delivery within primary care.

METHODS

The evaluation involves a large-scale, multi-site study of the implementation, effectiveness, and cost-effectiveness of this model of self-management support using a cluster randomised controlled trial in patients with three long-term conditions of diabetes, chronic obstructive pulmonary disease (COPD), and irritable bowel syndrome (IBS). The outcome measures include healthcare utilisation and quality of life. We describe the methods of the cluster randomised trial.

DISCUSSION

If the 'whole systems' model proves effective and cost-effective, it will provide decision-makers with a model for the delivery of self-management support for populations with long-term conditions that can be implemented widely to maximise 'reach' across the wider patient population.

TRIAL REGISTRATION NUMBER

ISRCTN: ISRCTN90940049.

The importance of the repressive coping style: findings from 30 years of research

During the last three decades there has been substantial research exploring the repressive coping style as defined by Weinberger, Schwartz, and Davidson. As "repressors," who score low on trait anxiety and high on defensiveness, account for up to 50% of certain populations, they are an essential group for psychologists to study. However, there are methodological issues in identifying repressors as well as considerable evidence that repressors avoid negative self-relevant information. Possible methods of addressing these difficulties are discussed in this review. Importantly, there is a body of evidence linking repressive coping and poor physical health, including heart disease and cancer. However, some preliminary findings suggest that repressors compared to non-repressors may be better at health behaviors that they perceive as under their personal control. This needs more extensive investigation as such behaviors are only one aspect of health and other factors may contribute to repressors' poor physical health. Possible future directions of research are discussed including: the need for systematic empirical research of a new theory of repressive coping--the Vigilance-Avoidance Theory--more longitudinal health studies, and an in-depth exploration of the physiological mechanisms which may underlie repressive coping.

Prevalence and determinants of physical activity and fluid intake in kidney transplant recipients

BACKGROUND AND SIGNIFICANCE

Self-care for kidney transplantation is recommended to maintain kidney function. Little is known about levels of self-care practices and demographic, psychosocial, and health-related correlates.

AIM

To investigate patients' self-reported exercise and fluid intake, demographic and psychosocial factors associated with these self-care practices, and health-related quality of life.

METHODS

Eighty-eight of 158 kidney recipients from two academic medical centers completed a semi-structured interview and surveys 2 months post-transplant.

RESULTS

Most patients were sedentary (76%) with a quarter exercising either regularly (11%) or not at current recommendations (13%). One-third (35%) reported drinking the recommended 3 L of fluid daily. Multivariate analyses indicated that private insurance, high self-efficacy, and better physical functioning were significantly associated with engaging in physical activity (p < 0.05); while male gender, private insurance, high self-efficacy, and not attributing oneself responsible for transplant success were significant predictors of adherence to fluid intake (p < 0.05). Despite the significance of these predictors, models for physical activity and fluid intake explained 10-15% of the overall variance in these behaviors. Multivariate analyses indicated that younger age, high value of exercise, and higher social functioning significantly (p < 0.05) predicted high self-efficacy for physical activity, while being married significantly (p < 0.05) predicted high self-efficacy for fluid intake.

CONCLUSION

Identifying patients at risk of inadequate self-care practice is essential for educating patients about the importance of self-care.

Qualidade de vida em doenças pulmonares crônicas: aspectos conceituais e metodológicos

O presente artigo teve por objetivo rever aspectos relativos ao conceito de qualidade de vida, tendo em vista a relevância de estabelecer parâmetros que permitam avaliar esse aspecto, especialmente em pacientes com doenças crônicas. Essa análise considerou a qualidade de vida como um dos componentes essenciais do cuidado médico e indicou as precauções a serem tomadas na escolha de instrumentos de avaliação, que devem ser sensíveis e fidedignos às dimensões que se pretende avaliar

Physical and psychological correlates of functioning in patients with chronic obstructive pulmonary disease

We studied the contribution of coping and illness perceptions to outcome in patients with chronic obstructive pulmonary disease (COPD). In a longitudinal study, 64 patients completed the Medical Outcomes Study Instrument and the Illness Perception Questionnaire. Data on coping and severity of illness (spirometry) were also collected. Regression analyses showed that first-time illness perceptions and coping significantly contributed to the prediction of social functioning, mental health, health perceptions, total functioning score, and prediction of visits to the outpatient clinic and prescribed medication 1 year later. These results have important implications for the medical management of patients with COPD.