Clinical relevance of the Marlowe-Crowne Scale: a review and recommendations

The Simplified Medication Adherence Questionnaire: validation of a Brazilian-Portuguese version in hypertensive adults

Background

Self-reported adherence scales are widely used in research and practice because they are low in cost and easy to apply. A free version in Brazilian-Portuguese of the Simplified Medication Adherence Questionnaire (SMAQ) can be a useful alternative for determining the adherent behavior of hypertensive patients.

Purpose

To translate and evaluate the psychometric properties of the Brazilian-Portuguese version of the SMAQ therapeutic adherence scale for patients with arterial hypertension.

Patients and methods

A multicenter, cross-sectional study was conducted in five outpatient units in Maceió-AL and Aracaju-SE between January and July 2019. A total of 117 patients aged over 18 years using antihypertensive drugs were recruited. The cross-cultural adaptation followed international methodological recommendations. Internal consistency (Cronbach's alpha) was tested as a reliability parameter. Criterion and construct validity were verified by concurrent validation, exploratory factor analysis (EFA), and validation by known groups.

Results

The participants had a mean age of 56.6 years (SD = 10.7 years); most were female (72.6%). The mean number of antihypertensives prescribed per patient was 1.87 (SD = 0.87). There were 79.5% (n = 86) of patients considered non-adherent. Internal consistency was satisfactory (Cronbach's alpha = 0.63). A satisfactory correlation coefficient was verified with the Morisky-Green-Levine test as an external criterion (r = 0.56, p < 0.001). The scale's sensitivity measured through known group validity was 75.3%, specificity 29.5%, positive predictive value 63.9%, and negative predictive value 41.9%. We identified two factors of the instrument's construct from EFA: specific medication-taking behaviors and barriers to adherence. The initial KMO measure of sampling adequacy was 0.691, and Bartlett's test of sphericity was significant (χ2 = 118.342, p < 0.001).

Conclusion

The Brazilian-Portuguese version of the SMAQ scale proved valid and reliable for determining adherence to the pharmacotherapy in hypertensive patients. It showed more ability to detect non-adherent patients but with low specificity, possibly influenced by high social desirability.

Socially desirable responding in geriatric outpatients with and without mild cognitive impairment and its association with the assessment of self-reported mental health

Background

Socially desirable responding is a potentially relevant issue in older adults and can be evaluated with the Marlowe-Crowne Social Desirability Scale (MCSDS). However, the eight-item MCSDS has never been specifically administered to geriatric subjects, and there is a dearth of literature on the relationship between social desirability and cognitive impairment. Also, the connection between social desirability and subjective measures of psychological well-being is a matter of controversy. This study has three main aims. First, to determine the psychometric properties of the eight-item MCSDS in geriatric outpatients without dementia (i.e. with normal cognition (NC) or mild cognitive impairment (MCI)). Second, to investigate the link between social desirability and cognitive functioning. Third, to determine the association between social desirability and the assessment of self-reported mental health.

Methods

Community-dwelling outpatients (aged ≥ 65) were consecutively recruited and neuropsychologically tested to diagnose NC or MCI (n = 299). Social desirability was assessed with the eight-item MCSDS. Depressive and anxiety symptoms were measured with the short Geriatric Depression (GDS-s) and the State-Trait Personality Inventory Trait Anxiety (STPI-TA) scales.

Results

On principal components analysis, the eight-item MCSDS was found to have a multidimensional structure. Of the initial three-component solution, only two subscales had acceptable internal consistency (Cronbach’s alpha > 0.6): “Acceptance of responsibility” and “Integrity”. The third subscale (“Kindness towards others”) appeared to gauge two distinct constructs of formal (i.e. politeness) versus substantive (i.e. forgiveness) compassion. On binary logistic regression, only higher income was a significant predictor of formal compassion. Test-retest reliability was substantial to excellent (Gwet’s AC2 ≥ 0.8). There were no meaningful differences in social desirability between the NC and MCI groups. Likewise, negative Spearman’s correlations between social desirability and cognitive Z-scores across the whole sample were weak (r_s < |0.3|) and confined to one MCSDS item. Although social desirability was an independent predictor of the STPI-TA score in multiple linear regression, it explained only a marginal amount of incremental variance in anxiety symptoms (less than 2%).

Conclusions

Our results suggest that social desirability need not be a major concern when using questionnaires to assess mental health in geriatric outpatients without dementia.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-021-02435-z.

Problematic smartphone use and affective temperaments among Lebanese young adults: scale validation and mediating role of self-esteem

BACKGROUND

Adults all over the world face serious issues from problematic smartphone use (PSU). It influences them negatively on a cognitive, behavioral, and emotional level, as well as on their tendencies and well-being. In Lebanon, the prevalence of PSU was shown to be 20.2% within the adult population, specifically with young adults (18-34 years old). This study investigates the validity and reliability of the Smartphone Addiction Scale (SAS) Arabic version. In addition, this study evaluates the association between PSU and affective temperaments and the mediating role of self-esteem in this association.

METHOD

A cross-sectional study was carried out between August and September 2020, using a sample of community-dwelling participants aged 18 to 29 years. The Smartphone Addiction Scale-Short Version was used to evaluate smartphone addiction among adolescents and adults. The five different temperaments of the patients were assessed by using the Affective temperament Scale (TEMPS-A). The Rosenberg Self-Esteem Scale was used to evaluate self-esteem.

RESULTS

461 participants were included in this study. All items of the SAS were extracted and yielded a one-factor solution with Eigenvalues > 1 (variance explained = 49.96%; α_Cronbach = 0.886). The confirmatory analysis results consolidated those obtained from the factor analysis. Higher depressive temperament (B = 0.46) was significantly associated with more smartphone addiction, whereas higher self-esteem (B =  - 0.28) was significantly associated with less smartphone addiction. Self-esteem was found to mediate the association between depressive and hyperthymic temperaments with smartphone addiction.

CONCLUSION

This study added a better understanding of the high smartphone addiction rate among adults in Lebanon. It confirms the association between affective temperaments and PSU through the mediating effect of self-esteem on Lebanese adults.

Ecological momentary assessment of emotional awareness: Preliminary evaluation of psychometric properties

The Levels of Emotional Awareness Scale (LEAS) is a well-validated performance measure of trait emotional awareness (EA), which is associated with psychological and physical problems. EA is, however, expected to vary over time and we aimed to adapt the LEAS to permit the measurement of EA in daily life as a function of momentary state. Twenty-five students completed 12 ecological momentary assessments (EMAs) of EA across 2 days. The correlation between the mean EMAs of EA and trait EA, and the change over time in EA, was also examined. Findings revealed a significant positive correlation between state and trait EA. The within-person reliability was substantial, suggesting that EMAs can reliably assess EA over time across individuals. Importantly, latent state-trait analysis showed that about 50% of EA variability was due to state variance whereas only 2% of EA variability was due to trait variance. Preliminary psychometric properties suggest that the developed method allows for the measurement of EA in daily life and supports the claim that EA can be measured using both hypothetical (as in the LEAS) and real-life (using EMAs) scenarios.

Smoking addiction: the shift from head to hands: Approach bias towards smoking-related cues in low-dependent versus dependent smokers

The dual process theory is central to several models of addiction, implying both an increase of stimulus salience and deficits in inhibitory control. Our major aim is to provide behavioral evidence for an approach bias tendency in smokers and more specifically during smoking cue exposure. The second aim is to examine whether this bias differs in low-dependent versus dependent smokers. Thirty-two smokers (17 low dependent and 15 dependent; cut-off FTND of 4) and 28 non-smokers performed a modified Go/NoGo task using tobacco-related words and neutral words as stimuli. Smokers generally made more mistakes and tended to be faster for smoking-related cues specifically. Low dependents acknowledged more their dependency in declarative questionnaires while making more errors and being slower specifically on smoking cues; dependent smokers were less prone to indicate their addiction, but were faster and accurate when it came to picking the smoking cues. These results suggest that a shift has operated from a mental preoccupation with smoking in the low-dependent group, to smoking as a motor habit in our dependent group. This finding invites experts to rethink smoking addiction in the light of this crucial moment, namely, the shift "from head to hands".

Differences in Social Desirability Scores of Students in Private and Public Schools

Social desirability is now receiving attention as a source of error of measurement and as a personality characteristic and behavioral predisposition. In this study the differences of Puerto Rican students' scores on social desirability, whether they attended private ( n = 47) or public schools ( n = 76), were explored. Youth scoring high on social desirability are seen as more conforming while those scoring low feel freer to express themselves.

Assessing Cultural Competence Among Oncology Surgeons

PURPOSE

Racial and ethnic minority groups in the United States have the highest mortality rates for the most common cancers. Various factors, including a perceived lack of culturally congruent care and culturally competent providers, might lead minority patients to decline or delay care. As part of a large multimethod study to understand barriers to care among American Indian and Alaskan native patients with cancer, we examined surgical provider attributes associated with culturally congruent care.

PATIENTS AND METHODS

Surgical providers from six hospitals in the Puget Sound region of Washington State were invited to participate. Participants completed a 50-item survey that assessed demographic data and incorporated the Cultural Competence Assessment (CCA) and the Marlowe-Crowne Social Desirability Scale.

RESULTS

Survey response rate was 51.1% (N = 253). Participants reported treating diverse patient populations; 71% encountered patients from six or more racial and ethnic groups. More than one half of participants (58%) reported completing cultural diversity training, with employer-sponsored training being the most common type reported (48%; 71 of 147). CCA scores ranged from 5.99 to 13.75 of a possible 14 (mean, 10.3; standard deviation, ±1.3), and receipt of diversity training was associated with higher scores than nonreceipt of diversity training (10.56 v 9.82, respectively; P<.001). After controlling for Marlowe-Crowne Social Desirability Scale score and hospital system,participation in diversity training was the variable most significantly associated with CCA score (P<.001).

CONCLUSION

Culturally competent care is an essential but often overlooked component of high-quality health care. Future work should compare training offered by various hospital systems.

Defensiveness: Another Interpersonal Correlate of Range of Ratings

Common sense suggests that personal defensiveness will tend to correlate negatively with the range that raters employ for appraising own and peers' interpersonal behavior when all ratings are fully shared. Correlations were computed between 78 college students precourse Marlowe-Crowne scores, taken as the defensiveness index, and the range they used 3 and 7 wk. later when rating the within-group conduct of all members of 16 small interpersonal groups on separate measures of acceptance of self and of others. Both Week 3 correlations (−.27) were negative and significant despite severe stability limitations of all measures. Following detailed in-group discussions and reviews of these conduct ratings, the parallel correlations were again negative (−.10) but nonsignificant 4 wk. later. The results support other recent evidence linking raters' range and personal security.

Moderating Influence of Defensiveness on the Relationship between Self-Esteem and Job Performance

The moderating influence of defectiveness on the relationship between self-esteem (global self-esteem or sense of competence) and job performance (self- or supervisor-rated) is investigated with a sample of 160 male electrical apprentices. For apprentices who are higher in defensiveness positive relationships exist between global self-esteem and self-rated performance, and between sense of competence and self- and supervisor-rated performance. Defensiveness also makes an independent contribution to self-esteem. The implications of the findings for the measurement of self-esteem are discussed.

The Effects of Repeated Administrations on Self-Report and Parent-Report Scales

The use of repeated measures to track the out-come of psychosocial interventions is becoming common practice in most organizations. One threat with this methodology is the retest artifact. This artifact is defined by a systematic change in scores for individuals who repeatedly complete an outcome instrument yet do not receive an) formal treatment. The retest artifact can call into question the validity of change associated with school-based treatment programs when this change is based upon repeated testing using outcome instruments. This study directly assessed the retest effect for both a youth and an adult psychosocial outcome measure. The frequency of retest administrations was systematically varied (weekly, biweekly, monthly, pre/post testing) over a 9-week period using a youth parent-report and an adult self-report Outcome Questionnaire. Results indicate a statistically significant improvement in functioning at the time of the second administration regardless of the lapse in time for the adult measure and a steady improvement in functioning for the parent-report youth measure. Implications of this finding for evaluating psychosocial interventions are discussed.

Use of Social Desirability Scales in Clinical Psychology: A Systematic Review

OBJECTIVE

There is still an open debate about the utility of social desirability indicators. This report systematically reviewed the use of social desirability scales in studies addressing social desirability in clinical psychology.

METHOD

A systematic review (January 2010-March 2015) was conducted, including 35 studies meeting the inclusion criteria of being published in peer-reviewed journals and describing quantitative findings about an association of social desirability with clinical psychology variables using a cross-sectional or longitudinal design.

RESULTS

Social desirability was associated with self-reports of various clinical-psychological dimensions. Most of the included studies treated social desirability as a 1-dimensional variable and only 10 of 35 disentangled the impression management and self-deception components. Although theoretical literature does not consider social desirability a mere response bias, only 4 of the reviewed articles controlled for the possible suppressor effect of personality variables on social desirability, while the majority focused upon the stylistic (response bias) rather than the substantive (personality) nature of this construct.

CONCLUSION

The present review highlighted some limitations in the use of social desirability scales in recent clinical psychology research and tried to offer a few suggestions for handling this issue.

The effect of social desirability on reported motivation, substance use severity, and treatment attendance

Research has not consistently supported an association between stage of change and substance abuse treatment retention. This study examined whether social desirability response bias could help explain why. Participants (N = 200) recruited from an outpatient program completed the University of Rhode Island Change Assessment Scale (URICA), Treatment Readiness Tool (TREAT), Marlowe-Crowne Social Desirability Scale, and other measures. Number of treatment groups attended was collected from program records. In bivariate analyses, neither the URICA nor the TREAT was related to attendance. However, higher social desirability was strongly associated with lower URICA (but not TREAT) total scores, and in a multivariate path model, a moderately strong association emerged between higher URICA scores and greater treatment attendance when accounting for social desirability. Higher social desirability was also an independent predictor of greater treatment attendance and was strongly associated with lower Addiction Severity Index alcohol, drug, and psychiatric severity. Results underline a critical problem in measuring motivation and problem severity that has been largely neglected.

Affective disturbances in psychometrically defined schizotypy across direct, but not indirect assessment modes

Affective disturbances in social domains are characteristic features and potential vulnerability markers of schizophrenia-spectrum pathology. The present study employed a comprehensive and multidimensional approach to understanding affect in individuals with psychometrically defined schizotypy and the controls. Measures were employed assessing trait and state social affective experiences across direct--involving explicit deliberative responses, and indirect domains--involving implicit, behavioral or otherwise non-deliberative responses. The indirect assessments included a modified Implicit Association Test and computerized lexical analysis of natural speech procured during a laboratory speech task. Our affect measures were also unique in that they allowed for separate measurement of pleasant and unpleasant affect. On all direct trait and "in-the-moment" state measures of social affect, individuals with schizotypy reported dramatically decreased pleasant and increased unpleasant affect compared to controls. This was not the case for the indirect measures, which indicated no significant group differences. This pattern was generally consistent regardless of positive, negative and disorganized schizotypal trait severity. These data suggest that affective deficits in schizotypy reflect deliberative rather than implicit/automatic processes. Implications of these findings are discussed.

Suicide ideation and social desirability among school-aged young people

A mixed male-female sample of 950 school-aged adolescents, corresponding to 10% of the young population aged 15-19 living in a rural district of Northeast Italy, was investigated with self-reported questionnaires about the links between social desirability and suicide ideation. On the whole 30.6% of females and 23.9% of males reported suicidal ideation of some degree, with 5% in both genders reporting suicide ideation of a high degree (i.e. quite a lot/extremely often). Those who scored higher at the Marlowe-Crowne Social Desirability Scale (SDS) reported lower levels of psychiatric symptoms on the Symptom checklist 90R (SCL-90R), with the "denial" subscale of the SDS resulting specifically associated to lower scores on SCL-90R items measuring hopelessness, thoughts about death and suicide ideation. The personality traits measured by the Marlowe-Crowne SDS, such as defensiveness, denial and self-deception, might be conceived as a protection against psychiatric disorders and suicide ideation.

Defensive avoidance of disapproval: the relationship of a defensive style to physical and mental health

This article presents an exploration of a clinically meaningful interpersonal style labeled here as defensive avoidance of disapproval (DAD), which involves a motivated inattention to physiological, affective, or cognitive reactions arising from stressful social transactions, thereby safeguarding a self-image of social competence. First, we discuss conceptual antecedents of DAD derived from post-Freudian theories of twentieth-century psychodynamic and interpersonally oriented clinicians. Second, we highlight measurement issues as they relate to DAD. Third, we review research on the association of DAD with psychophysiological stress reactivity and diminished health. Finally, DAD-related clinical implications are considered. Our discussion of DAD invites the (1) assessment of phenomenological "blind spots" regarding the physiological, affective, and cognitive components of disapproval-induced stress, (2) development of strategies to decrease premature therapy termination that may result from a defensive avoidance of social disapproval, and (3) cultivation of interventions to increase the high DAD patient's acknowledgement, rather than rejection, of the signs of social stress.

Assessment of behavioral and cognitive impulsivity: development and validation of the Lifetime History of Impulsive Behaviors Interview

The construction and initial psychometric evaluation of an interview assessment of clinically significant impulsivity (Lifetime History of Impulsive Behaviors; LHIB) is presented. Personality-disordered and control subjects participated by completing self-report measures of depression, anxiety and social desirability, along with self-report and laboratory analogue measures of impulsivity, and finally the LHIB. The LHIB demonstrated good to excellent internal consistency and test-retest reliability. Supporting concurrent construct validity, scores on the LHIB correlated with other self-report measures of impulsivity. Diagnostic group differences were obtained and the LHIB evidenced concurrent validity in its ability to classify subjects by scores. No relationship was obtained between the LHIB and laboratory analogue measures. While evidence of discriminant validity was mixed, these data suggest that the LHIB may be a useful instrument for the assessment of impulsive behavior.

Social desirability and eating disorders. A community study of an Italian school-aged sample

OBJECTIVE

To explore the links between social desirability and eating disorders in a sample of adolescents in a north-east area of Italy.

METHOD

A mixed male-female sample of 1000 school-aged adolescents, corresponding to 10% of the young population aged 15-19 years living in the district, were investigated with self-reported questionnaires, including the Eating Attitudes Test (EAT), the Bulimic Investigatory Test of Edinburgh (BITE), the Body Attitudes Questionnaire (BAT), and an Italian version of the Marlowe-Crowne Social Desirability Scale (MC-SDS).

RESULTS

Females scored higher than males at all eating disorder inventories. In both genders there was a negative relationship (in all cases P < 0.01) between scores at the eating disorder inventories and those at the MC-SDS. When analysing eating disorder "caseness", as measured by cut-off, "cases" reported significantly lower scores than "non-cases" at the MC-SDS in both genders.

CONCLUSION

Personality traits measured by the MC-SDS, such as defensiveness, self-esteem, and dependence from approval, might contribute to the development of abnormal eating patterns at risk of eating disorders.

Response bias influences mental health symptom reporting in patients with obstructive sleep apnea

The Medical Outcomes Study (MOS) inventory is widely used to assess quality of life in chronically ill patients. Although response bias was addressed during its initial validation, we are unaware ofsubsequent studies examining how personality characteristics influence responses on this instrument. We examined the impact of response bias on MOS data reported by 44 obstructive sleep apnea (OSA) outpatients who completed the MOS and Marlowe-Crowne Social Desirability Scale (MC). Social desirability implies responding in a way that the participant believes will be viewed favorably; MC is often used to statistically controlfor this form of response bias on self-report measures. The MOS yielded 2 summary scales (Mental and Physical Health) and 8 dimensions (based on Short Form-36 [SF-36]). Data were analyzed using multiple regression analyses. Results show that there is a significant relation between MC and the Mental and Physical Health factors (R2 = .194, F = 5.069, p = .011) and the eight SF-36 dimensions (R2 = .359, F= 2.448, p = .032). Post hoc analyses did not reveal that any one independent variable was a superior predictor of the MC. Participants scoring high on the MC reported 31% greater health than participants scoring low on the MC. Findings suggest that response bias has a significant influence on MOS data from OSA patients, with the greatest impact on mental health indexes. Controlling for response bias on the MOS and other self-report measures is important in both research and clinical situations with OSA and potentially other chronically ill patients.

High risk model of threat perception in chronic pain patients: implications for primary care and chronic pain programs

This study investigated the High Risk Model of Threat Perception (HRMTP) in middle-aged, urban chronic pain patients who had been referred to a secondary pain clinic after failing to respond to standard medical management. Relationships among absorption, social desirability (SD), and negative (e.g., depressive or anxious) affect were studied in 24 male and 73 female patients, (age range 22-88 years). Subjects completed the Tellegen Absorption Scale, the Marlowe-Crowne Social Desirability Scale, the Beck Depression Inventory--Second Edition, and the Beck Anxiety Inventory. The sample was significantly higher in SD and lower in absorption than normative groups. High SD patients endorsed significantly fewer items related to depression than those with low SD, but reported anxious ideation at about the same rate. These findings lend credence to the concept of chronic pain as a transduction of depressive, but not anxious, affect into somatic symptoms.

Negative affectivity, restriction of emotions, and site of metastases predict mortality in recurrent breast cancer

OBJECTIVE

To assess whether negative affectivity and restriction of emotions predict survival time with recurrent breast cancer.

METHODS

Thirty-two patients with recurrent breast cancer, diagnosed 6-19 months earlier and stabilized using surgical, medical and/or radiation therapies, were enrolled. Cox regression survival analyses, including initial severity of metastases (RR=4.3 [1.3-14.3]; p=0.02), were used to explore the association of psychological variables with survival.

RESULTS

Low chronic anxiety in the context of low emotional constraint predicted low mortality (RR 0.07 [0.01-0.52]; p=0.007). However, patients with low chronic anxiety scores but with high constraint had higher mortality (RR=3.7 [1.2-11.5; p=0.02). High chronic anxiety, with or without high constraint, also predicted earlier death, as did high control of feelings.

CONCLUSION

An integrated model of negative affectivity in the context of restriction of emotions appears to strengthen the prediction of survival based on severity of breast cancer metastases.

Defensiveness and essential hypertension

The purpose of this study was to investigate the association between essential hypertension and defensiveness. Fifty normotensive and 74 hypertensive subjects completed the State-Trait Personality Inventory (STPI) and State-Trait Anger Expression Inventory (STAXI) to assess perceived anger and anxiety, and the Marlowe-Crowne Scale of Social Desirability as an indicator of defensiveness. Hypertensive and normotensive groups did not differ in their scores on the anger, anger expression, and anxiety scales. In contrast, Marlowe-Crowne scores were higher in the hypertensive group (18.1+/-5.5 vs. 15.4+/-5.1) (p=0.006). Stepwise logistic regression that included age, gender, BMI, and Marlowe-Crowne scores (dichotomized at 18) showed that a high Marlowe-Crowne score was associated with a relative risk of 3.63 (CI 1.49-8.83) of being hypertensive, independent of age, gender, and BMI. Anger and anxiety scores did not predict hypertensive status and did not affect the relationship between Marlowe-Crowne score and hypertensive status. We conclude that defensiveness is more closely related to essential hypertension than is self-reported anger or anxiety. Better understanding of conscious and unconscious mechanisms of defensiveness are likely to be important in clarifying the link between emotions and hypertension.

A comparison of related and unrelated marrow donors

OBJECTIVE

The purpose of this investigation is to test whether related bone marrow donors experience more distress from marrow donation than volunteer unrelated donors.

METHOD

Participants in the study were 77 related and unrelated marrow donors who agreed to complete 11 pre- and 8 postdonation self report questionnaires. Related and unrelated donors were recruited from the Bone Marrow Transplant Programs at the Brigham and Women's Hospital and the Massachusetts General Hospital in Boston, MA. Additional unrelated donors were recruited from the American Red Cross-Carolinas and the Heart of America Bone Marrow Donor Registry in Kansas City, MO.

RESULTS

The 41 unrelated and 36 related marrow donors who participated in this prospective study had similar demographic backgrounds and predonation questionnaire results, although related donors endorsed more items on the Beck Depression Inventory, both before and after narrow harvesting. After narrow donation, related donors reported significantly more pain than unrelated donors (p = .0001).

CONCLUSIONS

It is unlikely that intraoperative events alone could account for the increased pain experienced by related donors. Related donors were more likely to experience moderate to severe physical pain after marrow donation than unrelated donors, on the basis of logistic regression analysis (odds ratio = 7.63; 95% confidence interval 2.74, 23.01).

Psychological distress among women with recurrent spontaneous abortion

Fifty-seven of 100 women with recurrent abortion completed questionnaires designed to assess demographic and reproductive variables, depression, anxiety, social desirability, self-esteem, locus of control, and marital adjustment. The results indicated that 32% of the women could be classified as depressed. The subjects also reported higher than average levels of acute and chronic anxiety. Fifty-three percent of the subjects reported below average marital adjustment. Post hoc analyses indicated that the women who had a previous elective abortion had higher levels of anxiety, lower marital adjustment, and different attributions regarding their pregnancy losses than the women who had not had an elective abortion. Having a living child was not a protective buffer against psychological distress.

The dependent personality and interpersonal problems

At the core of the dependent personality disorder lies an excessive reliance on other people for support, direction, and nurturance. However, because of their interpersonal style, many patients high in dependency have difficulties establishing and maintaining close interpersonal relationships. The present study examined interpersonal problems related to the dependent personality disorder. The relationships between dependency and interpersonal problems were examined in 43 adult psychiatric inpatients and 66 nonpatient adults. All subjects were assessed for social functioning in terms of social behaviors typically displayed, density of their social networks, and subjective feelings of loneliness. Using correlations and multiple regression analyses, results showed that dependency was closely related to social behavior and quality of social networks for both psychiatric inpatients and nonpatient controls. Pearson correlations showed the dependent personality style was related to negative and disruptive interpersonal behaviors. Also, measures of social functioning were related to feelings of loneliness and depression. Finally, interpersonal dependency was strongly related to both depressive symptoms and depressive attitudes, especially in the psychiatric inpatients. The present findings demonstrate the importance of interpersonal dependency as related to interpersonal problems.

Biobehavioral research on coronary heart disease: where is the person?

This study examined the thesis that patients with coronary heart disease (CHD) comprise discrete personality subtypes and that identification of these subtypes may benefit biobehavioral research on CHD. Measures of Negative Affectivity, Social Inhibition, and Self-Deception were used to generate a personality taxonomy through cluster analysis in a sample of 405 men with CHD. This empirical taxonomy served as a basis for the development of a conceptual model which delineates hardy, distressed, inhibited, and repressive subtypes. Coronary proneness may differ across these subtypes to the extent that potential behavioral correlates of CHD were associated with subtype membership. Distressed individuals (characterized by elevated levels of Type A behavior, anger, hostility, and life stress) and inhibited individuals (characterized by the nonexpression of anger) may be particularly coronary prone. It is concluded that research should focus on the interaction of global traits that may define subtypes of patients with CHD.

Dissimulation and the sex difference in self-assessed fears: a brief note

Since the publication of the first findings with a Fear Survey Schedule over five decades ago, there have been no published studies examining the extent of overlap of factorially-derived robust dimensions of irrational fears with social desirability or dissimulation. Due to measurement problems associated with the use of individual fear items or general fear measures, the findings reported to date are relatively meaningless. In the present study, community volunteers were administered the Fear Questionnaire and the Eysenck Personality Questionnaire-Lie scale, the correlation between both measures determined, and the influence of the Lie scores on the sex difference in self-assessed fears examined. Neither in males nor in females were Agoraphobic and Social fears significantly correlated with dissimulation. Significant associations reflecting small effect sizes were obtained in both samples between Blood-injury fears and Lie scores. Only the sex difference in Blood-injury fears was meaningfully affected by dissimulation: the usual finding of higher mean scores for females was obtained only after controlling for the influence of Lie scores. The importance of taking the research and practical implications of the findings with respect to the Blood-injury fears dimension seriously, despite the small magnitudes of the relevant data, was emphasized, as was the need for further studies in this area.

Social desirability response tendencies in psychiatric inpatient children

This study examined the substantive features of children's social desirability (SD) tendencies that could influence the nature and severity of psychopathology. Examinations of substantive features of SD responding in an inpatient child psychiatry unit (N = 76) suggested that higher scores on the Children's Social Desirability questionnaire were associated strongly with (1) lower mental age; (2) higher scores on self-reported social competence; (3) lower scores on self-reported anger; and (4) lower scores on parent-reported externalization behavioral disturbance. Results were interpreted as suggesting that SD responding for child inpatients may reflect a mixed picture of negative features of cognitive and social immaturity that could affect adversely their ability to judge their own and others' social behavior and of positive features of less external behavioral disturbance and more prosocial attitudes and behaviors.

Intellectual ability and educational achievement as predictors of patients' defensiveness

The Marlowe-Crowne Social Desirability Scale, a measure of defensiveness, is related to various psychotherapeutic process and outcome variables. The present study tested the hypothesis that lower intellectual ability and educational achievement are associated with defensiveness. In a sample of 50 patients in psychotherapy, defensiveness was not significantly correlated with WAIS—R IQs estimated from Shipley-Hartford scores and only weakly related (−.26) to education. It appears that patients' defensiveness is relatively unassociated with these objective indices of ability and achievement.

The Marlowe-Crowne and Edwards Social Desirability Scales: A Psychometric Perspective

Various psychometric characteristics of the Marlowe-Crowne and Edwards Social Desirability scales were assessed in a sample of 108 male and 189 female undergraduates. Major questions of interest focused on the degree of overlap of the two measures and the equivalency of the two measures for males and females. Means, standard deviations, intercorrelations, and internal consistency α were computed by least-squares methods. Results of these analyses were compared to those based on confirmatory maximum likelihood factor analysis. Results suggested that males and females show different means and similar internal consistency reliability and intercorrelation on these scales. The degree of association between the two measures in both males and females, corrected for attenuation, was approximately .4. Similar conclusions would have been reached with either statistical approach.

A test of the repression hypothesis in agoraphobics

In a recent study Turner et al. (1983) employed Bell & Byrne's (1978) Repression-Sensitization (R-S) scale to test the hypothesis that agoraphobics utilize repression as a method of avoiding anxiety-arousing forms of cognition. However, no support was found for this view. Rather, the R-S scores indicated general sensitization and attention to negative affect. In this paper it is argued that, on both theoretical and psychometric grounds, the R-S scale cannot be considered a suitable measure of the repression-sensitization process. A study was carried out in which a number of other defensivity measures were used in addition to the R-S scale. Weak support was found for Goldstein & Chambless' (1978) view that a defensive cognitive style is characteristic of agoraphobic patients when compared with non-phobic psychiatric controls.