Beyond HIV shame: the role of self-forgiveness and acceptance in living with HIV

Research is developing regarding the beneficial association of spirituality with numerous health outcomes in people living with HIV (PLWH); however, little attention has been paid to the association of these variables with forgiveness and acceptance of HIV status. This cross-sectional study used a sample of 648 PLWH from the United States aged 18-61 to test the mediating effects of forgiveness and acceptance of HIV status on the relationship of spirituality and life satisfaction. As expected, self-forgiveness and acceptance straightforwardly and serially explained the links between spirituality and life satisfaction, while forgiveness of others was not a significant mediator for this relationship. The data obtained suggest that spirituality and self-forgiveness are two important targets for future experimental research, and therapeutic interventions on these variables may have a synergistic effect of increasing acceptance and improving well-being in PLWH.

The mediating effects of anxiety on the relationships between persistent thinking and life satisfaction: A two-wave longitudinal study in patients with anxiety disorders

OBJECTIVE

According to cognitive theories, anxiety disorders may result from distorted beliefs, sensations, feelings, and decisions, leading to an overestimation of the danger presented by various stimuli.

METHODS

In this two-wave longitudinal study of 435 German patients with anxiety disorders, we assessed the association of negative persistent thinking, anxiety, and life satisfaction.

RESULTS & CONCLUSION

Structural equation modeling results suggest that persistent thinking may initiate the occurrence of anxiety, which in turn influences a decrease in life satisfaction. The convergence of the evidence from this longitudinal study with earlier results of evidence-based trials fortifies the case supporting the need to identify and reduce cognitive distortions in therapeutic interventions to improve health in people with anxiety disorders.

The Relationship Between Forgiveness and Health Outcomes Among People Living with HIV: A Cross-Sectional Study in France

Research to date has shown that HIV infection is a highly stressful experience for individuals, and one of the key adaptive resources after such painful experiences may be forgiveness. The aim of the present study was to examine the associations between dispositional forgiveness (assessed using Mullet's Forgivingness Questionnaire and Toussaint's Forgiveness Scale), perceived stress (single-item measure of stress symptoms), health perception (EuroQol visual analogue version of the scale) and life satisfaction (Satisfaction With Life Scale) in people living with HIV (PLWH) in France. Paper surveys were completed by 222 PLWH aged 18-78 (57% male). Multiple regression analysis revealed that sensitivity to circumstances, unconditional forgiveness, self-forgiveness, and forgiveness of others were significant predictors of health and happiness. Mediation analysis showed that these relationships are completely mediated by perceived stress. The present findings suggest that forgiveness and perceived stress may be important variables for healing in PLWH. Interventions designed to improve forgiveness and self-forgiveness may result in improved health and life satisfaction in PLWH.

Amygdala and Insula Retraining (AIR) Significantly Reduces Fatigue and Increases Energy in People with Long COVID

Long COVID affects approximately 10-30% of individuals after an acute COVID-19 infection (Ceban, Ling, et al. 2022; Ortona and Malorni, 2022). Numerous symptoms, including extreme fatigue, can persist for months, resulting in social and economic hardship for individuals and their families (Ortona and Malorni 2022). Therefore, approaches that offer some relief from Long COVID are urgently needed. Research suggests that Long COVID symptoms are akin to those of chronic conditions, such as myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and are likely caused by inflammation and immune dysfunction (Scordo et al., 2021). Amygdala and Insula Retraining (AIR), a neuroplasticity program, has successfully alleviated chronic conditions (Gupta 2010; Sanabria-Mazo et al. 2020; Toussaint et al. 2012). In this randomized controlled trial, AIR was tested against a structurally equivalent health and wellness intervention for its effectiveness in treating the symptom of fatigue among Long COVID sufferers. Results showed a significant decrease in participants' fatigue and a significant increase in their energy after the 3-month AIR intervention. Additionally, the AIR group experienced more significant outcomes than the active control group. The AIR group demonstrated a fatigue reduction effect size four times that of the active control group, and the absolute reduction in mean scores for the AIR group was more than double that of the control group. Furthermore, the AIR group showed an effect size in energy enhancement twice that of the active control group, and the absolute increase in energy mean scores for the AIR group was almost double that of the control group. These novel findings suggest AIR is a viable means of reducing fatigue and increasing energy among Long COVID patients. Limitations and future research are discussed.

Positive religious coping acts through perception of nature and silence in its association with well-being and life satisfaction among Polish Catholics

Previous studies indicate that perceptions of nature and thought-provoking silence can have positive consequences for individual functioning. The purpose of the present study was to assess the relationships between religious coping (assessed with the Brief RCOPE), perceptions of nature and silence (a subscale of the Perception of Change Questionnaire), well-being (the World Health Organization's five-item Well-Being Index) and life satisfaction (the Brief Multidimensional Life Satisfaction Scale). An online questionnaire was completed between 2021-2022 by 1,010 Polish Catholics ages 18 to 73, 61% of whom were women. Structural equation modeling showed that positive religious coping was positively related to well-being (β = 0.08, p = 0.011) and life satisfaction (β = 0.22, p < 0.001). In contrast, negative religious coping was related to reduced well-being (β = -0.07, p = 0.040) and life satisfaction (β = -0.25). In addition, more frequent perceptions of nature and reflective times of silence partially mediated the associations of positive religious coping with well-being (β = 0.04, p = 0.011) and life satisfaction (β = 0.04, p = 0.008). The data might suggest that interventions that help people develop an ability or awareness for nature as an exceptional encounter and may help to strengthen the ways they can utilize their religiosity as a resource and thus contribute to well-being and life satisfaction among Catholics.

Inflammation and depression symptoms are most strongly associated for Black adults

Although race/ethnicity is associated with substantial differences in risk for depression and other diseases of aging in the United States, the processes underlying these health disparities remain poorly understood. We addressed this issue by examining how levels of a robust marker of inflammatory activity, C-reactive protein (CRP), and depression symptoms varied across racial/ethnic groups. Additionally, we tested whether the inflammation-depression association differed across groups. Data were drawn from the Chicago Community Adult Health Survey, an epidemiological survey examining biopsychosocial factors affecting health and well-being. Participants were 3105 Chicago community adults, of which 610 provided blood samples and were included in analyses. C-reactive protein was assayed from blood samples, and depression symptoms were assessed using the 11-item Center for Epidemiologic Studies-Depression scale. Race/ethnicity was self-reported and consisted of Black, Hispanic, White, and other racial/ethnic groups. Results revealed that these racial/ethnic groups differed in terms of both their CRP and depression levels. Specifically, Black Americans exhibited higher levels of CRP as compared to White and other race/ethnicity Americans. Moreover, Black Americans exhibited more depression symptoms than Hispanic Americans. Finally, we found that inflammatory levels were strongly related to depression symptoms but only for Black Americans, with CRP alone accounting for 8% of the variance in depression symptoms in this subgroup. These data thus point to a biological process that may help to explain disparities in mental health outcomes across race/ethnicity in the United States. At the same time, additional research is needed to understand the social and structural factors driving these effects.

Polish Adaptation and Psychometric Properties of the Long- and Short-Form Interfaith Spirituality Scale

Spirituality is widely believed to play an important role in securing health, and modern health care is increasingly being combined with spiritual care. This state of affairs is generating widespread interest in the construct from practitioners and researchers, resulting in the need to develop accurate and comprehensive measures of spirituality. The purpose of this study was to adapt the Polish version of the Interfaith Spirituality Scale (IFS), which consists of twenty-two statements, as well as its short version, including four statements. The IFS is not limited to any one religious denomination, making it possible to conduct research across diverse communities. The analyses were conducted on a sample of 642 Poles aged 18-68, 48% of whom were women. The Polish version of the scale showed high internal consistency (α = 0.96 for the IFS and α = 0.81 for the short version). Confirmatory factor analysis showed that the structure of the IFS consists of a unitary second-order factor with four first-order factors (direct connection with the creator, asceticism, meditation, and divine love). On the other hand, the structure of the short version is unifactorial. There were positive correlations of the IFS with another measure of spirituality, post-traumatic growth severity, mental well-being, and ecological behaviour, as well as negative correlations with post-traumatic stress disorder symptom severity and depressiveness; these confirmed the high validity of the tool. The results suggest that the IFS may be useful in the study of spirituality on Polish soil.

Relationships between Spirituality, Religious Fundamentalism and Environmentalism: The Mediating Role of Right-Wing Authoritarianism

According to past research, religious attitudes can strongly influence individuals' beliefs and behaviors. The purpose of this study was to assess the relationships between spirituality (the Scale of Spirituality; dimensions include religious spirituality, expanding consciousness, searching for meaning, sensitivity to art, doing good, and sensitivity to inner beauty), religious fundamentalism (the Religious Fundamentalism Scale), support for right-wing authoritarianism (the Right-Wing Authoritarianism Scale), climate concerns (the Environmental Concern Scale), and pro-environmental behavior (the Pro-Environmental Behavior Scale). The cross-sectional study involved 512 Poles aged 18-63 (M = 34.63, SD = 5.96; Mdn = 33), including 51% females. Multiple regression analysis revealed that two dimensions of spirituality (sensitivity to art and doing good) and religious fundamentalism are significant and opposite predictors of climate concern and pro-environmental behavior. Spirituality appeared to foster increased climate concern and caring behavior, while religious fundamentalism negatively predicted the same variables. Mediation analysis revealed that the relationship between religion and environmentalism could be explained in part by differences in support for right-wing authoritarianism (authoritarianism itself was negatively related to environmental outcomes). In addition, analysis of variance revealed that believers (70% of participants in the study were Catholic) showed significantly lower scores regarding climate concerns and pro-environmental behavior than non-believers, yet the inclusion of support for right-wing authoritarianism as a covariate in the equation reduced intergroup differences to statistical insignificance. The data obtained suggest that religious attitudes and socio-political views may play important roles in solving environmental problems.

Use of Cannabidiol in the Management of Insomnia: A Systematic Review

Background: Cannabidiol (CBD), one of the major cannabinoids derived from the cannabis plant, is available over the counter. CBD is often used by patients for the management of insomnia, yet research supporting CBDs effectiveness as a treatment for insomnia is inadequate. Objective: The objective of this review was to critically evaluate the literature regarding the therapeutic benefits of CBD in the management of insomnia. Methods: A comprehensive search of the following databases from inception to December 29, 2021, was conducted: Ovid MEDLINE^® and Epub Ahead of Print, In-Process & Other Non-Indexed Citations and Daily, Ovid Embase, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, and Scopus. The search included randomized controlled trials, nonrandomized experimental studies, cross-sectional studies, cohort studies, case series, and case reports. Risk of bias was assessed with the Agency for Healthcare Research and Quality design-specific recommended criteria. Results: Thirty-four studies were eligible for inclusion. All studies reported improvement in the insomnia symptoms of at least a portion of their participants. Of the 34 studies, 19 studies used CBD predominant therapy and 21 studies used nearly equal ratios of CBD to Δ⁹-tetrahydrocannabinol (THC). Of the studies that performed hypothesis testing, 4 of 7 studies with a CBD predominant arm and 12 of 16 studies with a nearly equal ratio of CBD to THC arm reported significant improvement in insomnia outcomes. However, only 2 of the 34 studies focused on patients with insomnia, of which 1 study was a case report. Additionally, several studies used nonvalidated subjective measures, and most studies failed to include objective measures for symptom assessment. Conclusions: The results of our systematic review suggest that CBD alone or with equal quantities of THC may be beneficial in alleviating the symptoms of insomnia. Nevertheless, future research assessing CBDs effectiveness in population of patients specifically with insomnia utilizing validated subjective and objective measures is necessary before definitive inferences can be made.

Psychological Flexibility Is Key for Reducing the Severity and Impact of Fibromyalgia

Fibromyalgia has a significant impact on the lives of patients; symptoms are influenced by psychological factors, such as psychological flexibility and catastrophizing. The objective of this study was to determine the importance of these variables in moderating the association between the severity and impact of fibromyalgia symptoms. A total of 187 patients from a general hospital population were evaluated using the Combined Index of Severity of Fibromyalgia (ICAF), the Fibromyalgia Impact Questionnaire (FIQ), the Acceptance and Action Questionnaire-II (AAQ-II), and the Pain Catastrophizing Scale (PCS). A series of multiple regression analyses were carried out using the PROCESS macro and decision tree analysis. The results show that psychological flexibility modulates the relation between severity and the impact of fibromyalgia symptoms. Catastrophism has residual importance and depends on the interaction with psychological flexibility. Interaction occurs if the severity of the disease is in transition from a mild to a moderate level and accounts for 40.1% of the variance in the sample. These aspects should be considered for evaluation and early intervention in fibromyalgia patients.

Pain is not the major determinant of quality of life in fibromyalgia: results from a retrospective "real world" data analysis of fibromyalgia patients

OBJECTIVE

To identify correlates of quality of life (QoL) measured with the Quality of Life Scale (QOLS) in participants of a multidisciplinary day hospital treatment program for fibromyalgia (FM).

METHODS

In this cross-sectional, observational study, "real world" data from 480 FM patients including socio-demographics, pain variables and questionnaires such as the SF-36, Beck Depression Inventory (BDI), Multiphasic Pain Inventory (MPI), SCL-90-R and others were categorized according to the components (body structure and function, activities and participation, personal factors, environmental factors) of the International Classification of Functioning (ICF). For every ICF component, a linear regression analysis with QOLS as the dependent variable was computed. A final comprehensive model was calculated on the basis of the results of the five independent analyses.

RESULTS

The following variables could be identified as main correlates for QoL in FM, explaining 56% of the variance of the QOLS (subscale/questionnaire and standardized beta in parenthesis): depression (- 0.22), pain-related interference with everyday life (- 0.19), general activity (0.13), general health perception (0.11), punishing response from others (- 0.11), work status (- 0.10), vitality (- 0.11) and cognitive difficulties (- 0.12). Pain intensity or frequency was not an independent correlate.

CONCLUSIONS

More than 50% of QoL variance could be explained by distinct self-reported variables with neither pain intensity nor pain frequency playing a major role. Therefore, FM treatment should not primarily concentrate on pain but should address multiple factors within multidisciplinary therapy.

Alleviating Social Pain: A Double-Blind, Randomized, Placebo-Controlled Trial of Forgiveness and Acetaminophen

BACKGROUND

Research has suggested that physical pain (e.g., caused by injury) and social pain (e.g., caused by social rejection) are modulated by some of the same biological systems. Consequently, it is possible that acetaminophen, which is commonly used to alleviate physical pain through neurochemical pathways, may have social pain-relieving effects that interact with forgiveness, which reduces social pain through psychological pathways. To date, however, only a few studies have examined how experiences of social pain change over time, and none have examined how acetaminophen and forgiveness interact to influence these effects.

PURPOSE

We addressed these issues by investigating how acetaminophen administration and daily forgiveness are associated with experiences of social pain over 21 days. We hypothesized that acetaminophen-related reductions in social pain across the 21-day study period would be greatest on days following high levels of forgiveness.

METHOD

To test this hypothesis, we conducted a double-blind, randomized, placebo-controlled trial in which we randomly assigned 42 healthy young adults to an acetaminophen condition (1,000 mg of acetaminophen daily), placebo-control condition (400 mg of potassium daily), or empty-control (no pill) condition. We then assessed their levels of forgiveness and social pain for 20 consecutive days.

RESULTS

As hypothesized, acetaminophen reduced participants' social pain levels over time but only for those exhibiting high levels of forgiveness (i.e., 18.5% reduction in social pain over 20 days).

CONCLUSIONS

These data are the first to show that forgiveness and acetaminophen have interactive effects on experiences of social pain, which is one of the most common and impactful of all human experiences.

Clean and Contain: Initial Development of a Measure of Infection Prevention Behaviors During the COVID-19 Pandemic

Background

The Centers for Disease Control and Prevention (CDC) offer behavioral guidance to prevent the spread of infectious diseases like COVID-19. Cleaning (e.g., cleaning surfaces, washing and sanitizing hands) and containing (e.g., covering coughs, keeping distance from others, especially sick people) behaviors are recommended.

Purpose

To develop the Clean and Contain Measure, a brief measure of compliance with CDC recommendations for prevention of infectious disease, and validate the measure in individuals experiencing the COVID-19 pandemic.

Methods

Participants were recruited from Amazon Mechanical Turk and social media.

Results

In Study 1 (N = 97), exploratory factor analysis revealed two scales: (a) five items assessing cleaning behaviors and (b) four items assessing containing behaviors. Simple structure was obtained and alpha coefficients for both scales were >.83. In Studies 2 (N = 204) and 3 (N = 527), confirmatory factor analysis verified the identical factor structure found in Study 1. All loadings were statistically significant at p < .001. Alpha coefficients for both scales were >.84 for Studies 2 and 3.

Conclusions

Our measure is a reliable and valid indicator of compliance with cleaning and containing health behaviors that help to prevent the spread of diseases like COVID-19. Future research should replicate construct validity in more diverse samples and continue to refine items, examine construct validity, including predictive and discriminant validity, and improve the measure for future use. With continued use and refinement, this measure could allow health officials and researchers to accurately assess compliance with important infection prevention behavior guidelines.

Monitoring BMI Trends in a Midwest Regional Head Start Population: The Results of a Healthy Lifestyle Intervention

BACKGROUND

Childhood obesity represents a public health crisis in the United States. Thus, focusing on early childhood is crucial to modify the consequences associated with obesity. The Food and Fitness Initiative (FFI) is a community-based wellness program implemented in Northeast Iowa since 2009. FFI focuses on healthy eating and physical activity. Our aim is to describe the impact on body mass index (BMI) after implementing FFI in a Northeast Iowa Community Action Head Start (HS) population.

METHODS

Retrospective BMI data was collected from all children attending 14 HS sites from 2012 to 2018. Children with BMI measurements during July to December of the first year in HS were included in the study. Follow-up data the second year in HS was obtained. Overweight and obesity prevalence, as well as, BMI changes between year 1 and 2 in HS were analyzed.

RESULTS

Data from 1013 children were collected, 850 (84%) had qualifying BMI measurements during their first year in HS and 352 of those children (41%) had follow-up data in their second year. There was a decrease in BMI between years 1 and 2 in HS that approached statistical significance (t = 1.83, P = .07, d = .10). There were no statistically significant changes in the percent of overweight (Wald χ2 = .50, P = .48) or obese (Wald χ2 = 1.71, P = .19) children between the first and second year.

CONCLUSION

The FFI wellness program can be feasibly integrated into the HS curriculum and shows promising short-term results in improving BMI, but not to a statistically significant level when evaluated over 1 year.

Fibromyalgia impact and depressive symptoms: Can perceiving a silver lining make a difference?

Individuals with fibromyalgia are at greater risk for depressive symptoms than the general population, and this may be partially attributable to physical symptoms that impair day-to-day functioning. However, individual-level protective characteristics may buffer risk for psychopathology. For instance, the ability to perceive a "silver lining" in one's illness may be related to better mental and physical health. We examined perceived silver lining as a potential moderator of the relation between fibromyalgia impact and depressive symptoms. Our sample of persons with fibromyalgia (N = 401) completed self-report measures including the Fibromyalgia Impact Questionnaire-Revised, Depression Anxiety Stress Scales, and the Silver Lining Questionnaire. Moderation analyses covaried age, sex, and ethnicity. Supporting hypotheses, increasing impact of disease was related to greater depressive symptoms, and perceptions of a silver lining attenuated that association. Despite the linkage between impairment and depressive symptoms, identifying positive aspects or outcomes of illness may reduce risk for psychopathology. Therapeutically promoting perception of a silver lining, perhaps via signature strengths exercises or a blessings journal, and encouraging cognitive reframing of the illness experience, perhaps via Motivational Interviewing or Cognitive Behavioral Therapy, may reduce depressive symptoms in persons with fibromyalgia.

Hostility, forgiveness, and cognitive impairment over 10 years in a national sample of American adults

OBJECTIVE

We examined the extent to which self-forgiveness and forgiveness of others moderated the association of hostility with changes in cognitive impairment over 10 years in a nationally representative sample of adults in the United States.

METHOD

Participants were 1,084 respondents to the Americans' Changing Lives survey, a longitudinal study of American adults. Hostility, self-forgiveness, forgiveness of others, and cognitive impairment were measured at baseline, and cognitive impairment was assessed again at follow-up. Moderated multiple regression analyses tested whether self-forgiveness and forgiveness of others moderated the association of hostility with changes in cognitive impairment over time, controlling for baseline cognitive impairment and relevant sociodemographic and clinical factors.

RESULTS

As hypothesized, greater hostility levels at baseline predicted more cognitive impairment 10 years later, β = .08, p < .01. In addition, self-forgiveness at baseline moderated the association between baseline hostility and cognitive impairment at follow-up, β = -.07, p < .01. Decomposing this interaction revealed that hostility significantly predicted increased cognitive impairment at follow-up for individuals with low, β = .15, p < .001, and average, β = .08, p = .001, levels of self-forgiveness but not for persons with high levels of self-forgiveness, β = .03, p = .34. In contrast, forgiveness of others was not a significant moderator.

CONCLUSIONS

Greater hostility is associated with the development of more cognitive impairment over 10 years, and being more self-forgiving appears to mitigate these hostility-related effects on cognition. Enhancing self-forgiveness may thus represent one possible strategy for promoting cognitive resilience in adulthood. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

German Soldiers' Needs to Clarify Open Aspects in Their Life, to Talk About Fears and Worries, and to Forgive and to Be Forgiven as a Matter of Life Reflection

Background: In missions, soldiers are confronted with difficult situations which may impair their physical and mental health. As the resulting problems are commonly regarded as stigmata, soldiers may obviate talking about their experiences and try to oppress them. It was aim of this study to clarify whether soldiers do perceive needs to reflect back on life, to seek release from "open aspects" of their life, and to talk with others about fears and worries, to forgive others or to be forgiven. Further we intended to clarify whether these needs were related to stress perception, post-traumatic stress disorders (PTSD) symptoms and reduced life satisfaction on the one hand, and religious trust as a resource to cope on the other hand. Methods: Cross-sectional survey of 1,097 German soldiers (92% men). Existential/spiritual needs and mental health indicators, including stress perception, PTSD symptoms, life satisfaction, were assessed using standardized questionnaires. Results: For 30% of soldiers it was important to reflect on life, 23% had a strong need to clarify open aspects of life, 30% had a strong need to talk with others about their fears and worries, 13% had strong needs to forgive, and 13% had a strong need to be forgiven. Soldiers' needs to clarify open (and probably conflicting) aspects of life were moderately related to their intention to forgive others and to be forgiven (rs > 0.35). Soldiers treated in the hospital for psycho-mental trauma had significantly higher needs scores than soldiers still serving on active duty, particularly for the need to talk with others (F = 39.1; p < 0.0001) and to be forgiven (F = 26.0; p < 0.0001). Across all soldiers the best predictors of these needs were PTSD symptoms and stress perception, albeit with relatively weak predictive power (βs < 0.25; R ²s < 0.24). Conclusions: The process of life reflection and subsequent intention to solve conflicting situations and experiences can be considered a process of coping with one's own failures, guilt, and mistakes. It should be noted that these needs were significantly stronger in soldiers with trauma. Addressing unmet needs may help them to communicate and to reject the stigma of "weakness."

Depression as a Risk Factor of Organic Diseases:An International Integrative Review

PURPOSE AND DESIGN

This integrative review offers a systematic synthesis of the international literature regarding the role of depression as a risk factor in physical illnesses and the mechanisms of this connection. Special attention is paid to those modifiable factors.

FINDINGS

Published studies of depression and physical illness and disease(N = 24) from five countries that were indexed in PubMed, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), APA PsycNET, Scopus, Dialnet, and CUIDEN were examined. Results suggest that depression is a significant risk factor for the development of physical illnesses and diseases. More commonly studied were the connections between depression and cardiovascular disease, metabolic syndrome, biochemical alterations, diabetes, dementia, cognitive impairment, Alzheimer's disease, somatization and chronic pain, asthma, arthritis, and hyperlipidemia. Less frequently studied conditions connected to depression were cancer, infections, allergies, autoimmune disease, gastric ulcer, rhinitis, thyroiditis, bronchitis, migraines, fractures, and osteoporosis.

CONCLUSIONS

Mechanisms connecting depression to physical illness appear to involve alterations in the hypothalamic-pituitary axis, unhealthy lifestyle, chronic or acute stressors including posttraumatic stress, an increase in C-reactive protein (CRP) in men, taking antidepressant medication, and social and emotional loneliness.

CLINICAL RELEVANCE

A good patient-provider relationship can help to promote decreased acute or chronic stressors, increased family and social support, decreased loneliness, modification of unhealthy lifestyles such as smoking, obesity, physical inactivity, alcohol, control of CRP, and antidepressant medication. Nurses are well placed to help prevent physical diseases through detection and referral of patients who are depressed or undiagnosed and not receiving adequate mental health treatment.

Slowing BMI Growth Trajectories in Elementary School-Aged Children: The Northeast Iowa Food and Fitness Initiative

This project examines the Northeast Iowa Food and Fitness Initiative, a policy-, community-, and school-based effort to slow children's body mass index (BMI) growth over 6 years. Kindergarteners (K) to fifth graders (5) from 10 different school districts participated (N = 4101). Students with 0 to 1 years of initiative exposure showed greater growth in BMI compared with children who had 2 to 6 years of exposure, resulting in K-5 BMI savings of 1.5 points (6 lb) for median-height boys and girls. Results suggest that changes to policies, communities, and schools may provide effective obesity reduction in children.

Stress-related changes in personality: A longitudinal study of perceived stress and trait pessimism

Although research has shown that certain aspects of personality can change over time, the determinants of such change remain unclear. Stress alters neural dynamics and precipitates disorders that shape personality traits involving negative affectivity. In this study, therefore, we assessed the perceived stress and pessimism levels of 332 young, middle-aged, and older adults for five weeks to examine how levels of stress and pessimism change and interrelate over time. The best fitting longitudinal model was a bivariate latent growth curve model, which indicated that stress and pessimism both changed and exhibited significant variability in change over time. Moreover, changes in stress were associated with changes in pessimism. Pessimism thus changes over time, with alterations in stress potentially structuring these changes.

Perceived dyscognition reported by patients with fibromyalgia

OBJECTIVES

Patients with fibromyalgia often report dyscognition as a symptom; however, the literature on this symptom is sparse. Our objective for this cross-sectional study was to characterize dyscognition among patients with fibromyalgia, identify comorbid symptoms associated with dyscognition, and evaluate its relation with fibromyalgia severity.

METHODS

Dyscognition was assessed with the Multiple Abilities Self-report Questionnaire (MASQ) for 681 patients with fibromyalgia. Other assessed comorbid symptoms were pain, fatigue, sleep problems, mood, physical and mental health, and autonomic function. Correlation and regression modeling were used to identify relations between the MASQ subscales and other fibromyalgia symptoms. Mixed analysis of variance was used to examine the profile of dyscognition in different levels of fibromyalgia. MASQ subscale scores from a previously described healthy normal control population were used for comparison.

RESULTS

The mean (SD) age of the study patients was 55.8 (12.6) years, and most patients were female (93%) and white (91%). Perceived dyscognition was most related to depression, anxiety, and autonomic function. Across all fibromyalgia severity levels, patients had significantly higher levels of perceived dyscognition than the healthy controls. Significant differences existed for the MASQ total and most MASQ subscales among patients with mild, moderate, and severe fibromyalgia.

CONCLUSIONS

Our study results provide further evidence that perceived dyscognition in fibromyalgia is influenced by various comorbid symptoms. In treating patients with fibromyalgia who have dyscognition, clinicians should consider the multiple types of dyscognition and the effects of other fibromyalgia symptoms.

Post-traumatic stress disorder symptoms may explain poor mental health in patients with fibromyalgia

Symptoms of post-traumatic stress disorder are common in fibromyalgia patients. This study compared post-traumatic stress disorder symptoms in fibromyalgia patients and healthy controls and determined whether patient-control differences in post-traumatic stress disorder symptoms mediated differences in mental health. In all, 30 patients and 30 healthy controls completed questionnaires assessing symptoms of post-traumatic stress disorder and mental health. Fibromyalgia patients had greater symptoms of post-traumatic stress disorder and mental health than controls. Patient-control differences in mental health symptoms were fully or partially mediated by differences in post-traumatic stress disorder symptoms. Healthcare providers should understand the role of trauma as management of trauma symptoms may be one strategy for improving mental health.

Post-traumatic stress disorder symptoms may explain poor mental health in patients with fibromyalgia

Symptoms of post-traumatic stress disorder are common in fibromyalgia patients. This study compared post-traumatic stress disorder symptoms in fibromyalgia patients and healthy controls and determined whether patient-control differences in post-traumatic stress disorder symptoms mediated differences in mental health. In all, 30 patients and 30 healthy controls completed questionnaires assessing symptoms of post-traumatic stress disorder and mental health. Fibromyalgia patients had greater symptoms of post-traumatic stress disorder and mental health than controls. Patient-control differences in mental health symptoms were fully or partially mediated by differences in post-traumatic stress disorder symptoms. Healthcare providers should understand the role of trauma as management of trauma symptoms may be one strategy for improving mental health.

Psychological Resilience, Affective Mechanisms, and Symptom Burden in a Tertiary Care Sample of Patients with Fibromyalgia

Research demonstrates that patients with fibromyalgia who have higher positive and lower negative affect have lower symptom burden. Affect has been shown to be associated with resilience. This study examined the relationship between affect, resilience and fibromyalgia symptom burden in a clinical sample of patients with fibromyalgia. We hypothesized that (a) positive and negative affect would be associated with fibromyalgia symptom burden; (b) resilience would be associated with positive and negative affect; (c) resilience would be associated with fibromyalgia symptom burden; and (d) the connection between resilience and fibromyalgia symptom burden would be mediated by both positive and negative affect. A sample of 858 patients with fibromyalgia completed questionnaires. Mediation modelling revealed statistically significant direct effects of resilience on fibromyalgia symptom burden (β = -0.10, P < 0.001) and statistically significant indirect effects of resilience on fibromyalgia symptom burden through affect (β = -0.36, P < 0.001), suggesting that both resilience and affect influence fibromyalgia symptom burden. Our results suggest that improving affect through resiliency training could be studied as a modality for improving fibromyalgia symptom burden.

Decreased physical activity attributable to higher body mass index influences fibromyalgia symptoms

BACKGROUND

Although previous studies report associations between increased body mass index (BMI) and fibromyalgia symptoms, there is uncertainty as to whether this relationship is driven by physical factors, psychological factors, or both.

OBJECTIVE

To assess these relationships in a clinical sample of patients with fibromyalgia.

DESIGN

Cross-sectional study.

SETTING

Tertiary care facility.

PATIENTS

A total of 686 patients from an existing national fibromyalgia registry.

METHODS

Patients completed a demographic form and self-report questionnaires including the Fibromyalgia Impact Questionnaire-Revised (FIQ-R), the Medical Outcomes Study Short Form-36 (SF-36), the Brief Pain Inventory (BPI), and the 30-item Profile of Mood States (30-item POMS).

MAIN OUTCOME MEASUREMENTS

FIQ-R overall impact subscale.

RESULTS

BMI was significantly correlated with fibromyalgia impact (P < .001). The relationship between BMI and fibromyalgia impact was almost fully accounted for by physical factors and not by psychological factors.

CONCLUSIONS

Despite patient report that pain hinders physical activity, clinicians who encounter patients with fibromyalgia, particularly patients with increased BMI, should be cognizant of the need to invest time and resources to counsel patients on physical factors (ie, physical activity) that could improve the patients' symptom experience.

Prospective associations between unforgiveness and physical health and positive mediating mechanisms in a nationally representative sample of older adults

OBJECTIVE

This study examined the prospective association between unforgiveness and self-reported physical health and potential positive psychological mediators of this association.

DESIGN

Participants were a national sample of 1024 USA's adults of ages 66 years and older. Data were collected at two time points separated by three years.

MAIN OUTCOME MEASURES

Measures of trait unforgiveness, self-rated physical health, socio-demographics, health behaviours and positive psychological traits (e.g. life satisfaction, self-esteem) were included in a comprehensive survey known as the 'Religion, Aging, and Health Survey.'

RESULTS

The results indicated that unforgiveness was prospectively associated with declines in self-reported physical health three years later, and poor initial self-reported health status did not predict increases in unforgiveness across time. Furthermore, the prospective association of unforgiveness with self-reported health was mediated by a latent positive psychological traits variable.

CONCLUSION

These results confirm cross-sectional findings suggesting that unforgiveness is related to health. The present study also suggests that unforgiveness has a prospective, but not reciprocal, association with self-reported physical health. Unforgiveness may have its association with self-reported physical health through its interruption of other positive traits that typically confer health benefits.

Construction of a US fibromyalgia registry using the Fibromyalgia Research Survey criteria

Utilizing billing records, we identified patients seen at Mayo Clinic with a diagnosis or history of fibromyalgia who were then contacted for enrollment in a fibromyalgia research registry. Fibromyalgia was confirmed through medical record review. Eligible patients were mailed an invitation that included a demographic questionnaire and the Fibromyalgia Research Survey. The Fibromyalgia Research Survey yields a widespread pain score (scale range 0-19) and a symptom severity score (scale range 0-12). A total of 4,034 patients returned the completed survey; 92.8% were female, their mean age was 57.4 (±13.4), and 83.7% were from the Midwest region of the United States. The mean widespread pain score for all participants was 11.3 (±4.5) and the mean symptom severity score was 8.2 (±2.4), indicating moderate-to-severe fibromyalgia symptoms, which is not unusual for patients presenting to a tertiary care center. Using a systematic process, we describe the creation of a fibromyalgia registry for future research.

Development and factor analysis of an index of post-polio sequelae

PURPOSE

This present study describes the development, factor structure and initial validation of the Index of Post-Polio Sequelae (IPPS).

METHOD

The IPPS was tested on a sample of 849 community-dwelling polio survivors between the ages of 40 and 93 years old who participated in a large, national study of menopause and aging in late polio. Items from the IPPS were submitted to a factor analysis using principal components extraction and rotated to oblique simple structure using promax rotation. Convergent validity was assessed using bivariate correlation.

RESULTS

Three factors were extracted that accounted for approximately 53% of the variance in the original IPPS items. Factor 1 (Pain) was loaded most heavily by two items referring to muscle and joint pain. Factor 2 (Atrophy) was loaded by items referring to muscle atrophy, involved muscle weakness, and fatigue. Factor 3 (Bulbar) was comprised of two items referring to breathing and swallowing problems. Bivariate correlations between health and psychosocial variables and each of the factors all were significant and in expected directions.

CONCLUSIONS

This first validation of a standardized scale to assess the severity of post-polio sequelae in polio survivors suggests a psychometrically sound instrument whose factor structure represents commonly reported problems in the extant post-polio literature.

Menopause and post-polio symptoms as predictors of subjective sleep disturbance in poliomyelitis survivors

OBJECTIVES

Sleep disturbance in polio survivors is a common complaint, yet little is known about the effects of the interaction of physical disability and menopause on sleep. The purpose of this study was to understand the relative contribution of menopause factors and disability to subjective sleep disturbance.

METHODS

Participants were 465 women aged 50-65 years who had physical disabilities due to poliomyelitis. Hierarchical regression modeling was used to examine menopause (symptoms, status, hormone replacement use, ovarectomy status) and disability factors (post-polio symptoms) in sleep disturbance.

RESULTS

In the final model, 19% (frequency) and 17% (severity) of sleep disturbance variance was explained. Psychological symptoms exerted the most influence (for both outcomes) followed by post-polio symptoms, vasomotor symptoms, an interaction of vasomotor and post-polio symptoms and estrogen use. For women with fewer post-polio symptoms, vasomotor symptoms exerted greater influence on sleep disturbance than for women with greater post-polio symptoms.

CONCLUSIONS

Psychological symptoms had the strongest association with sleep disturbance in these women. Controlling for the influence of various menopause factors, our findings show that vasomotor symptoms were only one of several influences on sleep disturbance.

Patient health Questionnaire-9 in spinal cord injury: an examination of factor structure as related to gender

BACKGROUND/OBJECTIVE

Despite the attention depression after spinal cord injury (SCI) has received, research and clinical practice have been hampered by inadequate emphasis on reliable and valid measurement. Assessment of symptoms in persons with SCI is challenged by the presence of "trans-diagnostic" symptoms and unexamined effects of gender. The objective of this study was to examine the factor structure of the Patient Health Questionnaire-9 (PHQ-9; the 9-item depression scale of the Patient Health Questionnaire) and determine whether the structure replicates across gender.

METHODS

A total of 1,168 women and men were matched on level/completeness of SCI, follow-up year, and age to create 584 pairs. Exploratory factor analysis examined 1- and 2-factor models and congruence in 2 randomly split half samples to establish congruence of the factor solution and replication across gender.

RESULTS

The 1- and 2-factor solutions fit the structure of the items accounting for 41% to 51% of original item variance. Congruence between random samples was uniformly high for the 1-factor solution (r = 0.791-0.948) but variable for the 2-factor solution. Although congruence was high for the combined sample and men (r = 0.90-0.97 and 0.71-0.94, respectively), it was variable for women (r = 0.29-0.85).

CONCLUSIONS

Although there was support for the 1-factor structure of the PHQ within and between sexes, the low congruence between sexes and within women for the 2-factor structure indicates potentially important differences about how certain symptoms may be experienced or interpreted differently, by men and women with SCI. Future research should focus on where sexes diverge in cognitive, affective, and somatic dimensions of depressive symptoms and whether sex-specific or sex-neutral measures are warranted.

Preliminary reliability and validity of a Spinal Cord Injury Secondary Conditions Scale

BACKGROUND/OBJECTIVE

Although the impact of secondary conditions after spinal cord injury (SCI) on health, well being, and financial burden have been studied, there are psychometrically sound scales of secondary conditions in the extant literature. The use of such scales allows for cross-sample comparison of secondary condition prevalence rates and associations with functional, medical, and psychosocial factors. Thus, the purpose of this study was to evaluate the preliminary reliability of a SCI secondary conditions scale.

METHODS

The Spinal Cord Injury Secondary Conditions Scale (SCI-SCS) is a 16-item scale based on the Seekins Secondary Conditions Scale. Sixty-five individuals with SCI completed written surveys at 5 time-points over 2 years.

RESULTS

Internal consistency across each of the time-points exceeded 0.76; test-retest reliability ranged from 0.569 to 0.805. Convergent validity was assessed with 6 physical functioning items from the SF-12. Spearman (coefficients were all statistically significant and ranged from 0.317 (accomplished less because of health problems) to 0.644 (pain). The most prevalent secondary conditions were chronic pain, joint and muscle pain, and sexual dysfunction.

CONCLUSIONS

Preliminary testing of the SCI-SCS suggests that it is a reliable and valid scale, and further development (ie, factor analysis, item revision) and examination of validity are recommended with larger and more diverse SCI samples.

Menopause characteristics of women with physical disabilities from poliomyelitis

OBJECTIVE

To describe menopause characteristics of women with physical disabilities from poliomyelitis.

METHODS

Nine hundred and nine women with a history of poliomyelitis completed a survey on health, physical functioning, emotional well being and menopause.

RESULTS

The majority of the sample was postmenopausal having had a natural menopause around the average age of 50.3 years; 34.7% of the sample had had hysterectomies. Thirty-nine percent were using some form of hormone replacement therapy (HRT). Menopause symptoms were clustered into psychological, somatic-sensory, somatic-sleep and vasomotor factors. Among never and past HRT users, there were significant differences in menopause factor severity by menopause status. Somatic/sleep symptoms were lowest in never users; past users had significantly higher vasomotor symptoms; desire for sexual activity and painful intercourse did not vary by HRT use. Compared to population estimates, post-polio women had similar rates of hysterectomies overall, but among some age cohorts they had significantly lower rates, contrary to expectations. However, they used HRT at significantly higher rates than expected.

CONCLUSIONS

This study suggests that basic menopause characteristics of women with polio are generally similar to those of their non-disabled peers. There were few substantial differences in severity of menopause symptoms by HRT use, which is critical in light of the dearth of studies examining its risk-benefit ratio among women with physical disabilities. Until such studies provide some evidence of the specific risks or benefits to women with physical disability, each woman should carefully weigh the known risks and benefits with her physician.

Use of a standardized menopause symptom rating scale in a sample of women with physical disabilities

OBJECTIVE

To determine the psychometric properties of a menopause symptom rating scale developed on nondisabled women in a sample of women polio survivors with physical disabilities.

DESIGN

The 25-item Menopause Symptom List (MSL) was administered to 190 women between ages 40 and 65 not taking hormone or estrogen therapy. Factor analysis, bivariate correlation, and analysis of variance were performed to determine the scale's underlying structure, construct validity, and association with menopausal status.

RESULTS

Factor analysis revealed four factors: (1) psychological, (2) somatic-sensory, (3) somatic-sleep, and (4) vasomotor. Factors 1 and 3 were associated with postpolio sequelae, self-rated health, positive and negative affect, life satisfaction, and perceived stress. Factor 2 was associated with postpolio sequelae, basic activities of daily living, self-rated health, negative affect, life satisfaction, and perceived stress. Factor 4 was associated with postpolio sequelae, self-rated health, negative affect, and perceived stress. Comparison by menopause status found Factors 1 and 3 significantly differed between groups (F(2,181) = 6.68 and 4.17, respectively; P = 0.02). Contrary to expectations, vasomotor factor severity was not distinguished by menopause status.

CONCLUSIONS

Menopause symptom scales standardized on nondisabled women should be used cautiously with women with physical disabilities. Associations between construct validity measures and menopause symptomatology suggest a complex relationship between physical disability and menopause.

Describing quality of life and psychosocial outcomes after traumatic brain injury

OBJECTIVE

To describe the quality of life (QOL) and psychosocial outcomes of a sample of adults with traumatic brain injury in 50 community dwelling adults with traumatic brain injury and examine the associations among these variables.

DESIGN

Cross-sectional.

RESULTS

Mean QOL rating was low average. Standardized measures had acceptable internal reliability and normal distributions in this sample. Subjects had significantly lower QOL and social support, higher negative affect, and similar positive affect and spirituality compared with standardization and other nondisabled samples. They also had a significantly higher level of community integration than other traumatic brain injury samples. Regression analyses suggested that social support, community integration, and positive affect make a unique and significant contribution to the QOL variance with R of 0.492. The addition of spirituality reduced their respective unique variance, reducing positive affect to nonsignificant levels due to their high intercorrelation.

CONCLUSIONS

Findings suggest that this sample experiences a wide range of QOL. Factors significantly associated with good QOL include community integration, positive affect, and social support; demographic variables had virtually no association with QOL. Evaluation of the sample's response to standardized scales not designed for a traumatic brain injury population support their use in similar QOL investigations.

RISK PERCEPTIONS AND STRESS DURING THE THREAT OF EXPLOSION FROM A RAILROAD ACCIDENT

The derailment of a train carrying hazardous material resulted in the evacuation of an entire Midwestern community. Risk perceptions and stress were assessed in evacuees and controls (N=90) during the acute phase of the disaster while threat of explosion was looming. Consistent with the social amplification of risk theory (Kasperson et al., 1988), risk perceptions for routine transportation technologies did not become amplified in evacuees during the technological disaster; however, some elevation of risk perceptions related to less familiar chemical and nuclear technologies was evident in evacuees as compared to controls. Investigation of the relationship between risk perceptions and stress response showed that high risk perceptions for transportation technologies were associated with elevated emotional and psychological stress, and poorer concentration in evacuees compared to controls. Results suggest that monitoring risk perceptions related to the cause of a technological accident is useful in predicting variance in evacuee response during a disaster.