What leads to the expectation to return to work? Insights from a Theory of Planned Behavior (TPB) model of future work outcomes

OBJECTIVE

This study used a Theory of Planned Behavior (TPB) model to identify the factors influencing the future work expectations and outcomes of employees with a musculoskeletal injury.

PARTICIPANTS

Australians with a compensable work injury (N=174), mean age=43.7 years, 53.2% male, 48.3% back injury , and 34.2% unskilled.

METHODS

A TPB model of the target behavior 'working, or continuing to work … three months from now' was constructed. A questionnaire measuring the model's components was completed at baseline and three-months follow-up.

RESULTS

The model met standard psychometric requirements. Attitude, Subjective Norm and Perceived Behavioral Control explained 76% of the variance in Behavioral Intention (<formula>R^{2}</formula>= 0.76, p< 0.001). Behavioral Intention (the expectation to return to work) explained 51% of the variance in work participation at follow-up (Nagelkerke <formula>R^{2}</formula>=0.51, p< 0.001; sensitivity=86.4%, specificity=71.2%). The strength of key influences on expectations varied according to employment status, but included the availability of modified duties, social aspects of work, the opinion of the treating doctor, co-worker support, pain, and functional limitations.

CONCLUSION

The TPG is a useful model and conceptual framework for integrating the biopsychosocial determinantsof return to work (RTW) and identifying the influences on future work expectations and outcomes.

Co-calibration of deliberate self harm (DSH) behaviours: towards a common measurement metric

The purpose of this study was to co-calibrate items from different deliberate self-harm (DSH) behavioural scales on the same measurement metric and compare cut points and item hierarchy across those scales. Participants included 568 young Australians aged 18-30 years (62% university students, 21% mental health patients, and 17% community volunteers). Six DSH scales (containing 82 items) were administered, namely, Self-Injury Questionnaire Treatment Related (SIQTR), Self-Injurious Thoughts and Behaviours Interview (SITBI), Deliberate Self-Harm Inventory (DSHI), Inventory of Statements About Self-Injury (ISAS), Self-Harm Information Form (SHIF) and Self-Harm Inventory (SHI). Data were co-calibrated onto an underlying metric using the Rasch measurement model. The resulting calibration shows that the different scales occupy different ranges on the hierarchy of DSH methods with prevalence estimates ranging from 47.7 to 77.1%. A raw score conversion table is provided to adjust prevalence rates and to equate cut points on the six scales. A Rasch-validated hierarchy of DSH behaviours is also provided to inform the development of DSH nomenclatures and assist clinical practice.

Deliberate Self-Harm: Have We Scratched the Surface?

This article presents the current state of knowledge in deliberate-self harm (DSH). DSH presents as a comorbidity with a number of personality disorders and psychopathologies, but is also relatively common in the psychologically healthy population. Over the past 10 years, attention has shifted from the investigation of DSH as a cardinal or comorbid symptom of psychopathology to an attempt to understand the behaviour itself, without reference to other psychopathological processes. It is argued that this development in understanding the aetiology of DSH has not been matched by developments in treatment or management of DSH, with the majority of treatment programs targeting larger syndromes of which DSH is a symptom. Treatment regimes aimed at reducing DSH appear to be either untested or demonstrably unsuccessful.

Deliberate Self-Harm: The Interplay Between Attachment and Stress

This study investigated the relationship between attachment, mood and deliberate self-harm (DSH) in a nonclinical population (n= 114). In addition to a range of risky behaviours, the most commonly reported DSH behaviours wereHead-banging(47%),Hitting(46%),Scratching(38%) andCutting(34%). Those who engaged in DSH had poorer quality of attachment to both parents but not peers, and higher levels of depression, anxiety and stress. Path analysis was then used to examine the interaction between attachment, mood and DSH. The impact of the quality of attachment on DSH was found to be mediated by stress, which suggests that DSH may be a maladaptive coping mechanism. Attachment to father and peers was found to be more influential than attachment to mother. Our findings suggest that DSH may be more prevalent in the community than previously recognised, and that attachment, which is currently neglected in DSH research, warrants further investigation in both clinical and nonclinical populations.

Depression and anxiety in patients with rheumatoid arthritis: prevalence rates based on a comparison of the Depression, Anxiety and Stress Scale (DASS) and the hospital, Anxiety and Depression Scale (HADS)

BACKGROUND

While it is recognised that depression is prevalent in Rheumatoid Arthritis (RA), recent studies have also highlighted significant levels of anxiety in RA patients. This study compared two commonly used scales, the Depression Anxiety and Stress Scale (DASS) and the Hospital Anxiety and Depression Scale (HADS), in relation to their measurement range and cut points to consider the relative prevalence of both constructs, and if prevalence rates may be due to scale-specific case definition.

METHODS

Patients meeting the criteria for RA were recruited in Leeds, UK and Sydney, Australia and asked to complete a survey that included both scales. The data was analysed using the Rasch measurement model.

RESULTS

A total of 169 RA patients were assessed, with a repeat subsample, resulting in 323 cases for analysis. Both scales met Rasch model expectations. Using the 'possible+probable' cut point from the HADS, 58.3% had neither anxiety nor depression; 13.5% had anxiety only; 6.4% depression only and 21.8% had both 'possible+probable' anxiety and depression. Cut points for depression were comparable across the two scales while a lower cut point for anxiety in the DASS was required to equate prevalence.

CONCLUSIONS

This study provides further support for high prevalence of depression and anxiety in RA. It also shows that while these two scales provide a good indication of possible depression and anxiety, the estimates of prevalence so derived could vary, particularly for anxiety. These findings are discussed in terms of comparisons across studies and selection of scales for clinical use.

Psychometric analysis of the self-harm inventory using Rasch modelling

BACKGROUND

Deliberate Self-Harm (DSH) is the intentional destruction of healthy body tissue without suicidal intent. DSH behaviours in non-clinical populations vary, and instruments containing a range of behaviours may be more informative than ones with restricted content. The Self-Harm Inventory (SHI) is a widely used measure of DSH in clinical populations (mental and physical health) and covers a broad range of behaviours (self-injury, risk taking and self-defeating acts). The test authors recommend the SHI to screen for Borderline Personality Disorder (BPD) using a cut-off score of five or more. The aim of this study was to investigate the psychometric characteristics of the SHI in non-clinical samples.

METHODS

The SHI was administered to a sample of 423 non-clinical participants (university students, age range 17 to 30). External validation was informed by the administration of the Depression Anxiety Stress Scales 21 (DASS-21) to a sub-sample (n = 221). Rasch analysis of the SHI was conducted to provide a stringent test of unidimensionality and to identify the DSH behaviours most likely to be endorsed at each total score.

RESULTS

The SHI showed adequate fit to the Rasch model and no modifications were required following checks of local response dependency, differential item functioning and unidimensionality. The scale identified gender and age differences in scores, with females and older participants reporting higher levels of DSH. SHI scores and DASS-21 scores were related.

CONCLUSION

The recommended cut-off point of five is likely to comprise mild forms of DSH and may not be indicative of psychopathology in a non-clinical population. Rather it may be more indicative of developmentally related risk taking behaviours while a higher cut-off point may be more suggestive of psychopathology as indicated by higher levels of depression, stress and anxiety.

Variability in depression prevalence in early rheumatoid arthritis: a comparison of the CES-D and HAD-D Scales

Background

Depression is common in rheumatoid arthritis (RA), however reported prevalence varies considerably. Two frequently used instruments to identify depression are the Center for Epidemiological Studies Depression (CES-D) scale, and the Hospital Anxiety and Depression Scale (HADS). The objectives of this study were to test if the CES-D and HADS-D (a) satisfy current modern psychometric standards for unidimensional measurement in an early RA sample; (b) measure the same construct (i.e. depression); and (c) identify similar levels of depression.

Methods

Data from the two scales completed by patients with early RA were fitted to the Rasch measurement model to show that (a) each scale satisfies the criteria of fit to the model, including strict unidimensionality; (b) that the scales can be co-calibrated onto a single underlying continuum of depression and to (c) examine the location of the cut points on the underlying continuum as indication of the prevalence of depression.

Results

Ninety-two patients with early RA (62% female; mean age = 56.3, SD = 13.7) gave 141 sets of paired CES-D and HAD-D data. Fit of the data from the CES-D was found to be poor, and the scale had to be reduced to 13 items to satisfy Rasch measurement criteria whereas the HADS-D met model expectations from the outset. The 20 items combined (CES-D13 and HADS-D) satisfied Rasch model expectations. The CES-D gave a much higher prevalence of depression than the HADS-D.

Conclusion

The CES-D in its present form is unsuitable for use in patients with early RA, and needs to be reduced to a 13-item scale. The HADS-D is valid for early RA and the two scales measure the same underlying construct but their cut points lead to different estimates of the level of depression. Revised cut points on the CES-D13 provide comparative prevalence rates.

A longitudinal evaluation of the Center for Epidemiologic Studies-Depression scale (CES-D) in a rheumatoid arthritis population using Rasch analysis

Background

The aim of this study was to test the internal validity of the total Center for Epidemiologic Studies-Depression (CES-D) scale using Rasch analysis in a rheumatoid arthritis (RA) population.

Methods

CES-D was administered to 157 patients with RA over three time points within a 12 month period. Rasch analysis was applied using RUMM2020 software to assess the overall fit of the model, the response scale used, individual item fit, differential item functioning (DIF) and person separation.

Results

Pooled data across three time points was shown to fit the Rasch model with removal of seven items from the original 20-item CES-D scale. It was necessary to rescore the response format from four to three categories in order to improve the scale's fit. Two items demonstrated some DIF for age and gender but were retained within the 13-item CES-D scale. A new cut point for depression score of 9 was found to correspond to the original cut point score of 16 in the full CES-D scale.

Conclusion

This Rasch analysis of the CES-D in a longstanding RA cohort resulted in the construction of a modified 13-item scale with good internal validity. Further validation of the modified scale is recommended particularly in relation to the new cut point for depression.

Can a rural community-based work-related activity program make a difference for chronic pain-disabled injured workers?

OBJECTIVE

To assess the effectiveness of a clinical guidelines-informed multidisciplinary work-related activity program, and to improve the physical, psychological and occupational functioning of chronic pain-disabled injured workers.

DESIGN

An uncontrolled, repeated-measures, pilot study was conducted.

SETTING

The intervention was delivered in a community setting in regional New South Wales.

PARTICIPANTS

Participants (n = 30), mean age of 41 years, had a compensable musculoskeletal injury: 60% were male, 63% had back injuries; the mean time off work was 13 months.

INTERVENTION

A cognitive-behavioural, interdisciplinary intervention was delivered using a multi-contributor provider model (a clinical psychologist and physiotherapist from separate practices, working in liaison with the participant's occupational rehabilitation provider and treating doctor). Groups of six participants attended for one half day per week for six weeks.

MAIN OUTCOME MEASURES

The outcome measures included: physical functioning, pain intensity and psychological variables, which were assessed pre- and post-program; and medical certification and work participation, which was recorded pre-program and at six-month follow up.

RESULTS

Significant gains were made in pain intensity, physical and psychological functioning, and medical certification. The mean effect size of the intervention was medium to large (d = 0.70). There was no significant change in employment status at six-month follow up.

CONCLUSIONS

The results of this pilot study suggest that independent, rural or community-based practitioners, working collaboratively using an integrated treatment program, can produce positive outcomes for pain-disabled injured workers, and achieve results similar to those reported by metropolitan-based pain clinics.

Community beliefs about childhood obesity: its causes, consequences and potential solutions

BACKGROUND

The objective of this study was to explore community beliefs about the causes, consequences and potential solutions of childhood obesity.

METHODS

A convenience sample of 434 adults (41.2 +/- 13.3 years; 61% parents) in New South Wales, Australia, was surveyed using a newly developed childhood obesity scale.

RESULTS

Five causal (emotional eating; eating habits and food knowledge; environmental dysfunction; abundance of contemporary lifestyle; cost of contemporary lifestyle), four consequences (known consequences of obesity; behavioural consequences; social consequences; less-known physical consequences) and three potential solutions factors (parental actions; professional assistance; limiting behaviours) were identified. Parents did not differ from non-parents across the 12 factors nor were there any differences based on the level of education. There were, however, gender differences across two causal factors (emotional eating and abundance of contemporary lifestyle) and two consequences factors (behavioural consequences and social consequences), with females endorsing all four factors more strongly than males.

CONCLUSIONS

The results of this study suggest that this sample was aware of the complex nature of childhood obesity in terms of its causes, consequences and a range of potential solutions, but they endorsed more family rather than community-based interventions.

Depression in rheumatoid arthritis patients: demographic, clinical, and psychological predictors

OBJECTIVE

To confirm the prevalence of depression in a sample of rheumatoid arthritis (RA) patients; to identify the most significant predictors of depression in RA and to explore patients attitudes to medication in relation to depression.

METHODS

A cross-sectional survey was used to collect data from 134 RA patients (77% female, 23% male). Participants were divided into depressed and nondepressed groups based on their scores on the Center for Epidemiological Studies-Depression (CES-D) scale. Discriminant analysis was conducted to identify the predictors that would best categorise patients into those two groups.

RESULTS

Twelve predictors correctly classified 80% of patients into depressed or nondepressed groups. The strongest predictors of depression were high tension and low self-esteem followed by the perceived impact of RA, fatigue, passive coping, pain, and physical disability. Other predictors included medication effectiveness and importance as well as perceived lack of control over pain.

CONCLUSION

Both physical and psychological factors have an impact on depression in RA. The key predictors identified in this study need to be considered within the regular RA management as possible cues to depression development.

Does the ??rebro Musculoskeletal Pain Questionnaire predict outcomes following a work-related compensable injury?

The objective of this prospective study was to investigate the usefulness of the Orebro Musculoskeletal Pain Questionnaire (OMPQ) to predict return to work outcomes following a compensable musculoskeletal injury. Participants (n=196 injured workers, 66% male, 36% with back pain) were screened at 4-12 weeks, and followed up at 6 months, post-injury. Total scores on the OMPQ were able to differentiate between work status on both occasions, indicating the potential predictive validity of this instrument. This is the first study to evaluate the OMPQ in a compensable injury population, and although replication with a larger sample is required, the findings have significant relevance to the recommendation of routine screening for the early identification of injured workers at risk of long-term disability.

A biopsychosocial model of pain and depression in rheumatoid arthritis: a 12-month longitudinal study

OBJECTIVE

To cross-validate a biopsychosocial model using physical disability, helplessness and passive coping to predict depression and pain in rheumatoid arthritis (RA).

METHODS

Clinical and psychological measures were collected from 157 RA patients at three time points over a period of 12 months. Path analysis was used for cross-sectional and longitudinal prediction of depression and pain.

RESULTS

Helplessness and passive coping were found to be significant mediators of the relationship between the physical disability and future depression and pain. Cross-sectionally, the predictive model could account for 52-94% of the variance of pain and 37-71% of the variance of depression. Longitudinally, the predictive model could explain 29-43% of the variance of pain and 21-33% of the variance of depression.

CONCLUSIONS

These results suggest that physical disability, helplessness and passive coping have a significant impact on the levels of pain and depression experienced by RA patients.

Health science students' time organization and management skills: a cross-disciplinary investigation

One hundred and fifty-four final year health science undergraduates from the disciplines of Medical Radiation Sciences, Speech Pathology and Physiotherapy in the Faculty of Health Sciences, the University of Sydney completed the Australian Time Organisation and Management Scale (ATOMS). Findings identified the strengths and weaknesses of students on the four dimensions included in this analysis. Whilst the results indicated strengths in the area of students' sense of purpose, level of focus and goal-setting ability, areas of weakness were noted, particularly with regard to the use of basic time-management devices (e.g. use of a diary and making lists). How these skills and competences are related to age, gender and discipline is explored. In addition, the degree to which these time-management behaviours can be enhanced (eg with time management intervention programs), the generalizability of the findings to other settings (non-academic), and the development of these skills over time are major issues discussed in the paper.

The impact of passive coping on rheumatoid arthritis pain

OBJECTIVE

To determine the ability of coping to predict pain.

METHODS

Data on 111 rheumatoid arthritis (RA) patients (86 women and 25 men) were gathered from a mail survey. Statistical analyses were conducted on a range of clinical and psychological variables: physical disability, disease duration, pain, depression, helplessness, and passive and active coping. Pain was measured with both the pain subscale of the Arthritis Impact Measurement Scales and a visual analogue scale, and coping was measured with the Vanderbilt Pain Management Inventory.

RESULTS

A series of multiple regression analyses revealed that the optimal predictors of pain in RA were physical disability and passive coping, which accounted for 40% of the variance associated with pain. Path analysis revealed that passive coping mediates between the physical disability and pain, and between physical disability and depression.

CONCLUSION

The results of this study have implications for the overall management of RA. In addition to the medical treatment, the experience of pain and depression in RA should be addressed through an intervention programme designed to enhance coping strategies.