SY HLT (1) 0
INTERVENTIONS TARGETED TO THE HEALTHY POPULATION: PSYCHOLOGICAL ASPECTS OF HEALTH CHECKUPS AND SCREENING.
Conveners: ARO, Arja R. and JOHNSTON, Marteau
In wealthy societies an array of large scale health checkups and screening for risk factors, diseases and deficiences are targeted to the presumably healthy population. These interventions are based on the evidence of the reduction of mortality and morbidity by means of early detection and adequate care. The assumed individual benefits are: increased motivation to healthy life style and self care, change of risk behaviors and adequate treatment of diseases. Studies on cognitions, emotions and behaviours of both health professionals and those eligible for screening are presented. Psychological benefits as well as side effects and harm of screening will be included. Organisational and cultural factors influencing people's behaviour in the context of screening are also discussed.
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SEXUALITY AND REPRODUCTIVE BEHAVIOR.
BABAN, A; FRIEDMAN H. L; KNUDSEN, L; MATEJCEK, Z; PICK S and Kapor-Stanulovic, N.
It is the purpose of the symposium to present research findings and facilitate discussion with colleagues in the audience. A. Baban will report on perceptions of sexuality, partner relations, and reproductive behavior during the Ceaucescu era in Romania. H.L. Friedman will review WHO studies on adolescent sexual behavior in Africa. L. Knudsen will present a register-based analysis of early pregnancy resolution and subsequent fertility events among women born in Denmark in 1959 and 1964. Z. Matejcek will summarize the latest findings from the continuing study of persons born in 1961-1963 to Prague women twice denied abortion for the same pregnancy and pair-matched controls. S. Pick will note ongoing studies of sexuality education in Mexico City and N. Kapor-Stanulovic will describe her research on perceptions of reproductive behavior during a time of transition in the former Yugoslavia. H.P. David will serve as chair. Discussion with colleagues will be encouraged.
SY HLT (2) 1
ROMANIAN WOMEN' S PERCEPTION OF SEXUALITY, PARTNER RELATIONS AND REPRODUCTIVE BEHAVIOR.
BABAN, Adriana; University of Cluj, Romania.
Convener: DAVID, Henry P; Transnational Family Research Institute, Bethesda, USA.
One of the most dramatic chapters in the history of women's reproductive rights ended in Romania in 1989. For over 23 years, Romania had pursued a rigid enforced pronatalist policy, banning the sale of contraceptives, prohibiting most abortions, and imposing a tax on childless couples.
The aim of this study was to explore, through case histories, the psychosocial aspects of the Romanian pronatalist policy. The study group consisted of 50 women, aged between 18 and 55, with different sociodemographic and educational characteristics. As a method we used in-depth interviews which were concentrated on sexual and reproductive personal experiences.
The qualitative analysis of women's accounts revealed five major themes that were consistent among their life stories. The discussion will focus on: women's perceptions of sexuality as a taboo topic and/or source of threat and uncertainty; the range of feelings and attitudes towards unwanted pregnancies, perceived as catastrophic events; the process of making decisions for termination of pregnancies using illegal abortion, the psychological costs of adjusting the sexual life to the lack of modern means of contraception, and the quality of couple's life.
An understanding of the past will provide increased resources for a better knowledge of women's present needs in order to improve the quality of sexual life and women's reproductive health.
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THE WHO BEHAVIORAL RESEARCH PROGRAMME WITH ADOLESCENTS.
FRIEDMAN, Herbert L; World Health Organization, Genova, Switzerland.
The long range objective of the Adolescent Health Programme is to promote the health and development of adolescents and youth (10-24 years) worldwide. A methodology called The Narrative Research Design was developed to make use of story telling and role playing as natural devices for building a questionnaire and identifying adolescent behavioral patterns of relevance for reproductive health. Experience with this method and other research methods will be presented with examples from national studies.
SY HLT (2) 3
ADOLESCENT PREGNANCY RESOLUTION: DANISH LONGITUDINAL STUDIES.
KNUDSEN, Lisbeth B; Danmarks Statistik, Copenhagen, Denmark.
DAVID, Henry P; Transnational Family Research Institute, Bethesda, Maryland USA.
Abortion in Denmark became readily available and accessible on request on 1 October 1973. Both abortion and delivery are provided free of cost to the woman through national health insurance. This study tracked all Danish women born in 1959 and all Danish women born in 1964 (a total of 77,221 women in the recently developed Fertility Database) through the Danish national registers by individual person number through 1 January 1988.
Women having an abortion but no live birth before age 18 had fewer children by age 28 than those women who carried a pregnancy to term before age 18, but more children than women experiencing no fertility event before age 18. The proportion of women with the fewest years of education is highest among those who had their first child before age 18. There was little difference in educational attainment between early aborters (who had no deliveries before age 18) and women who experienced no fertility event before age 18. Women who terminated pregnancies before age 18 also tended to be in a more advantageous socioeconomic position at age 28 than those who decided to carry a pregnancy to term before age 18; they were about equal to those who experienced no fertility event.
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PERCEPTION OF REPRODUCTIVE BEHAVIOR IN TIMES OF TRANSITION.
KAPOR, Nila; Unicef, Belgrade.
People respond to own needs and wishes rather than to pressures of society, government and other outside forces. This has been evidenced for a long time among most couples in East European countries. In pite of new pronatalist trends, supported by church pressure and reduced access to abortion and contraceptive services, birth rates generally do not, respond with increased trends.
Women from Federal Republic Yugoslavia focus on here and now more than ever before. Deprived of all forms of social supportand benefits, living in a country with marked recession trends, they want and they have fewer and fewer children.
SY HLT (2) 5
PRAGUE STUDY ON CHILDREN BORN FROM UNWANTED PREGNANCIES.
MATEJCEK, Z and DYTRYCH, Z; Prague Psychiatric Center, Czech Republic.
220 children born to women twice denied abortion for the same pregnancy in Prague in 1961-63 and 220 pair-matched controls have been followed-up from childhood to adulthood. Independent data on prenatal and perinatal history as well as early development of the children were collected. Very thorough psychological, medical, and social assessments of the children were performed at the age of 9 years. The study subjects were then followed-up at the ages of 14-16, 21-23, and 25-27 (with focus on the marital partners). The differences found between the two groups widened over time to the disadvantage of the originally unwanted children.
A further follow-up at age over 30 is in progress now, including siblings of both of the groups of study subjects. The newest findings will be presented, the theory of psychological subdeprivation shortly outlined, and prevention by means of education and social policy discussed.
SY HLT (3) 0
AIDS: NEW FINDINGS AND DIRECTIONS IN PSYCHOSOCIAL RESEARCH
Convener: DIAZ-LOVING, Rolando and VILLAGRAN, Gabina, Universidad Autónoma de México, Mexico.
The absence of short-term medical solution to the effects and spread of HIV, has led to an increased role of behavioral models and interventions in primary prevention of HIV transmission and psychoterapy of AIDS patients. Thus, research on the effects of knowledge, attitudes, attribution, risk perception, personality and the other cognitive and affective variables and constructs on the behavioral patterns related or responsible for the transmission of HIV, is central to the development of effective programs and interventions.
During the present symposium, recent findings from several countries whose epidemiological research has shown differing risk behavior patterns in HIV transmission, examine the effects of psychosocial variables on the determination of preventive and risk behaviors. The research to be presented includes propositions of behavioral models an the evaluation fo their impact on the reduction of risk behaviors.
SY HLT (3) 1
AIDS: KNOWLEDGE, ATTITUDES AND BEHAVIOR OF PUERTO RICAN UNIVERSITY STUDENTS.
LUCCA IRIZARRY, Nydia and PACHECO, Ángel M; Unyversity of Puerto Rico, Puerto Rican.
Puerto Rico is the sight of one of the most alarming AIDS incidence rates in the world. The Center for Desease Control has informed that Puerto Rico has an incidence rate of 50.7: 100.000 inhabitants, and the metropolitan area of San Juan, the capital of 61.0: 100.000.
For the present study, in a sample of 212 students from different universities in the metropolitan area of San Juan, 56.6% reported being sexually active with 15.5 years of age as the average of sexual debut for males and 18.5 years for females religion. Religion and alcohol use were not related to sexual preactices. Although a mayority new what a condom was and how to use it. Only one quarter of the students gave correct answers regarding AIDS. Furthermore only a small percentaje indicated using condoms on a regular base, perhaps due to the fact that attitudes towards condom use were not very favorable.
Another possibility is that 72% of the participants were worried of possible contagion, although 3.9% indicated any type of possibility of getting infected.
The results of the sutudy replicate other findings which show students have active sexual lifes, with several sexual partners, and at the same time take few preventive measures to reduce the risk of HIV contagion.
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STRUCTURAL EQUATION ANALISIS OF BEHAVIORAL COMPONENTS RELATED TO AIDS.
PIÑA LÓPEZ, Julio A; MÁRQUEZ MUNGUÍA, Ivette and CORRAL VERDUGO, Víctor; Universidad de Sonora, Mexico.
Considering the multidetermination and multidimensional nature of AIDS prevention related behaviors, psychological research should adopt structural equation models in order to identify and evaluate the inter-relationships of behavioral variables in risk and prevention of HIV contagion. With this strategy, a closer and more precise analisis of the relation between theory and data should emerge.
In the present paper, data are presented for a sample of in habitants of Sonoral a northem state of Mexico, with a strong emphasis on the notion of dispositional categories, and their historical and situational variants as probability events of the instrumental execution of risk and prevention behaviors. Personality, stress, habits and the others personal and situational variables were entered into the equations as predictors of behaviors such as condom use.
A discussion will be made of the importance of structural models in the study of population problems such as AIDS, and their use in the construction of psychological models of health.
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A COMPARATIVE ANALYSIS OF THREE APPROACHES TO AIDS PREVENTION.
Zolik, Edwin S; DePaul University, Chicago, USA.
Behavior change is the key to reducing the incidence and subsequently the prevalence of AIDS. This presentation will compare the successes and problems experienced in a week long multi-media, TV, radio and newspaper preventive program in Chicago directed at adolescents and families, a Massachusetts program wich distributes condoms to junior high and high schools students instituted by fiat without community involvement, and a program in Florida wich focuses on education and behavior change and provides for choices by the community.
Positive results from the Chicago program include reports by the families that the program made it easier to talk to their children about AIDS, sexuality and other sensitive topics. The Massachusetts program was the least successful in that it polarized the community on the issue of condom distribution, forestalled a major focus being placed on AIDS prevention, and has resulted in politizing the AIDS issue. Results indicate that preventive programs need to engage in a bilevel analysis, one at the level of the adolescent target group and secondly at the community level along with risk perception, ethnic, cultural and religious mores as they impinge upon the proposed program.
SY HLT (4) 0
RECENT DEVELOPMENTS IN CARDIAC REABILITATION
DONKER, Frank; Sint Joseph Ziekenhnis, Veldhoven, The Netherlands.
Cardiovascular rehabilitation has been evolved in many places as an effective component in the cure for patients after myocardial infarction, for patients after cardiological surgery (bypass), and for other cardiological patients.
Clinical psychological intervention programs regarding the after care of coronary cardiological patients have been the subject of much research lately. Research demonstrates that some effects can be seen, while this kind of intervention programs can be implemented safely and compatibly into the standard cardiological care of the general hospital albeit that the demonstrated effects seem to be rather short-lived. The evaluation of cardiovascular rehabilitation programs so far has been directed mostly, however, towards medical and psychosocial variables in general, but in a lesser extent towards the more specific individual risk factors as known in the area, like the level of cholesterol, (over-)weight, hypertension, physical condition and the Type A Behaviour Pattern (TABP) of which the Hostility (HO) factor seems to be the most discriminating element.
After a more general introduction to the field (Dr. M. Johnston) and some of the more general aspects of this kind of intervention programs in coronary artery disease (social support/ compliance/ quality of life -Dr. Rodriguez) the different speakers in thissymposium will go into detail of some of the known individual risk factors connected to unhealthy life styles, like smoking (dr. Breteler), Hypertension (dr. Vinck), TABP and especially its hostile components (Dr. Barefoot)
Dr. Falger at last will present some data from a larger study which is being carried out in our hospital: starting from the abovementioned observations The Department of Clinical Psychology And Social Work of The St.Joseph Hospital in EindhovenVeldhoven/ Holland developed in coollaboration with the universities of maastricht and nymegen an educational and counseling program aimed at the alteration of 'risky' life styles ('risky' behaviour) and the digestion of psychosocial problems resulting from cardiovascular disease: Patients who are being included in the program are men who had a major cardiological event (MI, PTCA, Bypass operation); excluded are patients over 70, patients with congenital cardial problems/defects, having serious postoperative complications, patients with special surgery or patients with angina pectoris being the primary diagnosis. The Program started in january 1992 and will last untill 1995. We will follow patients until 2 years after inclusion.
SY HLT (4) 1
RESPONSE TO MYOCARDIAL INFARCTION.
JOHNSTON, Marie; FOULKES, Joan and GUDMUNDSDOTTIR, Hafrun; University of St. Andrews, Scotland.
Models of cardiac rehabilitation can potentially be further developed by additional information about patients and their partners responses to the myocardial infarction (MI). Responses may be considered in terms of knowledge, misconceptions, emotional states, coping strategies, attributions for the MI. activity levels and behavioural risk factor reduction.
Theoretical models in health psychology suggest systematic relationships between these responses; for example that accurate information should reduce distress and that attributions to the self and/or active coping strategies would be predictive of greater behavioural risk reduction.
These relationships were studies in a cohort of 120 patient and their partners. All participants were recruited within 72 hours of admission to hospital following an MI and interviewed on 5 occasions both in hospital and at home up to the one year after MI.
Results will be presented om the changing pattern of response to MI over the follow-up period and on the relationship between responses on each assessment occasion.
SY HLT (4) 2
SOCIAL SUPPORT AND CORONARY ARTERY DISEASES.
RODRÍGUEZ-MARÍN, Jesús; Department of Health Psychology, University of Alicante, Spain.
Many studies have reported a significant impact of social support on health-related variables. Social support has become regarded as a central psychosocial issue in health research. The general assumption is that social support is negatively related to coronary artery disease.
Social support can contribute to cardiovascular health in four ways: (1) by creating a growthpromoting environment that enhances self-esteem and well-being; (2) by decreasing the likelihood of stressful life events; (3) by providing feedback or confirmation that actions are leading to anticipated and socially desirable consequences; (4) by buffering the negative effects of stressful events. Social support affect observed health behavior. Significant others function as an important lay referral system for individuals making decisions to seek professional care for health promotion, illness prevention, or care in illness. In addition, social support can determine adherence behavior especially in the case of coronary artery disease.
The evidence of an effect of social support on cardiovascular is convincing, but that little is known about pathogenic mechanisms involved. One possible pathogenic pathway is via standard risks factors such as smoking, lack of exercise, etc. Other way is to hypothesize that lack of social support would provoke cardiovascular reactions similar to those in stressful situations. An finally, we can explore the role of social support in the field of rehabilitation after cardiac surgery.
This presentation will be present a review of all of this fields, in order to establish possible relationships between coronary artery disease experience and social support.
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CARDIAC PATIENTS, SMOKING AND HYPERLIPIDEMIA: BEHAVOIR CHANGE AFTER REVALIDATION.
BRETELER, MHM AND LASSCHUIT, I; University of Nijmegen, the Netherlands.
Convener: DONKER, F; VISSER, R and FALGER, P; Jozef Hospital, Eindhoven, The Netherlands.
The relationship between smoking and Coronary Heart Disease (CHD) has been well documented. Particularly heavy smokers have risk ratio's varying between 25:1 in the younger age groups to 2:1 at older age. Studies in patients show that the relative risk to die from CHD ranges between 1,5 and 2,7 for smokers compared with quitters.
Apart from this, a multiplicative relationship has been established between smoking and hyperlipidemia. Smoking is more hazardous for patients with hyperlipidemia than for those without it.
After reviewing the literature on these topics, we will present data of patients participating in a multidisciplinary cardiac revalidation program. Changes in the risk factor profile of these patients were measured between begin of treatment and follow-up at 12 months.
In accordance with previous studies, smoking and Type Acomponents, measured with the SI, turned out to be associated with serum cholesterol and triglyceride.
The relevance of these findings is discussed with regard to their consequences for cardiac rehabilitation. It is concluded that smokers deserve special attention, taking into account the addictive properties of smoking.
SY HLT (4) 4
THE EFFECTS OF RELAXATION TRAINING ON BLOOD PRESSURE AND HEART RATE DURING REST AND STRESS IN NORMOTENSIVE SUBJECTS.
PROPS, Annie, M. K; VINCK, J and ARICKX, M; Limburgs Universitair Centrum, Diepenbeek, Belgium.
JOHNSTON, D. W; University of St. Andrews, Scotland.
Relaxation training has been considered as a behavioural technique in the treatment of hypertension for some time. The results of some recent studies are rather disappointing and show little or no benefit. Some explanations might be called upon for this lack of effects: few studies used a stressor and a relaxation technique in the same experimental design, and cardiovascular measurement was often infrequent. We therefore used a pre-posttest randomized design to look at the effects of stress and relaxation on blood pressure and heart rate. Cardiovascular measures were taken continuously using the Finapres. Our experimental sample consisted of 82 normotensive second year medical students (n=37 males, n=45 females). Half of them received relaxation training between pre and posttest, half of them formed our control group. During pretest all subjects underwent the same experimental procedure: an 8' rest period followed by a stressor, Raven Matrices, for 15 '. During posttest both experimental and control subjects were randomly allocated to 2 conditions: 1 rest before stressor, 2 filler activity before stressor. We thus compared the effect of actual application of relaxation with a possible generalization effect. Cardiovascular measures were analysed by repeated measures analysis of variance. Results for all subjects show no beneficial effect of relaxation on lowering blood pressure or heart rate. Further analysis of results for subjects with high baseline and reactivity cardiovascular values shows no difference in results. Analysis of data of subjects who further trained the relxation technique and results of subjects who felt most stressed during the experiment yield no arguments for a beneficial effect of relaxation.
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DISTRESS AND MORTALITY AFTER MYOCARDIAL INFARCTION: THE ROLE OF PERSONALITY FACTORS.
Despite a decline in cardiac mortality in the Westem society, myocardial infarction (MI) still is a major health problem in terIns of excess mortality. Evidence also indicates that MI is a medical condition that significantly affects the patient's emotional well-being. Of note, emotional distress i.e. depression and social alienation- has been associated with long term-mortality in post MI patients. Emotional distress in these patients is not related to the severity of cardiac disorder but largely a function of stable personality traits. By contrast, the role of personality in post-MI mortality is unknown.
In the present study, 105 middle-aged men who survived a MI filled out STAI-trait,
HPPQinhibition, and Marlowe-Crowne scales to assess their personality type and,
subsequently, were followed for 2-5 years. Rate of death for patients with a 'distressed'
personality (11/28 = 39%) was +/- eight times that for the other personality types
(4/77=5%) (p
While other investigators found that depresson and social alienation were associated with post-MI mortality, we found that this determental effect of stress was related to individual differences in coping style. Importantly, interventions aimed at enhancing emotional well-being may improve longevity in patients with a distressed personality type.
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MODIFYING CORONARY-PRONE BEHAVIOR IN CARDIAC REHABILITATION PATIENTS.
FALGER, Paul R. J; Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands.
DONKER, FJS and Lasschuit, I; St. Joseph Hospital, Veldhoven, the Netherlands.
In cardiac rehabilitation, modifying personality and behavioral risk factors is necessary in reducing coronary artery disease (CAD) morbidity and mortality. We studied 200 consecutive male CAD-patients (pats) from a larger intervention about long-term effects of behavior modification and risk factor education on subsequent CAD-morbidity and mortality. All CAD-pats, including MI-, CABG-, and PTCApats, were from the Eindhoven Metropolitan Area (the Netherlands). We report, first, on baseline associations between components of Structured Interview (SI) derived Type A behavior, and total, HDL- and LDL-serum cholesterol, and left ventricular function (LVEF), and, second, on one year follow up results.
At baseline, there were no significant associations between SI-components and total cholesterol. However, in pats with complete HDL- and LDL-data, 'Global Type A', 'Total Hostility', and 'Hostile Cognitions' were associated with elevated HDL-, but not LDL-cholesterol. Also 'Total Hostility' and 'Hostile Cognitions' were associated with a less favorable HDL-LDL ratio. Moreover, in bicycle excercise electrocardiography, 'Total Hostility' and 'Hostile Cognitions' were positively associated with excercise duration. In pats assessed as scoring highest on 'Hostile Cognitions'. LVEF was significantly impaired. We concluded that in cardiac rehabilitation efforts should be directed primarily at modifying aspects of 'Hostility' since these were associated with less favorable HDL-LDL cholesterol ratio, significantly impaired LVEF, and excess exertion.
The follow-up results after one year will demonstrate the changes in those parameters in CAD-pats assigned to our behavior modification and risk factor education intervention program and in those CAD-pats who were not.
SY HLT (5) 0
PSYCHOLOGY AND AIDS.
EVANS, Richard I.; University of Houston, Houston, U.S.A.
As the HIV virus is infecting greater and greater numbers of individuals throughout the world, more challenges to psychological researchers emerge. Can social and health psychologists develop effective prevention strategies?. Can psychologists in psycho-neuro-immunological research determine the effects of psychosocial influences on the immune system?. Can clinical psychologists contribute to dealing with the problem of how AIDS victims and their significant others coan cope with their plight?.
This symposium will explore various facets of this criticalemerging challenge to psychologists throughout the world.
SY HLT 6
MEDICAL COMMUNICATION SKILLS: THEIR MEASUREMENTS AND OUTCOMES
WINEFIELD, Helen; University of Adelaide, Adelaide, Australia.
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VERBAL EXCHANGE STRUCTURE OF MEDICAL CONSULTATIONS: COMPARATIVE RESEARCH.
STILES, William B; Miami University, Ohio, USA.
A verbal exchange is a set of speech act categories that tend to occur together and are used together for some subtask within an encounter. Within each exchange, participants' speech acts are complementary and tend to elicit each other, for example, (a) questions and yes/no answers or (b) directives and agreements to comply or (c) telling a story and back-channel acknowledgments.
Seven principal exchanges (Exposition, Closed Question, Checking, Direction, Inquiry, Explanation, and Instruction/Contracts) have been identified by factor analysis of speech act frequencies in tapes or transcripts of over 1,100 medical consultations in the United States and the United Kingdom. The studies suggested that the patient-clinician joint repertoire of verbal exchanges is very consistent across settings, patient characteristics, and types of medical problems, although consultations differed in the relative amount and timing of each exchange.
In consultations with medical patients who presented with psychological problems, the repertoire of exchanges differed from the standard repertoire in ways that resembled the repertoire found in psychotherapy. For example, Exposition split into separate Revealing (emotional exposition) and Storytelling (social exposition) exchanges, perhaps representing a separate and greater emphasis given to subjective material in dealing with psychological distress.
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PHYSICIAN-PARENT-CHILD COMMUNICATION OVER THE YEARS: CHANGING INTERACTIONS?.
MEEUWESEN, Ludwien; KAPTEIN, Myriam and BENSING, Jozien; Utrecht University, The Netherlands.
In the extensive field of doctor-patient communication research, the position of the child has largely been neglected. In general practice, one in seven consultations refers to a child. Our study focused on the verbal behavior in the triad doctorparent-child, containing a comparison of the interactional patterns over a period of 15 years.
A frequency analysis with 'Roter's Interaction Analysis System' (RIAS), containing instrumental and affective dimensions (Roter, 1989), has been applied to videotaped observations of ten medical interviews with children (modal age = 9 years old) in the period 1975-1978 and ten in the period of 1988-1989. This analysis has been extended with a sequential analysis of turns, a 'Turn Allocation System' (TAS) (Aronsson & Rundstrom, 1988).
Results of these analyses indicate that over this period the nature of the doctor-parent-child interaction has changed substantially: 1) the conversational contribution of the child has increased significantly, and 2) patterns of interaction have changed and intensified. The results will be discussed in terms of transformation processes in society at large, and in terms of optimalization of doctor-patient communication in the case of juvenile patients. Relevant methodological issues in doing research on communication processes in a triad will be dealt with in more detail.
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DOCTORS' DECISION-MAKING ON GIVING INFORMATION TO CANCER PATIENTS.
RODRIGUEZ-MARIN, Jesus; University of Alicante, Spain.
A major focus in the literature about doctor-patient communication is information-giving. In the case of cancer patients, one significant issue is which factors determine whether and how, general practitioners and oncologists give information to their patients. Whatever may be the content of information, the most important choice for the doctor is to give information or not. Our research group at the Department of Health Psychology has conducted investigations in order to identify the significant determinants of decisions concerning giving information to cancer patients. A sample of 60 doctors from Alicante province in Spain were asked their criteria for giving information about a cancer diagnosis. Results showed that perceived intelligence and emotional control in the patients were the best predictors of the decision by doctors to give information. Age and socio-economic status were also significantly associated with the doctors' information-giving practices. These data suggest that the criteria for giving information to cancer patients are subjective and show a strong cultural influence.
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EXPLORATION OF DOCTOR AND PATIENT AGENDAS IN THE GENERAL PRACTICE CONSULTATION.
BUTLER, N. M and CAMPION, P. D; University of Liverpool.
COX, A. D; University of London, England.
A method for interaction analysis of the doctor-patient consultation is described. It satisfies criteria for any method of analysis for medical interviews proposed by Wasserman and Inui (1983) and is shown to be reliable. Results for the three principal agenda types (physical, emotional and social) are presented in terms of control exerted by either doctor or patient in determining the content of the interview. Both doctor and patient present physical agendas to a similar high degree. In contrast, patients present emotional agendas to a far greater extent than doctors address the concerns. The findings for social agendas are intermediate between those for physical and emotional. It is argued that doctors can facilitate the expression of emotional and social agendas by giving explicit or implicit permission for their presence in the interview. Analysis of doctor and patient problem solving behaviour shows that problem solving later in the consultation appears to be a function of the problem solving strategies which either party bring to bear on a given agenda. The implications of this are discussed briefly in terms of the quality of information obtained by the doctor and its implication for measurements of outcome.
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INFLUENCE OF PATIENT CHARACTERISTICS ON PROCESS AND OUTCOME IN PRIMARY CARE CONSULTATIONS.
Weinman, John; University of London, England.
Many studies of doctor-patient communication have attempted to investigate the relation between various components of the consultation process and such outcomes as satisfaction, adherence to treatment and health status. The findings are inconsistent, perhaps because one relatively ignored determinant of both process and outcome is the patient. The data come from a large recent study of 504 consultations of 30 general practitioners in London. The examination of patient expectations prior to the consultation, using the Patients Intentions Questionnaire (Salmon & Quine, 1989), revealed that requests for explanation/understanding were the most common (approximately 60%) followed by requests for tests/diagnosis (approximately 30%) and then for support (approximately 20%). The same individual difference variables were related to a number of basic consultation process measures (e.g. length of consultation, proportion of doctor/patient taLk) and to outcome (satisfaction). The results so far indicate that patient differences are important in explaining some of the variance in process and outcome. Hence it is not surprising that earlier studies have failed to provide a consistent picture of process-outcome effects in doctor patient communication since these are highly interactive with and dependent on the mood, age, cognitions, and expectations of patients.
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PATIENT-CENTREDNESS IN GENERAL PRACTICE: WHO DECIDES ON THE QUALITY OF CARE?.
WINEFIELD, Helen; MURRELL, Tim and CLIFFORD, Julie; University of Adelaide, Australia.
General practitioners (N = 21) allowed us to tape-record 10 of their consultations and interview the patients, in order to seek connections between the process and the outcomes of consultations. Process was described in terms of the verbal interaction, coded according to a modified form of Stiles' Verbal Response Mode system, while outcomes were operationalized as the post-consultation satisfaction of both parties, and the patient's compliance and health changes. We later visited participating doctors to discuss some of the consultations which they had found unsatisfying, using Arborelius' techniques for process recall.
Patients and doctors tended to feel satisfied after different type of consultation. Doctors liked consultations which were short and medically clear, whereas patients liked to discuss the recommended treatment. The qualitative data suggest that occupational stressors for doctors arise partly from individual patients, especially the frequent attenders who seem unresponsive to treatment, and partly from external worries such as time and financial pressures.
The communication deficits which cause problems in primary care seem therefore to occur between doctors and the health insurance authorities, as well as between doctors and patients. A peer support program for doctors wishing to monitor and improve their communication skills will be outlined.
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WORKSITE HEALTH PROMOTION.
KITTEL, France; University of Leiden, Leiden, The Netherlands.
Worksite Health Promotion has probably been one of the most rapidly developping area of health promotion in the last decade. Reasons for this are numerous, but accessibility of the target population, possible continuity for action and the potential benefits of the interventions are likely to be the most important ones. A thorough evaluation of various intervention programmes in different countries would be meaningfull. The speakers' contributions will permit to analyze in how far the application of health psychology principles as well the broadened scope of health promotion has increased effectiveness and efficiency in various cultural environments.
From a public health point of view it is interesting to diagnose moreover the socio-economical and political barriers which still exist or how they have been coped with. From a more fundamental research point of view it is essential to discuss internationally obtained effects and outcomes in the light of applied processes.
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PSYCH0S0CIAL PREDICTORS OF ABSENCE FROM WORK: TWO PROSPECTIVE STUDIES.
PARKES, Katharine R; University of Oxford, England.
Absence from work imposes high organizational costs in terms of reduced productivity, disruption of work groups, and increased demands on other employees. In seeking to identify the types of worksite interventions which might serve to reduce absence episodes, an understanding of the underlying factors is important.
Many studies have sought to identify correlates of sickness and absence; however, the retrospective nature of much of this work, and the tendency to focus on additive effects, limits interpretation of the findings. Analyses of prospective data, which take into account interactions between environmental, psychological and medical factors, can therefore make a potentially useful contribution.
The present paper reports two studies of sickness absence in which data (including smoking, body mass index, and mental health) were collected prior to the years over which absence was recorded. In the earlier study, absence among female student nurses (N=185) was found to be predicted by the main effect of smoking, by a curvilinear effect of body mass, and by an interaction between body mass and symptom levels. In the second study, similar patterns of relations are examined in prospective data obtained from a group of male civil servants (N=600). The findings of the two studies are compared, and implications for intervention strategies are considered.
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FINAL RESULTS OF THE "HEALTHIER WORK IN BRABANTIA" HEALTH PROMOTION PROGRAM.
KITTEL, F; MAES, S; SCHOLTEN, H and VERHOEVEN, C; Leiden University, Leiden, the Netherlands.
Some important worksite health promotion programs over the world, but essentially in the United States and in Australia, have shown to elicit significant health behavior changes. The originality of this "Healthier work in Brabantia" project consists of interventions directed not only at the individual level but also at the environmental and organizational level.
In this quasi-experimental study, identical measures were taken 4 times in the control and in the experimental group, namely before the program started, after 1 year, 2 years and after 3 years.
Interventions concerned life style and behaviors as well as the general work conditions (content and organization).
The effect evaluation of this program will be illustrated with some examples of the major outcome variables which are life habits, overall stressreactions and workstress, as well as absenteeism.
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QUALITY OF WORK AND HEALTH.
VAN DER DOEF, Margot P; KITTEL, F; MAES, S and DIEKSTRA, R; Leiden University, Leiden, the Netherlands.
During the last decade, research on the relationship between work aspects and health has extended to psychosocial job characteristics. For example, a high psychological workload in combination with low decision latitude has been found to be associated with the development of cardiovascular disease (Karasek & Theorell, 1990).
A questionnaire measuring Quality of Work was constructed, based on the Job Content Questionnaire (Karasek, 1985), a Dutch questionnaire on Organisational Stress (VOS-D; Bergers et al., 1986) and a Dutch structured interview method measuring Welness at Work (WEBA; Maes et al., 1990).
In the present study, questionnaires were distributed among the general working population by means of publication in diverse Dutch newspapers. From over 15.000 respondents, data on Quality of Work and health indicators, such as somatic complaints, depression, anxiety, hostility and sickleave, were obtained.
Cross-sectional results from this study concerning the relationships between quality of work and the above mentioned health parameters will be presented and discussed.
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AN ECONOMIC EVALUATION OF WORKSITE HEALTH PROMOTION PROGRAMS.
OLDENBURG, Brian F; Queensland University of Technology, Queensland, Australia.
By intervening early with the potential health problems of employees, employers hope to improve the health and productivity of their workforce, while reducting the costs associated with a subsequent deterioration of health. We have used outcome data from a randomised worksite intervention trial to examine the cost effectiveness of four cardio vascular disease risk reduction programs: health risk assessment, risk factor education, behavioural counselling and behavioural counselling plus incentives. The economic evaluation focused on outcomes during the initiation or "action" stage of lifestyle change as well as, on the longer term of "maintenance" stage of lifestyle change. Individualised behavioural counselling was found to be the most cost-effective strategy for the initiation and maintenance of risk factor reduction. These results are examined in relation to the need to develop and evaluate interventions which incorporate strategies directed at individuals as well as the organisation as a whole.
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APPLICATIONS OF PSYCHOLOGICAL THEORY IN COMMUNITY HEALTH PROMOTION.
Convener: LEE, Christina; Department of Psychology, University of Newcastle, Callaghan, Australia.
Cancers and coronary heart disease are major causes of death and ill health in developed countries, while infectious diseases continue to be a major problem in developing nations. While social and economic context is important, individual behaviours play a large role in the development and, conversely, in the prevention of these conditions. This symposium brings together researchers from Europe, Australia and Africa to discuss the application of contemporary psychological models of behaviour change to the development of risk-reduction interventions. Strategies derived from the Transtheoretical Model of health-related behaviour change, from social learning theory, and from relapse prevention are outlined. Research which applies these models to the primary prevention of cancers and heart disease at a community level, through the modification of diet, exercise, smoking, and other risk-related behaviours in developed countries, is described. By contrast, the final paper examines the relevance of Western psychology to community health promotion in Africa. The symposium emphasises the need for interaction between theory and application in the development of effective interventions.
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HEALTH BEHAVIOUR GOAL MODEL AND EXERCISE BEHAVIOUR.
GEBHARDT, Winifred A. and MAES, S; Dept. of Clinical and Health Psychology, Leiden University, the Netherlands.
The Health Behaviour Goal Model (Maes & Gebhardt, in prep.) is a theoretical framework, based on social-cognitive theories, that can be applied in the field of health behaviour modification. Main characteristics of the model are that it (1) incorporates the personal goal structure of the individual, (2) focuses on individual emotional and health costs as well as benefits of changing behaviour, and (3) encompasses all phases of behaviour change.
We applied the model to the area of exercise adoption and maintenance. A questionnaire on exercise behaviour, consisting of statements based on the principal constructs of the model, was developed and administered to a sample of 800 nurses and orderlies, working in nursing homes. Results from this study will be presented and their implications for the applicability of the model will be discussed.
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THE ROLE OF PSYCHOLOGICAL THEORY IN UNDERSTANDING AND INFLUENCING WOMEN'S EXERCISE CHOICES.
Lee, Christina; Department of Psychology, University of Newcastle, callaghan, Australia.
Although there is good evidence that regular physical exercise will significantly affect health and reduce premature morbidity and mortality, adults in developed countries are generally sedentary. Exercise rates are lower among women than among men, and drop steadily with increasing age; thus, the community group with the lowest levels of exercise are middle-aged and older women.
This paper presents data on psychological variables relevant to women's exercise involvement. Although psychological models such as the Transtheoretical Model are useful in distinguishing between women with different levels of exercise involvement, they are less useful in understanding the difference in participation rates between men and women. It is suggested that psychological theories of health-related behaviour focus too exclusively on intra-individual determinants of behaviour. There is a need for expanded models which take into account the social and systemic variables which affect participation in positive leisure time activities. Expanded models which combine psychological and sociological concepts to place the individual in a social context may be useful more generally in the understanding of health-related behavior choices.
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SMOKING PREVENTION: A DUTCH REPLICATION OF THE WISCONSIN SMOKING PREVENTION STUDY.
Chatrou, Marlène; Dept. of Clinical and Health Psychology, University of Leiden, Leiden, The Netherlands.
Smoking prevention interventions have been developed from different theoretical viewpoints. The first interventions were based on the idea that providing correct knowledge about the harmful effects of smoking would prevent youngsters from starting to smoke. It became clear very soon, that this was too simplistic a view.
Important elements as self-efficacy, the influence of important others etc. Were added to the models, resulting in the application of more expanded models as the Health Belief Model and Fishbein & Ajzen's Theory of Reasoned Action.
Leventhal's Parallel Response Model was the basis of a smoking prevention intervention which was successfully carried out in the United States of America. In this self-regulating model, a cognitive feedback loop operates simultaneously with an emotional feedback loop. The emotional aspect of starting (not) to smoke is denied in most smoking prevention interventions. In the Netherlands, however, a replication study of Leventhal's intervention showed the expected positive results. The results of this study are discussed on the basis of a model of smoking behaviour.
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TROPICAL HEALTH PROMOTION: ON LEARNING FROM THE COMMUNITY.
MACLACHLAN, Malcolm; Department of Psychology, Chanceller College, Malawi, Africa.
Twenty percent of Malawian children die before reaching the age of five. The great majority of these deaths arise from illnesses which are largely controllable and preventable. The challenge for health psychology is to develop effective methods of intervention that can integrate the realities of local resources with healthy living styles. To achieve this, however, psychologists must learn from the communities they seek to serve. Within Africa the process of health promotion requires a negotiation between the 'modern' methods of psychology and the 'traditional' methods of community life. To illustrate this argument, health promotion efforts regarding malaria, diarrhoea and immunization are critically reviewed.
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MEMORY FOR EVENTS DURING GENERAL ANESTHESIA.
Convener: MERIKLE, Philip M; Department of Psychology, University of Waterloo, Ontario, Canada.
During the past 30 years, there have been many anecdotal reports of surgical patients who have memory for at least some of the events that occurred during general anesthesia. In recent years, a number of research groups have attempted to establish whether or not there is in fact memory for events occurring during what is generally considered to be adequate general anesthesia. The resulting research studies suggest that some patients may have unconscious memory for some events that occur during general anesthesia. Tn addition, there is evidence suggesting that unconscious memory for positive suggestions during surgery may assist recovery following surgery by reducing analgesic requirements. However, there is also evidence suggesting that some patients may suffer post-traumatic stress disorder because of unconscious memory for events during surgery. The presentations will summarize recent findings obtained by major groups of investigators seeking to establish 1) when unconscious memory for events during anesthesia does and does not occur, 2) what types of information are most likely to be perceived and remembered unconsciously, and 3) the consequences for patient recovery and welfare of unconscious memory for events during anesthesia.
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IMPLICIT MEMORY DURING GENERAL ANESTHESIA: THE EFFECT OF WORD FREQUENCY AND TEST-DELAY INTERVAL.
BONEBAKKER, Annette E. and BONKE, B; Erasmus University, Rotterdam, The Netherlands.
KLEIN, J; Clara Hospital, Dept. of Anesthesiology, Rotterdam, The Netherlands.
MERIKLE, P. M; Dept. of Psychology, University of Waterloo, Ontario, Canada.
Implicit memory for words was studied in surgical patients undergoing elective procedures under general anesthesia. Before and during surgery, 80 patients were presented with both common and less common words via headphones. At the earliest convenient time after surgery (within 4h) and 24 h later, implicit memory was tested by asking patients to complete auditorily presented wordstems to the first word that came to mind. Part of the wordstems corresponded with the experimental words (target items). The remaining wordstems served as control items (distractors). After the second word completion session, (24 h after surgery) subjects were requested to perform a recognition task to assess explicit memory for both the pre- and intraoperative words.
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POST-OPERATIVE BENEFITS OF THERAPEUTIC. SUGGESTIONS DURING GENERAL ANAESTHESIA.
CASELEY-RONDI, Glenys J; MERIKLE, P. M. and BOWERS, K.B; University of Waterloo, Canada.
The primary questions addressed in the research that we present are whether surgical patients who are under adequate general anesthesia may perceive auditory information, and whether they can benefit from such information. In addition, we consider the relevance of hypnotic ability for perceptual processing in this context. Ninety-six adult patients, undergoing elective abdominal hysterectomy, were randomly allocated to one of four taperecorded conditions: therapeutic suggestions, melodies, suggestions-plus-melodies, or silence. Double-blind conditions were satisfied in every respect. Patients received a standardized, but typical, "balanced" anesthetic, and level of anesthesia was adequately monitored. Following surgery all patients received their analgesic medication (morphine) from a patient-controlled device. Patients who were played therapeutic suggestions used a significantly smaller dose of self-administered morphine than patients who were not played suggestions. Although hypnotic ability was not significantly associated with therapeutic outcome, there were indications that this is a relevant individual difference for processing information during general anesthesia No compelling evidence for memory of melodies was obtained. We conclude that personally salient information is perceived during general anesthesia, and that patients can benefit from this experience.
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IMPLICIT MEMORY DURING PROPOFOL SEDATION.
CORK, Randall and HEATON, J. F; Lsumc, New Orleans, Louisiana, Usa.
KIHLSTROM, J. F; University of Arizona, Tucson, USA.
Introduction: Recent evidence indicates that implicit memory may be preserved under light general anesthesia.1 The purpose of this study was to assess implicit memory in patients undergoing heavy sedation with propofol.
Methods: After approval by our university IRB and written informed consent, patients
scheduled for ambulatory procedures involving sedation were studied. Sedation was with
initial boluses of propofol 0.5 mg%kg-1 and fentanyl 50 mg%kg-1 i.v., followed by an
infusion of propofol 50 mg%kg-1. Administration of propofol 30 mg boluses intraoperatively
was controlled either by the patient or the anesthetist. At the last stitch, patients were
played a list of 15 stimulus words and the most frequent response (target), as indicated
by standard norms. After one hour in the recovery area, all patients were tested for free
recall, free association, cued recall, and recognition on the list presented during
surgery (critical list) as well as a matched list not presented (neutral list). Data of
all patients without free recall of words played were analyzed with repeated-measures
ANOVA. Significance was p
Results: Of 36 patients, 5 demonstrated free recall of target words. For the remaining 31 patients, cued recall and recognition tests showed no evidence of explicit memory; however, the free association tests demonstrated significant priming. The number (mean +- sem) of critical free associations was 6.58 +- 0.36, compared to 5.48 +- 0.40 neutral free associations (p<0.05).
Conclusions: Implicit memory is spared after loss of explicit memory during intra-operative sedation with propofol.
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IS THE EVIDENCE FOR MEMORY DURING ANAESTHESIA RELIABLE?
MILLAR, Keith; Glasgow University, Scotland.
The paper considers the reliabilíty of evidence, both positive and negative, for the supposed phenomenon of memory for events during general anaesthesia. The methodology of many studies is often the first factor to compromise the reliability of the results. Sample sizes may be too small, control conditions may be omitted or inadequate and inapporpriate memory assessments may be applied. While explicit memory tests are known to be insensitive, implicit tests have been applied uncritically in the mistaken belief that the reliably reflect unconscious memory processes. In fact, reference to the psychological literature indicates that many suppsosedly implicit memories are based upon explicit recall. This facts is neglected by reserarchers into memory for anaesthesia. Statistical analysis is a further defect which may fail to detect, or galsely suggest, significant effects. the conlcussions of some studies have been shown quite simply to be wrong because of incorrect calculations. However, the cardinal failing is the common omission of any measurement of depth or adequacy of anaesthesia wich then renders many positive and negative results uninterpretable. More recent sophisticated studies involving intra-anaesthetic monitoring of memory function and the brain´s cortical activity may suggest that memory for events during adequate anaesthesia is unlikely.
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TRAUMATIC EXPERIENCES RELATED TO ANESTHESIA.
MOERMAN, N; Department of Anesthesiology, Academic Medical Centre, University of Amsterdam, Amsterdam.
BONKE, B; Department of Medical Psychology and Psychotherapy, Erasmus University, Rotterdam, The Netherlands.
Traumatic experiences related to anesthesia usually have their origins in the pre and postoperative periods. Less known are the experiences originating in the anesthetic period itself, the so-called "awareness" phenomenon. A period of conscious awareness during general anesthesia may be extremely unpleasant for the patient. The unexpectedness, the incomprehensibility of the situation, the sensation of paralysis and the fear of experiencing pain cause great distress. Feelings of powerlessness and anxiety may be overwhelming. Such an experience may be followed by after effects. Subsequent symptoms include sleep disturbances, nightmares, flashbacks, feelings of discomfort and anxiety during the day and even phobia's. These after effects may last for several weeks or months or even longer. In serious cases post-traumatic stress disorder may develop. Counseling by an experienced anesthesiologist is required in order to give the patient a sense of acknowledgement of the symptoms and, if possible, an explanation of what has happened.
Three "awareness" cases are presented to illustrate what patients may experience during the period of awareness. The three cases differ as regards after effects. Some details of anesthetic techniques in use today are provided.
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HEALTH AT WORK: CONTRIBUTIONS FOR A GLOBAL APPROACH.
OLABARRÍA GONZÁLEZ, Begoña; Ayuntamiento de Madrid, Madrid, Spain.
In 1.989, EUROPEAN ECONOMIC COMUNITY, during the Spanish Presidency, issued a Directive about occupational health. All the members should respect this Directive since January 1st, 1.993.
EU´S Countries have been editing necesary rules in order to execute the Directive, that has to be applied in "all activity sectors, private or public (industrial, agricultural, trade, administrative, services,educational, cultural, leisure, etc.)".
Traditionally, Industrial Hygiene have taken in account, monocausaly and univocally, the relation betwen risk and occupational illness or labour accidents. Today, Occupational Health appears like an Area of complicate Intervention, including biological, psiquical and tecnical aspects, as they are in the working process.
Although Psicology have been making, for many years, important contributions, these have been exclusively in research scope. But in fact, the European Directive, opens a new Area of Intervention, that includes Psicology in a very important way.
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INTEGRATION OF OCCUPATIONAL LABOUR INTO SPANISH SANITARY SYSTEM.
DONALISIO, Roberto; Instituto de Salud Pública de Navarra, Pamplona, Spain.
According to Symposium title, this contribution tries a global approach to Occupational Health, this aproximation starts with the consideration of that labour atmosphere and laboral conditions are very important factors for health promotion or for patologies and health disturbances, in these problems, a mayority of adult population is involved.
With these premises, this report shows that knowledge of risk factors proceeding from labour atmosphere and laboral conditions like an approach to ethyological diagnostic according with health disturbances actually prevalent. All these konwledges should be integrated into Spanish Sanitary System, in this manner, preventional and attention actions would be much better guided.
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THE NEW EUROPEAN AND SPANISH AMBIT ABOUT OCCUPATIONAL HEALTH AND LABORAL SECURITY.
ALONSO, Florentino; Instituto Nacional de Seguridad e Higiene en el Trabajo, Madrid, Spain.
In 1957, European Community started working in Occupational Health and Security from its foundational agreement.
In 1979 and 1984, began two programs corresponding this object, and were taken legislative actions.
Nevertheless, right impulse in this object was produced in 1987, with the implementation into "European Single Act" of Article nº118a, this article fix members and community rols in this matter.
Third action program, founded in Article 118a, carried a lot of laws about occupational health and security. These laws formed the new normative and conceptual structure of European risk prevention.
This structure is well developped in Spain and inside, psycologist rol should be rexaminated and it must be considered as one of the professional involved in specific prevention actions.
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THE CONTRIBUTION OF PSYCHOLOGY TO HEALTH TOWARDS THE YEAR 2000.
Convener: OLDENBURG, Brian; Queensland University of Technology, Red Hill, Queensland, Australia.
In recent years psychology has brought its influence to bear on the World Health Organisation and other national and international initiatives to improve the public health of many countries around the world in relation to some of the major preventable causes of mortality and morbidity, including AIDS, cardiovascular disease and cancers. There are many recent examples of innovative public health programs in the workplace, primary health care and the community, more generally, which demonstrate the important contribution that psychology has to make. This symposium will provide some illustrations of this contribution in terms of the following developments, including: measurement of quality adjusted life years; our understanding of psychophysiological mechanisms; intervention strategies based on concepts derived from behavioural epidemiology and public health psychology; and improved understanding of the linkages between the social and work environment and physiological outcomes.
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PATHWAYS TO BETTER HEALTH IN AUSTRALIA THROUGH PRIMARY HEALTH CARE.
OLDENBURG, Brian; Queensland University of Technology, Australia.
Health promotion and disease prevention activities in Australia over the last 20 years have shifted away from behaviour and lifestyle change toward structural and environmental change. This has resulted from increasingly sophisticated analyses of determinants of health, research demonstrating the improved effectiveness of such changes in terms of improved health status, and from the experience of health promoters working to promote health in communities, workplaces and schools. Some of the most influential models and planning frameworks such as the Ottawa Charter for Health Promotion now incorporate this understanding. National health goals and targets which have been developed in many countries around the world over the past 10 years have in many instances also attempted to reflect this analysis of social, economic, and physical determinants of health. We have applied these various elements to the development, implementation and evaluation of health promoting strategies in primary health care settings. Most recently, we have been testing strategies for disseminating programs more effectively to general practitioners and their patients, by utilizing other community resources and facilities and supporting these with a mediabased program.
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BEHAVIORAL MEDICINE IN SWEDEN.
ORTH-GOMER, Kristina; National Institute for Psychosocial Factors and Health, Stockholm, Sweden.
Empirical evidence is accumulating showing that the contributions of psychology and behavioral sciences to school medicine have become indispensable. This is true for diagnostic and rehabilitation, but perhaps most evident in treatment and prevention.
At the Swedish National Institute for Psychosocial Factors and Health, Karolinska Institute, Stockholm, we have focused our work on intervention towards noxious factors in the social and work environment and their modification. We have shown that it is possible to alleviate stress in the work place, or decrease social isolation in a neighborhooh - and demostrate beneficial physiological effects on lipids, blood pressure etc. These studies will be discussed and their impact for the development of behavioral medicine, nationally and internationally will be highlighted.
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QUALITY ADJUSTED LIFE YEARS IN HEALTH OBJECTS FOR THE YEAR 2000.
KAPLAN, ROBERT M; University of California, California, USA.
The world wide pressure to use resources efficiently has created a demand for new health indicators. Public health analysts have traditionally focused on three major outcomes: life expectancy, infant mortality, and disability days. These measures are inadequate as public health indicators because they ignore most variation in wellness that is affected by medical and behavioral treatment. Health-related quality of life measures combine morbidity and mortality to express health outcomes in units analogous to years of life. The years of life figure, however, is adjusted for diminished quality of life associated with diseases or disabilities. The measures are called Quality Adjusted Life Years (QALYs). QALYs solve the complex problem of trade offs between length of life and quality of life. The first overall public health object for the year 2000 in the US is to increase the span of healthy life. Healthy life span is conceptually equivalent to the QALY. This presentation will present original data on the development of QALY measures and their applications to the evaluation of the health goals for the year 2000. Estimates of the public health impact of diseases such as arthritis and Alzheimer's disease will be presented.
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THE ROLE OF HEALTH PSYCHOLOGY IN THE PROMOTION OF PUBLIC HEALTH.
VINCK, Jan; Limburgs Universitair Centrum, Diepenbeek, Belgium.
In the area of prevention and health promotion, the contribution of health psychology has been dominated by the health education or the health belief approach. This approach assumes that behavioral adaptation has to start from the "awareness" of some problem.
From there an intention to change behavior must develop and action must be taken. At best, it is admitted that environmental variables can hinder or support such behavior change. In our view such "problematization" of behavior is risky, and, most of the time, unnecessary. It is risky because the process of changing behavior in this way is difficult to achieve and even more difficult to maintain and because "problematizing" can lead to adverse effects. It is often unnecessary because many health related behaviors are not experienced as problematic or as related to health risks and because these behaviors can be changed without "problematization". Health Psychology will, therefore, contribute more to promotion of public health when it changes to an environmental approach, which, in a sense, fits better in psychological theory. The traditional "public health approach", which has always been more environmental, can in this way also find additional theoretical support. The implications of such reorientatior of the role of health psychology in public health in terms of opportunities, limitations, training and research will be discussed.
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PSYCHOPHYSIOLOGICAL CONTRIBUTIONS TO HEALTH IN THE YEAR 2000.
STEPTOE, Andrew; University of London, United Kingdom.
Psychophysiological methods play an important role in the exploration of the mechanisms linking psychosocial factors with health risk, and in the identification of individuals at elevated risk for stress-related disorders. New measurement technologies are increasing the possibilities for monitoring physiological functions that are significant for health outside the laboratory under everyday life conditions. A recent development in psychophysiology is the experimental modelling of psychosocial processes that have been shown in epidemiological studies to be relevant to health. The purpose of this modelling is to investigate under controlled conditions how factors such as social support or job strain actually impact on cardiovascular and neuroendocrine function. Illustrations of these approaches will be taken from recent research on the psychophysiological consequences of lack of control over work pace. Lack of control has been shown to elicit substantial acute stress-related cardiovascular and neuroendocrine responses in the laboratory, while job strain influences blood pressure recorded using ambulatory methods during the working day.
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BURNOUT IN HEALTH CARE: ETIOLOGY AND INTERVENTION
SCHAUFELI, Wilmar; University of Nijmegen, Nijmegen, The Netherlands.
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BURN-OUT: THEORY AND PRACTICE REVISITED.
COX, Thomas; Department of Psychology, University of Notthingham, United Kingdom.
DEWE, P; Department of Human Resource Management, Massey University, New Zealand.
LEITER, M; Department of Psychology, Acadia University, Canada.
This paper critically considers the nature and structure of the burn-out construct and its measurement. In doing so it explores the philosophy under-pinning the development of the construct and its application.
A brief review of the history of the burn-out construct is offered. Issues are then raised about the nature of burn-out and the dimensionality of the measured construct. Evidence is presented in favour of burn-out as a multidimensional and multi-faceted construct. Questions are then posed about its diagnostic (and defining) features and about the relationships among its different elements. The importance of 'emotional exhaustion' is flagged, and the status of this particular element is then examined. Implications for measurement are explored.
Comments are then offered on the dominant philosophy under-pinning the development of the burn-out construct and associated measures, and complementary approaches are offered for consideration. Attention is paid to the difference in viewpoints and in utilisation offered and demanded by clinical, social and organizational psychology.
Finally, the application of the construct and measures of burn-out are then explored in the organizational setting. Attention is drawn to the wide variety of current applications, and some of the more imaginative are flagged. An agenda is offered for future research and application.
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THE ETIOLOGY OF BURNOUT: A PERSPECTIVE FROM EQUITY THEORY.
VAN DIERENDONCK, Dirk; Utrechs University, The Netherlands.
Since its "discovery" in the early seventies burnout has been considered the result of demanding and emotionally charged relationships of professionals with recipients of their care. However, virtually no attention has been paid to the theoretical social psychological underpinnings. This presentation will link social psychological theory and burnout research by taking a perspective from equity theory.
For professionals two basic types of relationships have to be considered in relation to burnout. First of all, the interpersonal relationship between professional and recipient. This relationship is inequitable by its very nature since caregivers invest more in this relationship they receive in return. Secondly, professionals have an exchange relationship with the organization they are employed in.
This presentation will discuss the relevance of equity theory for understanding the underlying mechanisms of burnout based on the dual exchange relationship of the professional with his/her recipients and with the organization. A research model will be presented based upon studies among (1) general practitioners, (2) student-nurses, (3) staff working with mentally handicapped and (4) therapists.
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COPING WITH STRESS AND BURNOUT IN FRlENCH PEDIATRIC RESSUSCITATION UNITS.
GIRAULT-LIDVAN, Noëlle; Université René Deseartes, Paris, France.
I - Objectives
This research aims to evaluate relationships between stress, burnout, and coping, in french hospital units specialized in pediatric ressuscitation, in order to promote burnout prevention actions, as well as effective methods for reducing perceived stress and burnout of medical personnel.
Moreover, it has two specific objectives: 1. Complementary validation of the french adaptation of the MBI (first realized on 212 physicians and nurses); 2. Development of a health-professions-specific coping scale.
II - Methods and sample
A questionnaire has been used for the evaluation of stress and occupational strain sources, along with three scales: 1. MSP, french version of a canadian general stress scale (Lemyre and Tessier, 1988); 2. MBI (Maslach & Jackson, 1986); 3. MPCI (Medical Professions Coping Inventory), first version of a 24 items coping scale focusing on coping behaviors directed towards the burnout components (emotional exhaustion, depersonalization, personal accomplishment), in the occupational and private life.
About 300 physicians and nurses, belonging to 20 pediatric ressuscitation french units, participated in the research.
III - Results
Compared to the MBI french population of validation, physicians and nurses in pediatric ressuscitation units exhibit a higher level of emotional exhaustion (p<.OOO1), and a lower level of depersonnalization (p<.0001), in frequency and intensity, and 41% are "burnoutees". Emotional exhaustion appears to be correlated with actual perceived stress (p<.0001, for frequency and intensity). Nevertheless, organizational strains do not appear to be associated with stress level, but only with emotional exhaustion, for two of them (overtime, unpredictable changes in time off). Finally, though it needs further validation, item analysis shows several strong and consistent relationships between MPCI items and burnout levels. On this basis, concrete bumout prevention and reduction actions are proposed and should be applied in the next months, with a follow-up study.
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WORK - AND CLIENT-RELATED STRESSES AS PREDICTORS OF BURNOUT: RESULTS FROM A THREE WAVE LONGITUDINAL STUDY.
ENZMANN, Dirk; Sozialpädagogisches Institut Berlin, Berlin, Germany.
To study causal effects of stresses on burnout, a three-wave longitudinal study across two years was conducted. Burnout (MaslachBurnout-Inventory) and the frequency of work-related (time pressure and lack of decision latitude) and client-related stresses (problems in interactions with clients and confrontation with dying) were assessed using self-report inventories. Subjects were 193 nurses, physicians, psychologists, and social workers from three fields of work (AIDS, oncology, geriatry). Multiple regression analyses ignoring autocorrelations of burnout measures showed that work-related stresses could explain emotional exhaustion and depersonalization significantly and better than client related stresses. Confrontation with death and dying had no effects. In contrast, when linear structural equation modeling was applied and autocorrelations of burnout were partialed out, only small direct effects of stress on burnout could be found. However, long-term effects were bigger than short-term effects. This could be due to the stability of the measures: In two years emotional exhaustion and depersonalization had a stability of 40%, personal accomplishment 80%, time pressure and confrontation with death and dying 70%, and lack of decision latitude and problems in the interaction with clients 50%. Different longitudinal models for the analysis of long-term effects of stress on burnout (including additional variables such as coping and empathy) are presented and discussed.
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THE CONTEXT SPECIFIC NATURE OF BURNOUT: IMPLICATIONS FOR TRAINING AND TREATMENT.
LEITER, Michael P; Acadia University, Wolfville, Canada.
COX, Tom; University of Nottingham, Nottingham, United Kingdom.
DEWE, Phillip; Massey University, Palmerston North, New Zealand.
This symposium reviews a series of studies examining the ways in which burnout is specific to occupational setting. One direction in this research are studies that have found that burnout is more closely associated with aspects of the work setting in contrast to the employees' home situation. Another study found that health care employees who use Employee Assistance Programs (EAPs) to be reporting problematic levels of emotional exhaustion and depersonalization while maintaining the same levels of personal accomplishment as their colleagues. These findings confirm that emotional exhaustion is the aspect of burnout that is not only the most similar to colloquial definitions of burnout, but related to the experience of psychological distress as well. They also confirmed that EAP users who identified the worksetting as the source of their problems scored higher on emotional exhaustion than did EAP users who attributed their problems to difficulties at home. A third direction in this research differentiates the Maslach Burnout Inventory from the Beck Depression Inventory through a confirmatory factor analysis that confirms the three factor model of burnout and the differentiation of global burnout and depression factors.
In summary, this line of research confirms that burnout continues to be a construct that provides a distinct perspective on difficulties at work, in contrast to more context free constructs, such as depression, that have implications for a broader sphere of life.
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A NURSE EDUCATION AND BURNOUT PREVENTION PROGRAM.
JANCZUR, Beata; Jagiellonian University, Cracow, Poland.
This report describes the results of the "Nurse Education and Burnout Program (NEBP). The primary objectives of the NEBP are to: (1) encourage nurses to use their increased knowledge and understanding of job stress and burnout in their personal and work environments to increase their tolerance for subsequent stress inducing events by developing realistic coping strategies ("stress innoculation") and, (2) provide the impetus for the creation of supportive "stress reducing" structures in the work environment. A pilot program, based on research findings from structured interviews with Polish nurses was designed and administered to 180 nurses in one Polish hospital. Results of the pilot program were used to develop the NEBP. Based on the results of the current NEBP offered to 150 nurses at the Polish American Children's hospital in Kraków, Poland, the authors conclude that "stress inoculation" coupled with organizational strategies to promote positive working conditions, is an effective means of reducing stress and burnout, especially in a changing cultural environment where one's sense of security is threatened. The authors recommend that the NEBP be included in nursing curriculum and staff development programs.
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COPING, SOCIAL SUPPORT AND HEALTH
SCHWARZER, Ralf; Freie Universität Berlin, Berlin, Germany.
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THRASHING AND BASHING FRIENDS AND LOVERS: HOW MEN'S COPING HARMS OTHERS TO HELP THEMSELVES.
HOBFOLL, Stevan E; MONNIER, Jeannine and DUNAHOO, Carla; Kent State University, USA.
A Multiaxial Model of Coping was developed that is represented by 3 axes: (1) active-passive, (2) prosocial-antisocial, and (3) direct-indirect. High mastery and lower psychological distress were found to be related to active, direct, prosocial coping strategies, as predicted by the model. Research further indicated that the model and accompanying instrument were more gender and culture fair than other models and instruments. Women were no less assertive than men, but more prosocial. Men were more aggressive than women, but their coping was also more likely to be antisocial. This suggests that actionfocused coping of men may have negative social ramifications that may harm others and isolate them from social support. Women, in contrast, may be more comfortable with coalition building. Implications of this alternative coping model are discussed.
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COPING STRATEGIES AND ADJUSTMENT IN PERSONS WITH RHEUMATOID ARTHRITIS.
WALLSTON, Kenneth A; and SMITH, Craig A; Vanderbilt University, Nashville, USA.
Individuals vary greatly in their adaptation to chronic, potentially debilitating diseases, such as rheumatoid arthritis (RA). At any given level of pain or physical symptomatology, some individuals appear to be minimally affected by their condition, whereas others demonstrate considerable functional impairment and relatively poor psychological adjustment. One task for psychologists is to identify the factors and processes that differentiate between those who adjust relatively well and those who adjust relatively poorly.
The purpose of this presentation is to describe a newly developed measure of coping strategies, the Vanderbilt Multidimensional Pain Coping Inventory (VMPCI), and to begin to answer the following set of questions: What are the profiles differentially associated with adaptational outcomes? Are all of the various coping strategies subsumed under the umbrella of "passive coping" equally maladaptive or are some particularly harmful and others relatively neutral in their implications? Finally, do certain combinations of coping strategies bear special relations to adjustment?
The VMPCI assesses how one typically copes with pain in terms of nine distinct strategies. Data to begin to answer the above questions come from a study of 172 persons with RA. Using cluster analysis, 156 of the 172 subjects were classified into one of six coping profiles. We then conducted a MANCOVA that tested for differences in three outcome variables (degree of impairment due to arthritis; depressive symptoms; and life satisfaction) across the six groups, partialling out pain. One group, labeled "Catastrophizers" consistently demonstrated above-average impairment and maladjustment, whereas a second group, labeled "average copers" demonstrated considerably less impairment and maladjustment than others.
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COPING STRATEGIES AS PREDICTOR OF POST-TRAUMATIC STRESS.
ZEIDNER, Moshe;
This paper explores the role of coping strategies as predictors of post-traumatic stress in the aftermath of the Persian Gulf War. Data on coping styles and post-traumatic symptoms were gathered on a sample of 822 adult respondents in northern Israel. Demographic and personal variables, coping, and perceived stress emotions at time of war were assessed as correlations of post-traumatic stress and affective reactions after the war. The results imply that the effects of war on key variables, i.e., post-traumatic stress and anxiety, and bodily symptoms, as attitudes, was weak. Trait-anxiety and emotionfocused coping appeared to be the most salient variables associated with stressrelated variables across the various analyses. Emotion-focused coping was related to a high level of post-traumatic stress as well as anxiety and bodily symptoms reported for the post-war period. By contrast, active coping strategies do not generally appear to be meaningful predictors of outcome variables, save for attitudinal changes during the crisis. The results will be discussed and related to post-traumatic stress theory and research.
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PREDICTING ANXIETY AND DEPRESSION IN THE ELDERLY: SOCIAL SUPPORT AND PERCEIVED HEALTH AS COPING RESOURCES.
SCHWARZER, Christine; University of Düsseldorf, Germany.
Environmental and personal resources influence coping with stress and psychosocial outcomes of stress. Physical health is expected to serve as a protective factor against poor mental health, as indicated by measures of anxiety and depression. Social resources add their share of beneficial influence. A panel study was conducted with 72 elderly women and men, with two points in time one year apart. Perceived physical health and family support were chosen to create four groups with different levels of resources: Group 1 reported good health and satisfactory family support at both waves, Group 2 was in good health but lacked support, Group 3 felt ill but received support, whereas Group 4 reported ill health and lack of support. Anxiety and depression were associated with these four risk/resource levels, with Group 1 feeling best and Group 4 feeling worst. A repeated measures ANOVA revealed a significant interaction of groups by time on anxiety. Anxiety in Group 3 (ill health, but supported) declined over time. Thus, family support appears to buffer daily stress (such as chronic illness). The results are discussed in terms of resource appraisals in the stress process.
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THE SOCIAL CONTEXT OF COPING FINDINGS FROM A STUDY ON COPING SCRIPTS.
DE RIDDER, Denise T. D. and HEIJMANS, Monique J. W. M; Utrecht University, The Netherlands.
There has recently been a shift toward integrating the transactional and 'common stress' approach (e.g. Thoits, 1987) to stress and coping. Thus Thoits (1991) proposed to broaden the perspective: elaborating on individual coping processes an effort should be made to integrate it with the social risk group approach. To explore the potential of this integrative approach, the conceptual gap between social variables such as demographic measures on the one hand and psychological variables like coping measures on the other, has to be bridged. More specifically, more proximal measures of social context (Folkman, 1992), e.g. social scripts on stress and coping behavior, have to be developed. In our paper we discuss the contribution from scripts concerning the social aspects of stress and coping behavior. We present empirical findings from a population study (n=430) on the relation between demographic measures (gender, age and SES), beliefs about stress, coping and health, and coping behavior with respect to daily hassles, as well as preliminary findings from a small scale study on stress and coping scripts of people with low, medium and high SES. Our findings suggest that the diverse SES groups share meanings about the way stress should be handled, but that within these groups there is still variation in their concepts of stress and coping.
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PERSONAL AND SOCIAL RESOURCES FOR COPING WITH THE STRESS OF UNEMPLOYMENT IN BULGARIA.
TODOROVA, Ilina L. G. and KOTZEVA, Tatyana; Bulgarian Academy of Sciences, Moskovksa, Sofia, Bulgaria.
The aim of this study is to reveal the sociopsychological effects of unemployment in the transition of Bulgarian society from a centralized state economy to a market economy and democratic political structures.
The study focuses on the following factors social support, coping strategies, health consequences, as well as duration of unemployment and demographic parameters. We directed our attention to the issues of the way in which the causes of unemployment are conceptualized by the unemployed and to the advantages and disadvantages of unemployment as perceived by them.
Thus the study specifies two main tasks:
1) descriptive - to delineate the complexity of the socio-psychological effects of unemployment on attitudes and behavior of individuals with such an experience;
2) explanatory - to explain the moderating influences of different factors on the psychological and physical well-being of the unemployed.
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HEALTH BEHAVIOUR AND BELIEFS: AN INTERNATIONAL PERSPECTIVE.
Convener: STEPTOE, Andrew; Department of Psychology, St George's Hospital Medical School, University of London, London, United Kingdom.
Health behaviours include actions that increase risk of disease (eg cigarette smoking), and those which may help maintain health (such as physical exercise). The topic is of immense importance now that the involvement of lifestyle has been recognised in the many serious health problems that confront the population, including heart disease, cancer and accidents. Applied psychology has a major role to play in the understanding of the cognitive and emotional determinants of health behaviours, their patterning (reflected in the concept of "healthy lifestyle") and in the development of methods of modifying health practices. The proposed symposium will address the current state of knowledge concerning health behaviours and beliefs from an international perspective, emphasising both theoretical foundations and applied empirical research.
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HOME, SCHOOL AND PEER RELATIONS: THE ECOLOGY OF HEALTH BEHAVIOURS.
WOLD, Bente; Research Center for Health Promotion, University of Bergen, Norway.
The overall goal of the Health Behaviour in School-Aged Children (HBSC) study is to gain new insights into and to increase our understanding of health behaviours, lifestyles and their context in young people. The study also aims at increasing the understanding of how young people perceive health itself. The project is based on surveys among 11, 13 and 15 year-old children carried out at regular intervals (preferably every fourth year, and with special surveys in between) in a growing number of mainly European countries. Three surveys have been conducted, and the fourth survey is being carried out in 1993-94 in 24 countries. Within the study, the socialization perspective constitutes a common framework for the understanding of health-related behaviours. The socialization perspective implies the systematic exploration of how the behaviours of young people are influenced by various "arenas". The main socializing arenas influencing children's development of health and health behaviours are (a) family, (b) school, (c) peer groups. Based on analyses of 1989-90 HBSC data from 11 countries, the paper explores how indicators of children's adjustment to these arenas are related to their lifestyle in general, and to specific behaviours such as smoking tobacco, drinking alcohol and leisure-time physical activity. The findings are discussed in relation to ecological developmental theory.
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A SOCIAL-COGNITIVE ANALYSIS OF PHYSICAL ACTIVITY IN ADULTS AND ADOLESCENTS.
SALLIS, James F; HOVELL, Melbourne F; HOFSTETTER, C. Richard and ZAKARIAN, Joy M; San Diego State University, San Diego, USA.
Physical inactivity is a major risk factor for numerous chronic diseases, yet a minority of people in developed nations follow physical activity recommendations. Understanding the influences on physical activity behaviors may contribute to the development of improved intervention programs. A social-cognitive theory perspective on the influences on physical activity leads to an examination of personal factors, such as beliefs, in conjunction with environmental variables. Using behavioral epidemiologic methods, surveys were conducted with a community sample of over 2000 adults and 2000 high school students. Similar surveys were administered to both groups that assessed sociodemographic, cognitive, behavioral, social, and physical environmental variables. Regression analyses examining associations with vigorous physical activity were conducted. Results generally indicated that variables from multiple domains appear to be influencing physical activity habits of both adults and adolescents. Some correlates were significant in both adult and adolescent samples. The findings imply that effective interventions may need to include both education/behavior components as well as components to modify social and physical environments.
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KNOWLEDGE, ATTITUDES AND BEHAVIOUR IN HEALTH PROMOTION IN YOUNG PEOPLE IN EUROPE.
WARDLE, Jane; Institute ol Psychiatry, University of London, United Kingdom.
STEPTOE, Andrew; Department of Psychology, St Georges Hospital Medical School, University of London, United Kingdom.
International comparisons of knowledge and behaviour in relation to prevention of chronic disease are increasingly important in European health policy. Studies of populations exposed to different kinds ol health information also permit evaluation of the links between knowledge, beliefs and behaviour. The European Health Behaviour Survey was initiated within the CEC Medical and Health Research Programme to evaluate i) awareness of links between behaviour and illness, ii) beliefs about the importance of lifestyle to health, and iii) health behaviour practices, in 20 countries, using a uniform protocol. Data have been collected on beliefs and behaviours in a range of domains including diet, smoking and exercise from over 15,000 students.
This paper focuses on the results concerning behaviour, beliefs and knowledge about salt and fat consumption. The results indicated substantial differences between countries but the overall knowledge about links between salt and hypertension, or fat and heart disease, was poor. However, associations between knowledge and behaviour were modest. Beliefs about the importance of prudent dietary practices showed consistent relationships with behaviour across all countries. These results suggest that improving preventive health behaviour in young people demands not only providing information about lifestyle and disease, but also identifying strategies to convince them of the value of carrying out preventive behaviours.
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MODELING THE PRECAUTION ADOPTION PROCESS.
WEINSTEIN, Neil D; Rutgers University, USA.
Most models of health protective behavior (including the theory of reasoned action, the theory of planned behavior, subjective expected utility theory, protection motivation theory, and, to some extent, the health belief model) view the process by which people come to adopt precautions in terms of movement along a continuum. To predict behavior, these models combine independent variables in an algebraic equation. The numerical value of the equation reflects the individual's beliefs, experiences, and attributes and places that person along a continuum representing the likelihood of action. Stage models, in contrast, suggest that reactions to health threats are not adequately described by a single prediction rule. Stages are qualitatively different, not just different in degree. In particular, people at different stages are held to face different barriers, implying that the factors determining progress toward action vary from stage to stage. This presentation will contrast continuum and stage theories, both in terms of their conceptualization of the precaution adoption process and their implications for the design of interventions. In addition, a particular stage theory will be presented along with data from home radon testing that provide some support for this theory.
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PROTECTIVE FACTORS AND HEALTH
UUTELA, Antti; University of Helsinky, Helsinky, The Netherlands.
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SENSE OF COHERENCE, SOCIAL SUPPORT AND COPING STRATEGIES AS PROTECTIVE FACTORS FOR HEALTH.
KALIMO, Raija; Finnish Institute of Occupational Health; Finland.
The protective and promoting role of an individual's internal resources such as sense of coherence, external resources such as social support, and behavior such as coping strategies belong to the key components of a resource-oriented approach to health. Empirical studies have repeatedly shown that these factors are, indeed, related to health. There are, however, inconsistencies in the interpretation of the findings, which are largely due to the variety of possible ways these factors may have their effect involving 1. direct impact on health and on one s environmental situation, e.g. presence of job stressors, 2. moderating effect on the link between a stressor and health and, 3. mediation of the effect of a stressor on health. A review of the literature shows that the mediating and moderating role of the resources as well as their direct impact on health have received more attention than their more recently demonstrated connection to the environmental factors, e.g. stressors. Our research indicates that people are guided to the stressor situations to certain extent according to their resources which, together with coping strategies affect the perception of the stressors as well. Another important current issue is to further clarify the possibly different role of a certain resource in different environmental situations of which we have found some evidence in the study on workrelated stress.
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SOCIAL AND PERSONAL RESOURCES IN COPING WITH STRESS: A PANEL STUDY ON EAST GERMAN MIGRANTS.
SCHWARZER, Ralf; HAHN, André and APPEL, Elke; Freie Universitat Berlin, Germany.
On the basis of transactional stress theory, the adaptation process of East German migrants was studied over a two-year time period. Social networks and optimistic self-beliefs were expected to predict mental and physical health. Being involved in an intimate relationship was used as an indicator of social integration. Levels of generalized perceived self-efficacy were used as indicator of personal resources. Refugees who had a partner were less likely to suffer from depression and health complaints. Those who had high levels of self-efficacy at Wave 1, had lower depression and symptom scores at Wave 3, two years later. Personal and social resources predicted individual differences in mental and physical health over long periods of time. It is concluded that optimistic self-beliefs and social bonds represent powerful resources to cope with stress and to maintain health.
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THE IMPORTANCE OF SELF-EFFICACY EXPECTATIONS FOR HEALTH BEHAVIORS.
DE VRIES, Hein; ABC Cancer Prevention Program, Department of Health Education, University of Limburg, Netherlands.
Behavior in general is influenced by cognitions. Social learning theory distinguishes outcome expectations from self-efficacy expectations. Outcome expectations refer to an individual's perception of the possible consequences of his behavior. Self-efficacy expectations refer to a person's expectation with respect to his ability to perform the behavior. During the last decades, the importance of self-efficacy expectations for behavioral change have received increased attention. Several studies have found that high self-efficacy expectations are related with positive health behavior and behavioral change.
In the presentations the importance of this factor for various health behavior will be summarized briefly. Second, the relative importance of self-efficacy in relation with other concepts, such as outcome expectations (attitudes and social support) will be discussed by using an integrative model that combines social learning theory, theory of planned behavior and the transtheoretical model. Several results of empirical studies (e.g. on smoking, exercise) will be presented as well.
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JOB DEMANDS AND SICK-LEAVE ABSENTEEISM: DO SOCIAL, PERSONAL OR JOB RELATED FACTORS MODIFY THE RELATION.
VAHTERA, Jussi and PENTTI, Jaana; Turku Regional Institute of Occupational Health,
UUTELA, Antti; University of Helsinky, Finland.
The study examines the role of job control, sense of coherence and social support in sick leaves in occupations with varying job demands. The subjects were 930 (75 % women, initial average age 41 years) Finnish urban municipal employees, who were still in their jobs during the two year follow-up. Objective job demands were determined using the Frese and Zapf (1989) method and absenteeism on the basis of registers containing identifiable information on every absence period with reason(s). Poisson regression analyses were used to study the effects of job demands and various resources on the number of sick leave periods. The models for men and women were dissimilar. Among men demands correlated negatively, among women positively, with the number of sick-leaves. The demand-control-sense of coherence interaction was also related to the number of sick-leaves. Among women with low job demands, any high level resource guaranteed low absenteeism. For both genders facing high job demands, good job control and a strong sense of coherence were needed for low absenteeism. Supervisor support moderated the demand-control interaction only among men. Type of occupation, work related norms and social factors are discussed as potential explanations for the findings.
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VALUE ORIENTATION AS A VARIABLE MEDIATING THE INFLUENCE OF MACRO-SOCIAL STRESS ON PSYCHOSOCLAL WELL-BEING.
Boehnke, Klaus; University of Technology Chemnitz-Zwickau, Germany.
Studies have shown that the relationship of perceived macro-social stress and psychosocial well-being is weak, whereas the association of that stress with certain value orientations is stronger. Thus, subjects emphasizing post-materialistic values report a stronger macro-social stress than subjects who prefer other value orientations. Different links of value-orientations and well-being have been suggested. This paper views values as mediators between perceived macro-social stress and psychosocial well-being. Based on a 7-year 3-wave longitudinal study of young adults (N=541) from West-Germany it can be alleged, that perceived macro-social stress is indeed strongly correlated with value orientations, that perceived macro-social stress in middle or late adolescence influences values in early adulthood and, that perceived macro-social stress has no direct effect on mental health whereas values do show such an influence. This result is obtained both in time-lagged and concurrent analyses. A causal interpretation of the findings will be given: high perceived macro-social stress in adolescents lead to postmaterialistic value orientations, and these value orientations see to it that the youth's mental health is better in a culture where materialistic values are favored by the power elite.
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SOCIAL LEARNING THEORY AND HEALTH PSYCHOLOGY
WALLSTON, Kenneth A.; Vanderbilt University Medical Center, Nashville, U.S.A.
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THE CONTEXT OF COGNITIONS AND EXPECTATIONS.
NEWMAN, Stanton and DURRANCE, Pauline; University of London, Great Britain.
It is assumed in health psychology that the cultural context is equivalent once different medical/clinical conditions are similar. For example, studies of chronic illness have assumed that beliefs within chronic illness and expectations about the continuance of health would be similar across populations and cultures. In many cases norms from large scale studies, frequently from the USA, are used by researchers in other cultures to make comparisons. Culture and cultural differences have been a neglected area of study (Landrine & Klonoff 1992). In order to assess the potential impact of the cultural context on health related cognitions, a comparison was made between studies of patients with rheumatoid arthritis in the US and the UK. The particular measure selected for study was the widely used Multidimensional Health Locus of Control scales. These studies indicate dramatically different beliefs about control between these two cultures. At a more contextual level, an examination was made of control beliefs around different illnesses. It would be expected that different illnesses create their own expectation about control over the future course of one's health. In addition, having a chronic illness is likely to have an impact on general beliefs about health, illness and the powers of medical intervention. A comparison was made between the beliefs about control between individuals at different levels of HIV infection and individuals with rheumatoid arthritis. These findings indicated a clear impact of experience of disease on control beliefs.
These studies will be placed within the context of social learning theory to examine how belief systems are generated around illnesses and how the cultural and disease context helps to shape patients' expectations about the future course of their health and the impact that they and others may have on it.
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CONSEQUENCES OF BELIEVING IN A DIVINE LOCUS OF CONTROL OVER ONE'S ILLNESS.
WALLSTON, Kenneth A. and STEIN, Mitchell J; Vanderbilt University, Nashville, USA.
The major contribution of Rotter's social learning theory to health psychology has been the application of the construct of locus of control to the understanding of health behavior and health status. In 1978, Wallston et al. developed Forms A & B of the Multidimensional Health Locus of Control (MHLC) Scales in which internal control over health was assessed separately from external control. The MHLC further distinguishes between chance externality and control of one's health by powerful other persons. Form C of the MHLC (Wallston et al., in press) allows the assessment of locus of control beliefs to be made specific to any medical condition and further separates powerful others externality into control by doctors and control by other people. None of these instruments, however, assess persons' beliefs regarding God's influence over their health or illness. To rectify this, a set of items assessing this dimension of locus of control was included in the 11th wave of an ongoing longitudinal investigation of behavioral aspects of rheumatoid arthritis. This presentation explores the correlates of different dimensions of locus of control beliefs regarding whether one's arthritis improves or worsens. The criterion measures examined include: self-efficacy; pain; fatigue; dysfunction; depression; life satisfaction; and pain coping strategies. Subjects were 140+ persons with RA, 75% female, with a mean age of 61 + years and a mean duration since diagnosis of 11 + years. The God locus subscale correlated .46 with chance beliefs, but was independent of the other dimensions and contributed unique variance to the explanation of the criterion measures. In general, belief in God as a locus of control was associated with undesirable outcomes and behaviors. Discussion will center on the unique contribution of assessing beliefs about God's control over illness.
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SELF-EFFICACY AND HEALTH BEHAVIORS.
SCHWARZER, Ralf; Freie Universitat Berlin, Germany.
It has been found that health cognitions precede the adoption and maintenance of health behaviors. Risk percepfions include one's vulnerability and the perceived severity of a disease or other critical event. Outcome expectancies represent contingency knowledge. People learn to see actions as causes of events and believe in the changeability of health risks and risky habits. Perceived self-efficacy implies that people see themselves as agents of change.
Studies are described that compare the role of self-efficacy with that of risk perceptions and past behavior. The intention to use condoms with a new partner was best predicted by past experience but the intention to stop smoking, to eat healthy foods, and to exercise were mainly determined by self-efficacy. The intention to undergo cancer screening was also influenced by self-efficacy but this had to be qualified in terms of age, sex, and interactions with outcome expectancies.
The evidence has particular value for the further development of a health behavior theory that comprises multiple stages of motivation and volition. Adopting precautions or changing risky habits must be seen as a self-regulation process that can be subdivided into stages: Having formed an intention to change is the endpoint of the motivation phase, and subsequent events comprise volition processes that include initiation and maintenance.
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SELF-EFFICACY PREDICTS SURVIVAL IN LUNG DISEASE.
KAPLAN, Robert M; University of California, San Diego, USA.
Chronic obstructive pulmonary disease (COPD) is leading cause of death in most developed countries. COPD patients are usually assessed using pulmonary function testing and related assessment of arterial blood gases. The validity of self-efficacy expectations as predictors of mortality was evaluated for 119 patients with chronic obstructive pulmonary disease (COPD). Patients completed four physiological measures that represent common clinical indicators of disease severity: 1) forced expiratory volume in one second (FEV1.0);2) arterial blood gas measurement of the resting partial pressure of oxygen (PaO2); 3) the single-breath diffusing capacity (DLco); and 4) maximum oxygen uptake (V02max) during exercise In addition, selfreported self-efficacy expectation for walking on a treadmill was measured. Self-efficacy was a significant univariate predictor of 5 year survival. However, when controlling for FEV1.0 in multivariate survival analysis, self-efficacy had a reduced effect. A social learning based intervention improved efficacy expectations, but did not increase survival or have long term effects upon other measures of health status. We conclude that expectations for health outcome provide important information about health status. Social learning based measures are simple, inexpensive, and may provide unique information about chronically ill adults.
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COPING HEALTH AND PSYCHOSOCIAL IMPLICATIONS.
SALJO, Roger; University of Liukoping, Sweden.
SEIFFGE-KRENKE, Inge; University of Bonn, Germany.
FRYDENBERG, Erica; University of Melbourne, Australia.
Convener: GREENGLASS, Esther; York University, Toronto, Canada.
MULLER, Jennifer, University of British Columbia, Vancouver, Canada.
MOORE, Kathleen A.; Deakin University, Toorak Campus, Australia.
This symposium seeks to advance our understanding of the theoretical construction of coping and its concomitants, especially as they relate to health, careers and psychosocial competence. Some of the assumptions inherent in the linguistic representations of the construct are challenged and research relating to adolescents and adults in communities across Europe, Canada and Australia is presented. Studies with adolescents from Germany report on young people's capacity to respond to normative demands and how these are met in clinic and non clinic populations. Coping research conducted in Australia over a five year period records the association between family climate, ethnicity, gender and coping. While research in the adult community records a link between health-related lifestyle change and coping. In Canada the link between careers, the utilising of social support and internal coping is examined. A study in a Canadian adolescent community explores the association between self concept and help seeking and coping. Research fromadolescent and adult communities helps to identify the critical constructs related to coping and how they impact on psychosocial functioning across a broad spectrum of the lifespan.
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LINGUISTIC REPRESENTATIONS OF COPING.
Saljo, Roger; University of Liukoping, Sweden.
The basic interest behind the present paper concerns how psychological phenomena and psychological states such as coping, are produced in language. The underlying rationale for exploring linguistic representations is the assumption that language plays a very important role in the constitution of psychological phenomena. Expressed differently, psychology language must be seen not merely as a representational device that provides etiquettes for clearly delimited entities, but also as a significant element in the process through which such phenomena are construed. Since psychological phenomena cannot be reduced to processes at a biological level nor be understood to refer to observed behaviours only, metaphors and metaphorical constructions play an important role in the creation of psychological insight. This would apply to scientific as well as to lay discourse on psychological phenomena. In the paper, some aspects of the notions of coping found in scientific presentations as well as in lay discourse wil be analysed. It will be argued that the role of metaphors in understanding psychological states should be given serious attention. Furthermore, a proper understanding of the role of discourse would allow for a more fruitful perspective on human psychological functioning than the dominant dualist position in which a clear line of division between mental (and discursive) and concrete practices is pre supposed.
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COPING BEHAVIOR IN NORMAL AND CLINICAL SAMPLES: MORE SIMILARITIES THAN DIFFERENCES?.
SEIFFGE-KRENKE, Inge; University of Bonn, Germany.
In our studies we tried to integrate a developmental and, a clinical perspective on coping and adaptation in adolescence.
Starting with a review of the author's own research, involving over 3000 12 - to 20 - year-olds from various cultures, the problems typical of this developmental phase and the way of coping with these normative demands are presented. The results show that coping skills of young people in dealing with age-apedific problems have so far been considerably underestimated. Their response to problems stemming from different developmental fields such as parents, peers, school or future involved three main modes of coping: Active Coping. Internal Coping and Withdrawal. Withdrawal was employed very rarely and only for certain types of problems. Age, gender and problem specific effects in coping were found. Whereas normal adolescents most frequently choose to cope with difficulties actively by means of social resources and to think out possible solutions, risk populations appear to have a more ambivalent pattern of coping strategies with high functionality and high dysfunctionality. Even their appraisal of problems is already disturbed; they feel more readily threatened by everyday problem situations and respond more uniformly with withdrawal.
Finally, similarities between the female coping style in normal samples and the more pronounced ambivalent pattern in clinical samples were discussed and related to psychopathology.
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ADOLESCENT HEALTH AND WELL BEING: WHAT THE ADOLESCEN COPING SCALE TELLS US.
FRYDENBERG, Erica; University of Melbourne, Australia.
This paper reports on research spanning a five year period relating to the coping actions of Australian adolescents in, different contexts, using as the central indicator of coping the Adolescent Coping Scale, an 80 item checklist that identifies 18 coping strategies commonly used by adolescents.
There are clear indications that age, gender and family of origin are indicators of coping. Furthermore, coping varies according to adolescent perceptions of the self, family climate and according to the experience of stress in the family.
It was found that functional family climate is generally associated with the use of functional styles of coping. Adolescent who are identified as highly able of gifted use a different coping repertoire than their non gifted peers.
To deal with divorce in the family young people in separated households use similiar strategies to manage their general concerns as do young people living in intact families. When it came to dealing with separation of parents, young people were found to be generally adaptive in their use of coping strategies.
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COMPONENTS OF SOCIAL SUPPORT, COPING STRATEGIES AND ANXIETY.
GREENGLASS, Esther; York University, Toronto, Canada.
The purpose of this study was to examine the relationship between coping forms and components of social support and their effects on anxiety experienced on the job. Participants for the study were 114 managers employed in a large Canadian city. Self-report measures were employed to assess coping and social support. Coping forms studied were Internal Control. Preventive Coping and Palliative Coping such as Wishful Thinking and Self Blame. Social support from three sources such as one's boss, co-workers, and family and friends was assessed and included practical, informational and emotional components. Multiple regression results showed Internal Control interacted significantly with practical support in predicting anxiety - when practical support was low, anxiety decreased with increasing Internal Control. High practical support from all three sources was associated with lower anxiety, regardless of degree of Internal Control. As with Internal Control, increased Preventive Coping was associated with lower anxiety when support was low; anxiety remained relatively low with high support regardless of level of Preventive Coping. Analyses further indicated that when coworkers' emotional support was low, anxiety increased with greater Palliative Coping. However, when support was high, anxiety remained relatively low despite increases in Palliative Coping. The data indicate that a comprehensive theory of coping needs to take account of the joint effects of social support and coping strategies.
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SEEKING HELP AND SOCIAL SUPPORT IN ADOLESCENCE: THE ROLES OF AGE, GENDER, AND SELF-CONCEPT.
MULLER, Jennifer and SCHONERT- REICHI, K. A; University of British Columbia, Vancouver, Canada.
Previous research has shown that adults cope more successfully with stressful events when they perceive they have friends and family to whom they can turn for advice. Nevertheless, scarce research has been conducted investigating the social support that adolescents perceive and utilize. Furthermore, little research exists which has examined the manner in which different dimensions of self-concept are associated with differences in the helping agents to whom adolescents turn for help. The present study examined how different domains of self-concept relate to help-seeking bahaviour in a sample of 220 (111 males, 109 females) adolescents, ranging in age from 12 to 19 years (mean age = 15.0 years). Adolescents were administered Harter's Self-Perception Profile and were asked to report whether or not they had sought help from their mothers, fathers, friends and professionals foe assistance with emotional problems during the past year. Findings revealed that many adolescents sought help, with the majority having sought help from mothers and friends. Older adolescent females sought more help than younger adolescents from friends and professionals. Multiple regression analyses were conducted in order to determine the manner in which differing dimensions of self-concept predict seeking help from the various helping resources.
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SELF-RESPONSIBILITY: A DETERMINANT OF HEALTHY LIVING, COPING AND CAREER SATISFACTION.
MOORE, Kathleen A.; Deakin University, Toorak Campus, Australia.
The World Health Organization (WHO) defined health as 'not only the absence of infirmity and disease but also a state of physical, mental and social well-being'. Whilst many individuals may have no apparent ill-health, their level of well-being in terms of these three domains may be uncertain. This study is part of a program designed to elicit lifestyle change in a non-ill population: to live healthy. The program involves subjects' setting their own short-and long-term goals for a healthy lifestyle predicted upon WHO's criteria. Amongst the goals identified by subjects are to: Feel Fit, Lose Weight, Maintain Weight, Look Good; Improve Coping skills; Be Assertive; and to have a Better Body Image. The mechanisms subjects' select for themselves to achieve these goals include: self determined exercise and diet programs, as well as participation in cognitive-behavioural sessions focusing on healthy living and coping strategies. Data indicate that this selfdirected approach has a significant positive impact upon subjects' mood state, their relationships with others as well as on their physical well-being and self-image. Self-reports also indicate that these subjects have improved job satisfaction and rate themselves as better able to deal with either personal or work-related problems. Results demonstrate that the reality of health is more than the absence of illness.
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A SOCIAL PSYCHOLOGICAL APPROACH TO THE STUDY OF AIDS-RELATED SEXUAL BEHAVIORS.
Convener: CHAN, Darius K. S; The Chinese University of Hong Kong, Hong Kong.
DONALD, Maria; Nacional Center for HIV Social Research, University of Queensland, Bristone, Australia.
ALBARRACIN, Dolores; University of Illinois, Champaign, USA.
FISHBEIN, Martín; Centers for Disease Control and Prevention, University of Illinois, Champaign, USA.
While some progress has been made in finding medication to delay the transition from HIV seropositivity to AIDS, and to prolong the life-expectancy f those already afflicted with AIDS, it has become increasingly clear that primary intervention must focus on behavior and behavior change. In order to change or maintain any behavior, one must first understand the determinants of that behavior. The more one knows about the factors underlying the performance of a given behavior, the grater the probabilitythat influence it. The proposed symposium will include examined the determinance of high risk sexaul ....... among various populations in the U.S. and Australia. specifically, the symposium will focus on research based on some theoretical formulation in social psychology. It will explore the role of important social psychological variables, such as attitudes, perceived normative pressure, perceived control, and self-efficacy, in understanding the performance or nonperformance of high risk sexual behaviors. It is expected that the symposium can provide a venue for exchanging some of the most updated research findings in the area, as well as delivering both theoretical and applied implications of these findings.
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AN EXAMINATION OF BEHAVIORAL. NORMATIVE AND CONTROL BELIEFS OF COLLEGE STUDENTS´ CONDOM-USING BEHAVIOR: IMPLICATIONS FOR DESIGNING BELIEF-BASED INTERVENTIONS.
CHAN, Darius K. S; Chinese University of Hong Kong, Hong Kong.
According to Fsihbein and Middlestadt's (1990) idea of sample-specific interventions, an effective AIDS intervention program should aim at identifying and changing the important beliefs that differentiate those who perform (actors) and those who do not perform (non-actors) the target behavior within a given population (e.g., use condoms during sexual intercourse among college students, or clean needles with bleach when sharing needles among intravenous drug users). In the present study, over 400 sexually active college students in the U.S. completed a questionnaire designing to investigate their condom-using behavior. Guided by Ajzen's (1985) Theory Of Planned Behavior, we identified these students' behavioral, normative, and control beliefs with respect to using a condom every time they have sexual intercourse. While the results generally support the theory, an examination of individual beliefs provides some interesting ideas for designing belief-based AIDS interventions targeting college population. For instance, while selfimage and relationship issues were consistently found to be the more immediate concerns for both male and female students to use (or not use) condoms, health consequences appeared to be less important. Specifically, those who used and those who did not use condoms regularly both perceived the effectiveness of using condoms in stopping AIDS/STDs to similar extent. Consistent with Fishbein and Middlestadt (1990), the results from this study illustrate how identifying important beliefs differentiating actors and non-actors within a given population is crucial for designing effective interventions. Both theoretical and applied implications of the results will be discussed.
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SOCIAL AND BEHAVIORAL DETERMINANTS OF HIGH RISK SEXUAL BEHAVIORS AMONG AUSTRALIAN ADOLESCENTS.
DONALD, María; National Center for HIV Social Research, University of Queensland, Bristone, Australia.
In June 1993, the Australian HIV Surveillance Report stated that 17,475 Australians have been diagnosed with HIV infection which is a rate of 100 per 100,000. Most of these people (approximately 82%) were homosexual/bisexual men and 29 % of the infections were diagnosed among 20 to 29 year olds many of whom would have become infected with the virus during their adolescence. While 13 to 19 year olds represent only 2.1% of the people infected with HIV in Australia, it is clear that adolescence is a crucial time for prevention of HIV infection. This paper provides an overview of the epidemiology of HIV in Australia and reports survey data collected from 932 sexually active grade 10 to 12 students from a sample of 2,655 school students from 72 public secondary schools in seven of the eight Australian states and territoties. The results of the survey identify some of the differences between 'low' and 'high' risk adolescent sexual behavior in terms of gender, age, ethnicity, geographic location, HIV and STD relevant knowledge, and attitudes, self-efficacy in safer sex negotiation, communication with peers, parents and others about sexual health issues and, importantly, peer norms for safer sex. With regard to condom use, younger students were more likely than older students and boys were more likely than girls to report having protected sex on the last occasion. For both boys and girls, cotnmunication with a partner about avoiding infection with HIV/STDs, the belief that more peers use condoms, and a higher perceived risk of becoming infected with HIV/STDs were associated with using a condom.
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APPLYING THE THEORY OF REASONED ACTION TO AIDS RESEARCH: A META-ANALYSIS.
ALBARRACIN, Dolores; University of Illinois, Champaign, USA.
FISHBEIN, Martín; Centers for Disease Control and Prevention, University of Illinois, Champaign, USA.
The Theory of Reasoned Action (TORA; Fishbein & Ajzerl, 1975; Ajzen & Fishbein, 1980) as applied in the area of AIDS-related behaviors was reviewed. Based on that review, condom use was selected as the focus of the present study for being the behavior most represented in the literature. A meta-analysis was conducted to determine whether TORA holds for predicting condom use. Another purpose of this study was to analyze the impact of three moderators on the results. These moderators are, namely, threats to construct validity, controllability of the behavior, and demographic variables. The overall sample of articles testing the theory was restricted to include those which had to (a) address condom-using intention and/or behavior; (b) include measures of the criterion variable (i.e., behavioral intention and/or behavior), attitude toward performing the behavior, and normative pressure with respect to performing the behavior; and (c) have a report of correlational analyses. TORA was tested through average weighted correlations and regression coefficients. In addition, corrections for artifacts and homogeneity tests were conducted to analyze the influence of validity variables. Analyses showed that TORA holds for explaining condom use. The results will be presented and discussed in view of behavioral change objectives.
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USING THEORY BASED COMMUNITY INTERVENTIONS TO REDUCE AIDS RISK BEHAVIORS: THE CDC´S AIDS COMMUNITY INTERVENTION DEMONSTRATIONS PROJECT.
FISHBEIN, Martín; University of Illinois, Champaign, USA.
HIGGINS, Donna and SCHNELL, Dan; Centers for Disease Control and Prevention.
AIDS Community Demonstration Projects.
The Centers for Disease Control and Prevention are supporting a number of projects designed to implement, and evaluate the effectiveness of, interventions to reduce AIDS risk. One of these projects, the AIDS Community Intervention Demonstration Project, is evaluating the effectiveness of a theory based community intervention designed to increase condom use in a number of ethnically diverse, high risk populations: men who have sex with men but do not gay-identify, intravenous drug users (IDUs), female sex partners of IDUs, prostitutes, and street youth. The present paper provides an overview of this project and presents data demonstrating the validity of the theory underlying the intervention. In addition, preliminary findings supporting the intervention effectiveness will be presented.
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ASSESSMENT OF EATING DISORDER PSYCHOPATHOLOGY.
RAICH, Rosa M; Universidad Autónoma de Barcelona, Spain.
This Symposium will focus on assessment issues in the area of eating disorders. The first paper (Raich) will focus on recent research on predictive factors in bulimia. The second paper will focus on the use of the Eating Disorder Inventory (EDI-2) in a Spanish clinical population (Hebon). Results will be compared with North American samples. The third paper (Holtz) will present data using the EDI-2 in several non-clinical high school and college populations, comparing the results with North American samples. The final paper (Garner) will present data on an updating of the validation of the provisional subscales of the EDI-2 as well as normative data for clinical and non-clinical samples. The symposium will emphasize discussion of general assessment issues with eating disorders and will encourage audience questions. Symposium participants will discuss the cross-cultural implications of results and the practical problems in item translation with psychometric instruments aimed at eating disorder psychopathology.
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LISREL ANALYSIS ON BULIMIA FACTORS.
RAICH, Rosa M and MORA, M; Universidad Autónoma de Barcelona, Spain.
In this work we tray to find the most relevant risk factors of Bulimia in a female students sample of the Universitat Autonoma de Barcelona (n = 153). The first step was to review the literature and to choose the most important variables for Bulimia. We decided that those were: sociocultural factors of slimness, self-esteem, depression, teasing history by overweight, body dissatisfaction and concerns.
The second one was to find the right instruments to measure them.
The third one was the translation into spanish of most of them.
The fourth was to administrate the questionnaires and take weight and height measures in a big sample.
Finally, we did a lisrel analysis on the answers we had and reorganized the pathway analysis on the view of the firsts results.
The results will be provided.
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EATING DISORDERS IN MEXICO: INCIDENCE AND CLINICAL FEATURES.
GARNER, David M; Center for Cognitive Therapy, Philadelphia, USA.
HOLTZ, Victoria; Universidad Iberoamericana, Mexico City, Mexico.
Very little is known about the existence of eating disorders in Mexico,an there are no validated screening tools in Spanish for eating Disroders. The purpose of the present paper is to show the validation of the Spanish translation fo the EDI-2 (by Garner, D.M., 1991) for Mexican students, and to examine the percentages of eatings disorders and weight-related behaviors found among them. The research was done in different groups of high school and college students in Mexico City: 600 students from privte high schools, 600 students from public high schools; 600 students from a public university and 600 sutdents from private universities.
The EDI-2 proved to be a helpful instrument not only in estimating the prevalence of eating disorders in the population and the percentgage of subjects concerned about their wight, shape and dieting, but also in providing a profile of the characteristics of hte persons who have probable eating disorders. Comparisons between studies done with American high schools and college students, using the EDI-2 and the Mexican schools, as well as the implications of the findings will be discussed.
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FURTHER VALIDATION OF THE EATING DISORDER INVENTORY.
GARNER, David M; Center for Cognitive Therapy, Philadelphia, USA.3
Recent descriptive refinements along with advances in the areas of diagnosis, pathogenesis, and treatment have resulted in tremendous improvements in the technology of assessment. While there is no universally accepted assessment protocol for eating disorders, there is a consensus on the value of a multi-trait and multi-method approach to assessment, based on their conceptualization as multidetermined and heterogeneous in nature.
The Eating Disorder Inventory (EDI) is a standardized, multi-scale instrument for assessing psychological traits common in eating disorders. It is comprised of three subscales tapping attitudes and behaviors concerning eating, weight, and shape (Drive for Thinness, Bulimia, Body Dissatisfaction) plus subscales assessing more general psychological traits or organizing constructs clinically relevant to eating disorders (Ineffectiveness, Perfection, Interpersonal Distrust, Interoceptive Awareness, Maturity Fears). The EDI-2 adds three subscales to the original instrument (Asceticism, Impulse Regulation, and Social Insecurity). Recent research on the psychometric properties of the EDI will be reviewed. Different methods for assessing psychopathology in eating disorders will also be discussed along with their different aims, strengths and weaknesses.
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ANXIETY AND HEALTH.
Convenors: MIGUEL-TOBAL, Juan J. and CANO VINDEL, Antonio; Complutense University of Madrid, Madrid, Spain.
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ANXIETY, ANGER, AND CARDIOVASCULAR DISORDERS.
MIGUEL-TOBAL, Juan J. and CANO VINDEL, Antonio; Complutense University of Madrid, Madrid, Spain.
Cardiovascular disorders are a major public health problem, due to its great incidence in developed societies, where, like in USA, account for more than half of all deaths today; being very similar in Spain (42% of the deaths in 1986), and other countries. Current status of research in this field reveals the relationship between cardiovascular disease and a set of physiological, psychological and environmental variables. Among psychological factors with more empirical evidence, it could be remarked Type A behavior, stress, anxiety, hostility, and anger. The aim of our research is to identify emotional factors related to cardiovascular disorders and the relationship between them in two different groups: Hypertension and myocardial infarction, and focusing on two main emotions: anxiety and anger.
For this purpose, we have used the Inventory of Situations and Responses of Anxiety - I.S.R.A. - (Miguel-Tobal & Cano Vindel, 1986, 1988), and the experimental Spanish version of the State-Trait Expression Inventory - STAXI - (Spielberger, 1986, 1991). Both inventories were administered to a sample of myocardial infarction patients, a sample of hypertensive patients, and another of "normal" subjects.
The variables considered in this study were: (1) From the ISRA; the general trait of anxiety, the three components of anxiety response (cognitive, physiological, and motor), and four situational areas or specific traits of anxiety (test anxiety, interpersonal, phobic, and daily life events). (2) From the STAXI; state anger, trait anger, angry, temperament, angry reaction, anger-in, anger-out, anger control and anger expression.
Data show a great level of anxiety, in all studied variables, for hypertensive group, but not for myocardial infarction group. These results, apparently contradictory, are analyzed in detail. On the other hand, anger variables show differences between cardiovascular disorders groups and control group, as well as between both disorders groups.
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ANXIETY, WELL-BEING AND LIFE-STYLE IN PULMONARY PATIENTS
BAUER, Hende; University of Leiden, Leiden, The Netherlands
Patients with pulmonary diseases e.g. chronic obstructive pulmonary disorders (COPD) such as asthma, chronic bronchitis and emphysema suffer from several complaints (Maillé & Kaptein, 1991). As a consequence, quality of life is severely deteriorated (Hodgkin & Petty, 1987). Adherence to healthy life habits is a way to optimize both physical complaints and emotional functioning.
Several studies show that subjective parameters are better predictors of quality of life and the ability to cope with COPD than objective parameters (for example objective indicators of obstruction; see Niederman et al., 1991). Therefore subjective parameters are important.
We investigated the relationship between life-style (or healthy habits, see Breslow et al., 1980) and indicators of well-being, e.g. anxiety, emotional well-being, physical complaints and subjective illness severity. Our sample consisted of 90 patients with COPD, aged 24 to 84 (M=58). Participants were recruited from a pulmonary rehabilitation programme.
In this presentation the specific problems of patients with COPD will be presented (from a behavioral or learning theoretical perspective) and some of our findings regarding the relationship between life-style on the one hand and emotional and physical well-being and subjective illness severity on the other hand will be disscussed.
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EMOTIONAL AND NEUROPSYCHOLOGICAL ASPECTS OF CHRONIC PAIN.
PUENTE, Antonio E.; WILLIAMS, Steve and FORD, Sara; University of North Carolina at Wilmington, U.S.A.
The chronic pain patient poses a unique challenge for the health practitioner not only because of its ever increasing number but because of its difficulty in the treatment of such a syndrome. As a consequence, strong affective response to chronic pain is common and often manifested in the form of anxiety. The first portion of this study summarizes the results of the administration of the English translation of the Spanish Questionnaire, Inventory of Situations and Responses of Anxiety, to 30 outpatients being treated for chronic pain secondary to an industrial or motor vehicle accident. Initial findings suggest no major differences in total score relative to controls. However, specific elevations are noted in response to the pattern of responding to anxiety with the physiological/motor components being most affected. The second portion of the presentation will address the potential complication of head injury as they pertain to the classical chronic pain patient. An additional sample of 15 patients with primary complaints of pain were evaluated for cognitive deficits. Neuropsychological findings using indices from the Halstead-Reitan Battery (i.e., Category Test) reveal subtle cognitive deficits in patients previously considered to be only chronic patients. Theoretical and practical applications of these findings will be discussed.
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ANXIETY AND CONTROL IN THE MENSTRUAL CYCLE.
PÉREZ-PAREJA, Fco. Javier; BORRAS; Carmen; PALMER, Alfonso L.; Universidad de las Islas Baleares, Spain.
With the study of the menstrual cycle and specially with the study of the premenstrual syndrome (PMS) and the premenstrual changes, it's can determine that women who suffer these disorders experience greater levels of anxiety throughout the menstrual cycle, as well as that these women show an internal locus of control, while those women who do not suffer the premenstrual syndrome (PMS) do more external attributions. That is, women who suffer PMS or negative premenstrual changes think that they can do nothing to mitigate their symptoms.
In our work we pretend to determine if any relationship between the general anxiety response and the perceived control exists.
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DIFFERENCES IN ANXIETY MANIFESTATIONS BETWEEN THE GENERAL
POPULATION AND PATIENTS WITH SKIN DISORDERS.
AMORIM GAUDÊNCIO BEZERRA, Carmen W. and ARRUDA MEIRA, M. Isabel;
Conselho Nacional de Desenvolvimento Cientíco e Tecnológico, Brazil.
Hospital Universitario Alcides Carneiro, Universidade Federal da Paraiba, Brazil.
In this research, anxiety is assessed in two different samples; the general opulation and patients suffering dermatological disorders presumibly associated with enviromental stress and/or anxiety reactions. The anxiety variables studied are: cognitive anxiety, physiological anxiety, motor anxiety, general anxiety trait, as well as four anxiety specific traits - test anxiety, interpersonal anxiety, phobic anxiety and anxiety in the daily-life situations. These eight variables are assessed by the Inventory of Situations and Responses of Anxiety (ISRA - Miguel Tobal and Cano Vindel, 1986, 1988) in its version in Portuguese, which is being adapted to the Brazilian population. Both samples originate and were obtained in Brazil. The clinical sample is composed by patients treated in a dermatological clinic, who were recommended psychological treatment. Differences between both groups are analyzed and discussed according to the following theories: Tridimensional Theory of Anxiety (Lang,1968), The Theory of Interactive Anxiety (Endler, Magnusson, 1974, 1976) and The Theory of Emotional Stress (Lazarus y Folkman, 1984; Everly, 1989).
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DIFFERENTIAL DIAGNOSIS OF ANXIETY DISORDERS USING THE I.S.R.A.
CANO-VINDEL, Antonio and MIGUEL-TOBAL, Juan J.; Universidad Complutense de Madrid, Madrid, Spain.
In the last years several anxiety approaches are focusing on two main axes: first, the three systems of emotional response, and on the other hand, the different types of situations associated with anxiety reactions. We have developed an inventory (Inventory of Situations and Responses of Anxiety -Miguel-Tobal & Cano-Vindel, 1986, 1988) which permits the assessment the three systems of anxiety response (cognitive, physiological and motor), and four types of natural situations that can, or can not, lead to an anxiety reaction, depending on the individual differences. These four types of situations associated with differences in the general trait of anxiety can be considered as specific traits of anxiety, and they are labelled as: test anxiety, interpersonal anxiety, anxiety or fear in phobic situations, and anxiety in daily life situations.
By means of the I.S.R.A. several samples with different anxiety disorders (D.S.M. III-R) are assessed with the purpose to obtain typical response profiles (cognitive, physiological, motor), as well as typical specific-traits profiles (test, interpersonal, phobic, daily life), associated with each anxiety disorder. Since the D.S.M. III-R classifies anxiety disorders attending more to characteristics of the anxiety reactions related with type of situations, than to intensity or type of anxiety response, we suppose that the profile of specific traits of anxiety will be more related with the type of anxiety disorder than the other I.S.R.A. profile (response systems profile). With the two profiles we are trying to make differential diagnosis of the anxiety disorders.