Search

Generalized anxiety disorder (GAD) is the most common of the pervasive anxiety disorders among older adults, with lifetime prevalence estimates of 6%. Because of this high prevalence rate, it is important to establish the utility of assessment tools with this population. Preliminary data exist with regard to the use of anxiety measures with older anxious adults; however, no similar information is available for self-report measures of depression in this population. This study examined the psychometric properties of the Beck Depression Inventory (BDI) and the Geriatric Depression Scale (GDS) with a sample of 54 older adults diagnosed with GAD, 22 of whom were diagnosed with a coexistent depressive disorder. Internal consistency, convergent and divergent validity, construct validity, and discriminative validity of the BDI and the GDS were examined. Overall, the results support the reliability and validity of these self-report measures of depressive symptoms in a sample of older anxious adults. [ABSTRACT FROM AUTHOR]

Penelitian ini bertujuan menguji pengaruh motivasi terhadap minat mahasiswa untuk mengikuti Pendidikan Profesi Akuntansi. Motivasi dalam penelitian ini terdiri dari motivasi kualitas, motivasi karir, dan motivasi ekonomi. Data diperoleh dengan menggunakan kuesioner yang disebarkan pada 88 responden sebagai sampel penelitian. Model analisis yang digunakan adalah analisis regresi berganda. Hasil penelitian menunjukkan bahwa motivasi kualitas dan motivasi karir berpengaruh secara positif terhadap minat mahasiswa untuk mengikuti Pendidikan Profesi Akuntansi. Akan tetapi, motivasi ekonomi berpengaruh secara negatif terhadap minat mahasiswa untuk mengikuti Pendidikan Profesi Akuntansi.

Suicidal activity among youths has increased dramatically in recent years, yet little objective research in non-hospital settings has been conducted. The present study analyzed attitudes of suicidal ideator and nonideator groups at elementary, middle, and high school levels. Responses to the Student Attitude Measure (S.A.M.) were analyzed with a multivariate analysis of variance. Ideators' attitudes were found to be significantly more negative than those of nonideators. Some grade level and gender differences also were revealed. The ability of this instrument to differentiate potentially suicidal youths from their nonsuicidal peers has the potential for providing schools with a critical proactive strategy. [ABSTRACT FROM AUTHOR]

The present study revealed an association between the family configurations of cohesion and adaptability and juvenile offenders' level of ego development. This association was explained by four post hoc comparisons which revealed that functional perspectives of family cohesion and adaptability by the juvenile offender and one or both parents were associated with higher levels of ego development. Lower levels of ego development were associated with (a) shared dysfunctional perspectives of the family dimensions by the juvenile offender and both parents, and (b) a functional perspective of the family dimensions by the juvenile offender which was not shared by either parent. These results were based on 61 nonchronic juvenile offenders and their parents who were assessed by the Family Adaptability and Cohesion Evaluation Scales II. The offenders' level of ego development was assessed by the Washington University Sentence Completion Test. [ABSTRACT FROM AUTHOR]

An array of measures of anxiety and related disorders (viz., Albany Panic and Phobia Questionnaire; Anxiety Sensitivity Index; Beck Anxiety Inventory; Beck Depression Inventory-II; Body Sensation Questionnaire; Fear Questionnaire; Padua Inventory; Penn State Worry Questionnaire; Post-Traumatic Stress Disorder Diagnostic Scale; Social Interaction Anxiety Inventory; and Worry Scale) was edited or translated from English into Spanish. Following an extensive edit and translation process, bilingual participants (n = 98) were assessed with the English and Spanish versions of these measures. Coefficient alphas were excellent and comparable across language versions. Means and standard deviations were also comparable across language versions. Evidence of convergent and discriminant validity was found for both language versions. The two language versions of each measure correlated highly with each other. This psychometric comparability adds confidence in using the newly edited or translated Spanish language measures in clinical practice and research. [ABSTRACT FROM AUTHOR]

Background: Chemotherapy-induced peripheral neuropathy (CIPN) includes negative sensations that remain a major chronic problem for cancer survivors. Previous research demonstrated that neurofeedback (a closed-loop brain-computer interface [BCI]) was effective at treating CIPN versus a waitlist control (WLC). The authors' a priori hypothesis was that BCI would be superior to placebo feedback (placebo control [PLC]) and to WLC in alleviating CIPN and that changes in brain activity would predict symptom report., Methods: Randomization to one of three conditions occurred between November 2014 and November 2018. Breast cancer survivors no longer in treatment were assessed at baseline, at the end of 20 treatment sessions, and 1 month later. Auditory and visual rewards were given over 20 sessions based on each patient's ability to modify their own electroencephalographic signals. The Pain Quality Assessment Scale (PQAS) at the end of treatment was the primary outcome, and changes in electroencephalographic signals and 1-month data also were examined., Results: The BCI and PLC groups reported significant symptom reduction. The BCI group demonstrated larger effect size differences from the WLC group than the PLC group (mean change score: BCI vs. WLC, -2.60 vs. 0.38; 95% confidence interval, -3.67, -1.46 [p = .000; effect size, 1.07]; PLC, -2.26; 95% confidence interval, -3.33, -1.19 [p = .001 vs. WLC; effect size, 0.9]). At 1 month, symptoms continued to improve only for the BCI group. Targeted brain changes at the end of treatment predicted symptoms at 1 month for the BCI group only., Conclusions: BCI is a promising treatment for CIPN and may have a longer lasting effect than placebo (nonspecific BCI), which is an important consideration for long-term symptom relief. Although scientifically interesting, the ability to separate real from placebo treatment may not be as important as understanding the placebo effects differently from effects of the intervention., Plain Language Summary: Chemotherapy-induced nerve pain (neuropathy) can be disabling for cancer survivors; however, the way symptoms are felt depends on how the brain interprets the signals from nerves in the body. We determined that the perception of neuropathy can be changed by working directly with the brain. Survivors in our trial played 20 sessions of a type of video game that was designed to change the way the brain processed sensation and movement. In this, our second trial, we again observed significant improvement in symptoms that lasted after the treatment was complete., (© 2023 American Cancer Society.)

Objective: Cancer-related abdominal and pelvic pain syndromes can be debilitating and difficult to treat. The objective of this study was to evaluate the efficacy of superior hypogastric plexus blockade or neurolysis (SHPN) for the treatment of cancer-related pelvic pain., Design: Retrospective study., Setting: MD Anderson Cancer Center, Houston, Texas., Methods: We enrolled 46 patients with cancer-related pelvic pain who underwent SHPN. A numeric rating scale (NRS) was used for pain intensity, and symptom burden was evaluated using the Edmonton Symptom Assessment System at baseline, visit 1 (within one month), and visit 2 (within one to six months)., Results: Forty-six patients who received SHPN showed a significant reduction in pain score from 6.9 to 5.6 at visit 1 (P = 0.01). Thirty of the 46 patients continued to complete visit 2 follow-up, and the NRS score was consistently lower at 4.5 at visit 2 (P < 0.0001), with anxiety and appetite improved significantly. There was no significant change in the morphine equivalent dose at visits 1 and 2. The efficacy of the block was not influenced by patients' age, gender, type of cancer, cancer stage, regimen of chemotherapy and/or radiation therapy, diagnostic block, approach or laterality of procedure, or type or amount of neurolytic agent. Nonsmokers with high baseline pain scores were more likely to have improved treatment outcomes from SHPN at short-term follow-up. Adverse effects with SHPN were mild and well tolerated., Conclusions: SHPN was an effective and relatively safe procedure for pain associated with pelvic malignancies. There is a need for larger prospective trials., (© 2019 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Context: Chemotherapy-induced peripheral neuropathy (CIPN) is a common side effect of cancer treatment and may adversely affect quality of life (QOL) for years., Objectives: We explored the long-term effects of electroencephalographic neurofeedback (NFB) as a treatment for CIPN and other aspects of QOL., Methods: Seventy-one cancer survivors (mean age 62.5; 87% females) with CIPN were randomized to NFB or to a waitlist control (WLC) group. The NFB group underwent 20 sessions of NFB where rewards were given for voluntary changes in electroencephalography. Measurements of pain, cancer-related symptoms, QOL, sleep, and fatigue were obtained at baseline, end of treatment, and one and four months later., Results: Seventy one participants enrolled in the study. At the end of treatment, 30 in the NFB group and 32 in the WLC group completed assessments; at four months, 23 in the NFB group and 28 in the WLC completed assessments. Linear mixed model analysis revealed significant group × time interaction for pain severity. A general linear model determined that the NFB group had greater improvements in worst pain (primary outcome) and other symptoms such as numbness, cancer-related symptom severity, symptom interference, physical functioning, general health, and fatigue compared with the WLC group at the end of treatment and four months (all P < 0.05). Effect sizes were moderate or large for most measures., Conclusion: NFB appears to result in long-term reduction in multiple CIPN symptoms and improved postchemotherapy QOL and fatigue., (Copyright © 2018 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.)

Background: Chemotherapy-induced peripheral neuropathy (CIPN) is a significant problem for cancer patients, and there are limited treatment options for this often debilitating condition. Neuromodulatory interventions could be a novel modality for patients trying to manage CIPN symptoms; however, they are not yet the standard of care. This study examined whether electroencephalogram (EEG) neurofeedback (NFB) could alleviate CIPN symptoms in survivors., Methods: This was a randomized controlled trial with survivors assigned to an NFB group or a wait-list control (WLC) group. The NFB group underwent 20 sessions of NFB, in which visual and auditory rewards were given for voluntary changes in EEGs. The Brief Pain Inventory (BPI) worst-pain item was the primary outcome. The BPI, the Pain Quality Assessment Scale, and EEGs were collected before NFB and again after treatment. Outcomes were assessed with general linear modeling., Results: Cancer survivors with CIPN (average duration of symptoms, 25.3 mo), who were mostly female and had a mean age of 62.5 years, were recruited between April 2011 and September 2014. One hundred percent of the participants starting the NFB program completed it (30 in the NFB group and 32 in the WLC group). The NFB group demonstrated greater improvement than the controls on the BPI worst-pain item (mean change score, -2.43 [95% confidence interval, -3.58 to -1.28] vs 0.09 [95% confidence interval, -0.72 to -0.90]; P =·.001; effect size, 0.83)., Conclusions: NFB appears to be effective at reducing CIPN symptoms. There was evidence of neurological changes in the cortical location and in the bandwidth targeted by the intervention, and changes in EEG activity were predictive of symptom reduction. Cancer 2017;123:1989-1997. © 2017 American Cancer Society., (© 2017 American Cancer Society.)

Purpose: Psychological symptoms are a common part of the cancer pain experience, yet little is known about how these factors relate to implantable device outcomes in patients with cancer pain. The purpose of this study was to examine how psychological symptoms relate to implantable device outcomes in cancer pain management., Methods: We retrospectively examined the medical records of 79 cancer patients, collecting information on psychological symptoms and pain, as assessed on the Edmonton Symptom Assessment System. Data were collected prior to and at three points following the implantation of either a spinal cord stimulator or an intrathecal pump., Results: Pain was correlated with both anxiety, r = 0.39 (n = 74, p < 0.01), and depression, r = 0.38, (n = 75, p < 0.01), at the presurgery baseline. Results of linear mixed model (LMM) analysis indicated that neither baseline anxiety nor baseline depression main effects were significantly associated with pain at postimplant assessments, when adjusting for baseline pain, demographics, and clinical factors. However, the group-by-time interaction was significant for anxiety (beta = 0.223, p value = 0.037). The trajectory of pain scores over time differed by baseline anxiety scores, with pain scores increasing over time at a higher rate for those with a high baseline anxiety score, compared to those with low baseline anxiety scores., Conclusion: Presurgery psychological symptoms should be considered, along with other medical, psychosocial, and individual characteristics in multidisciplinary treatment planning. Multidisciplinary care which includes aspects of mood management or supportive psychotherapy would likely be beneficial to cancer patients presenting with high psychological symptoms.

Background: Opioids are recognized as an integral part of the armamentarium in the management of cancer pain. There has been a growing awareness of the misuse of prescription opioids among cancer patients. More research is needed to detail risk factors and incidence for opioid misuse among cancer pain patients., Methods: We reviewed 522 patient charts that were seen in our Pain Center from January 1, 2009 to June 30, 2009 for risk stratification of opioid misuse with demographic and clinical factors utilizing the Screener and Opioid Assessment for Patients with Pain-short form (SOAPP-SF). Group differences based on High (≥4) and Low (<4) SOAPP-SF scores were evaluated at initial visit, follow-up within a month and 6-9 months., Results: One hundred forty-nine of the 522 (29%) patients had a SOAPP-SF score of ≥4. The mean age for patients with high SOAPP-SF score (≥4) was 50 ± 14 vs 56 ± 14 for patients with low SOAPP-SF score (<4) (P < 0.0001). The pain scores were higher for patients with high SOAPP-SF score compared with patients with low SOAPP-SF score at consult (P < 0.0001). Morphine equivalent daily dose (MEDD) was higher for patients with high SOAPP-SF score compared with patients with low SOAPP-SF score at consult (P = 0.0461). Fatigue, feeling of well-being, and poor appetite were higher among the high SOAPP-SF group at initial visit (P < 0.0001, <0.0001, <0.0149, respectively). The high SOAPP-SF score patients also had statistically significant (P < 0.05) higher anxiety and depression scores at all three time points. In the multivariate analysis, patients younger than 55 years have a higher odds of having a "high" SOAPP-SF score than patients 55 years and older {odds ratio (OR) (95% confidence interval [CI]) = 2.76 (1.58, 4.81), P = 0.0003} adjusting for employment status, disease status, treatment status, usual pain score, and morphine equivalency at consult. Patients with higher usual pain score at consult have higher odds of a "high" SOAPP-SF score (OR [95% CI] = 1.34 [1.19, 1.51], P < 0.0001) adjusting for age, employment status, disease status, treatment status, and morphine equivalency at consult., Conclusion: Patients classified by the SOAPP-SF in the current study as high risk tended to be younger, endorse more pain, have higher MEDD requirement, and endorse more symptoms of depression and anxiety. These findings are consistent with the literature on risk factors of opioid abuse in chronic pain patients which suggests that certain patient characteristics such as younger age, anxiety, and depression symptomatology are associated with greater risk for opioid misuse. However, a limitation of the current study is that other measures of opioid abuse were not available for validation and comparison with the SOAPP-SF., (Wiley Periodicals, Inc.)

Objective: In response to the Accreditation Council for Graduate Medical Education's (ACGME) new pain medicine fellowship requirement, which emphasizes multidisciplinary training strategies aimed at providing improved clinical care for pain patients, we developed a multidisciplinary team training education model for trainees in our institution's Fellowship Program in Pain Medicine. Although the biopsychosocial model guides the delivery of care by multidisciplinary pain teams, there is a gap on how to improve team attitudes and functioning within an already extensive pain medicine curriculum. The current study aimed to fill that gap by developing and incorporating an educational model that focuses on interpersonal relationships among team members and strategies for improving team performance over time., Design, Setting, Participants, Intervention, and Outcome Measures: Here, we provide a brief overview of our institution's pain medicine fellowship training program highlighting how we have included a team training component into lectures, interdisciplinary case conferences, and journal club articles that focus on topics in the ACGME pain medicine curriculum. We present data from a team attitude and functioning assessment battery administered to 11 pain medicine fellows at the outset and end of their fellowship., Results and Conclusions: Mean assessment scores increased from the beginning of the fellowship to the end of the fellowship on interdisciplinary pain team knowledge, current team skills, and attitude toward health care teams. The current study demonstrated effective ways for assessing team attitudes and functioning and including this educational component into a 1-year pain medicine curriculum. Based on our results, we will continue to teach and model effective teamwork in an effort to enhance our trainees' attitudes toward working on an interdisciplinary pain team.

Background: Primary care physicians often treat older adults with Generalized Anxiety Disorder. Objective To estimate physician diagnosis and recognition of anxiety and compare health service use among older adults with GAD with two comparison samples with and without other DSM diagnoses., Methods: Participants were 60+ patients of a multi-specialty medical organization. Administrative database and medical records were reviewed for a year. Differences in frequency of health service use were analyzed with logistic regression and between-subjects analysis of covariance., Results: Physician diagnosis of GAD was 1.5% and any anxiety was 9%, and recognition of anxiety symptoms was 34% in older adults with GAD. After controlling for medical comorbidity, radiology appointments were increased in the GAD group relative to those with and without other psychiatric diagnoses, chi(2) (2, N = 225) = 4.75, p < .05., Conclusions: Most patients with anxiety do not have anxiety or symptoms documented in their medical records.

The Depression Anxiety Stress Scale (DASS) was designed to efficiently measure the core symptoms of anxiety and depression and has demonstrated positive psychometric properties in adult samples of anxiety and depression patients and student samples. Despite these findings, the psychometric properties of the DASS remain untested in older adults, for whom the identification of efficient measures of these constructs is especially important. To determine the psychometric properties of the DASS 21-item version in older adults, we analyzed data from 222 medical patients seeking treatment to manage worry. Consistent with younger samples, a three-factor structure best fit the data. Results also indicated good internal consistency, excellent convergent validity, and good discriminative validity, especially for the Depression scale. Receiver operating curve analyses indicated that the DASS-21 predicted the diagnostic presence of generalized anxiety disorder and depression as well as other commonly used measures. These data suggest that the DASS may be used with older adults in lieu of multiple scales designed to measure similar constructs, thereby reducing participant burden and facilitating assessment in settings with limited assessment resources.

This study describes and compares patients' reports of somatic symptoms and physicians' ratings of the same symptoms in patients with chronic non-cancer-related and cancer-related pain. Ninety-seven patients with chronic non-cancer-related pain and 100 patients with chronic cancer-related pain reported somatic symptoms using a newly developed checklist of somatic symptoms. Patients also completed the Brief Symptom Inventory-18, Courtland Emotional Control Inventory, Catastrophizing scale, two items from the Coping Strategies Questionnaire (one about efficacy to control and another about ability to decrease pain), and a numeric rating of average pain. After they completed medical histories and physical examinations on patients, physicians rated the degree to which the patients' reported somatic symptoms on the checklist were medically unexplainable. Over 80% of patients in both groups reported somatic symptoms that their physicians rated as not fully explainable. Strong associations existed between patient-reported somatic symptoms and negative mood states. For the majority of patients, results supported a concept of combined illness- and affect-related pathology rather than one of pure somatoform disorder. Assessing patients' reports of somatic symptoms and negative mood states and incorporating physicians' ratings of level of medically unexplainable somatic symptoms were useful for distinguishing these diagnoses.

This study was undertaken to characterize pain in individuals with hereditary multiple exostosis (HME). Two hundred ninety-three patients with HME completed a questionnaire designed to assess pain as well as its impact on their life. Eighty-four percent of participants reported having pain, indicating that pain is a real problem in HME. Of those with pain, 55.1% had generalized pain. Two factors were found to be associated with pain outcome: HME-related complications and surgery. Individuals who had HME-related complications were five times more likely to have pain, while those who had surgery were 3.8 more likely to have pain. No differences were found between males and females with respect to pain, surgery, or HME-related complications. The results of this study indicate that the number of individuals with HME who have pain has been underestimated and that pain is a problem that must be addressed when caring for individuals with HME.

Objectives: The purposes of this study were to: 1) characterize physical performance in individuals with human immunodeficiency virus; and 2) examine group differences by pain and fatigue on a multivariate profile of disease, physical, and psychologic symptoms., Methods: One hundred outpatients, 78 men and 22 women (mean age 40.70 +/- 7.49 years) participated. Patients completed a battery of physical performance tests in which the time taken or the distance reached or walked was measured. Self-report questionnaires included measures of pain (0-10 numerical rating scale), fatigue (Brief Fatigue Inventory), and perceived health status (Medical Outcomes Survey-HIV scale)., Results: Physical performance was compromised in a task specific manner. Patients took twice as long as healthy individuals on a belt-tie and 4 times as long on a sit-to-stand task and in 6 minutes walked 75% of the distance covered by healthy individuals. Fifty percent of patients (n = 50) had pain at the time of testing (mean 6.3 +/- 2.4), and 98% had fatigue (mean 5.4 +/- 2.3). Multivariate analysis of variance showed pain had a greater influence on performance than fatigue. Pain, distance walked in 6 minutes, and unloaded forward reach accounted for 26% of the variability in quality of life (r = 0.51, P < or = 0.0001)., Discussion: Pain has a substantial impact on physical performance and quality of life among ambulatory human immunodeficiency virus patients. Fatigue also impacts physical performance. Compromised ability to perform certain physical tasks affects quality of life. Further investigation of the roles of these relevant variables should be investigated in path analyses.

The purpose of this study was to survey the membership of the American Pain Society and the American Academy of Pain Medicine to determine their beliefs about ethical dilemmas in pain management practice. Respondents rated ethical dilemmas for their importance as well as their own competence in dealing with these ethical issues. The survey also included an open-ended question that asked respondents to describe clinical situations in which they had encountered ethical dilemmas. A total of 1,105 surveys were analyzed, with physicians (N = 612), nurses (N = 189), and psychologists (N = 166) representing the professions with the greatest response. Management of pain at the end of life, general undertreatment of pain, and undertreatment of pain in the elderly were the most frequently encountered dilemmas. Qualitative data were analyzed to identify ethical issues in the case examples provided by the respondents. Major themes included inappropriate pain management, barriers to care, interactions and conflicts with others, regulatory/legal issues, euthanasia, assisted suicide, and research issues. We conclude that ethical dilemmas are common in pain management practice and that resolution of these dilemmas requires commitment by individual professionals as well as health systems.

Anxiety is a major health problem for older adults. The cornerstone for further work in this area is research that establishes the psychometric utility of standardized measurement strategies to characterize anxiety in older adults. The goals of the current study were to replicate and extend prior research addressing the psychometric properties of five self-report measures of anxiety in a sample of 57 older adults with generalized anxiety disorder (GAD). Data addressed the descriptive characteristics, internal consistency, test-retest reliability, interrelation of subscales, and convergent and divergent validity of the Penn state worry questionnaire (PSWQ), worry scale (WS), Spielberger state-trait anxiety inventory - Form Y (STAI), and two versions of the fear questionnaire (FQ). Descriptive data generally replicated prior findings, with some increased state and trait anxiety in the current sample. Measures were internally consistent, with evidence that a revised version of the FQ that focuses on severity of fear irrespective of associated avoidance demonstrated greater internal consistency than the original version. Measures of content-specific fears and worries (WS, FQ) were stable over time and demonstrated convergent validity. Evidence of convergent validity also was evident for measures of worry and general anxiety (WS, PSWQ, STAI-Trait), but two of these measures (PSWQ, STAI) were not reliable over time. Only the PSWQ showed evidence of divergent validity with respect to self-report measures of depression.

Objective: To determine the relationships among self-reported activity limitation and clinician-measured functional performance tests., Design: Case series survey., Setting: A referral-based orthopedic spine clinic in Houston, TX., Patients: Eighty-three patients (48 women, 35 men) with low back pain (LBP)., Interventions: The Roland-Morris Disability Questionnaire (RMDQ) and a physical performance test (PPT) battery., Main Outcome Measures: Self-reported activity limitation (eg, walking, bending, getting out of chair, putting on sock, doing heavy jobs) was assessed by the RMDQ. Clinician-measured functional performance was assessed with the PPT, a battery comprised 6 tests: lumbar flexion range of motion, a 50-foot walk at fastest speed, a 5-minute walk, 5 repetitions of sit-to-stand, 10 repetitions of trunk flexion, and loaded reach task (patients reached forward while holding a weight weighing 5% of their body weight)., Results: Pearson's product-moment correlations between total RMDQ score and each of the performance tests ranged from.29 to.41. Point biserial correlations between individual RMDQ items and their corresponding performance tests were slightly lower, ranging from.20 to.33., Conclusion: There were moderate correlations between self-reported activity limitation and corresponding clinician-measured performance tests. The unique perspective each method provides appears to be useful for a comprehensive understanding of physical function in patients with LBP.

Generalized anxiety disorder (GAD) is the most prevalent of the chronic anxiety disorders for older adults. Although a variety of self-report measures are beginning to be utilized to assess anxiety and related symptoms in older adults, there is a paucity of data regarding the convergence of self-report measures with clinician ratings of symptom severity. This situation is problematic in that interpretability of assessment data is limited, as is our broader understanding of the construct of GAD in an older adult population. To address these issues, we examined convergence across assessment modalities among 64 older adults who met diagnostic criteria for GAD. In addition to two Anxiety Disorders Interview Schedule for DSM-IV (ADIS-IV) interviews conducted by independent raters, participants completed four self-report measures (Penn State Worry Questionnaire [PSWQ], Worry Scale [WS], State-Trait Anxiety Inventory [STAI], Beck Depression Inventory [BDI]) as part of a more extensive pretreatment assessment battery. Results revealed significant correlations between clinician-rated GAD severity and the BDI, STAI, and PSWQ. Regression analyses indicated that the BDI (r2 = .15) and the PSWQ (r2 = .07) were particularly useful predictors of clinician-rated GAD severity. A comorbid mood disorder, however, was identified as an important mediator of these relations. Specifically, presence of coexistent depression accounted for 17% of the variance in clinician severity ratings (CSR; P < .01), with individuals diagnosed with a comorbid mood disorder receiving higher clinician severity ratings. The only self-report measure that accounted for additional significant variance was the PSWQ (7%). The study highlights the need to address coexistent psychological conditions when examining convergence between assessment modalities, and expands upon the relatively neglected area of anxiety assessment in older individuals. Specifically, the BDI and the PSWQ are identified as particularly useful screening instruments that may be helpful in conceptualizing GAD severity within an older adult population.

Objective: To determine the extent to which there may be major differences in scores on a battery of physical performance tasks among men with nonspecific, mechanical low back pain (LBP), women with LBP, healthy men, and healthy women., Design: Case series survey., Setting: A referral-based orthopedic clinic., Patients: Thirty-three men and 46 women with LBP. Control Subjects: Twenty-one men and 25 women healthy controls., Intervention: Completion of six clinician-assessed physical performance tasks and self-report inventories., Main Outcome Measure: Performance scores on distance walked in 5 minutes, 50-foot walk at fastest speed, repeated sit-to-stand, repeated trunk flexion, loaded forward reach, and the Sorensen fatigue tasks., Results: Discriminant function analysis revealed that the four groups of subjects performed the physical tasks significantly different in two major ways: (1) healthy control subjects outperformed LBP patients, irrespective of gender, on tasks involving trunk control, coordination, and stability while withstanding heavy or quickly changing loads on the spine; (2) men outperformed women, irrespective of patient or nonpatient status, on tasks involving anthropometric features of limb length. The findings provide guidance on reasonable performance expectations for men and women patients with LBP. Future studies of treatment effectiveness also will be able to assess physical performance change in terms of the intersection between standards set by the men and women healthy control subjects and those of men and women patients. However, whether a return to nonpatient status is an appropriate treatment goal is left to future research.

Objective: To determine what percentage of patients have none of the five nonorganic behavioral processes known as Waddell signs, and the relational pattern between Waddell signs and somatic complaints, disturbed functional performance, negative treatment attitudes, physical pathology, depression, generalized anxiety, and MMPI-2 validity scales., Design: Case series survey., Setting: A referral-based multidisciplinary pain center affiliated with a state medical school., Patients: Seventy-five consecutive patients with chronic back pain., Intervention: Medical evaluation and completion of self-report inventories., Main Outcome Measure: Total number of Waddell signs, physical pathology, and pain intensity ratings were assessed by a physician during an initial medical evaluation. Degree of disturbed functional performance and psychological symptoms were assessed by self-report measures at the initial evaluation., Results: Sixty-four percent of the patients had no Waddell signs. Total number of Waddell signs yielded positive and statistically significant correlations (p < or = .05) with depression, disturbed functional performance, somatic complaints, and pain intensity ratings. Correlations of slightly smaller and statistically nonsignificant magnitudes were revealed for Waddell signs with generalized anxiety, negative treatment attitudes, and physical pathology. Waddell signs were unrelated to age, duration of pain, gender, number of lumbar surgeries, and MMPI-2 validity scales., Conclusions: Taken together, multiple Waddell signs and some of their correlates present various factors that might interfere with optimal response to treatment.

Univariate and multivariate analyses were used to investigate intrinsic and contextual sources of coping variability among 90 patients with chronic pain. Pain coping strategies were assessed by the subscales of the Coping Strategies Questionnaire. Intrinsic variables included demographic characteristics and dispositional optimism. Contextual variables included pain-related variables and pain control appraisals. In univariate analyses, ethnicity was a statistically significant intrinsic source of variability for the praying and hoping coping subscale; however, comparisons between pairs of ethnic groups were not statistically significant. A multivariate perspective of the data found three independent and salient patterns of correlation between the intrinsic and contextual variables and coping subscales. These patterns of correlation accounted for 96% of the total variance and were conceptualized as optimistic active coping, educated rational coping, and optimistic restricted coping. The findings raise the prospect that there are intrinsic and contextual explanations of coping variability for patients with chronic pain.

The psychometric distinctiveness of self-reported anxiety and depression in patients with chronic pain was investigated. The item-level responses of 220 patients with heterogeneous pain conditions from the Beck Depression Inventory and State--Trait Anxiety Inventory State--Anxiety scale were submitted to common factor analysis. Three first-order factors were identified: depression, anxiety-absent, and anxiety-present. One second-order factor of negative affect was also identified. Correlations of first-order factor scores with other psychometric measures suggested only minor distinctiveness. The findings indicated that it is possible to distinguish anxiety and depression psychometrically in patients with chronic pain but suggested that negative affect may be the primary underlying construct of the affective experience of these patients.

Evidence from 85 adult medical outpatients supported psychometric comparability of the 2 halves of the Washington University Sentence Completion Test (SCT) Form 81 and of the female and male forms of the SCT. There was slightly stronger internal consistency for the first versus the second half of the SCT. Each half correlated highly with the ogive total protocol rating and 36-item-sum rating. Intercorrelations of the 2 halves with external measures also suggested essentially equivalent relations. For the 30 identical items across gender, the median correlation between individual item ratings with the item-sum ratings was nearly equal for women and men. When the 6 nonidentical items were considered with the identical items, the median item-total correlation was slightly higher for men (45) than women (41). This difference was accounted for by the slightly larger variability in the mate subsample. Practically speaking, the 2 halves and the female and male forms may be used with minimal concern regarding psychometric comparability in similar medical outpatient settings.

The MMPI basic validity and clinical scales' patterns of 295 White-, African- and Latino-American pain patients were compared. Mean group differences across ethnic groups on scales L, F, K, Mf, and Si were revealed in multivariate analysis of covariance for females, while differences across ethnic groups on scales F, K, Mf, Sc, Ma, and Si were revealed for males. In the univariate follow-up analyses of covariance, significant main effects were obtained for ethnicity along with education and (occasionally for males) duration of pain. Various high-point, two-point, and other profile patterns were examined and notable gender/ethnic group differences were found. The pattern of intercorrelations of the MMPI scales mean T scores with various demographic and clinical characteristics suggested some notable divergence across subgroups on certain correlates of the pain experience.

This modified replication of Jurich and Holt's (1987) test-retest study investigated the stability of scores on the Washington University Sentence Completion Test (SCT; Loevinger, 1985; Loevinger & Wessler, 1970; Loevinger, Wessler & Redmore, 1970) across alternate instructional formats. Initially, 90 adult participants completed the SCT using standardized instructions. After a 1-week interval participants were readministered the SCT based on random assignment to either a standardized instruction (control) group, a role-play instructional set, or a best-effort instructional set. A repeated measures multivariate analysis of variance yielded statistically significant differences in ego level scores across the 3 instructional sets. The differences in ego level scores were approximately one-half level higher for the role-play and best-effort instructional sets. Effect sizes for the experimental instructional sets ranged from .23 using item sum scores to .45 using total protocol ratings. Results are supportive of Jurich and Holt's (1987) findings, indicating that the standardized instruction SCT may be susceptible to the motivational set of the test-taker.

Background and Objectives: Reflex sympathetic dystrophy (RSD) has sometimes been hypothesized to derive from a unique psychological predisposition because of its enigmatic features, as well as the profound behavioral and emotional characteristics manifested by some patients. This study compares the psychological characteristics of RSD and myofascial pain syndrome (MPS) patients to discern the extent of any aspects unique to RSD., Methods: The patients included 58 with RSD and 214 with MPS, all of whom completed the Minnesota Multiphasic Personality Inventory (MMPI) as well as a pain questionnaire. Additional pertinent demographic and clinical characteristics were ascertained., Results: The only significant demographic group differences revealed a higher proportion of RSD patients not working (P < .05) and a higher proportion of RSD patients receiving Workers' Compensation payments (P < .001). The RSD patients had shorter duration of pain (P < .01) and were taking fewer pain medications (P < .01) than the MPS group, but the two groups had comparable numbers of pain-related surgeries, pain intensity ratings, perceived ability to cope, and ongoing extent of involvement in social or recreational activities. A wide range of functioning was in evidence for both groups on the MMPI clinical scales, but with duration as a covariate, the RSD group had significantly (P < .05) lower scores on the hypochondriasis, depression, hysteria, and psychasthenia scales and higher scores on the hypomania scale. The duration covariate was significant (P < .05) only for the infrequency (rare responses) and depression scales. Duration and certain scale scores were inversely correlated., Conclusions: With only a few exceptions, RSD and MPS patients appear comparable with respect to a wide range of demographic, clinical, and psychological functioning indices. A specific psychological profile, uniquely neurotic or otherwise, has yet to be demonstrated in terms of any etiologic or maintenance factors in RSD.

Objective: To investigate the extent to which gender differences in the expression of depressive symptomatology exist among chronic pain patients., Setting: A multidisciplinary pain center affiliated with a state medical school in the southern United States., Patients: A total general sample of 245 patients with heterogeneous chronic pain complaints randomly selected from a database of approximately 1,000 pretreatment evaluation patient files. A depressed subsample of 113 patients based on scores > or = 15 on the Beck Depression Inventory (BDI)., Measure: The 21-item BDI., Results and Conclusions: Gender differences in total BDI scores were not revealed for the total general sample or depressed subsample, but gender differences in the expression of depressive symptoms (i.e., item level responses) were found via separate discriminant function analyses on the total general sample and depressed subsample. Consistent with previous studies performed on diverse samples, females' higher endorsement of body image distortion was noted in both of our samples. Females also endorsed significantly higher levels of fatigue in our total sample. Items that were not significant in our total sample include females' higher levels of loss of appetite and crying. In the depressed subsample, items probing pessimism and failure were not statistically significantly different to males' endorsing higher levels of each. Sensitivity to these gender differences is suggested in clinical practice. The likely consequences that these differences in the experience and expression of distress have on coping activities (e.g., help-seeking responses) and the reactions of others (e.g., health-care providers) are highlighted.

The authors compare theoretical perspectives of chronic pain using a restrictive comprehensive categorization. Four of the perspectives (mind-body dualism, psychological, radical operant--behavioral, and radical cognitive) are categorized as restrictive. The other 4 perspectives (International Association for the Study of Pain, gate control, nonradical operant--behavioral, and cognitive-behavioral) that incorporate multiple facets are categorized as comprehensive. On the basis of empirical support, practical application, and issues concerning potential research design problems, the restrictive perspectives could be rejected for not providing a model in which chronic pain can be thoroughly investigated. The comprehensive perspectives, however, demonstrate greater potential for serving that role. Nonetheless, the need for additional theory development by the comprehensive perspectives is noted.

Comparative evaluation of population recovery capabilities of 35 cluster analysis methods defined by different combinations of 5 profile similarity measures and 7 agglomeration rules was undertaken using artificial data that represented duplicate mixture samples from 4 latent populations. The latent population mean profiles differed primarily in elevation or in pattern parameters. Latent population sampling variances were controlled to provide two different levels of realistic overlap. The within-population distributions were multivariate normal with diagonal covariance structure. Across all conditions examined, complete linkage and Ward's minimum variance methods, used with Euclidian or city block interprofile distance measures, performed best. Single linkage, median, and centroid methods were substantially inferior for clustering individuals in accordance with true population memberships.

The progressive sequence of ego development levels as measured by the Washington University Sentence Completion Test was examined in relation to component scores on a construct identified from 12 objective measures related to ego development. The analysis was based on 229 adult subjects. The sequence of component scores for three groupings of ego development levels (Pre-Conformist, Conformist, and Post-Conformist) followed the predicted progression. Large standard deviations relative to the mean component scores for the groupings of ego development levels suggested overlap among the levels of ego development, which is consistent with the notion of décalage in developmental theory.

This study investigated the reliabilities and conjectured factor structure of the subscales comprised by Lorr and DeJong's (1986) abbreviated form of the Interpersonal Style Inventory (ISI). The results suggest that internal consistency reliabilities of the subscales are presently inadequate for clinical or research purposes. The five-factor structure described by Lorr (1986) appeared to conform well to the empirical grouping in the data set. Only one scale, Approval Seeking, appeared incorrectly placed according to the a priori description. Another weakness in the a priori structure was that the Rule-Free subscale had only a minor role in identifying its conjectured factor. These results were based on ISI protocols from 268 adults. Overall's (1974) marker variable factor analysis was implemented to assess the adequacy of the a priori factor structure.