Annemarie M. Kolk

Sex differences in physical symptoms: the contribution of symptom perception theory.

Health surveys, studies on physical symptom reporting, and medical registration of physical complaints find consistent sex differences in symptom reporting, with women having the higher rates. By and large, this female excess of physical symptoms is independent from the symptom measure, response format and time frame used, and the population under study. As most studies concern healthy individuals, the sex difference can not simply be attributed to a greater physical morbidity in women. In this paper we propose a number of explanations for this phenomenon, based on a biopsychosocial perspective on symptom perception. We discuss a symptom perception model that brings together factors and processes from the extant literature which are thought to affect symptom reporting, such as somatic information, selection of information through attention and distraction, attribution of somatic sensations, and the personality factors somatisation and negative affectivity. Finally, we discuss the explanations for sex differences in physical symptoms that arise from the model.

Assessment of Parental Psychological Stress in Pediatric Cancer: A Review

OBJECTIVES We present an overview of the literature between 1997 and 2007 on parental stress reactions following the diagnosis of childhood cancer and we evaluate methodological strengths and weaknesses of the studies. METHODS PubMed, PsychInfo, and Cinahl databases were used. Sixty-seven were included in the review. RESULTS The conceptualization of parental stress and timing of assessment varies considerably between the studies, which makes comparison difficult. Most emotional stress reactions are seen around the time of diagnosis, with mothers reporting more symptoms than fathers. As a group, parents seem relatively resilient, although a subset of parents reports continuing stress even up to 5 years or more postdiagnosis. CONCLUSIONS The authors recommend clear definitions of parental stress, fixed points in time to assess parental stress, and an approach that highlights both parental strengths and weaknesses. Improved assessment can contribute to tailoring psychological care to those parents most in need.

Gender differences in physical symptoms and illness behavior: A health diary study

Recent studies on symptom perception have highlighted the role of psychological factors, such as mood states and external involvement, in physical symptom reporting. To date, the consistently found higher physical symptom reports in women have not been studied from this perspective. The present study aimed to investigate the psychological determinants of gender differences in physical symptoms and illness behavior on a daily basis. During four adjacent weeks, a healthy primary care sample of 92 women and 61 men kept health diaries, containing scales for physical symptoms, illness behavior, external information and positive and negative mood. The daily health records showed the typical gender difference in physical symptoms, but not in illness behavior. Negative mood was found to be the strongest predictor of physical symptoms. Physical symptoms in turn were the strongest predictor of illness behavior. The modest gender difference in physical symptoms disappeared after controlling for positive and negative mood. Thus, mood states seem to mediate gender differences in symptom reporting.

Predicting medically unexplained physical symptoms and health care utilization: A symptom-perception approach

OBJECTIVES The present study investigated the contribution of demographic characteristics (age, gender, socioeconomic status [SES]) and symptom-perception variables to unexplained physical symptoms and health care utilization. In addition, the consequences of the use of four frequently applied symptom-detection methods for relations among study variables were examined. METHOD A group of 101 men and women were administered a standardized interview and several questionnaires. Their general practitioners (GPs) rated (un)explained symptoms and consultations over the previous year. RESULTS Path analyses showed that direct and indirect effects on symptoms and GP consultations depend on method of symptom detection, the largest difference being between self-reported symptoms and registered symptoms. The model including self-reported common symptoms demonstrated the direct and indirect effects of the symptom-perception variables: chronic disease, negative affectivity, selective attention to bodily sensations, and somatic attribution. In the model including registered symptoms, only chronic disease and SES showed effects on symptoms and GP consultations. CONCLUSION This study demonstrates the usefulness of a symptom-perception approach to the experience of unexplained symptoms, the importance of selection of a symptom-detection method, and the need for different models for the explanation of daily experienced symptoms and their presentation in health care.

A symptom perception approach to common physical symptoms

This study investigated variables assumed to influence the symptom perception process, as well as the sociodemographic variables of age, gender and socioeconomic status, regarding their relation to common physical symptoms. In addition, it ascertained the predictors of two symptom measurement methods (prospective and retrospective). A group of 152 men and women completed a standardized interview as well as several questionnaires and kept a diary for 4 weeks. Path analyses showed an adequate data fit irrespective of symptom measure. Two main routes to both prospectively and retrospectively measured physical symptoms were found: one from more negative affectivity via a stronger tendency to selective attention and the other from unemployment or a higher number of chronic diseases via a lower quantity of external information. The effect of age on physical symptoms was mediated by the number of chronic diseases and the tendency to selectively attend to bodily sensations. The effects on physical symptoms proved to depend partly on the method of symptom measurement and varied according to the mediating role of negative mood and the tendency to make psychological attributions. Overall, this study highlights the importance of estimating the independent contribution of variables to the experience of common physical symptoms in a comprehensive model while taking into account the method of symptom measurement. In addition, it demonstrates the usefulness of a symptom perception approach for further study.

Psychometric evaluation of symptom perception related measures

Abstract Psychological theories on symptom perception have put forward determinants of physical symptom reporting. These determinants concern either attentional strategies, attributional processes or personality factors. In this paper, we bring together five major determinants of symptom reporting (external information, selective attention to body, attributional style, negative affectivity and somatization) in a cognitive-psychological model. Sex differences on these determinants may contribute to explaining the usually found female excess of physical symptoms. Five psychological self-report measures, assessing these symptom perception related concepts, were translated into Dutch or newly developed. Their psychometric characteristics were investigated in both a student and a patient sample. All scales were found to be sufficiently reliable. Correlations with validity measures and between the scales themselves support the inter relatedness of psychological distress, somatic distress and general neuroticism. Significant sex differences were observed on four of the five scales, though these differences were inconsistent across samples. The sex effects remained significant when gender role orientation was taken into account. Lastly, sex differences in physical symptoms were independent from the trait versus state character of the symptom measure, and were found for a general disposition to report symptoms (somatization) as well as for daily registered symptoms in health diaries.

Biological sex, sex role orientation, masculine sex role stress, dissimulation and self-reported fears

Abstract Given meta-analytic findings showing females to be generally more fearful than males on multi-dimensional self-report measures of fear, an empirical attempt was made to examine whether this outcome could be explained by psychological factors such as sex role orientation and masculine sex role stress. In addition, the bearing of dissimulation tendencies on findings relating self-reported fears to biological sex, sex roles, and masculine sex role stress was also addressed. Using a non-clinical sample of volunteers from Britain, it was observed with simple correlational analyses that females were more fearful than males on Social, Agoraphobic, Harmless animals and Sexual and aggressive scenes fears, even after holding constant the combined influences of Masculinity and Masculine sex role stress. The sex difference in Bodily injury, death and illness fears emerged only after adjusting for the joint influences of Masculinity and Masculine sex role stress. Applying hierarchical multiple regression analysis with interaction terms, it was found that (a) Biological sex contributed significantly in increasing the proportion of variance accounted for in scores on Social, Agoraphobic, Harmless animals and Sexual and aggressive scenes fears, after accounting for the joint influences of Masculinity (M), Femininity (F), Masculine sex role stress (MGRS), Dissimulation (Lie) and other potentially confounding factors; (b) following the simultaneous adjustment for the influences of the same set of potentially confounding factors (thus including M, F, MGRS, and Lie scores), Biological sex emerged as a consistent predictor of all five types of fears considered, with, as hypothesized, being female predicting high fear scores; (c) the same applied to the predictive ability of Masculine sex role stress (with Biological sex now included as a covariate), with, as predicted, higher stress being predictive of higher fear levels; (d) again, taking into account potentially confounding factors, Masculinity predicted all types of fears considered, except Fears of sexual and aggressive scenes, with, as anticipated, high Masculinity predicting low levels of fear, whereas, contrary to expectations, Femininity and Dissimulation did not succeed in predicting fear scores of any type; (e) few combinations of independent variables (involving Biological sex, M, F, MGRS and Lie) predicted fear scores significantly following adjustment for potential confounds, the significant predictors being MGRS × Biological sex (in relation to Social fears), Lie × Biological sex (Fears of bodily injury, death and illness) and M × F (Harmless animals fears) with respective β s of −.14, .17 and .22 (.01 ⩽ P ⩽ .05); (f) while Biological sex, Masculinity and Masculine sex role stress were all factors predicting the magnitude of self-reported fears, their relative contributions varied according to the fear dimension. Five major hypotheses about the relationship between sex roles and mental and physical health have been advanced in the literature: the traditional hypothesis, the balance theory of androgyny, the main effects androgyny hypothesis, the emergent properties theory of androgyny, and the Masculinity hypothesis (cf. K. Davidson-Katz (1991) . Gender roles and health. In C. R. Snyder & D. R. Forsyth (Eds.), Handbook of Social and Clinical Psychology: The Health Perspective . New York: Pergamon). The present findings supported only the Masculinity theory across four out of five fear dimensions (all but the Sexual and aggressive scenes component). The implications of the findings and suggestions for new research directions are discussed.

Cross-National constancy of dimensions of parental rearing style: The Dutch version of the Parental Bonding Instrument (PBI)

Abstract The Dutch version of the Parental Bonding Instrument was administered to students, community residents and to phobic outpatients in order to examine whether the two-dimensional model of Care and Protection described originally in Australian data, could be replicated. In line with previous findings with a similar, originally Swedish, instrument (the EMBU), clear evidence was found for replicability of the corresponding factors. In addition, the factor structure of the PBI proved to be robust across ‘sex’ and ‘age-groups’. The findings support both the cross-sample invariance and the cross-national constancy of the major dimensions of parental rearing behaviour. Findings with respect to the internal consistency of the PBI scales and the homogeneity of the item sets which make up the scales were very encouraging. The dimensions were generally moderately negatively correlated with each other, a finding which tallies with Australian and British figures. Sex influences on the PBI scores were negligible, as were those of age in sample in which its distribution was not extremely skewed.

The influence of respiratory sounds on breathlessness in children with asthma: a symptom-perception approach.

The discordance between the objective and subjective symptoms of asthma has major effects on proper medication and management. In 2 studies the influence of respiratory sounds in the process of symptom perception underlying breathlessness was investigated in children aged 7-17 years. In Experiment 1, asthmatic wheezing sounds were recorded in 16 children during histamine-induced airway obstruction. Breathlessness correlated significantly with rank order of amount of wheezing, but not with lung function. In Experiment 2, after standardized physical exercise, 45 asthmatic and 45 nonasthmatic children were randomly assigned to (a) false feedback of wheezing, (b) quiet respiratory sounds, or (c) no sound. Asthmatic children reported significantly more breathlessness in the 1st versus the 3rd condition. In conclusion, many asthmatic children were easily influenced by wheezing in their estimation of asthma severity, reflected in breathlessness.

The capacity of children with and without asthma to detect external resistive loads on breathing.

Clinical observations and research with adults consistently showed that subjective symptoms of asthma poorly reflect actual airway obstruction. The lack of accurate symptom perception poses a problem for medication and management of asthma. The accuracy of airflow detection was studied in 46 children with and 46 without asthma (aged 7-18 years). They breathed through a facemask and responded to load stimuli of different intensity. Sessions consisted of 10 blocks of 5 min, each with 10 stimuli presented. Experiment 1: Loads of increasing intensity presented to 36 children with and 36 without asthma. Seven asthmatics had a reliable detection threshold (just noticeable difference, jnd) analogous to approximately equal to 64% fall in forced expiratory volume in 1 sec (FEV1). Ten normal controls had a jnd of approximately 39% fall. Experiment 2: Loads randomly presented to 10 children with and 10 without asthma. Four asthmatics had a jnd of approximately equal to 64% fall in FEV1. Six normal controls had a jnd of approximately equal to 39% fall. The results demonstrated that children generally were poorly perceiving load stimuli and that asthmatics were less accurate.