Charles P. McCreary

Independent and mediated contributions of personality, coping, social support, and depressive symptoms to physical functioning outcome among patients in cardiac rehabilitation.

This study examined the direct and mediated contributions of psychosocial variables to posttreatment physical functioning among 142 patients receiving cardiac rehabilitation. Two models were proposed and tested. In the first model, psychosocial factors were correlated and made to predict baseline and 6-week physical functioning. The results showed that after controlling for age, illness severity, baseline physical functioning, and other psychosocial correlates, optimism and social support still significantly predicted better posttreatment physical functioning. In the second model, we explored both the direct and mediational relationships between psychosocial factors and physical health outcomes. Optimism and social support were found to contribute to health outcomes not only directly but also indirectly through the mediation of less engagement in detrimental coping and lower depressive symptoms, whereas hostility and negative coping only predicted outcomes indirectly through mediators. These findings highlighted the importance of addressing psychosocial issues and their interrelationships in cardiac rehabilitation.

The MMPI as a predictor of response to conservative treatment for low back pain

Studies that used the MMPI to predict the response of chronic low back pain patients to standard medical treatment have not produced definitive results. Patients seen in a university hospital orthopedic back pain clinic were given the MMPI before treatment, and 6 to 12 months later 76 patients completed follow-up forms that indicated their level of intensity during the previous week and their ratings of the success of treatment in relieving their pain as well as in enabling them to return to normal activities. Predictions of poor response were made in terms of either single MMPI scales or code types. Patients with poor outcome on two of the three criteria (level of pain intensity and ability to return to normal activities) had significantly higher scores on the Hs scale. The predicted high risk code types very accurately identified patients with poor response on the same two criteria; however, the code-type procedure overpredicted poor response in the good outcome group.

Differences between functional versus organic low back pain patients

&NA; There are contradictory findings about whether there are differences in personality and/or amount of emotional disturbance between patients with functional versus organic low back pain. The MMPI scores of 42 back pain patients diagnosed as “organic” were compared with the scores of 37 patients classified as “functional”. The functional patients scored significantly higher than the organics on the Hs, Hy, Pd, Sc, Ma, and Si scales. The organics scored significantly higher than the functional on the K scale. The results confirm the view that certain symptoms of emotional disturbance are more characteristic of patients who have relatively little evidence of physical findings. However, the degree of overlap between groups was high enough to suggest caution in making predictions and diagnoses about functional versus organic pain on individual patients solely on the basis of personality data.

Principal dimensions of the pain experience and psychological disturbance in chronic low back pain patients

Abstract The principal dimensions of the pain experience of 102 patients with chronic low back pain were studied and components of the pain experience were compared to pre‐treatment measures of emotional disturbance. Responses on the McGill Pain Questionnaire (MPQ) were factor analyzed revealing dimensions of the pain experience that seemed to represent sensory, affective, and evaluative aspects. Patients with high scores on the MMPI hypochondriasis scale portrayed their pain as more intense and as high in terms of affective and evaluative descriptors on the MPQ. Other MMPI scales reflecting emotional disturbance (depression, hysteria) were also associated with a more intense description of pain and higher scores on an affective descriptor dimension. The evaluative descriptive dimension was highly related to the overall intensity of the pain experience. Only the affective dimension was related to emotional disturbance separately from the effects of intensity alone.

MMPI differences among black, Mexican-American, and white male offenders.

MMPI scores of black, Mexican-American, and white male offenders were compared in order to investigate whether cultural and/or socioeconomomic factors affect this personality inventory. Comparisons were performed on unmatched and matched (education and occupation) groups that utilized all profiles or valid ones only and examined both trait (individual scales) and type (Goldberg indices) differences. Black-white differences on the MA, K, and HY scales appeared to reflect cultural factors, while differences on MF and alcoholism seemed to be accounted for by socieconomic differences among the groups. Cultural factors seemed to be related to differences between Mexican-Americans and white on the L,K,and overcontrolled hostility scales, while socioeconomic factors appeared to explain differences on the Hs scale. Type differences were not apparent except that Mexican-Americans were classified more often as psychiatric, while whites and blacks scored well into the sociopathic range.

Emotional disturbance and chronic low back pain

Treated chronic low back pain patients (N = 102) in a university hospital clinic. Ss were given the EPI, the Recent LIfe Changes Questionnaire, and the Locus of Control Scale in order to isolate the principal dimensions of emotional disturbance in such patients and to see whether derived dimensions were related to response to conservative treatment for back pain. Self-report ratings of current pain intensity were obtained approximately 1 year after the start of treatment. Factor analysis revealed five factors: Distrust and alienation, somatic concern, vulnerability, extraversion, and social desirability; these accounted for 71% of the total variance among patients. Patients with above-average pretreatment distrust and alienation scores more frequently failed to return the follow-up form than patients with below-average scores. Low scores on somatic concern were related to good outcome. Results suggest that patients in alienation and distrust may be prone to be poor compliers. Because only the somatic concern dimension predicted outcome, a single scale that measures this characteristic may be sufficient for effective identification of the potential good vs. poor responders to conservative treatment of low back pain.

A comparison of clinically and empirically derived MMPI groupings in low back pain patients

Two methods of grouping MMPI scales were employed with 271 patients who were attending a Back Clinic at a university hospital. One method involved clinically derived decision rules, while the other utilized a multivariate clustering procedure. Five subgroups of patients were identified with each method. Both procedures showed subgroup differences in terms of pretreatment pain intensity, activity limitations, McGill affective scores, and physician ratings of degree of functional impairment; the elevated subgroups showed more dysfunction. Follow-up comparisons revealed that, regardless of the classification procedure used, the elevated subgroups showed poorer response to treatment. Only the clinically derived groupings had significant differences in chronicity of pain and total scores on the McGill Pain Questionnaire. On the other hand, only the statistically based system showed significant differences on age and marital status. Furthermore, only the statistical system identified subgroups of male patients that predicted followup pain intensity decreases in a manner that indicated clinical usefulness.

Locus of Control, Repression-Sensitization, and Psychological Disorder in Chronic Pain Patients.

Examined the relationship between locus of control and psychological disorder in chronic pain patients controlling for the effects of response sets. Fifty-nine patients with chronic low back pain were given Rotters Internal-External Locus of Control (I-E) scale and the MMPI. Multiple regression analysis showed that the MMPI K, F, and Pt scales produced the most efficient prediction of I-E scores. Response set tendencies to dramatize problems and traits that involve excessive rumination and self-doubt were related to external locus of control.

Psychosocial functioning following successful surgical relief from seizures. Evidence of prediction from preoperative personality characteristics

Abstract The relationship of preoperative personality tests to psychosocial functioning following relief of seizures was studied in a group of nonpsychiatric patients of average intelligence. Patients with no psychopathology in their preoperative personality tests were correctly predicted by a clinical medical psychologist to have good psychosocial adjustment following surgical success. However, predictions of postoperative psychosocial functioning in patients with psychopathology on their preoperative personality tests were correct in only 26% of the cases. Analyses of the personality test results showed that the younger patients who had evidence of disorganized confusion preoperatively did well psychosocially following surgical relief of seizures. On the other hand, older patients with indications of an organized, well-structured psychopathology had poor psychosocial adjustment postoperatively, even though seizures were relieved.

Personality Comparisons of Responders and Nonresponders to a Mailed Personality Inventory

Response and nonresponse bias is a concern of researchers who employ mail survey questionnaires. This study compared personality characteristics of responders and nonresponders to a mailed personality inventory. The Comrey Personality Scales were initially administered to two first-year dental school classes. In a readministration after graduation, the inventory was mailed to all initial participants. Differences between responders and nonresponders were examined for 10 scales. Responders tended to score higher than nonresponders on the Trust versus Defensiveness and Social Conformity versus Rebelliousness scales. This study lends only weak support for the notion that responders to mail surveys have different personality profiles than nonresponders.