Glenn N. Jones

A Daily Stress Inventory: development, reliability, and validity.

This article describes the development of the Daily Stress Inventory, a measure introduced to provide researchers and clinicians with a psychometrically sound self-report instrument for the daily assessment of the sources and individualized impact of relatively minor stressful events. It was designed to assess sources of stress not typically assessed by major life-event scales. Generalizability coefficients indicate that the scale has significant homogeneity and a useful degree of stability. Several studies investigating the concurrent and construct validities suggest that the scale measures the construct commonly referred to as “stress”. Implications for uses in theoretical and basic research as well as clinical assessment are discussed.

Postconcussion symptoms and daily stress in normal and head-injured college populations.

The postconcussion syndrome is a term invoked to describe a constellation of cognitive (decreased memory and concentration), emotional (increased irritability and nervousness or anxiety), and physical (increased headaches and dizziness) changes that are commonly reported following minor or severe head injuries. The first section presents the development and validation of the Postconcussion Syndrome Checklist. The second section describes the daily changes in symptom reports as a function of daily stress levels. A population of head-injured subjects and controls monitored postconcussion symptoms and stress across a 6-week period. The frequency, intensity, and duration of symptoms reported were correlated with daily stress levels as measured by the Daily Stress Inventory for both groups. Yet, the number of symptoms reported by our head-injured group did not vary significantly from the normal subjects. The data support models which predict that postconcussion syndrome varies with stress, but the evidence for a reduction in the cerebral reserve capacity after head injury was not supported with this population. Explanations for this finding are presented and implications of this research and directions for future research are outlined.

The Utility of the Ces-D as a Depression Screening Measure among Low-Income Women Attending Primary Care Clinics

Objective: Depressive disorders are among the most common medical disorders seen in primary care practice. The Center for Epidemiologic Studies-Depression (CES-D) scale is one of the measures commonly suggested for detecting depression in these clinics. However, to our knowledge, there have been no previous studies examining the validity of the CES-D among low-income women attending primary care clinics. Method: Low-income women attending public primary care clinics (n = 179, ages 20–77) completed the CES-D and the Diagnostic Interview Schedule for the DSM-IV (DIS-IV). Results: The results supported the validity of the CES-D. The standard cut-score of 16 and above yielded a sensitivity of .95 and specificity of .70 in predicting Major Depressive Disorder (MDD). However, over two-thirds of those who screened positive did not meet criteria for MDD (positive predictive value = .28). The standard cut-score appears valid, but inefficient for depression screening in this population. An elevated cut-score of 34 yielded a higher specificity (.95) and over 50 percent of the patients who screened positive had a MDD (positive predictive value = .53), but at great cost to sensitivity (.45). Conclusion: Results indicated that the CES-D appears to be as valid for low-income, minority women as for any other demographic group examined in the literature. Despite similar validity, the CES-D appears to be inadequate for routine screening in this population. The positive predictive value remains very low no matter which cut-scores are used. The costs of the false positive rates could be prohibitive, especially in similar public primary care settings.

Predictors of outpatient medical appointment attendance among persons with HIV.

Non-adherence to medical regimens is a critical threat to the health of HIV-infected individuals. Patients who do not adhere to routine medical care cannot fully benefit from the increasingly efficacious treatments available to them. Consistent attendance at medical appointments plays a central role in both prolonging life and enhancing quality of life for persons living with HIV/AIDS. By identifying why many patients do not reliably attend medical services, interventions can be undertaken to improve appointment-keeping. The primary purpose of the present study was to identify factors predictive of HIV-related medical appointment attendance. One-hundred-and-forty-four outpatients in a public hospital ambulatory care HIV clinic were followed for seven months. Demographic, medical care and psychosocial factors were measured in order to prospectively predict the percentage of missed clinic appointments by persons with HIV disease. Greater outpatient appointment non-attendance was associated with younger age, minority status, less severe illness and lower perceived social support. Treatment duration, provider consistency, hopelessness and religious coping did not emerge as significant predictors of outpatient appointment-keeping in this sample. Practical and theoretical implications of these findings are discussed in light of recent medical advances in HIV/AIDS care.

Validation of the Beck Depression Inventory-II in a Low-Income African American Sample of Medical Outpatients.

The psychometric properties of the Beck Depression Inventory-II (BDI-II) are well established with primarily Caucasian samples. However, little is known about its reliability and validity with minority groups. This study evaluated the psychometric properties of the BDI-II in a sample of low-income African American medical outpatients (N=220). Reliability was demonstrated with high internal consistency (.90) and good item-total intercorrelations. Criterion-related validity was demonstrated. A confirmatory factor analysis supported a hierarchical factor structure in which the BDI-II reflected 2 first-order factors (Cognitive and Somatic) that in turn reflected a second-order factor (Depression). These results are consistent with previous findings and thus support the use of the BDI-II in assessing depressive symptoms for African American patients in a medical setting.

Factors associated with depression in a heterogeneous HIV-infected sample

The present study examined factors contributing to depressive symptomatology in a low SES, heterogeneous HIV seropositive sample. The sample was comprised of 120 HIV-infected patients who completed psychosocial measures upon their initial visit to an outpatient HIV clinic. Length of time since HIV seropositive notification and HIV-related symptomatology were also assessed. Social support, major life stress, and HIV-related symptomatology were significantly associated with depression. Perceived availability of social support accounted for the greatest variance in depression scores. Length of time since seropositive notification was not significantly associated with depression. These findings extend previous research with middle-class, homosexual, white males to the rapidly growing minority, heterosexual, and low SES populations and point to the need for the inclusion of social support interventions in the provision of services of these individuals.

Utilization of medical services and quality of life among low-income patients with generalized anxiety disorder attending primary care clinics.

Objective: Anxiety disorders appear to influence morbidity and medical utilization. However, little is known about the relationship between Generalized Anxiety Disorder, quality of life, and medical utilization, especially among low-income patients. The goals of this investigation were to 1) determine if low-income patients with GAD utilize medical services more than patients with other Axis I diagnoses, or no psychopathology, and 2) compare the health-related quality of life of these three groups. Method: Participants were randomly recruited from public primary care clinics and administered intake assessments of demographics, stress, and health-related self-report questionnaires. At the end of the first year a structured psychiatric interview was administered (N = 431). Over the second year, patients (n = 360) were administered a health-related quality of life measure every three months for four assessments. Medical charts were abstracted to collect information about chronic illnesses and visits to outpatient clinics and the emergency department during the two years. Results: Patients were predominantly middle-aged, low-income, uninsured African-American females. In this low-income sample, patients with GAD utilized the emergency department more and reported poorer quality of life than patients with other Axis I disorders and patients without any psychopathology. Conclusion: Low-income patients with GAD utilize the emergency department more and report poorer quality of life than patients with other Axis I disorders and patients without any psychopathology. Programs to identify and treat patients with GAD may yield improvements in quality of life, as well as reduce emergency department utilization.

The Influence of Income Level and Ethnicity on Coping Strategies

The Ways of Coping Questionnaire (WCQ) by S. Folkman and R. S. Lazarus (1988) has been used widely; however, few studies have evaluated this assessment tool in research concerning populations from different income levels and ethnic backgrounds. The purpose of this study was to compare the endorsement of the 8 coping strategies as outlined by Folkman and Lazaruss original research with Caucasian, middle class participants to the endorsement of coping approaches in a low income, primary care sample. Results suggest that low income individuals report utilizing greater rates of coping strategies overall and specifically employ emotion-focused coping strategies more than Folkman and Lazaruss original sample. Ethnic differences within the present studys low income sample were also examined and suggest that even within this low income sample, African Americans use certain emotion-focused coping strategies significantly more than Caucasian participants.

The Daily Stress Inventory: Validity and Effect of Repeated Administration

The Daily Stress Inventory (DSI) is a self-report measure of minor stressors which is administered daily. One test of the validity of a measure of daily stress is its sensitivity to the difference between the stressors of workdays and those of weekends. A second concern in establishing the validity of a test administered repeatedly is that self-monitoring may influence the obtained scores. The present study investigated these two issues using a sample of 70 community adults who reported full-time employment. These subjects provided a week of self-monitoring with the DSI. The results indicated that the DSI was sensitive to the difference between weekends and weekdays. The analyses of the effect of repeated administration suggested that the first day of self-monitoring may differ from the other days of self-monitoring. When the first day was eliminated, there was no significant difference among the days of self-monitoring, and the difference between the weekdays and the weekends remained. The data suggest that the DSI is a valid measure of the construct of daily stress and that any influence of repeated self-monitoring with the scale may be easily resolved.

A prospective study of the impact of stress on quality of life: An investigation of low-income individuals with hypertension

The role that major and minor life events play in the quality of life in low-income hypertensives was examined. Participants were randomly recruited from 2 primary care clinics at a public medical center. The study utilized a prospective design. Participants were determined to have hypertension and were being treated with antihypertensive medication prior to and throughout the duration of the study. Participants were administered the Life Experiences Survey and the Weekly Stress Inventory repeatedly during Year 1 to assess major and minor stress, respectively. Participants were repeatedly administered the RAND 36-Item Health Survey during Year 2 to assess quality of life. Usable data were obtained from 183 patients. Analyses revealed that major and minor stress were significant predictors of all measured domains of quality of life, even after age and number of chronic illnesses were statistically controlled. Minor stress contributed uniquely to the prediction of each dimension of quality of life even when age, number of chronic illnesses, and major life events were accounted for. Findings suggest that stress has a significant, persistent impact on the quality of life of low-income patients with established hypertension. These findings extend prior research that has examined the impact of medications on quality of life and suggest that stress needs to be accounted for as well.