Julie Werrett

A multiple-indicator multiple-cause model for posttraumatic stress reactions : Personality, coping, and maladjustment

Objective: This study aimed to develop a multiple-indicator multiple-cause model (MIMIC) to describe the relationship among posttraumatic stress (PTSD) responses, general health problems, death anxiety, personality factors, and coping strategies among community residents exposed to the technological disasters of aircraft and train crashes. Materials and Methods: One hundred forty-eight community residents, after exposure to the aircraft or train crash, were assessed using the Impact of Event Scale, the General Health Questionnaire-28, the Death Anxiety Scale, the Eysenck Personality Questionnaire, and the Ways of Coping Checklist. The control group (n = 90) comprised members of the general public, who had not been exposed to the disasters, from another city. Results: The model showed significant associations between the impact of the disaster and general health problems, which varied depending on where community residents lived in relation to the disaster site, whether they were present when the disaster occurred, and the type of disaster. The model also suggested that death anxiety was associated with type of disaster and neuroticism. The model supported the interactive model in that personality factors interacted with coping strategies in maintaining or generating PTSD and general health problems. Conclusions: After exposure to technological disasters, community residents could develop PTSD and general health problems; however, increased death anxiety was a separate psychological reaction. The interaction between certain personality traits and coping strategies was one reason for PTSD and general health problems. MIMIC = multiple-indicator multiple-cause model; PTSD = posttraumatic stress disorder; POWS = prisoners of war; IES = The Impact of Event Scale; GHQ-28 = The General Health Questionnaire; DAS = The Death Anxiety Scale; EPQ-R = The Eysenck Personality Questionnaire-R Short Scale; WOC = The Ways of Coping Checklist; ANOVA = analysis of variance; RMSEA = root mean square error of approximation.

Cancer genetic predisposition: information needs of patients irrespective of risk level

Increased insight into the information needs of people about cancer genetic predisposition could allow materials to be developed to improve decision-making for those at high risk, whilst those at lower risk could have their anxiety reduced without the need for referral to genetics services. This study aimed to identify information needs of patients concerned about a genetic predisposition to cancer, and explore how this varied according to risk perception, cancer worry, personal motivation and demographics. Stage 1 used semi-structured telephone interviews pre and post participants’ genetic risk assessment. The findings informed stage two, a structured questionnaire survey of 1,112 patients, pre and post their genetic risk assessment. Participants were stratified by risk level and included those concerned about an inherited predisposition to breast, ovarian or colorectal cancer. About 512 (46%) responded with equal proportions of responders and non-responders across the risk categories. Findings indicated that irrespective of a person’s actual or perceived level of risk, cancer worry, demographic background or personal motivation; priorities in the type of information required were similar. Greatest emphasis focused on information provision about how risk was assessed. Least important was acquiring an understanding about genes and inheritance patterns. Most participants reported difficulties accessing or finding information. Peoples’ information needs are consistent irrespective of their risk level and therefore generalised information packages could be developed for anyone requesting cancer genetic risk assessment. Better information is likely to assist patients’ understanding and ultimately increase concordance with recommended screening and preventative measures.

Differentiating posttraumatic stress between elderly and younger residents

Abstract This study aimed to differentiate between the posttraumatic stress responses of elderly and younger community residents who had been exposed to two technological disasters (a train collision and an aircraft crash). One hundred and forty-eight community residents were assessed using the Impact of Event Scale (IES) and the General Health Questionnaire (GHQ-28). The results showed that age differences were not affected by impact of disaster (IES), suggesting that elderly and younger community residents responded to the disasters similarly. Instead, the community residents exposed to the aircraft crash experienced significantly more intrusion and avoidance than those exposed to the train collision. Also, the community residents who had experienced high exposure to the disasters had significantly more intrusive thoughts and exhibited significantly more avoidance behavior than the low/medium exposure group. The results also showed no main effects in general health between the elderly and younger community residents, suggesting that their health status was similar. Instead, the community residents exposed to the aircraft crash had significantly more general health problems than the train disaster residents and the control group. Also, the community residents in either the low/medium or the high exposure group experienced more general health problems than the control group. Correlation coefficients showed that intrusion, avoidance, and the total impact of the disasters were significantly correlated with all general health subscales for both elderly and younger groups.

A regional evaluation of the impact of the Leading an Empowered Organisation leadership programme

This paper reports on an evaluation of the Leading an Empowered Organisation (LEO) leadership programme. The aims of the study were to evaluate the first phase of the programme in the West Midlands Region and to identify changes in practice as a result. The study focuses on the first cohorts on the programme in 2001 and 2002. The study involved administering a pre-test survey at the outset of the programme and completing a post-test survey of the same group three months after the programme was completed. There were 550 participants in the pre-test and 181 in the post-test. Data were collected via a structured scale designed to measure perceived importance and use in practice (performance) of 33 dimensions of leadership. Open questions enabled participants to comment on their experience when responding to the post-test. Analysis of quantifiable data shows differences in performance measure at the post-test in aspects of practice related to team and management issues, staff support and development, and creative management and assertiveness. Qualitative data supported these findings in that they highlighted areas of development since participants had completed the LEO programme. Further longitudinal evaluation is recommended to monitor the long-term impact of LEO programmes on clinical practice.