Kiran Sarma

Chronic pain in the Republic of Ireland—Community prevalence, psychosocial profile and predictors of pain-related disability: Results from the Prevalence, Impact and Cost of Chronic Pain (PRIME) study, Part 1

&NA; The aims of the PRIME study (Prevalence, Impact and Cost of Chronic Pain) were 3‐fold: (1) to determine the point prevalence of chronic pain in Ireland; (2) to compare the psychological and physical health profiles of those with and without chronic pain; and (3) to explore a predictive model of pain‐related disability. A postal survey of 3136 people was conducted with a representative community‐based sample of adults. Measures were obtained for sociodemographic variables, physical and psychological well‐being, depressive symptoms, presence of pain, pain severity, pain‐related disability, and illness perceptions. Responses were received from 1204 people. The prevalence of chronic pain was 35.5% (95% CI = 32.8–38.2) (n = 428). No gender difference in prevalence was found. Prevalence of pain increased with age and was associated with manual employment. The most commonly reported site of pain was the lower back (47.6%); however, multiple pain sites was the norm, with more than 80% of participants reporting more than 1 pain site. Approximately 12% of participants were unable to work or were on reduced work hours because of pain. Of those with chronic pain, 15% met the criteria for clinically relevant depression compared with 2.8% of those without pain. A multiple regression analysis, predicting 67% of variance, showed that pain intensity was the strongest predictor of pain‐related disability. Depression and illness perceptions were also predictive of pain‐related disability, after controlling for the effects of pain intensity. Chronic pain is a prevalent health problem in Ireland and is associated with significant psychological and functional disability. Psychological factors appear to influence the level of pain‐related disability. Chronic pain affects approximately one‐third of the population in Ireland, and depressive symptoms occur 5 times more often than in persons without chronic pain.

Comparison of an Online Mindfulness-based Cognitive Therapy Intervention With Online Pain Management Psychoeducation: A Randomized Controlled Study.

Background:This study tested the effectiveness of a computerized mindfulness-based cognitive therapy intervention compared with computerized pain management psychoeducation in a randomized study. Methods:Using an intention-to-treat approach, 124 adult participants who reported experiencing pain that was unrelated to cancer and of at least 6 months duration were randomly assigned to computerized mindfulness-based cognitive therapy (“Mindfulness in Action” [MIA]) or pain management psychoeducation programs. Data were collected before and after the intervention and at 6-month follow-up. Results:Participants in both groups showed equivalent change and significant improvements on measures of pain interference, pain acceptance, and catastrophizing from pretreatment to posttreatment and the improvements were maintained at follow-up. Average pain intensity also reduced from baseline to posttreatment for both groups, but was not maintained at follow-up. Participants in both groups reported increases in subjective well-being, these were more pronounced in the MIA than the pain management psychoeducation group. Participants in the MIA group also reported a greater reduction in pain “right now,” and increases in their ability to manage emotions, manage stress, and enjoy pleasant events on completion of the intervention. The changes in ability to manage emotions and stressful events were maintained at follow-up. Conclusions:The results of the study provide evidence that although there were equivalent changes across outcomes of interest for participants in both conditions over time, the MIA program showed a number of unique benefits. However, the level of participant attrition in the study highlighted a need for further attention to participant engagement with online chronic pain programs.

Psychological factors associated with indices of risky, reckless and cautious driving in a national sample of drivers in the Republic of Ireland

This paper presents the results of a national survey of drivers in the Republic of Ireland that sought to examine psychological predictors of specific driving behaviours. 1638 respondents attending National Car Testing (NCT) centres nationwide completed a questionnaire battery that included personality, attitudinal, locus of control and social influence measures. The driving behaviours examined were drawn from a Driving Behaviour Scale (Iversen, 2004) and included Speeding and Rule Violation, Reckless Driving, Wearing of Seat Belts, Cautious Driving and Drink Driving. Cross-group comparisons suggested that males engaged in more risky and less cautious driving behaviours than females, and participants under the age of 25 were more risky and less cautious than those 25 years or older. Statistically significant models of each driving outcome emerged. The best model fit was for speeding and rule violation, which was predicted by a model including positive attitudes towards speeding, greater normative influences of friends and higher perceived behavioural control, extraversion and driving anger. These findings offer important insights into the correlates of different driving behaviours and can help inform the work of road safety practitioners.

The Impact of Threat Appeals on Fear Arousal and Driver Behavior: A Meta-Analysis of Experimental Research 1990–2011

The existing empirical research exploring the impact of threat appeals on driver behavior has reported inconsistent findings. In an effort to provide an up-to-date synthesis of the experimental findings, meta-analytic techniques were employed to examine the impact of threat-based messages on fear arousal and on lab-based indices of driving behavior. Experimental studies (k = 13, N = 3044), conducted between 1990 and 2011, were included in the analyses. The aims of the current analysis were (a) to examine whether or not the experimental manipulations had a significant impact on evoked fear, (b) to examine the impact of threat appeals on three distinct indices of driving, and (c) to identify moderators and mediators of the relationship between fear and driving outcomes. Large effects emerged for the level of fear evoked, with experimental groups reporting increased fear arousal in comparison to control groups (r = .64, n = 619, p<.01). The effect of threat appeals on driving outcomes, however, was not significant (r = .03, p = .17). This analysis of the experimental literature indicates that threat appeals can lead to increased fear arousal, but do not appear to have the desired impact on driving behavior. We discuss these findings in the context of threat-based road safety campaigns and future directions for experimental research in this area.

Quality of life and level of anxiety in youths with inflammatory bowel disease in Ireland.

Objective: Little is known of the psychological well-being of youths diagnosed as having inflammatory bowel diseases (IBDs). Much of the literature available focuses on adults with IBD and those that focus on youths tend to use generic measures of health-related quality of life (QOL). The primary aim of this research is to obtain a profile of the IBD-related QOL and levels of anxiety of youths of ages 9 to 17 years presenting with IBD to a national hospital. It is also intended to examine the clinical utility of the IMPACT-III questionnaire. Patients and Methods: A questionnaire battery containing the IMPACT-III questionnaire and the Spence Childrens Anxiety Scale (SCAS) was posted to all of the patients on the database of the gastrointestinal clinic between the ages of 9 and 17 years (n = 215), resulting in an achieved sample size of 79 (response rate of 36.7%). Results: It was found that 63% (n = 50) of participants had total IMPACT-III scores below the cutoff of 143, previously established for remission. In addition, 5 participants reported being unhappy with their lives. Thirty-nine percent (n = 31) of participants had elevated anxiety symptoms on ≥1 of the SCAS subscales. Anxiety level was found to be a significant predictor of QOL (&bgr; = −0.616, P = 0.001). Qualitative feedback highlighted the variability of physical and psychological symptoms participants experience, feelings of anger or embarrassment around the condition, and posed numerous questions, indicating that there is a lack of knowledge among patients around IBD. Conclusions: These findings support the utility of screening patients with IBD for psychological difficulties and estimates of QOL. Further research and group interventions are recommended.

The psychological impact of male factor infertility and fertility treatment on men: a qualitative study

This study investigated the subjective experiences of males attending a fertility treatment unit due to male factor infertility (MFI). In particular, the study aimed to explore how infertile males construe their infertility and how this impacts on their psychological well-being. In-depth interviews were conducted with nine males and analysed using grounded theory. Three inter-dependent themes were identified: (1) Impact to Self, (2) Social Impact and (3) Relationship and Support. The men initially felt shocked and ‘abnormal’ at their diagnosis and the possibility of a childless future. They felt their role in treatment was primarily supportive, which meant having to relinquish control and ‘put on a brave face’. Socially, MFI was regarded as a stigma, and disclosure to others was rare. Aspirations towards a male hegemonic culture intensified same. The theme ‘Relationship and Support’ describes how a supportive partnership mitigated the impact of diagnosis and influenced how well the men were able to both g...

Defensive Propaganda and IRA Political Control in Republican Communities

The IRAs training manual, the Green Book, stresses the importance of preparing their sympathetic audiences for impending attacks through propaganda campaigns that vilify the intended target and otherwise support the moral legitimacy of the action. Such “defensive propaganda” creates the conditions under which a population with normal moral values can either support or be apathetic toward terrorist actions. Or drawing on terminology introduced by Albert Bandura, the strategy facilitates the communitys moral disengagement from an inherently immoral action and in doing so protects the popular support upon which the republican movement relies for its military and political existence. This article examines the IRAs use of defensive propaganda against members of their sympathetic community and introduces a conceptual overview of the structure of such campaigns.

Risk assessment and the prevention of radicalization from nonviolence into terrorism.

This article considers the challenges associated with completing risk assessments in countering violent extremism. In particular, it is concerned with risk assessment of those who come to the attention of government and nongovernment organizations as being potentially on a trajectory toward terrorism and where there is an obligation to consider the potential future risk that they may pose. Risk assessment in this context is fraught with difficulty, primarily due to the variable nature of terrorism, the low base-rate problem, and the dearth of strong evidence on relevant risk and resilience factors. Statistically, this will lead to poor predictive value. Ethically, it can lead to the labeling of an individual who is not on a trajectory toward violence as being “at risk” of engaging in terrorism and the imposing of unnecessary risk management actions. The article argues that actuarial approaches to risk assessment in this context cannot work. However, it further argues that approaches that help assessors to process and synthesize information in a structured way are of value and are in line with good practice in the broader field of violence risk assessment.

New Directions in Gender Role Conflict Research

Gender role conflict theory has made a significant contribution to the area of men’s health (O’Neil 2008). However, despite its popularity, numerous criticisms have been directed against the GRCS – both theoretical and psychometric. For example, items have been critiqued for not directly measuring conflict “as it is generally understood (i.e., the result of two competing response tendencies)” (Betz & Fitzgerald. Annual Review of Psychology, 4(1), 360, 1993). Recently, an attempt was made to develop an adolescent version of the GRCS (Blazina et al. Psychology of Men & Masculinity, 6(1), 39–45, 2005). None of the psychometric concerns that had been raised about this scale were addressed and only nominal changes were made to item content (e.g., “When I am sexually involved with others, I do not express my strong feelings” was modified to “When I am personally involved with others, I do not express my strong feelings”). A vital omission was that, in the development of this scale, adolescents did not inform item generation, and no contact was made with adolescents to see if they considered factors, traditionally used with men, to possess personal relevance (i.e., there is no reference to face or content validity). A psychometrically sound measure which targets adolescent boys should be “grounded in and relevant to [their] experiences” (Chu et al. Men and Masculinities, 8(1), 99, 2005) as there may be factors used in adult scales that are not salient to younger individuals. Conversely, there may be latent factors left unexplored or unrealized when researchers do not involve adolescents in the formulation of scale items. This chapter outlines critiques of gender role conflict theory and of the psychometric properties of the adult and adolescent versions of the GRCS. Advancements in psychometric theory and in masculinity research have occurred since the GRCS was created in 1986. Thus, the chapter argues that this measure needs to be updated. Using data obtained from focus groups and personal interviews of adolescent males residing in the Republic of Ireland, the authors contend that modifications to GRC, as it pertains to adolescents, are required. Such modifications will ensure that resultant measures are culturally nuanced and cohort specific. It is anticipated that this chapter will make an important advance in social scientists’ understanding of gender role conflict theory as adolescents experience it.

‘Systemic Trauma’: The Impact on Parents Whose Children Have Experienced Sexual Abuse

This article examines the impact on parents in an Irish context whose children have experienced sexual abuse and aims to explore the pathways to distress. This is in order to understand what factors facilitate or hinder parents from supporting their child to the best of their ability, given that parental support is a crucial moderating factor in children’s recoveries. Semistructured interviews were carried out with 13 parents in this context and analyzed using a grounded theory methodology. The overall concept that emerged was termed “systemic trauma” and was composed of eight categories that help to explain the pathways of impact for parents. This model can help clinicians understand and respond to the needs of parents in the aftermath of CSA.