Michael J. Power

Social support in patients with anorexia nervosa and bulimia nervosa.

OBJECTIVE To investigate the social support networks of patients with anorexia nervosa (AN) and bulimia nervosa (BN). METHOD Social support was measured using the Significant Others Scale for 44 patients with AN, 81 patients with BN, and 86 polytechnic students. RESULTS Eating disorder patients had smaller social networks than the students. AN patients were significantly less likely than BN patients to have a spouse or partner as a support figure. Both AN and BN patients reported less actual emotional and practical support than students. AN patients perceived their social support to be adequate, whereas BN patients were dissatisfied with their support. Patients set lower ideals for support than the students. Social support was not correlated with duration of illness. DISCUSSION AN and BN patients have deficient social networks. In BN patients there is disturbance in both the size and perceived adequacy of social relationships.

eating disorders and multi-level models of emotion: an integrated model

This paper examines the relationship between emotions, depression and eating disorders. Initially, a review is undertaken of the current state of the research and clinical literature with regard to emotional factors in eating disorders. This literature is then integrated within a version of the multi-level model of emotion proposed by Power and Dalgleish. The aim of this paper is to incorporate a basic emotions, multi-modal perspective into developing a new emotions-based model that offers a theoretical understanding of psychological mechanisms in eating disorders. Within the new Schematic Propositional Analogical Associative Representation System model applied to eating disorders, it is argued that the emotions of anger and disgust are of importance in eating disorders and that the eating disorder itself operates as an inhibitor of emotions within the self. It is hoped that the development of a multi-levelled model of eating disorders will allow for the construction of number of specific testable hypotheses that are relevant to future research into the psychological treatment and understanding of eating disorders.

Social support moderates outcome in a randomized controlled trial of exposure therapy and (or) cognitive restructuring for chronic posttraumatic stress disorder.

Objective: To understand what predicts good outcome in psychiatric treatments, thus creating a pathway to improving efficacy. Method: Our study investigated relations between predictor variables and outcome (on the Clinician Administered Posttraumatic Stress Disorder [PTSD] Scale [CAPS]) at posttreatment for 77 treatment completers in a randomized controlled trial of exposure therapy and (or) cognitive restructuring, compared with relaxation, for chronic PTSD in adults. Results: More social support on the Significant Others Scale significantly predicted better outcome on the CAPS, even after controlling for the effects of treatment group and of pretreatment severity. Importantly, social support was only a significant predictor of outcome for participants receiving cognitive restructuring and (or) exposure therapy and not for participants in the relaxation condition. Conclusions: Better social support is associated with significantly greater gain following cognitive restructuring and (or) exposure therapy for PTSD. Future interventions should consider augmenting social support as an adjunct to treatment.

Validation of an instrument to evaluate quality of life in the aging population: WHOQOL-AGE

BackgroundThere is a need for short, specific instruments that assess quality of life (QOL) adequately in the older adult population. The aims of the present study were to obtain evidence on the validity of the inferences that could be drawn from an instrument to measure QOL in the aging population (people 50+ years old), and to test its psychometric properties.MethodsThe instrument, WHOQOL-AGE, comprised 13 positive items, assessed on a five-point rating scale, and was administered to nationally representative samples (n = 9987) from Finland, Poland, and Spain. Cronbach’s alpha was employed to assess internal consistency reliability, whereas the validity of the questionnaire was assessed by means of factor analysis, graded response model, Pearson’s correlation coefficient and unpaired t-test. Normative values were calculated across countries and for different age groups.ResultsThe satisfactory goodness-of-fit indices confirmed that the factorial structure of WHOQOL-AGE comprises two first-order factors. Cronbach’s alpha was 0.88 for factor 1, and 0.84 for factor 2. Evidence supporting a global score was found with a second-order factor model, according to the goodness-of-fit indices: CFI = 0.93, TLI = 0.91, RMSEA = 0.073. Convergent validity was estimated at r = 0.75 and adequate discriminant validity was also found. Significant differences were found between healthy individuals (74.19 ± 13.21) and individuals with at least one chronic condition (64.29 ± 16.29), supporting adequate known-groups validity.ConclusionsWHOQOL-AGE has shown good psychometric properties in Finland, Poland, and Spain. Therefore, considerable support is provided to using the WHOQOL-AGE to measure QOL in older adults in these countries, and to compare the QOL of older and younger adults.

Built Environment and Elderly Population Health: A Comprehensive Literature Review

Global population aging over recent years has been linked to poorer health outcomes and higher healthcare expenditure. Policies focusing on healthy aging are currently being developed but a complete understanding of health determinants is needed to guide these efforts. The built environment and other external factors have been added to the International Classification of Functioning as important determinants of health and disability. Although the relationship between the built environment and health has been widely examined in working age adults, research focusing on elderly people is relatively recent. In this review, we provide a comprehensive synthesis of the evidence on the built environment and health in the elderly.

The response scale for the intellectual disability module of the WHOQOL: 5-point or 3-point?

OBJECTIVE To deal with the question of whether a 5-point response Likert scale should be changed to a 3-point scale when used in the field testing of people with intellectual disabilities (IDs), which was raised after the pilot study of World Health Organization Quality of Life (WHOQOL)-DIS, a module being developed with the World Health Organization measure of quality of life for disabilities. METHODS Three possible ways were used to generate hypothetical data by merging a 5-point scale into a 3-point scale. The analyses were based on both item response theory and classical measurement theory. The partial credit model for polytomous response was performed for item evaluation; the confirmatory factor analysis was used to check construct validity, the Cronbachs alpha for domain reliability, and correlation analyses for the relationship between the 5-point scale and the generated 3-point scale. RESULTS Most items with a 5-point response scale had disordered response options and/or unequal-length intervals between successive response options; these deficiencies were removed or improved without decline of validity and reliability in the hypothetical data of 3-point scales. CONCLUSION Instead of the 5-point scale, a 3-point scale could be used for IDs in the field test of developing the module WHOQOL-DIS.

Emotional priming in clinically depressed subjects

A study is described in which the Emotional Priming Paradigm (Power and Brewin (1990) Cogn. Emotion 4, 39-51) was used with a group of currently depressed patients and a group of nondepressed controls. The results for the depressed patients showed significant facilitation effects on both the speed and rate of endorsement of negative trait adjectives when these were preceded by negative emotional primes. These results contrast with those obtained with the control subjects who failed to show such facilitation effects. The results are discussed in relation to the role of cognitive biases in depression.

Counterfactual thinking and functional differences in depression

The purpose of the studies reported in this paper was to evaluate the function of counterfactual thinking (CT) in depression. In Experiment 1, depressed and non-depressed participants were asked to imagine themselves as the protagonist of a hypothetical situation, and to think counterfactually about three different scenarios. The results showed that there was a similar CT style (in terms of direction, structure and focus of mutation) for the depressed and the non-depressed groups. It was also found that the perceived preparation for a future similar situation increased after CT and, contrary to our hypotheses, this effect was observed in both groups. In Experiment 2, a real-life situation was used (a course examination) in which participants experienced a negative outcome (a poor score on the test). Again, it was observed that depressed and non-depressed participants showed the same CT style, but non-depressed participants were more likely to use CT spontaneously. In addition, the second study showed further differences between the two groups: depressed participants not only showed a lack of cognitive benefits from thinking counterfactually (i.e., after CT they do not feel more prepared for future similar events, nor able to avoid a similar bad outcome, in contrast to the non-depressed participants), but also show a lack of behavioural changes (both intentions to change and actual changes over the subsequent week). In conclusion, these results provide evidence about the function of CT both in depressed and in non-depressed thinking, and highlight both the similarities and differences for these two groups.

Preliminary validation study of the Spanish version of the satisfaction with life scale in persons with multiple sclerosis

Abstract Purpose: To assess Life Satisfaction, using the Satisfaction with Life Scale (SWLS), and to analyze its psychometric properties in Multiple Sclerosis (MS). Method: Persons with MS (n = 84) recruited at the MS Centre of Catalonia (Spain) completed a battery of subjective assessments including the SWLS, the World Health Organization Quality of Life instrument and disability module (WHOQOL-BREF, WHOQOL-DIS) and the Hospital Anxiety Depression Scale-Depression (HADS-D); sociodemographic and disability status data were also gathered. Psychometric properties of the SWLS were investigated using standard psychometric methods. Results: Internal consistency (Cronbach’s alpha coefficient) was 0.84. A factor analysis using a principal components method showed a one factor structure accounting for 62.6% of the variance. Statistically significant correlations were confirmed between SWLS with WHOQOL-BREF, WHOQOL-DIS and HADS-D. SWLS scores were significantly different between a priori defined groups: probable depressed versus nondepressed and participants perceiving a mild versus severe impact of disability on their lives. Conclusion: To the best of our knowledge, this study is the first to report on the psychometrics properties of the SWLS in persons with MS. It might be a valuable tool to use in appraising persons with MS through the continuum of care. Implications for Rehabilitation The Spanish version of the Satisfaction with Life Scale (SWLS) is a reliable and valid instrument in Multiple Sclerosis (MS). The SWLS is able to discriminate between participants with low or high scores on depressive symptoms or disability impact on life. SWLS might be useful through the continuum of care in persons with MS, including Rehabilitation Services.

A Randomized Controlled Trial of IPT Versus CBT in Primary Care: With Some Cautionary Notes About Handling Missing Values in Clinical Trials

A randomized controlled trial is reported in which three treatments were compared for the management of depression in Primary Care. The treatments were Treatment As Usual (TAU) carried out by the General Practitioners, Cognitive-Behaviour Therapy (CBT) or Interpersonal Psychotherapy (IPT). Measurements of depressive symptomatology were taken at Baseline (Time1), at end of treatment (Time2), and at 5-month follow-up (Time3). An initial analysis of the longitudinal data revealed that there were a significant number of missing values, especially in the Time3 follow-up for the TAU group. That is, the missing data were not missing at random within the dataset, which is one of the considerations for usual procedures for replacement of missing values (RMV). The paper presents, therefore, the outcome of different approaches to RMV and their consequences for conclusions about the relative efficacy of the treatment conditions. The results showed that clients in all conditions improved significantly, with at least some analyses showing superiority of IPT and CBT at end of treatment Time 2. However, by the follow-up clients in all conditions performed equally well.