Biomedical subjects

H Tennen

Publications and source records attributed to H Tennen.

At least 19 recordsLinked to original sources

PubMed1998

Depression and the long-term risk of pain, fatigue, and disability in patients with rheumatoid arthritis.

OBJECTIVE: To determine whether a previous episode of major depression leaves a "scar" that places previously depressed patients with rheumatoid arthritis (RA) at risk for experiencing high levels of pain, fatigue, and disability. METHODS: A cohort of 203 patients with RA was randomly selected from a national panel and interviewed by phone about pain, fatigue, depressive symptoms, disability, and history of major depression. RESULTS: Excluding patients who met the criteria for current major depression, patients with both a history of depression and many depressive symptoms at the time of the interview (dysphoria) reported more pain than those without current dysphoria, irrespective of whether they had a history of depression. Dysphoria alone was not reliably related to pain reports. CONCLUSION: An episode of major depression, even if it occurs prior to the onset of RA, leaves patients at risk for higher levels of pain when depressive symptoms persist, even years after the depressive episode.

Arthritis, Rheumatoid↗

PubMed1998

Fibromyalgia and women's pursuit of personal goals: a daily process analysis.

For 30 days, 50 women with primary fibromyalgia syndrome reported daily progress and effort toward a health-fitness and a social-interpersonal goal and the extent to which their pain and fatigue hindered their accomplishment. They also carried palmtop computers to assess their sleep and their pain, fatigue, and positive and negative mood throughout the day. Analyses of the person-day data set showed that on days during which pain or fatigue increased from morning to evening, participants perceived their goal progress to be more attenuated by pain and fatigue. Unrestorative sleep the night before predicted the following day's effort and progress toward accomplishing health-fitness goals, but not social-interpersonal goals. Finally, participants who reported more progress toward social-interpersonal goals on a given day were more likely to evidence improvements in positive mood across the day, regardless of any changes in pain or fatigue that day.

Adaptation, Psychological↗

PubMed1998

Distress, depressive symptoms, and depressive disorder among caregivers of patients with brain injury.

OBJECTIVE: To examine the prevalence and correlates of major depression in caregivers of individuals with moderate to severe traumatic brain injuries. DESIGN: Repeated-measures design involving structured diagnostic interview and self-report of psychological distress administered on two occasions separated by 6 months. SETTING: Three acute care rehabilitation hospitals. SUBJECTS: Fifty-nine caregivers (39 mothers and 20 spouses) of individuals with moderate to severe brain injuries recruited from previous inpatient rosters. All caregivers were currently residing with the person with traumatic brain injury. MAIN OUTCOME MEASURE: The Diagnostic Interview Schedule-Revised [DIS-R] was utilized to assess depression. The Symptom Checklist 90-Revised (SCL 90-R) measured general psychological distress. RESULTS: Forty-seven percent of caregivers initially met diagnostic criteria for depression, and 43% met criteria 6 months later. Nearly two thirds of those who were initially depressed continued to be depressed 6 months later, and 17% of those who were not depressed initially subsequently met criteria for depression. The best predictor of depression was a previous (pre-brain injury) depressive episode. Neither time since injury nor injury severity predicted diagnostic status, and spouses were no more likely to be depressed than were mothers. The SCL 90-R, including its depression scale, showed high specificity but low sensitivity in predicting diagnostic status. CONCLUSIONS: The prevalence of major depression is high in caregivers of individuals with brain injuries. Because depression may interfere with the capacity to provide care and contribute to the rehabilitation process, it is important for clinicians to carefully assess both the current and preaccident affective status of primary caregivers.

Adolescent↗

PubMed1998

Personality disorders in substance abusers: relation to substance use.

Previous studies have documented high but variable rates of DSM personality disorders (axis II) in clinical samples of substance abusers. Distinguishing between personality disorder symptoms that are independent versus substance-related (SR) is a particular challenge for diagnosing comorbid axis II disorders in substance abusers. DSM-IV guidelines currently recommend excluding axis II symptoms that are accounted for by an axis I disorder, including a substance use disorder. In this study, axis II diagnoses were made on a heterogenous clinical sample of 370 patients entering treatment for substance use disorders. Axis II diagnoses were made according to DSM-III-R criteria using the Structured Clinical Interview for DSM-III-R (SCID-II), which was modified to determine, on an item-by-item basis, whether symptoms were attributed to subjects' substance use disorders or independent of these disorders. The majority (57.0%) of substance use disorder patients met criteria for at least one comorbid axis II disorder, with cluster B (45.7%) being particularly prominent, especially antisocial personality disorder (ASP) (27.0%) and borderline personality disorder (BPD) (18.4%). Notably, inclusion of SR symptoms led to a substantial number of newly diagnosed cases, especially for ASP (19.2%) and BPD (11.4%). Including SR symptoms improved the reliability of ASP and did not change the reliability of BPD diagnoses. Generally, patients with SR and independent personality disorders had a similar clinical profile.

Adult↗

PubMed1998

Personality disorder and dimension differences between type A and type B substance abusers.

Substance abuse subtype differences in DSM-IV personality disorders and normal personality dimensions were evaluated in 370 inpatient and outpatient alcohol, cocaine, and opiate abusers. The Type A/Type B distinction was replicated, with Type B substance abusers exhibiting more premorbid risk factors, more severe substance abuse, and greater psychosocial impairment. As predicted, compared to Type A, Type B were more commonly diagnosed with, and had more severe symptoms of, all personality disorders except Schizoid. With regard to normal personality dimensions, Type B scored higher on neuroticism, novelty seeking, and harm avoidance; Type A scored higher on agreeableness, conscientiousness, cooperativeness, and self-directedness. These subtype differences remained after controlling for the effects of antisocial personality and psychiatric symptoms.

Adult↗

PubMed1998

Levels and patterns of alcohol consumption using timeline follow-back, daily diaries and real-time "electronic interviews".

OBJECTIVE: This study was designed to compare the Timeline Follow-Back (TLFB) to daily and real-time assessments of drinking. Our purpose was to evaluate overall correspondence and day-to-day agreement between these two methods among both problem and moderate drinkers. METHOD: In Study 1, problem drinkers (n = 20) reported their alcohol consumption daily during 28 days of brief treatment. In Study 2, moderate drinkers (n = 48), recruited from the community, used a palm-top computer to record their drinking for 30 days. In both studies participants completed the TLFB covering the recording period. RESULTS: Participants in Study 1 reported fewer drinking days, fewer drinks per drinking day and fewer total drinks per day on the TLFB, and those in Study 2 reported fewer drinks per drinking day, fewer ounces per drinking day, fewer total drinks per day and fewer total ounces per day. The magnitude of the difference, however, was modest. There was considerable between-person variation in day-to-day correspondence of TLFB and the daily and real-time reports. Neither person characteristics (gender, education and income) nor the distributional characteristics of drinking (including average consumption, variation) predicted concordance between TLFB and real-time reports. CONCLUSIONS: The Timeline Follow-Back method captured overall levels of drinking quite well compared to a 28-day daily diary and a 30-day electronic interview. Vast individual differences in day-to-day correspondence suggest that the TLFB may be less useful for detecting patterns of consumption.

Adult↗

PubMed1997

Validity of the longitudinal, expert, all data procedure for psychiatric diagnosis in patients with psychoactive substance use disorders.

The longitudinal, expert, all data (LEAD) procedure has been employed as a criterion for the assessment of the procedural validity of diagnostic instruments. This study evaluated the procedure's concurrent, discriminant and predictive validity. Interview and questionnaire data obtained from 100 individuals in a substance abuse treatment program were used to assess current and lifetime substance use disorders and common comorbid disorders. An experienced, doctoral-level clinician formulated LEAD diagnoses for each patient, based on an initial interview, ongoing clinical contact and the results of the research assessment and all available clinical records. LEAD-derived substance use diagnoses showed good concurrent, discriminant and predictive validity. The validity of comorbid diagnoses obtained using the LEAD procedure was generally fair to good. Comparison with diagnoses based only on the clinician's unstructured initial interview showed that the availability of additional data enhanced diagnostic validity. Diagnoses derived by a research technician using the Structured Clinical Interview for DSM-III-R showed validity comparable to that of LEAD diagnoses. To enhance its diagnostic validity, applications of the LEAD standard should include a structured interview. Other variations in the application of the LEAD standard, including a longer evaluation period, may also enhance its performance as a diagnostic criterion measure.

Adult↗

PubMed1997

A dual pathway model of daily stressor effects on rheumatoid arthritis.

This study evaluated the initial promise of a dual-pathway conceptual model linking daily event stressors to rheumatoid arthritis (RA) disease activity through changes in immune system activation and mood. Fifty individuals, who were studied on five occasions two weeks apart, reported daily event stressors on the Daily Life Experience Checklist, daily mood on an abbreviated version of the Profile of Mood States-B, and daily joint pain on the Rapid Assessment of Disease Activity in Rheumatology. Serial clinical examinations comprised ratings of joint tenderness and swelling, and blood drawn during exams was analyzed for sedimentation rate (an indicator of systemic inflammation) and soluble interleukin-2 receptors (a marker of immune system activation known to correlate with RA disease activity). Across-person analyses failed to establish links from daily event stressors to either disease activity or composites of joint pain and joint inflammation when associations were adjusted for the effect of neuroticism on self-report measures. Pooled within-person analyses, however, were generally consistent with the relations predicted by the dual-pathway model. Increases in daily event stressors during the week preceding each clinical exam were associated with increased joint pain (regardless of changes in mood). At the same time, increased daily stressors were indirectly associated with decreased joint inflammation through reduction in levels of soluble interleukin-2 receptors. The dual-pathway model, which may be limited to short-term psychological and psychoimmunologic processes, underscores the importance of distinguishing potentially opposing effects of stress on pain versus inflammation in individuals with rheumatoid arthritis.

Activities of Daily Living↗

PubMed1997

Pain coping strategies and coping efficacy in rheumatoid arthritis: a daily process analysis.

Data from daily diaries were used to analyze pain coping processes in rheumatoid arthritis patients. For 30 consecutive days, 53 individuals described the pain coping strategies they used that day and rated the efficacy of their coping, joint pain, and positive and negative mood. Relations among variables were examined across-persons and within-persons over time. At the across-persons level of analysis, (i) daily coping efficacy was unrelated to pain coping or pain intensity, and (ii) the more frequent daily use of a wide variety of pain coping strategies was correlated with greater pain. Within-person analyses provided unique information about the relations among coping, pain, and mood not apparent in the across-persons results. Specifically, these analyses showed that increases in daily coping efficacy were not only related to decreases in pain, but also to decreases in negative mood and increases in positive mood. Time-lagged effects of coping and coping efficacy were also found. Individuals who reported high levels of coping efficacy on one day had lower levels of pain on the subsequent day. The daily use of pain reduction efforts and relaxation strategies also contributed to an improvement in next-day pain and an enhancement of positive mood. The implications of these findings for the assessment of pain and coping in rheumatoid arthritis patients are discussed.

Adaptation, Psychological↗

PubMed1997

Personality, temperament, and character dimensions and the DSM-IV personality disorders in substance abusers.

The authors evaluated the relationship between P. T. Costa and R. R. McCrae's (1992) NEO 5-factor model, C. R. Cloninger's (1993) 7-factor Temperament and Character Inventory (TCI), and the American Psychiatric Association's (1994) Diagnostic and Statistical Manual of Mental Disorders, 4th ed., personality disorders in 370 inpatient and outpatient alcohol, cocaine, and opiate abusers. NEO Neuroticism was associated with many disorders, and different patterns for Agreeableness, Conscientiousness, and Extraversion emerged for the different disorders. Several TCI scales were associated with different personality disorders, although not as strongly as the NEO dimensions. Results did not support most predictions made for the TCI. Normal personality dimensions contributed significantly to the prediction of personality disorder severity above and beyond substance abuse and depression symptoms.

Adult↗

PubMed1996

Sequential daily relations of sleep, pain intensity, and attention to pain among women with fibromyalgia.

Fifty women with fibromyalgia syndrome (FS) recorded their sleep quality, pain intensity, and attention to pain for 30 days, using palm-top computers programmed as electronic interviewers. They described their previous night's sleep quality within one-half hour of awakening each day, and at randomly selected times in the morning, afternoon, and evening rated their present pain in 14 regions and attention to pain during the last 30 min. We analyzed the 30-day aggregates cross-sectionally at the across-persons level and the pooled data set of 1500 person-days at the within-persons level after adjusting for between-persons variation and autocorrelation. Poorer sleepers tended to report significantly more pain. A night of poorer sleep was followed by a significantly more painful day, and a more painful day was followed by a night of poorer sleep. Pain attention and sleep were unrelated at the across-persons level of analysis. But there was a significant bi-directional within-person association between pain attention and sleep quality that was not explained by changes in pain intensity.

Adult↗

PubMed1996

Construing benefits from adversity: adaptational significance and dispositional underpinnings.

The discovery of benefits from living with adversity has been implicated in psychological well-being in numerous investigations, is pivotal to several prominent theories of cognitive adaptation to threat, and can be predicted by personality differences. This article summarizes the prevalence and adaptive significance of finding benefits from major medical problems, locates the place of benefit-finding in stress and coping theories, and examines how it may be shaped by specific psychological dispositions such as optimism and hope and by broader personality traits such as Extraversion and Openness to Experience. The distinction between beliefs about benefits from adversity (benefit-finding) and the use of such knowledge as a deliberate strategy of coping with the problem (benefit-reminding) is underscored and illustrated by daily process research on coping with chronic pain.

Adaptation, Psychological↗

PubMed1996

Validity of the SCID in substance abuse patients.

Structured or semi-structured interviews, including the Structured Clinical Interview for DSM-III-R (SCID), are used widely to maximize the reliability and validity of psychiatric diagnoses. Although the reliability of such interviews appears adequate, there has been little effort to evaluate their validity. In a sample of 100 substance abuse patients, we evaluated the concurrent, discriminant and predictive validity of SCID substance use diagnoses, as well as co-morbid disorders that occur commonly among these patients. The validity of current and life-time substance use diagnoses obtained by a research technician using the SCID was good; it was moderate for antisocial personality disorder and major depression and poor for anxiety disorders. Although accurate diagnosis of substance use disorders in substance abuse patients can be accomplished by a research technician, the diagnosis of co-morbid psychiatric disorders requires either additional expertise or the use of a diagnostic instrument specially designed for that purpose.

Adult↗

PubMed1995

Depression research methodologies in the Journal of Personality and Social Psychology: a review and critique.

Personality and social psychological studies of depression and depressive phenomena have become more methodologically sophisticated in recent years. In response to earlier problems in this literature, investigators have formulated sound suggestions for research designs. Studies of depression published in the Journal of Personality and Social Psychology (JPSP) between 1988 and 1993 were reviewed to evaluate how well these recommendations have been followed. Forty-one articles were examined for adherence to 3 suggestions appearing consistently in the literature: (a) multiple assessment periods, (b) multiple assessment methods, and (c) appropriate comparison groups. The studies published in JPSP have not adhered well to these standards. The authors recommend resetting minimum methodological criteria for studies of depression published in the premier journal in personality and social psychology.

Anxiety Disorders↗

PubMed1995

The measurement structure of the Center for Epidemiologic Studies Depression Scale.

This study examined the temporal stability of the measurement structure of the Center for Epidemiologic Studies Depression Scale (CES-D; Radloff, 1977) in 813 individuals with rheumatoid arthritis. Participants completed the CES-D (Radloff, 1977) on three occasions 1 year apart. Structural equation models and polyserial correlations were used to address methodological limitations of previous studies. Four competing measurement structures were tested with one factor, three factors, four factors, and a single second-order factor underlying the four-factor model. The four-factor and the second-order-factor models provided the best fit at Time 1. When cross-validated at Times 2 and 3, the four-factor and the second-order-factor models remained invariant. Researchers can now more confidently use the CES-D to examine how distress changes in chronic physical disorders.

Affect↗

PubMed1995

Reactions to impaired fertility: the vicissitudes of primary and secondary control appraisals.

Recent formulations about how perceived control influences adaptation to chronic medical conditions suggest that although a sense of personal (primary) control may decline over time, there are ample opportunities for individuals to make other adaptation-enhancing "secondary control" appraisals such as construing benefits or finding meaning in their threatening circumstance. We describe a longitudinal study of men and women with impaired fertility that evaluates a dynamic relation between primary and secondary control--one in which anticipated benefits increase over time as failed efforts to achieve a desired pregnancy lead to declines in primary control. Forty-six men and women with impaired fertility rated their sense of personal control over fertility outcomes, the extent to which they anticipated benefits in this situation and their outcome expectancy on two occasions separated by 14 months. As predicted, perceived control diminished over time. Changes in anticipated benefits were unrelated to changes in personal control. Anticipating benefits, however, was inversely related to changes in outcome expectancy, such that a more pessimistic expectancy over time was associated with an increase in anticipated benefits. This relation was independent of perceived control and was not mood dependent. We discuss these findings in terms of current theories of control, the need for further longitudinal investigations to evaluate the temporal relations between primary and secondary control appraisals, and implications for infertility research.

Adaptation, Psychological↗

PubMed1994

Unique clinical and psychological correlates of fibromyalgia tender points and joint tenderness in rheumatoid arthritis.

OBJECTIVE: We investigated the relationship of fibromyalgia (FM) tender points to other manifestations of rheumatoid arthritis (RA). METHODS: Sixty-seven RA patients completed questionnaires at study entry and described symptoms, emotionally significant events, and mood every evening for 75 days. Joint and tender point examinations were conducted every 2 weeks. RESULTS: Controlling for joint tenderness, the tender point count correlated with the degree of daily stress. Depression was not significantly related when daily stress was controlled for. CONCLUSION: We conclude that FM tender point counts correlate uniquely with RA patients' reports of daily stress.

Adult↗

PubMed1994

Person and contextual features of daily stress reactivity: individual differences in relations of undesirable daily events with mood disturbance and chronic pain intensity.

We examined the mood-related and pain-related consequences of daily stressors among 74 individuals with rheumatoid arthritis who supplied daily reports for 75 days. Meta-analyses of time series regression coefficients disclosed a significant same-day relation between events and mood but no consistent effects of events on same-day pain, next-day mood, or next-day pain. With distributional characteristics of the daily data controlled, Ss with more active inflammatory disease showed a greater positive relation of events with same-day and next-day pain, those with a recent history of more major life stressors showed a greater positive relation of events with next-day pain, and those with less social support showed a greater positive relation of events with next-day mood disturbance. Implications of these and other findings for theories of stress and adaptation and the methodological challenges of daily experience research are discussed.

Adult↗