Biomedical subjects

Howard Tennen

Publications and source records attributed to Howard Tennen.

At least 37 records · Page 2Linked to original sources

PubMed2004

History of affective disorder and the experience of fatigue in rheumatoid arthritis.

OBJECTIVE: To evaluate how a prior affective disorder (major depression or generalized anxiety disorder) affects current fatigue among individuals with rheumatoid arthritis (RA). To determine whether that relationship is mediated by self-efficacy expectations. METHODS: Forty-eight RA patients with a prior affective disorder and 74 without a history of affective disorder completed a mailed questionnaire that included the Multidimensional Assessment of Fatigue and indicators of neuroticism and self efficacy. RESULTS: RA patients with a history of affective disorder reported higher levels of fatigue than those with no previous affective disturbance. Controlling for neuroticism and self efficacy, affective disorder history continued to predict current fatigue. Mediational analyses revealed both direct and indirect effects (via self efficacy) of history of affective disorder on the experience of fatigue in RA. CONCLUSION: History of affective disorder independently predicts higher levels of fatigue in RA patients, and self efficacy plays a mediating role in this relationship.

Aged↗

PubMed2004

Prospective association of anxiety, depressive, and addictive disorders with high utilization of primary, specialty and emergency medical care.

The empirical evidence concerning the relationship of psychiatric disorders to health care utilization and costs is mixed and primarily retrospective. Therefore, a case-control study was conducted to prospectively examine the association of psychiatric disorders with health care utilization in an adult primary care internal medicine patient population, controlling for the effects of medical morbidity, adverse events, age, race, gender, employment status, and health insurance coverage. Samples of primary care high utilizer (HU; 125 men, 125 women with primary care visits in 1998 above the 95th percentile) vs. mid-range utilizer (MU; 125 men, 125 women; two primary care visits in 1998) patients were compared using archival automated medical record data from the index year (1998), and from the following year (1999) for prospective analyses. HU (compared to MU) participants were younger, had higher medical and psychiatric morbidity, and had higher levels of outpatient specialty medical care utilization. In multivariate analyses, (a) anxiety disorder diagnoses uniquely contributed to identifying HU patients, and (b) after controlling for initial primary care utilization status, anxiety, depressive and addictive disorders were prospectively associated with medical illness complexity and primary, specialty, and emergency medical care utilization. Although behavioral health disorders (including addictive as well as depressive and anxiety diagnoses) and high utilization of primary health care services are related, these prospective findings suggest that behavioral health disorders make an independent contribution to non-psychiatric health care utilization.

Adolescent↗

PubMed2004

Targeted naltrexone treatment moderates the relations between mood and drinking behavior among problem drinkers.

One hundred fifty-three problem drinkers were randomly assigned to receive naltrexone 50 mg or placebo on a daily or targeted (to high-risk drinking situations) basis. Using structured nightly diaries, participants recorded negative and positive mood, desire to drink, and alcohol consumption over 8 weeks. Results indicated that individuals engaged in any drinking and heavy drinking more on days characterized by relatively higher levels of positive or negative mood states. Naltrexone attenuated the positive association between heavy drinking and both positive and negative mood, and targeted administration attenuated the positive association between heavy drinking and positive mood. There was also evidence that desire to drink mediated the effect of targeted administration on the relation between positive mood and any drinking that day. These findings underscore the utility of daily measurement for understanding the processes that underlie pharmacological interventions for problem drinking.

Affect↗

PubMed2004

Do we know how we cope? Relating daily coping reports to global and time-limited retrospective assessments.

The current study examined the concordance among daily, trait (global retrospective), and time-limited retrospective reports of coping. A sample of 93 adults completed the COPE (C. S. Carver, M. F. Scheier, & J. K. Weintraub, 1989) prior to recording coping with the day's most negative event for 30 consecutive days. At the end of daily data collection, participants recalled to what extent they used each of 16 coping strategies over the past 30 days. Whereas findings indicate generally good concordance between daily and time-limited retrospective reports, concordance between global and daily reports was weak. Only limited evidence was found for systematic individual differences in concordance. Time-limited reports appear to be an adequate, though not ideal, method of determining usual patterns of coping with stress.

Adaptation, Psychological↗

PubMed2004

Using daily interactive voice response technology to measure drinking and related behaviors in a pharmacotherapy study.

BACKGROUND: Interactive voice response technology (IVR) allows investigators to collect daily measures of drinking, medication adherence, mood, and other treatment-relevant variables that may change day to day during a clinical trial. Despite these advantages, no published studies have used IVR in alcohol pharmacotherapy trials. METHODS: Subjects provided daily data via IVR during the 12-week treatment period. Seven subjects completed the trial. RESULTS: We found a high level of participant adherence to the IVR protocol, higher levels of drinking reported by IVR than by a commonly used recall method, and distinct within-day associations between daily mood and alcohol consumption: these could not be obtained through traditional assessment methods. CONCLUSIONS: IVR seems to be feasible for the collection of daily indicators of treatment outcomes and processes in pharmacotherapy studies among problem drinkers.

Adult↗

PubMed2004

Appraisal-coping goodness of fit: a daily internet study.

Using an Internet daily diary methodology, this study tested the goodness of fit hypothesis, which highlights the importance of the match between controllability appraisals and coping efforts in adjustment to stressful events. For 28 days, 190 undergraduates described their most stressful event and its controllability, how they coped, and their daily positive and negative mood. Individuals demonstrated fit across situations, with control appraisals associated positively with problem-focused coping and negatively with emotional approach coping and avoidance coping. A pooled within-person interaction indicated that problem-focused coping had a stronger positive association with positive mood when dealing with high versus low control stressors. Significant variation also was found in several other within-person interactions between control appraisals and coping, and some evidence was found for the notion that individual differences in the degree of matching coping to control appraisals were associated with person-level adjustment.

Adaptation, Psychological↗

PubMed2004

The daily stress and coping process and alcohol use among college students.

OBJECTIVE: To examine whether students drink more alcohol on higher-stress days than on lower-stress days; whether daily coping strategies and affective states mediate the within-person relationship between stress and drinking; and whether the daily stress-drinking process varies as a function of previously identified between-person risk factors (sex, family history, coping motives, sensation seeking, neuroticism). METHOD: College students (N = 137) completed daily surveys for 28 consecutive days. RESULTS: With daily coping, affect and weekly trends in drinking controlled for, students consumed more alcohol on days that had events perceived as relatively more stressful. Students also drank more on days characterized by relatively lower problem-focused coping and relatively higher positive and negative affect. Contrary to predictions, the effect of stress on drinking was not fully mediated by coping and affect. Findings also revealed individual differences in several links in the daily stress coping-drinking process. CONCLUSIONS: The daily stress coping-drinking process is complex, and it appears that there are both positive and negative affective pathways underlying daily alcohol consumption.

Adaptation, Psychological↗

PubMed2003

A comparison of self-reports of distress and affective disorder diagnoses in rheumatoid arthritis: a receiver operator characteristic analysis.

OBJECTIVE: To compare 3 commonly used psychiatric symptom checklists (the Center for Epidemiological Studies Depression Scale [CES-D], the Positive and Negative Affect Schedule, and the Endler Multidimensional Anxiety Scales [EMAS]) to determine their sensitivity, specificity, and ability to discriminate between a disorder (Major Depression [MD], Generalized Anxiety Disorder [GAD]), and no disorder. To compare the checklists for their ability to discriminate between type of disorder (MD and GAD). To evaluate the discriminant ability of the subscales, particularly positive affect; whether the somatic items in the CES-D artificially inflate affective scores; and the optimal cut off score for the CES-D. METHODS: We compared the 3 scales to diagnostic criterion of MD, GAD, and comorbid disorder using receiver operator characteristic (ROC) and logistic regression analyses. The sample consisted of a national panel of 415 individuals with rheumatoid arthritis (RA). RESULTS: Each of the scales had high sensitivity and specificity (areas under the curve: CES-D = 0.92, negative affect = 0.88, positive affect and EMAS = 0.82). The CES-D, however, demonstrated better sensitivity and specificity than the positive affect and the EMAS, but not the negative affect scale. CONCLUSION: All 3 self-reports have high combined sensitivity and specificity as measures of affective disorders among RA patients.

Aged↗

PubMed2003

A daily process examination of the stress-response dampening effects of alcohol consumption.

The authors used a daily process design to assess alcohol's stress-response dampening (SRD) effects. Moderate to heavy social drinkers (N=100) reported on palmtop computers their alcohol consumption and social context in vivo for 30 days. Participants also reported on their mood states in the late morning and early evening and completed a paper-and-pencil daily diary in which they recorded their negative events. The association between negative events and mood was weaker on days when individuals consumed alcohol prior to the final mood assessment. However, the moderating effect of alcohol on the negative event-mood association was limited to drinking in social situations. Alcohol's SRD effects varied as a function of several between-person risk factors.

Adaptation, Psychological↗

PubMed2003

A daily diary validity test of drinking to cope measures.

Data from 2 daily diary studies of stress, negative affect, and drinking were used to examine the correspondence between global self-reports of drinking to cope (DTC) and within-person stress/negative affect-drinking associations. In Study 1, 83 community-residing drinkers recorded data in nightly booklets on negative events, perceived stress, negative affect, and drinking for 60 consecutive days. In Study 2, 88 community-residing drinkers recorded data on negative events and negative interpersonal exchanges nightly and negative affect and drinking in near-real time on palmtop computers for 30 consecutive days. Both studies showed only modest correspondence between self-reported DTC and between-person differences in within-day, daily, and weekly associations between stress/negative affect and drinking. The findings indicate that individuals who report higher DTC simply may drink across a wider variety of conditions than those who report relatively lower DTC.

Adaptation, Psychological↗

PubMed2003

Measurement and prediction of medication compliance in problem drinkers.

BACKGROUND: A variety of methods have been used to measure medication compliance. Although electronic monitoring has been considered to be the best method, it has some potential for error and its high cost may limit its feasibility. This study examined the concordance of data on medication compliance that was obtained by using an electronic monitoring system (Medication Event Monitoring System, or MEMS), daily diary reports, and tablet counts. METHODS: Subjects were 150 problem drinkers participating in a pharmacotherapy trial. Subjects were randomly assigned to receive naltrexone 50 mg (n = 75) or placebo (n = 75) and to receive either daily (n = 72) or targeted (n = 78) medication administration. Comparisons between methods were conducted at the aggregate and individual daily levels, and the association between compliance and three alcohol-related outcomes was evaluated. RESULTS: Daily diaries showed good day-to-day concordance with MEMS and a higher correlation with MEMS than did tablet counts. However, high-compliance subjects did no better than low-compliance subjects on any of three alcohol-related outcome measures. CONCLUSIONS: Compliance measurement using a daily diary method yielded results that are comparable to those obtained with electronic monitoring, which served as a criterion measure. In contrast, tablet counts provided data that were less concordant with the criterion measure. The unique nature of the study sample (i.e., the majority of subjects were not committed to a goal of abstinence), combined with the targeted approach to treatment, may explain the lack of association between compliance and alcohol-related outcomes. Further research should aim to ascertain the factors affecting the relationship between compliance and outcomes.

Adult↗

PubMed2003

Psychometric properties of the short index of problems as a measure of recent alcohol-related problems.

BACKGROUND: The Drinker Inventory of Consequences (DrInC) measures overall consequences of drinking and yields five subscale scores. A short form of the DrInC, the Short Index of Problems (SIP), was developed for use when time does not permit completion of the DrInC. This study investigates the psychometric properties of the SIP. METHODS: The study sample consisted of 153 problem drinkers who were participants in a placebo-controlled trial of naltrexone and brief counseling. RESULTS: The SIP showed good internal consistency, good concurrent validity, and adequate stability. Four of the five SIP subscales contributed unique variance beyond general drinking consequences. CONCLUSIONS: The SIP is useful for measuring drinking consequences in a sample of problem drinkers, and the subscale scores can be interpreted clinically. Further research on the SIP in other populations is warranted.

Adult↗

PubMed2003

Targeted naltrexone for early problem drinkers.

Most published studies of the efficacy of naltrexone for alcohol treatment have focused on daily medication for relapse prevention among abstinent alcoholics. The present study compared the effects of naltrexone with those of placebo in a sample of early problem drinkers who received study medication either daily or targeted to situations identified by the patients as being high risk for heavy drinking. Patients (n = 153; 58% male) were randomly assigned to receive naltrexone (50 mg) or placebo on a daily or targeted basis, yielding comparable numbers of patients in each of four treatment groups. Patients were trained to use structured nightly diaries in which they recorded their alcohol consumption and medication intake. Analysis was conducted with hierarchical linear modeling. Irrespective of whether they received naltrexone or placebo, patients in the targeted condition showed a reduced likelihood of any drinking. There was a reduced likelihood of heavy drinking, both for patients who received naltrexone and for patients who were in the targeted groups (either naltrexone or placebo), although these effects diminished as the number of tablets available to the targeted groups was reduced over the 8-week treatment period. Although the effect was a modest one, daily naltrexone reduced the risk of heavy drinking in this patient group. Furthermore, use of a targeted approach to medication treatment appears to be a useful strategy for reducing both drinking and heavy drinking. Efforts to replicate these findings are warranted, since they suggest that schedules of medication administration other than daily should be evaluated for treatment of problem drinking.

Adult↗

PubMed2002

Effect of ingestion of honey on symptoms of rhinoconjunctivitis.

BACKGROUND: Allergic rhinoconjunctivitis is a common disorder, affecting >20% of people of all socioeconomic strata. Despite this high prevalence, relatively few sufferers seek professional medical help, presumably because of a widespread reliance on complementary remedies. OBJECTIVE: We investigated the widely held belief among allergy-sufferers that regular ingestion of honey ameliorates the symptoms of allergic rhinoconjunctivitis. METHODS: The study was conducted at the University of Connecticut Health Center's Lowell P. Weicker General Clinical Research Center. Thirty-six participants who complained of allergic rhinoconjunctivitis were recruited. All recruits were scratch-tested at entry for common aeroallergens. The cohort was randomly assigned to one of three groups, with one receiving locally collected, unpasteurized, unfiltered honey, the second nationally collected, filtered, and pasteurized honey, and the third, corn syrup with synthetic honey flavoring. They were asked to consume one tablespoonful a day of the honey or substitute and to follow their usual standard care for the management of their symptoms. All participants were instructed to maintain a diary tracking 10 subjective allergy symptoms, and noting the days on which their symptoms were severe enough to require their usual antiallergy medication. RESULTS: Neither honey group experienced relief from their symptoms in excess of that seen in the placebo group. CONCLUSIONS: This study does not confirm the widely held belief that honey relieves the symptoms of allergic rhinoconjunctivitis.

Administration, Oral↗

PubMed2002

Rehabilitation therapy self-efficacy and functional recovery after hip fracture.

Little is known about the role of psychological factors in the functional recovery process of hip fracture patients. This study employed a prospective cohort design to test the hypothesis that hospitalized hip fracture patients with greater reported self-efficacy for conducting rehabilitation therapy would have a greater likelihood of recovering to a pre-fracture level of locomotion function six months after the fracture. This hypothesis was tested controlling for pre-fracture level of function and depressive symptoms reported during hospitalization for surgical repair. An original measure of rehabilitation therapy self-efficacy was evaluated prior to hypothesis testing. Study patients were recruited from two hospitals, interviewed during hospitalization and followed up six months later. Patients included in hypothesis test analyses (n = 24) were mostly women (82%) with a mean age of 79 years. Results showed that patients with higher self-efficacy scores had a greater likelihood of locomotion recovery, controlling for pre-fracture locomotion function level (adjusted odds ratio (AOR) = 1.21; 95% confidence interval (CI) = 1.00-1.45; P= 0.05). This positive association between rehabilitation therapy self-efficacy and likelihood of locomotion recovery persisted after adding depressive symptoms (the Center for Epidemiological Studies-depression (CES-D) score) to this logistic regression model (AOR for self-efficacy = 1.18; 95% CI = 0.99-1.42; P= 0.07). It is concluded that rehabilitation therapy self-efficacy is a potentially important psychological factor in helping hip fracture patients recover locomotion functioning.

Activities of Daily Living↗

PubMed1999

Everyday life with osteoarthritis or rheumatoid arthritis: independent effects of disease and gender on daily pain, mood, and coping.

The effects of disease (form of arthritis) and gender on pain, mood, and pain coping strategies were examined in a prospective 30-day diary study of 71 patients with osteoarthritis (OA) and 76 with rheumatoid arthritis (RA). Diary instruments included joint pain ratings, POMS-B checklists for positive and negative mood, and the Daily Coping Inventory. Women's average daily pain was 72% greater than men's pain, and RA patients' average daily pain was 42% greater than OA patients' pain. Hierarchical Linear Models were estimated for (a) within-person associations between pain and next-day mood; coping and next-day pain; and coping and next-day mood; and (b) the independent effects of disease and gender on individual intercepts for pain, mood, and coping and on individual slopes for pain-coping-mood relations. Women, regardless of their disease, and RA patients, regardless of their gender, reported more daily pain. Women used more emotion-focused strategies each day than did men, regardless of their disease and even after controlling for their greater pain. Men were more likely than women to report an increase in negative mood the day after a more painful day. RA patients' pain worsened, but OA patients' pain improved, following a day with more emotion-focused coping. Implications for research and clinical practice are summarized.

Adaptation, Psychological↗

PubMed1992

Daily coping with pain from rheumatoid arthritis: patterns and correlates.

Seventy-five individuals with rheumatoid arthritis reported their pain coping, mood, and joint pain for 75 consecutive days. Pain coping strategies used most often were taking direct action to reduce the pain and using relaxation strategies; those used least often were expressing emotions about the pain and redefining the pain to make it more bearable. Several background characteristics, including gender, disability, neuroticism, and pain control perceptions predicted use of various coping strategies. Controlling for these characteristics, individuals who used relaxation more frequently as part of their daily coping repertoire had less daily pain during the course of the study, and those who reported more overall coping efforts were more likely to display declining levels of daily pain across time. Pain severity moderated the relations of seeking emotional support and use of distraction with daily mood. At low levels of pain, greater use of these strategies related to more positive mood but, at high levels of pain, related to less positive mood. Finally, individuals who reported a greater number of distinct forms of coping were more apt to enjoy improving daily mood over the course of the study. Findings are discussed in terms of the advantages of prospective daily research designs.

Adaptation, Psychological↗

PubMed1987

Downward comparison and coping with serious medical problems.

Correlates of selective comparisons by mothers of high-risk infants and individuals with rheumatoid arthritis showed that mothers were especially likely to make downward comparisons. Arthritis patients making downward comparisons were rated by their health care providers as more positively adjusted, independent of actual severity of illness. Implications for support providers are discussed.

Adaptation, Psychological↗