Biomedical subjects

Mark A Lumley

Publications and source records attributed to Mark A Lumley.

18 recordsLinked to original sources

PubMed2006

Relationship of alexithymia to cardiovascular disease risk factors among African Americans.

BACKGROUND: Alexithymia, a deficit in emotional awareness and expression, may contribute to cardiovascular disease (CVD) and other diseases. African Americans have a high prevalence of CVD, but almost nothing is known about alexithymia in this ethnic group. This study examined the relationship of alexithymia to a range of risk factors for CVD among African Americans. METHODS: On a community sample of 162 African American adults, we assessed alexithymia (Toronto Alexithymia Scale-20) and several risk factor domains: physiological (body mass index, blood pressure), behavioral (smoking, exercise), emotional (trait anxiety, depression, and anger; forms of anger expression), racial discriminatory, and socioeconomic (income, education). RESULTS: Alexithymia was positively correlated with all emotional risk factors (P < .01) and inversely correlated with socioeconomic status (P < .01). Alexithymia has a small, inverse relationship with responses to racism (P < .01) but was not significantly related to the experience of racism. Alexithymia was weakly related to smoking but was unrelated to physiological risk factors. These relationships were largely unchanged when only people without hypertension (n = 116) were studied. CONCLUSIONS: This pattern of relationships is consistent with findings on ethnic majority samples and suggests that alexithymia as measured with the Toronto Alexithymia Scale-20 is a valid construct among African Americans. It correlates with socioeconomic and emotional variables in this population, but only minimally or not at all with behavioral or physiological factors. If alexithymia influences CVD and other diseases, it appears to do so through social and emotional pathways.

Adolescent↗

PubMed2006

Psychosocial correlates of pregnant women's attitudes toward prenatal maternal serum screening and invasive diagnostic testing: beyond traditional risk status.

This study examined whether psychosocial variables predict pregnant women's attitudes toward maternal serum screening and invasive diagnostic testing, beyond the influence of traditional obstetric risk status (based on advanced maternal age, history of genetic disorders, etc.). In a sample of 612 pregnant women (66.5% high risk, 33.5% low risk) we assessed responses to hypothetical scenarios of invasive testing following normal or abnormal maternal serum screening. We also assessed psychosocial variables stemming from the theory of planned behavior (e.g., knowledge, concern for fetus, attitudes toward termination, health locus of control). Overall, two thirds of the women would want serum screening. Follow-up invasive diagnostic testing would be sought by 37.2% of the women after a negative screening, and by 75.0% after a positive screening. As expected, traditional risk status predicted desire for screening and also invasive testing following either a negative or positive screen. Yet, controlling for risk status, many psychosocial variables predicted a women's interest in screening and in invasive testing: more knowledge about prenatal testing, concern about fetal health, willingness to terminate a pregnancy, and an internal or medical profession health locus of control. We conclude that psychosocial variables influence women's desire for screening or invasive testing beyond traditional risk status.

Adult↗

PubMed2006

The health effects of at-home written emotional disclosure in fibromyalgia: a randomized trial.

BACKGROUND: The presence and severity of the chronic pain syndrome fibromyalgia (FM) is associated with unresolved stress and emotional regulation difficulties. Written emotional disclosure is intended to reduce stress and may improve health of people with FM. PURPOSE: This study tests the effects of at-home, written emotional disclosure about stressful experiences on the health of people with FM and uses multiple follow-ups to track the time course of effects of disclosure. METHODS: Adults with FM (intention-to-treat, n=83; completers, n=72) were randomized to write for 4 days at home about either stressful experiences (disclosure group) or neutral time management (control group). Group differences in immediate mood effects and changes in health from baseline to 1-month and 3-month follow-ups were examined. RESULTS: Written disclosure led to an immediate increase in negative mood, which did not attenuate across the 4 writing days. Repeated-measures analyses from baseline to each follow-up point were conducted on both intention-to-treat and completer samples, which showed similar outcomes. At 1 month, disclosure led to few health benefits, but control writing led to less negative affect and more perceived support than did disclosure. At 3-month follow-up, these negative affect and social support effects disappeared, and written disclosure led to a greater reduction in global impact, poor sleep, health care utilization, and (marginally) physical disability than did control writing. Interpretation of these apparent benefits needs to be made cautiously, however, because the disclosure group had somewhat poorer health than controls at baseline and the control group showed some minor worsening over time. CONCLUSIONS: Written emotional disclosure can be conducted at home, and there is tentative evidence that disclosure benefits the health of people with FM. The benefits, however, may be delayed for several months after writing and may be of limited clinical significance.

Adult↗

PubMed2005

Health effects of written emotional disclosure in adolescents with asthma: a randomized, controlled trial.

OBJECTIVE: To test the effects of written emotional disclosure on the health of adolescents with asthma and to examine how language in disclosures predicts outcomes. METHODS: We randomized 50 adolescents with asthma to write for 3 days at home about stressful events (disclosure) or control topics. At baseline and 2 months after writing, we assessed symptoms, affect, disability, internalizing behavior problems, and lung function; parents independently rated internalizing behavior and disability. RESULTS: Compared with control writing, disclosure writing led to improved positive affect and internalizing problems. Disclosure also decreased asthma symptoms and functional disability among adolescents with baseline elevations of these difficulties. Lung function was not changed. Disclosures with more negative emotion, insight, and causal words--and increased causal or insight words over days--predicted improved health. CONCLUSIONS: Written emotional disclosure improves emotional and behavioral functioning among adolescents with asthma, particularly those whose writings suggest emotional processing and cognitive restructuring.

Adolescent↗

PubMed2005

Do others really know us better? Predicting migraine activity from self- and other-ratings of negative emotion.

OBJECTIVE: The validity of self-reported negative emotion to predict health status is limited by response biases, introspection limitations, and methodological confounds. The reports of significant others about the patients' negative emotion may circumvent these limitations. This study sought to compare the validity of self- versus other-reported negative emotion as a correlate of migraine headache activity. METHODS: On 89 patients with migraine headache (74 women and 15 men), we correlated self-ratings and significant-other-ratings of patients' negative emotion with patients' report of migraine frequency and severity, which were assessed both cross-sectionally and prospectively, 3 months later. RESULTS: Other-reported negative emotion correlated with migraine activity better than did self-reported negative emotion, both cross-sectionally and prospectively. Patterns were different for women and men, however. Among women, other-reported negative emotion was positively associated with migraine activity. Among men, other-reported negative emotion was inversely associated with migraine frequency and severity. CONCLUSION: The results suggest that it may be valuable to obtain significant-other-ratings when assessing negative emotion in patients and that the genders may differ in how others' ratings are related to the patients' health.

Adolescent↗

PubMed2005

Alexithymia and pain in temporomandibular disorder.

OBJECTIVE: To clarify the relationship of global alexithymia and its facets with pain, assessed prospectively using experience sampling methods (ESMs), in temporomandibular disorder (TMD). METHODS: People with painful TMD (n=49), pain-free somatic controls (24 people with disk displacement), and healthy controls (n = 28) completed measures of alexithymia (Toronto Alexithymia Scale-20 [TAS-20]) and depressed mood. Patients with painful TMD used ESM to record jaw pain multiple times daily for a week. RESULTS: The somatic and the healthy controls were equivalent on alexithymia and were combined. The painful TMD group had higher difficulty in identifying feelings but lower externally oriented thinking (EOT); only the latter effect remained after covarying depressed mood. Among patients with painful TMD, the TAS-20 total and EOT correlated positively with pain severity after controlling for depressed mood. CONCLUSION: Findings highlight the complex relationships of alexithymia and its facets to TMD pain. Research should examine alexithymia facets separately and distinguish between methods that compare groups on alexithymia (e.g., pain patients versus controls) and those that correlate alexithymia with pain severity within a group.

Adult↗

PubMed2005

Assessing alexithymia and related emotional ability constructs using multiple methods: interrelationships among measures.

This study examined relationships among various measures of emotional ability reflecting different methods of assessment: self-report, clinical interview, collateral report, and emotion-relevant performance. On 140 young adults, the authors assessed self-reported alexithymia, emotional approach coping, and trait metamood skills; observer-reported alexithymia; interviewer-rated alexithymia; emotional awareness in response to vignettes; and emotional intelligence test performance. There were moderate magnitude correlations among the self-report measures, but correlations among other measures were relatively low. Confirmatory factor analyses supported a 3-factor model in which explicit self, implicit self, and explicit other measures were differentiated. These emotional ability measures do not form a unitary construct but differ as a function of the person providing the information and whether the measure is explicit or implicit.

Adolescent↗

PubMed2004

Alexithymia, emotional disclosure, and health: a program of research.

This article reviews a program of research on alexithymia, emotional disclosure, and health. The article first describes two lines of research and then outlines current work attempting to integrate these lines. The first research line involves basic correlational studies on alexithymia's link to health problems; these studies suggest that alexithymia is a potential risk factor for symptoms and illness behavior, although not necessarily organic disease. The second research line involves experimental studies of the health effects of emotional disclosure via expressive writing or talking; these studies suggest that disclosure improves health on average, but that the effects are not that robust and that various moderators likely are involved. The next section of the article describes recent attempts to integrate the two research lines by examining how baseline levels of alexithymia influence the effects of emotional disclosure; these analyses suggest that alexithymia interferes with or attenuates the health benefits of disclosure. Finally, the article describes initial forays into research on interventions with the alexithymic patients. This evolving program of research demonstrates the value of integrating emotion, personality, and health, and highlights the bidirectional relationship between clinical problems and basic research.

Affective Symptoms↗

PubMed2003

Age and gender differences in cardiac reactivity and subjective emotion responses to emotional autobiographical memories.

This research reports age and gender differences in cardiac reactivity and subjective responses to the induction of autobiographical memories related to anger, fear, sadness, and happiness. Heart rate (HR) and subjective state were assessed at baseline and after the induction of each emotion in 113 individuals (61 men, 52 women; 66% European American, 34% African American) ranging in age from 15 to 88 years (M = 50.0; SD = 20.2). Cardiac reactivity was lower in older individuals; however, for anger and fear, these age effects were significantly more pronounced for the women than the men. There were no gender differences in subjective responses, however, suggesting that the lower cardiac reactivity found among older people is dependent on gender and the specific emotion assessed.

Adolescent↗

PubMed2002

Barriers to treatment adherence among African American and white women with systemic lupus erythematosus.

OBJECTIVE: To determine whether African Americans with systemic lupus erythematosus (SLE) have poorer treatment adherence than whites, and to determine ethnic group differences in barriers to adherence, and how barriers affect adherence. METHODS: We compared 68 African American and 54 white women with SLE on 19 potential barriers, on 2 adherence behaviors during the past year, and on how the potential barriers relate to each nonadherence behavior. RESULTS: African Americans and whites were similar on most barriers, although African Americans were more likely to rely on religion and were more concerned about long-term medication effects. The 2 ethnic groups were comparable on medication nonadherence, but whites tended to have poorer clinic appointment adherence than African Americans. Finally, we found that barriers related to negative affect (depression, medication concerns, physical symptoms) as well as short-term memory problems and the need for child or elder care were associated with nonadherence among African Americans, whereas perceived treatment inefficacy and lacking trust in physicians were associated with nonadherence among whites. CONCLUSION: Relationships between adherence barriers and nonadherence may be ethnicity specific, suggesting that interventions to address barriers should be targeted to specific groups.

Adult↗

PubMed2002

Maternal correlates of health status in adolescents with inflammatory bowel disease.

OBJECTIVE: People with inflammatory bowel disease (IBD) manifest great variability in health status, but little research has examined correlates of this variability, especially among adolescents with IBD. This study examined family dysfunction, maternal physical symptoms and maternal positive affect (PA) as correlates of variability in depression, pain/fatigue, functional disability and bowel movement frequency among adolescents with IBD. We also tested whether these relationships were independent of maternal negative affect (NA). METHODS: Participants were 62 adolescents with IBD (36 with Crohn's disease (CD) and 26 with ulcerative colitis [UC]) and their mothers. Mothers completed measures about the family and themselves, and adolescents provided health status measures. RESULTS: Controlling for the duration since diagnosis, we found that family dysfunction correlated significantly and positively with bowel movement frequency of the adolescent (partial r=.27), and mother's PA correlated inversely with adolescent's depression (partial r=-.30) and functional disability (partial r=-.28). These relationships remained significant after controlling for maternal NA. Maternal symptoms were not related to the adolescent's health status. Analyses indicated that relationships did not differ for the two IBD subtypes. DISCUSSION: Family dysfunction and maternal PA appear to account for some of previously unexplained variance in the health status of adolescents with IBD. Family interventions should be explored to determine whether these familial and maternal factors influence the health of the adolescent, and whether improving family functioning can lead to health improvements in the children.

Adolescent↗

PubMed2002

The relationship of alexithymia to pain severity and impairment among patients with chronic myofascial pain: comparisons with self-efficacy, catastrophizing, and depression.

OBJECTIVE: Alexithymia is elevated among patients with chronic pain, but the relationship of alexithymia to the severity of pain among chronic pain patients is unclear. Also, studies have rarely examined whether alexithymia is unique from other, more widely studied constructs in the chronic pain literature (i.e., self-efficacy, catastrophizing, and depression), and research has not examined how alexithymia relates to the sensory versus affective dimensions of pain. METHODS: Among 80 patients with chronic myofascial pain, we tested how alexithymia (Toronto Alexithymia Scale-20) was related to three competing constructs--self-efficacy, catastrophizing, and depression--and to the sensory and affective dimensions of pain as well as physical impairment. We then determined whether alexithymia remained correlated with pain and impairment when tested simultaneously with each of the three competing constructs. RESULTS: Analyses controlled for patients' sex, age, marital status, and duration of pain. Alexithymia was moderately correlated with less self-efficacy and greater catastrophizing, and substantially correlated with greater depression. Alexithymia was positively related to both affective pain and physical impairment, but was unrelated to sensory pain, whereas all three of the competing constructs were related to both types of pain as well as physical impairment. Regression analyses indicated that alexithymia remained a significant and independent correlate of affective pain severity while controlling for either self-efficacy or catastrophizing, but depression accounted for alexithymia's relationship with affective pain. Also, alexithymia was no longer related to physical impairment, after controlling for any of the other three constructs. CONCLUSION: Although alexithymia is not related to the sensory component of pain, it is correlated positively with the affective or unpleasantness component of pain, independent of self-efficacy or catastrophizing. The emotional regulation deficits of alexithymia may lead to depression, which appears to mediate alexithymia's relationship to affective pain. Alexithymia's relationship with physical impairment appears to be better accounted for by self-efficacy or catastrophizing.

Adult↗

PubMed2002

Contrasting emotional approach coping with passive coping for chronic myofascial pain.

Passive or emotion-focused coping strategies are typically related to worse pain and adjustment among chronic pain patients. Emotional approach coping (EAC), however, is a type of emotion-focused coping that appears to be adaptive in some nonpain populations but has not yet been examined in a chronic pain population. In a sample of 80 patients (75% women, M = 48.67 years of age) with chronic myofascial pain, we contrasted how EAC (assessed with the Emotional Approach Coping Scale) and 5 passive pain-coping strategies (assessed with the Vanderbilt Multidimensional Pain Coping Inventory (VMPCI)) were related to sensory and affective pain, physical impairment, and depression. Passive coping strategies were positively correlated with one another, but EAC was inversely correlated with most of them. The VMPCI passive strategies were substantially positively related to negative affect, whereas EAC was inversely related to negative affect. Controlling for potentially confounding demographics, higher EAC was related to less affective pain and depression, even after controlling for negative affect. Using passive coping strategies, in contrast, was associated with more pain, impairment, and depression, although these relations were greatly attenuated after controlling for negative affect. When considered simultaneously, EAC, but not passive coping, was related to affective pain, and both EAC and passive coping were significant correlates of depression, although in opposite directions. In secondary analyses, we found that EAC was related to less pain (particularly sensory) among men and to less depression among women. Unlike the use of passive pain-coping strategies, which are associated with worse pain and adjustment, the use of EAC (emotional processing and emotional expression) with chronic pain is associated with less pain and depression. This suggests that some emotion-focused types of pain coping may be adaptive, and it highlights the need to assess emotional coping processes that are not confounded with distress or dysfunction.

Activities of Daily Living↗

PubMed2002

The Psychological Mindedness Scale: factor structure, convergent validity and gender in a non-psychiatric sample.

Although the concept of psychological mindedness (PM) originated in the psychoanalytic literature, its use has been expanding beyond the realm of assessing suitability for, or psychic change following, psychotherapy or psychoanalysis. For example, since PM bespeaks a capacity to tolerate psychological conflict and stress intrapsychically rather than by regressive means of conflict management or resolution such as somatization, its role, like that of alexithymia, in the genesis of psychosomatic illness is becoming evident. The Psychological Mindedness Scale (PMS), a 45-item self-report instrument intended to measure PM, was administered to a non-clinical sample of 397 undergraduates to assess the stability of its previously reported item-factor loadings and factor structure. Two main factors emerged, viz. Belief in the benefits of discussing one's problems and Access to feelings. Lower-order factors were Willingness to discuss problems with others, Interest in meaning and motivation of own and others' behaviour and Openness to change. Convergent validity of the PMS was also demonstrated by the negative correlations obtained between its total and factor/subscale scores with those of the Toronto Alexithymia Scale. The PMS needs further development to increase the congruence between its factor structure and the concept of PM. Females were also found to be more psychologically minded than males. The implications of these findings and the potential uses of this scale are discussed.

Adolescent↗

PubMedDate not supplied

Child behavior problems and family functioning as predictors of adherence and glycemic control in economically disadvantaged children with type 1 diabetes: a prospective study.

OBJECTIVE: This prospective study examined how child behavior problems and family functioning predict adherence behavior and glucose regulation (glycemic control) in a sample of economically disadvantaged children. METHODS: Children with type 1 diabetes (N = 116; 58.6% African American) were assessed for externalizing and internalizing behavior problems and family adaptability and cohesion and followed for a mean of 3.8 years. Glycemic control (glycosylated hemoglobin [HbA1c]) was assessed at baseline and follow-up, and adherence was assessed at follow-up. RESULTS: Analyses controlled for baseline HbA1c and years to follow-up. Multivariate analyses indicated that better adherence was predicted by high family cohesion. Better glycemic control was predicted by high family cohesion, the absence of externalizing behavior problems, and the presence of internalizing behavior problems. In addition, tests of moderation indicated that better follow-up glycemic control occurred among girls from high cohesion families and younger children from low adaptability families. Although better adherence predicted better glycemic control, adherence did not mediate the relationships of behavior problems or family functioning with glycemic control. CONCLUSIONS: A child's behavior problems and family functioning may influence both adherence to the diabetes regimen and glycemic control several years later, suggesting the potential value of interventions that address child behavior and family functioning.

Adaptation, Psychological↗

PubMedDate not supplied

Changing face of pain: evolution of pain research in psychosomatic medicine.

OBJECTIVE: This article provides an overview of how psychosomatic research on pain has evolved over the past 60 years as exemplified by studies published in Psychosomatic Medicine. METHODS: Each issue of Psychosomatic Medicine from 1939 to 1999 was reviewed to identify papers that dealt with pain, painful medical conditions, or pain management. A total of 150 papers were identified and grouped into seven categories: 1) case studies; 2) studies of personality traits and other individual differences; 3) psychophysiological studies of pain; 4) studies using pain induction techniques; 5) studies examining the relation of relation of race, ethnicity, and culture to pain; 6) studies of pain unique to women; and 7) studies examining treatments for pain. RESULTS: A substantial number of studies on pain and painful conditions were published in the Journal in the 1940s and 1950s, and that number has almost doubled in the most recent full decade of the Journal. Within the pain area, however, the topics of interest to psychosomatic researchers have been, and continue to be, quite diverse. Although publications on certain methods or topics (eg, psychodynamic case studies, physiological correlates of pain) have decreased over time, publications on other topics (eg, personality traits and individual differences) have remained relatively constant, and publications on still other topics (eg, studies using pain induction techniques; studies of race, ethnicity, and culture; women's pain; and treatment studies) have flourished recently. CONCLUSIONS: Considered overall, the results of our review suggest that the face of pain research published in PM has changed considerably in the past 60 years. Given the ongoing commitment of psychosomatic researchers to this area, we expect this evolution to continue in the years to come.

Female↗

PubMedDate not supplied

For whom does it work? Moderators of the effects of written emotional disclosure in a randomized trial among women with chronic pelvic pain.

OBJECTIVE: Although written emotional disclosure has potential as a stress management intervention for people with health problems, the main (group) effects of disclosure in medical populations are limited. This study sought to identify individual difference moderators of the effects of written disclosure among women with chronic pelvic pain. METHODS: In a prospective, randomized trial, 48 women with chronic pelvic pain completed 3 individual difference measures and then wrote for 3 days about stressful consequences of their pain (disclosure) or positive events (control). Health status was assessed at baseline and 2 months after writing. RESULTS: Main effect group comparisons indicated that disclosure writing resulted in significantly lower evaluative pain intensity ratings than control writing at follow-up, but there were no main effects on other outcome variables (sensory or affective pain, disability, affect). Three baseline individual difference measures, however, significantly moderated group effects. Compared with control writing, disclosure led to less disability among women with higher baseline ambivalence over emotional expression or higher catastrophizing, and to increased positive affect among women with higher baseline negative affect. Ambivalence, but not catastrophizing, was independent of negative affect in its moderation effect. CONCLUSION: Although the main effects of writing about the stress of pelvic pain are limited, women with higher baseline ambivalence about emotional expression or negative affect appear to respond more positively to this intervention.

Adaptation, Psychological↗

PubMedDate not supplied

Alexithymia and pain in three chronic pain samples: comparing Caucasians and African Americans.

OBJECTIVE: African Americans often report greater pain than do Caucasians, but the factors responsible for this discrepancy are not known. We examined whether alexithymia-the trait of difficulty identifying and describing one's feelings and lacking introspection-may contribute to this ethnic group difference. We tested whether the mean level of alexithymia is higher, and whether alexithymia and pain are more highly correlated, among African Americans than among Caucasians in patients with chronic pain disorders. DESIGN: Three cross-sectional, correlational studies were conducted on three separate samples of patients with chronic pain. Analyses examined the full sample and then Caucasians and African Americans separately. SETTING AND PATIENTS: Patients were recruited primarily from treatment settings. Samples were patients with rheumatoid arthritis (N = 155), migraine headaches (N = 160), or systemic lupus erythematosus (N = 123), and each sample included only Caucasians or African Americans. MEASURES: The Toronto Alexithymia Scale-20 assessed global alexithymia and three alexithymia facets. Pain severity, functional disability, or symptoms were also measured on each sample. RESULTS: Similar findings occurred across all three samples. African Americans had only slightly higher mean alexithymia levels than did Caucasians, and this was partly accounted for by socioeconomic differences between groups. More importantly, alexithymia correlated only weakly with pain or symptom severity for each full sample, but the two ethnic groups showed different patterns. Alexithymia correlated positively with pain severity among African Americans, but was uncorrelated with pain among Caucasians, even after covarying for various socioeconomic variables. CONCLUSIONS: Alexithymia is more correlated with pain severity among African Americans with chronic pain disorders than among Caucasians, potentially contributing to the higher pain reports among African Americans.

Adolescent↗