Measures Of Psychosocial Functioning Research Articles

Psychometric evaluation of the child attitude toward illness scale—sibling version

ABSTRACT The Child Attitude Toward Illness Scale (CATIS) is an established measure of how CSHCN perceive the impact of chronic conditions on their lives. We tested the psychometric properties of the CATIS adapted for use with siblings (CATIS-S) of youths with spina bifida (SB), a complex congenital birth defect. Confirmatory factor analysis (CFA) tested the factor structure of the CATIS-S in a sample of 208 adolescent siblings of youths with SB. Construct validity was ascertained by evaluating relationships between the CATIS-S and measures of psychosocial functioning. CFA yielded a 12-item two-factor solution comprised of an Emotion subscale ( = 0.85) and Social subscale ( = 0.76). Construct validity was indicated through significant associations between CATIS-Emotional and self-concept (r = 0.30, p < .001) and parent-perceived SB severity (r = −0.17, p = .01), as well as CATIS-Social and sibling conflict (r = −0.26, p < .001), behavior problems (r = −0.37, p < .001), and self-concept (r = 0.50, p < .001). Results provide preliminary support for a 12-item, two-factor version of the CATIS-S. Social workers can administer the CATIS-S to assess the psychosocial strengths and needs of youths who have siblings with SB and provide targeted interventions to those at-risk to improve their psychosocial functioning.

Development and Initial Evaluation of the Patterns of Activity Measure-Pain Short Form.

There has been growing interest in examining pain-related activity patterns and their relationships to psychosocial functioning. The Patterns of Activity Measure-Pain (POAM-P) is frequently used to measure 3 pain-related activity patterns: avoidance, overdoing, and pacing. Although the POAM-P possesses excellent psychometric properties, its length may limit its utility where multiple measures of functioning are required or the time available for assessment is limited. The present studies describe the development and evaluation of a short-form version of this measure. In Study 1, 775 individuals with ongoing pain completed the original POAM-P at the start of a treatment program. Item analyses were conducted to construct a short-form of the POAM-P. In Study 2, a separate sample of 171 individuals completed the original and short-form of the POAM-P, and measures of psychosocial functioning. Correlations between the short-form and original, and between the short-form and measures of psychosocial functioning were examined to evaluate the reliability and validity of the short-form. The 3 scales of the short-form were found to have excellent internal consistency and correlated well with corresponding scales on the original POAM-P. Correlations between scales on the short-form and measures of psychosocial functioning supported the construct validity of the measure. The short-form of the POAM-P possesses good psychometric properties and correlates well with the long-form of the measure. It appears to be a promising addition to existing measures of pain-related activity. It may be useful as an addition to questionnaire batteries that comprehensively assess the psychosocial functioning of individuals with ongoing pain.

Executive functioning but not IQ or illness severity predicts occupational status in bipolar disorder

BackgroundBipolar disorder is associated with significant functional deficits including occupational functioning. Despite the high rates of unemployment and sick leave in the patient population, only a limited number of studies have examined factors associated with occupational functioning in bipolar disorder. The aim of the study was to investigate the relative importance of demographic, clinical, and neuropsychological factors on occupational dysfunction in bipolar disorder.MethodsA sample of 120 partially or fully remitted bipolar disorder I and II patients were included in the study. Patients were stratified into an active and an inactive group based on the number of hours per week working or studying. Active (n = 86) and inactive (n = 34) patients were compared with respect to demographic factors, clinical characteristics, medication, measures of psychosocial functioning, and cognitive functioning (i.e., IQ and executive functions). No other cognitive domains were examined.ResultsUnivariate analyses revealed better overall cognitive function in active patients in terms of IQ and executive functioning. However, only executive functioning accounted for a significant amount of the variance in occupational status when other significant predictors were taken into account.ConclusionsExecutive functioning was a more powerful predictor of occupational status in bipolar disorder patients than IQ and other clinical factors, including illness severity.

A Longitudinal Examination of Community Violence Exposure, School Belongingness, and Mental Health Among African-American Adolescent Males

African-American males from urban communities are disproportionately exposed to community violence, placing them at increased risk for mental health problems compared to youth from other racial/ethnic groups. While risk factors for violence exposure have been identified in the literature, protective variables and competencies are studied with less frequency. The purpose of the current study is to identify the role of school belongingness as a protective factor against the deleterious outcomes associated with community violence exposure. Participants were 119 African-American male adolescents (M = 15.33, SD = .95 at Time 1) attending an all-male charter high school in an urban community. Consistent with prior research, community violence exposure showed a negative association with various measures of psychosocial functioning 12–15 months later, controlling for prior levels of functioning. Moderation analyses revealed that at low levels of school belongingness, community violence exposure positively predicted a range of negative psychological outcomes, consistent with a protective-stabilizing effect. Results are discussed in terms of the importance of fostering adaptive levels of school connectedness for youth in high-risk communities.

Associations between Family Weight-Based Teasing, Eating Pathology, and Psychosocial Functioning among Adolescent Military Dependents.

Weight-based teasing (WBT) by family members is commonly reported among youth and is associated with eating and mood-related psychopathology. Military dependents may be particularly vulnerable to family WBT and its sequelae due to factors associated with their parents’ careers, such as weight and fitness standards and an emphasis on maintaining one’s military appearance; however, no studies to date have examined family WBT and its associations within this population. Therefore, adolescent military dependents at-risk for adult obesity and binge-eating disorder were studied prior to entry in a weight gain prevention trial. Youth completed items from the Weight-Based Victimization Scale (to assess WBT by parents and/or siblings) and measures of psychosocial functioning, including the Beck Depression Inventory-II, The Rosenberg Self-Esteem Scale, and the Social Adjustment Scale. Eating pathology was assessed via the Eating Disorder Examination interview, and height and fasting weight were measured to calculate BMIz. Analyses of covariance, adjusting for relevant covariates including BMIz, were conducted to assess relationships between family WBT, eating pathology, and psychosocial functioning. Participants were 128 adolescent military dependents (mean age: 14.35 years old, 54% female, 42% non-Hispanic White, mean BMIz: 1.95). Nearly half the sample (47.7%) reported family WBT. Adjusting for covariates, including BMIz, family WBT was associated with greater eating pathology, poorer social functioning and self-esteem, and more depressive symptoms (ps ≤ 0.02). Among military dependents with overweight and obesity, family WBT is prevalent and may be linked with eating pathology and impaired psychosocial functioning; prospective research is needed to elucidate the temporal nature of these associations.

E.05.01 The structure, course, and consequences of cognitive impairment in bipolar disorder

The aim of this study was to estimate the prevalence of clinically significant cognitive deficits in a sample of euthymic older age bipolar disorder (OABD) patients, and its relationship with functional outcome. Sixty-six outpatients and 30 controls completed a neuropsychological battery and a measure of psychosocial functioning. There were 33.3% (CI95% 22–44%) of patients without clinically significant cognitive deficits, 36.4% (CI95% 24–48%) with selective deficits, and 30.3% (CI95% 19–41%) with global deficits. Patients without cognitive deficits were indistinguishable of healthy controls in terms of psychosocial functioning, while patients with cognitive impairments had lower functional outcome. Neurocognitive and psychosocial functioning might be heterogeneous among patients with OABD.

A comparison of treatment preferences, decision making, and psychosocial outcomes in advanced cancer patients with and without minor children: A matched cohort study.

91 Background: Patients with advanced cancer who have minor children face unique challenges when coping with their life-limiting illness and the impact of their illness on their families. The goal of this study was to examine whether psychosocial functioning, treatment preferences, and treatment decisions in advanced cancer differ by parental status. Methods: A cohort of 60 parents with metastatic solid tumors age-matched with 60 non-parents (N = 120) participated in three structured interviews assessing treatment preferences and decisions over six months with complementary medical record review. Participants also completed validated measures of psychosocial functioning. Results: Seventy percent (n = 85) of the sample completed all study assessments. Mean age (45 years, SD 8), mean performance status score (ECOG = 1.2, SD 0.9), median duration of metastatic illness (19 months, range 1-115), gender ratio (66% female), and dropout rates were similar between groups. Parents and non-parents reported similar overall health-related quality of life, but parents were more likely to report poorer emotional well-being (p = 0.006) and more symptoms of depression (p = 0.04) and anxiety (p = 0.04) than non-parents. Parents and non-parents were equally likely to describe life-extension as their primary goal of anti-neoplastic treatment. Parents reported greater willingness to live in pain (48% “very willing” vs 27%, p = 0.007) and accept intubation/ventilation (40% vs 20%, p = 0.01) for life-extension. Compared to non-parents, parents were more likely to report their family members as the most influential factor in their decision-making (44% vs 12%) and less likely to cite their oncologist’s recommendation (25% vs 41%). There were no significant differences between groups for completion of a health care power of attorney or living will. Conclusions: Compared to similarly aged adults with metastatic cancer, parents experience greater psychological distress, are more willing to live in pain for life extension, and place greater importance on family-related factors in their cancer treatment decision-making.

A Comparison of Medical Comorbidities, Psychosocial, and Sexual Well-being in an Online Cross-Sectional Sample of Women Experiencing Persistent Genital Arousal Symptoms and a Control Group

BackgroundPersistent genital arousal disorder (PGAD) is characterized by symptoms of distressing physiological sexual arousal (Persistent genital arousal [PGA] symptoms such as genital vasocongestion, sensitivity, or both) that occur in the absence of sexual desire. There continues to be a lack of systematic research on this condition. Little is known about the common medical comorbidities and psychological, sexual, or relationship well-being of individuals who experience PGA symptoms. AimsTo compare these biopsychosocial factors in an age-matched sample of women with and without symptoms of PGA. A secondary aim was to examine what symptom factors (associated distress, symptom severity) and cognitive factors (eg, catastrophizing of vulvar sensations) were associated with psychosocial outcomes in women with symptoms of PGA. MethodsAge-matched samples of women with (n = 72) and without (n = 72) symptoms of PGA completed a comprehensive online survey. Main Outcome MeasuresParticipants self-reported their medical histories and completed validated measures of psychosocial functioning (depressive and anxiety symptoms, catastrophizing of vulvar sensations, sexual functioning and distress, and relationship functioning). ResultsWomen with symptoms of PGAD reported significantly greater depressive and anxiety symptoms, sexual distress, and suicidal ideation, as well as significantly poorer relationship functioning than women without PGA symptoms. Catastrophizing of vulvar sensations was related to PGA symptom ratings (greater severity, distress) and psychosocial outcomes (greater depression, anxiety, and sexual distress). Clinical ImplicationsThe results of this study highlight medical and psychosocial difficulties associated with PGA symptoms, which should be assessed and addressed as essential components of treatment. Strengths & LimitationsThis study seeks to address the paucity of research on the well-being of women with PGA symptoms by undertaking a comparison of age-matched samples using validated questionnaires. This study is limited by its self-report, cross-sectional design. ConclusionPGA symptoms are associated with significant health and psychological difficulties. These results highlight the need for continued research in this area to improve identification and treatment for this population.Jackowich RA, Poirier É, Pukall CF. A Comparison of Medical Comorbidities, Psychosocial, and Sexual Well-being in an Online Cross-Sectional Sample of Women Experiencing Persistent Genital Arousal Symptoms and a Control Group. J Sex Med 2020;17:69–82.

The Child Outcome Rating Scale: validating a four-item measure of psychosocial functioning in community and clinic samples of children aged 10-15.

Psychosocial functioning is considered an important and valued outcome in relation to young people's mental health as a construct distinct from psychiatric symptomology, especially in the light of an increasing focus on transdiagnostic approaches. Yet, the level of psychosocial functioning is rarely directly asked of young people themselves, despite the widespread recognition that the young person's perspective is valuable andis often at odds with those of other reporters, such as parents or professionals. One possible reason for this is that the field lacks a clear agreed tool to capture this information in a non-burdensome way. To begin to address this gap, this paper describes psychometric analysis of the Child Outcome Rating Scale (CORS), a brief and highly accessible self-report measure of young people's psychosocial functioning already used extensively by mental health professionals around the world but with only limited data on psychometric robustness. Using large community (n = 7822) and clinic (n = 2604) samples, we explore the factor structure, construct validity, internal consistency, differential item functioning, and sensitivity of the CORS. We found that the CORS stands up to psychometric scrutiny, having found satisfactory levels of reliability, validity, and sensitivity in this sample. We also found that the CORS is suitable for use with young people as old as 15years old. That the CORS has been found to be psychometrically robust while being highly feasible (brief, simple, easy to administer) for use in busy clinical settings, combined with the fact that the CORS has already been widely adopted by clinicians and young people, suggests CORS may be an important tool for international use.

Sexual Violence in Childhood and Post-Childhood: The Experiences of Young Men Who Have Sex With Men in Beirut.

Sexual violence has been found to have psychosocial and sexual ramifications for men who have sex with men (MSM) but has not been studied in the Middle East. We assessed the prevalence and correlates of experiences of child and post-child sexual violence among young MSM residing in Beirut, Lebanon. In total, 226 MSM, aged 18 to 29, were recruited with long-chain peer referrals and administered a survey that included questions on history of being pressured to have sex, as well as specific forms of sexual harassment and abuse, in addition to measures of psychosocial functioning and sexual behavior. Logistic regression analysis was used to examine correlates of child sex abuse and experiences of sexual violence post-childhood; 17.3% experienced sexual abuse as a child (below age 13), while 63.3% experienced any form of sexual violence post-childhood-furthermore, 48.7% had experienced being forced or pressured to have sex during their lifetime, including 32.3% prior to age 18. Participants who experienced child sex abuse were more likely to experience abusive relationships in adulthood, as well as at least one type of sexual harassment/abuse post-childhood. Experience of any sexual violence post-childhood was correlated with greater recent sexuality-related discrimination and more recent male sex partners. These findings reveal a high prevalence of sexual violence among MSM in Beirut, both in childhood and post-childhood. More research within the Middle East is needed to better understand the drivers of sexual violence in this population, and how to best provide prevention and coping services.

How should the severity of depression be rated on self-report depression scales?

Almost all depression measures have been developed without discussing how to best conceptualize and assess the severity of depression. The most valid rating format of depression severity scales is unsettled and has been little studied. In the present study from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, we compared the validity of alternative approaches towards rating the severity of depressive symptoms. Data was collected using TurkPrime. One hundred eighty-five participants currently in treatment for a mental health problem completed a self-report measure of depression and rated the symptoms on two 4-point ordinal scales assessing symptom frequency and symptom intensity. The respondents also rated their global level of depression severity and completed a measure of psychosocial functioning and quality of life. The symptom ratings based on intensity and frequency were highly correlated with each other, and equally highly correlated with subjects’ global rating of overall severity of depression, as well as ratings of psychosocial functioning and quality of life. A composite index of severity based on the sum of frequency and severity ratings was no more highly correlated with the external validators. The results of the present study suggest that ratings of depressive symptoms based on either symptom intensity or symptom frequency are equally valid.

Overweight and Obese Children are at Increased Risk for Failure to “Thrive” and Difficulties with Peer Relationships

Purpose: Children who are overweight or obese are at increased risk for psychosocial challenges. The 2016 National Survey of Children’s Health (NSCH) provides an opportunity to evaluate the impact of weight status on two newly added measures of psychosocial functioning. “Flourishing” (otherwise known as “thriving”) was introduced in the 2011/12 NSCH and then substantially revised in the 2016 NSCH. It is a composite measure to reflect resilience, self-regulation, and curiosity and discovery about learning. In terms of peer relations, the 2016 NSCH not only continues to ask if …

Understanding familial response to parental advanced cancer using the family management style framework

Purpose: A parental advanced cancer diagnosis can have profound and lasting impact on family functioning. We used an adapted version of the Family Management Style Framework (FMSF) to identify and describe patterns of family management in parental advanced cancer.Design: This is a secondary analysis of data from a cross-sectional, mixed-methods study. Forty-two adults participated in semi-structured, in-depth interviews about their experiences as a parent with advanced cancer and completed measures of psychosocial functioning. We analyzed interviews using codes derived from the FMSF and used directed content analysis to identify themes reflected in the coded data.Findings: We identified five distinct patterns of family management in parental advanced cancer: (1) Equipped and Optimistic; (2) Equipped and Pragmatic; (3) Discouraged and Struggling; (4) Apprehensive and Passive; and (5) Discouraged and Conflicted.Conclusions: The FMSF was a useful framework for differentiating and understanding underlying patterns of family response to parental advanced cancer.

Usefulness of a Novel System for Feedback of Patient-Reported Outcome Measures in Children Recovering From Burns.

The Burn Outcomes Questionnaire for children ages 5-18 years (BOQ5-18) is a widely used, reliable, and valid parent-reported outcome measure designed to assess children's recovery from burn injuries in 12 physical and psychosocial domains. This study evaluated the feasibility, acceptability, and usefulness of a feedback system that delivered BOQ and Pediatric Symptom Checklist (PSC-17; a widely used measure of psychosocial functioning) results to burn care clinicians prior to an outpatient appointment or a postoperative surgical encounter. The BOQ and the PSC-17 were administered to the parents of 147 children receiving outpatient or surgical care in two pediatric burn hospitals. Clinician and parent perceptions of the feedback system were evaluated using debriefing questionnaires. Over half of all patients were at-risk on at least one BOQ subscale, and risk on three or more BOQ domains was significantly associated with a higher likelihood of poor psychological scores on the PSC-17 (P < .001). Significant differences in BOQ scores were found between the two hospital sites on four BOQ subscales, three related to physical ability and one to psychosocial well-being. Parent ratings of the feedback system were positive, with 90% of parents in both settings agreeing that the BOQ tablet experience was easy and helpful. Clinician attitudes differed across the two settings with more positive clinician ratings of the system in the outpatient setting (P < .001). Clinician interviews revealed that the data was especially useful in bringing to light psychosocial aspects of functioning relevant to long-term recovery from burn injuries.

Recovery-Oriented Outcomes Associated with Long-Acting Injectable Antipsychotics in an Urban Safety-Net Population.

This study examined whether transitioning patients from oral antipsychotics (POs) to long-acting injectable antipsychotics (LAIs) helps patients achieve recovery-oriented goals. Data was extracted from San Francisco County's electronic medical record system for this retrospective pre-post observational study. Patients reflect a safety-net population treated in community-based mental health settings during 2015. The San Francisco Adult Strengths and Needs Assessment (SF ANSA), a measure of psychosocial functioning, was used to assess within-subject change when treated with POs versus LAIs. In our study sample (N = 77), LAI SF ANSA scores showed significant improvements in criminal behaviors (p = .017), medication adherence (p = .008), and spirituality (p = .028), and a non-significant trend for residential stability (p = .073). This is the first study to evaluate improvements in key psychosocial areas after treatment with LAIs. This work suggests that LAIs can be another tool for providers to help patients work towards their recovery-oriented goals.

The Positive Brain - Resting State Functional Connectivity in Highly Vital and Flourishing Individuals.

The World Health Organization has defined health as “complete physical, mental and social well-being and not merely the absence of disease or infirmity” (World Health Organization, 1948). An increasing number of studies have therefore started to investigate “the good life.” However, the underlying variation in brain activity has rarely been examined. The goal of this study was to assess differences in resting state functional connectivity (RSFC) between regular healthy individuals and healthy individuals with a high occurrence of flourishing and subjective vitality. Together, flourishing, a broad measure of psycho-social functioning and subjective vitality, an organismic marker of subjective well-being comprise the phenomenological opposite of a major depressive disorder. Out of a group of 43 participants, 20 high-flourishing (highFl) and 18 high-vital (highSV) individuals underwent a 7-min resting state period, where cortical activity in posterior brain areas was assessed using functional near-infrared spectroscopy (fNIRS). Network-based statistics (NBS) of FC yielded significantly different FC patterns for the highFl and highSV individuals compared to their healthy comparison group. The networks converged at areas of the posterior default mode network and differed in hub nodes in the left middle temporal/fusiform gyrus (flourishing) and the left primary/secondary somatosensory cortex (subjective vitality). The attained networks are discussed with regard to recent neuroscientific findings for other well-being measures and potential mechanisms of action based on social information processing and body-related self-perception.

PSYCHOLOGICAL FUNCTIONING AND CARDIOMETABOLIC RISK OVER FOUR DECADES: FINDINGS FROM THE VA NORMATIVE AGING STUDY

AbstractThe role of psychological functioning in risk of incident cardiometabolic conditions is well-known, but less studied are its effects on underlying pathophysiology. This study examined the prospective association between psychological functioning and 40-year trajectories of cardiometabolic risk. Among men from the VA Normative Aging Study, measures of psychosocial functioning were obtained by survey between 1975 and 1986 (N=905–1562). Cardiometabolic risk (CMR) was assessed as the mean z-score across 7 biomarkers, assessed triennnially from 1975 to 2016. Growth curve models indicate that CMR increased linearly from midlife through age 64, followed by a less-steep increase in older ages. Higher levels of neuroticism, worry, fear, and anger, and lower levels of self-regulation, were each associated with higher levels of CMR. Psychological functioning was unrelated to change in CMR over age. These findings suggest common risk factors underlying psychological functioning and cardiometabolic risk, or biological programming of trajectory “set-points” at earlier ages.

Profiles of recovery from alcohol use disorder at three years following treatment: can the definition of recovery be extended to include high functioning heavy drinkers?

Recovery from alcohol use disorder (AUD) is often narrowly defined by abstinence from alcohol and improvements in functioning (e.g. mental health, social functioning, employment). This study used latent profile analysis to examine variability in recovery outcomes, defined by alcohol use, alcohol-related problems and psychosocial functioning at 3years following treatment. Secondary analysis investigated pre-treatment, post-treatment and 1- and 3-year post-treatment covariate predictors of the latent profiles. Secondary analysis of data from a randomized clinical trial. United States. We used data from the out-patient arm of Project MATCH (n=806; 29.7% female, 22.2% non-white). Recovery was defined by latent profile analyses including measures of psychosocial functioning and life satisfaction (Psychosocial Functioning Inventory), unemployment and mental health (Addiction Severity Index), alcohol and other drug use (Form 90) and alcohol-related consequences (Drinker Inventory of Consequences) 3 years following treatment. Mixture modeling was used to examine correlates of profiles. We identified four profiles at 3years following treatment: (1) poor functioning frequent heavy drinkers, (2) poor functioning infrequent heavy drinkers, (3) high functioning occasional heavy drinkers and (4) high-functioning infrequent non-heavy drinkers. There were relatively few differences on indicators of functioning and treatment-related variables between the high functioning infrequent non-heavy drinkers and the high-functioning occasional heavy drinkers, other than high-functioning occasional heavy drinkers having lower alcohol dependence severity [odds ratio (OR)=0.94, 95% confidence interval (CI)=0.90, 0.98], fewer post-treatment coping skills (OR=0.54, 95% CI=0.32, 0.90) and lower 3-year post-treatment abstinence self-efficacy (OR=0.37, 95% CI=0.28, 0.49) and Alcoholics Anonymous (AA) involvement (OR=0.87, 95% CI=0.85, 0.99). The two high-functioning profiles showed the greatest improvements in functioning from baseline through the 3-year follow-up, whereas the low-functioning profiles showed the least amount of improvement. High-functioning occasional heavy drinkers had higher purpose in life than the poor-functioning profiles. Some individuals who engage in heavy drinking following treatment for alcohol use disorder may function as well as those who are mostly abstinent with respect to psychosocial functioning, employment, life satisfaction and mental health.

Domains of psychosocial disability and mental disorders.

This study examined relations between comprehensive domains of psychosocial disability and mental disorders to determine (1) whether differential patterns of associations exist between psychosocial disability dimensions and commonly diagnosed mental disorders and (2) whether these relations differ between self-reported and interviewer-rated psychosocial disability domains. Self-reported and interviewer-rated psychosocial functioning measures and an interviewer-rated diagnostic assessment tool were administered to 181 psychiatric outpatients. Internalizing disorders showed the strongest and most pervasive associations with psychosocial impairment across both self-reported and interviewer-rated measures, followed by thought disorder; externalizing showed the weakest associations. More specifically, logistic regression analyses indicated that lower well-being factor score significantly increased the odds of distress-disorder diagnoses, and poor basic functioning increased the odds of PTSD. Results clearly showed differences in the magnitude of associations between three dimensions of psychosocial-disability and commonly diagnosed disorders, and that these differences were similar regardless of rater type.

Is knowledge of family history related to psychosocial functioning? Comparison of adolescents living in institutional care and adolescents living with their biological families

We tested adolescents growing up in institutional care and adolescents living with their birth families using the ‘Do you know?’ scale and other measures of psychosocial functioning. We found that children living in group homes knew significantly less of their family history, exhibited more behavioural problems and had a more external locus of control. Moreover, the correlations between self-esteem and knowledge of family history were significantly different between the groups. This may suggest that the contribution of the knowledge of family history to self-esteem is different depending on the quality of family history. We also found a significant correlation between locus of control and behavioural problems for the children in institutional care, but not children living with their birth families, which may indicate that their behavioural problems may partially stem from the sense of lack of control over their lives.