Millon Behavioral Health Inventory Research Articles

Psychosocial assessment tools for use before transplantation are predictive of post-operative psychosocial and health behavior outcomes: a narrative review of the literature

IntroductionIn end-stage diseases, transplantation may be necessary. The limited number of donors led to the development of several pre-transplant psychosocial assessment tools. We summarized the predictive value of these tools before solid-organ transplantation.MethodsThe PRISMA search strategy and the MEDLINE database were used to review the literature. From 1,050 records, we found thirteen studies using four different scales (Millon Behavioral Health Inventory [MBHI], Psychosocial Assessment of Transplant Candidates [PACT], Stanford Integrated Psychosocial Assessment for Transplantation [SIPAT], and Transplant Evaluation Rating Scale [TERS]).ResultsTERS and MBHI were associated with the highest number of positive studies concerning pre-transplant scores and primary outcomes. Psychosocial scales predict in a systematic way psychosocial and health behavioural outcomes, but generated mixed results for mortality and rejection.DiscussionThis narrative review underlines the need for multidisciplinary evaluation and well-conducted clinical trials to assist transplant teams in utilizing psychosocial evaluation effectively during evaluation of candidates.

A comparison of the millon behavioral medical diagnostic and millon behavioral health inventory with medical populations

There is a lack of normative data on broadband omnibus types of personality tests with medical populations. In fact, the only two tests normed on medical populations are the Millon Behavioral Medicine Diagnostic (MBMD) and the Millon Behavioral Health Inventory (MBHI). The internal consistency, test-retest reliabilities, and validity studies of these instruments are reviewed and compared in an effort to aid clinicians in discerning their relative psychometric strengths and weaknesses. Due to the lack of validity studies with the MBMD and the fact that reliability limits the ceiling of validity coefficients, the MBMD has yet to meet the challenges it was designed to meet. Implications for practice are addressed.

Chronic Pain and the Measurement of Personality: Do States Influence Traits?

This is a structured evidence-based review of all available studies on the effect of pain, (a state phenomenon) on the measurement of personality characteristics (a trait phenomenon). To determine whether pain treatment changes trait scores. Recent evidence from the psychiatric literature indicates that the measurement of personality characteristics (traits) can be affected or changed by the presence of state psychiatric disorders, for example, depression. At issue then is whether the measurement of chronic pain patients' (CPPs') trait characteristics is affected by the presence of pain, a state problem. Computer and manual literature searches for pain studies that reported a prepain treatment and postpain treatment (test-retest) personality test or inventory score produced 35 such reports. These references were reviewed in detail and information relating to the above problem was abstracted and placed into tabular form. Each report was also categorized as to the type of study it represented according to the guidelines developed by the Agency of Health Care Policy and Research (AHCPR). In addition, a list of 15 quality criteria was utilized to measure the quality of each study. Each study was independently categorized for each criterion as positive (criterion filled), negative (criterion not filled), or not applicable, by two of the authors. Only studies having a quality score of 65% or greater were utilized to formulate the conclusions of this review. The strength and consistency of the evidence represented by the remaining studies were then categorized according to the AHCPR guidelines. Conclusions of this review were based on these results. Of the 35 reports, 32 had quality scores of 65% or greater. According to the AHCPR guidelines, there was a consistent finding that the Minnesota Multiphasic Personality Inventory (MMPI) scores changed (improved) with treatment. In reference to the Millon Behavioral Health Inventory, Locus of Control, the Symptom Checklist-90-Revised (SCL-90-R), trait anxiety, and personality disorders, there were not enough studies to draw conclusions about consistency. In reference to coping/self-efficacy inventories, somatization/illness behavior inventories, and personality questionnaire studies, there was a generally consistent finding that these tests changed (improved) with pain treatment. Overall, of the 32 reports, 92.3% demonstrated a change in trait scores (improvement) with pain treatment. This evidence was categorized as consistent. Finally, 100% of a subgroup of reports (N = 12) that had controlled for pain indicated that there was a relationship between a change in pain scores and a change in trait scores. Based on the above results, it was concluded that some trait tests and inventories may not be pain state independent. Therefore, caution is warranted in interpreting postpain development personality profiles as being indicative of the true prepain personality structure, if measured by these tests. Why trait scores may change with treatment, confounding test-retest issues, and whether trait tests actually measure what they allegedly measure are discussed.

Personality in Keratoconus in a Sample of Patients Derived From the Internet

Keratoconus is a corneal disease that manifests itself in young adulthood and decreases vision. Anecdotally, keratoconus patients are commonly described as having unusual personality characteristics; however, previous researchers have not been able to define a unique keratoconus personality profile. We sought to better define the personality of patients with keratoconus. The Millon Behavioral Health Inventory (MBHI) is a psychological instrument designed for use with physically ill patients to assess factors relevant to their medical care. The MBHI may aid in the evaluation of keratoconus patients and provide information relevant to the doctor-patient relationship. Patients with keratoconus were recruited through the World Wide Web. Surveys were conducted by mail, with all responses returned anonymously. One hundred fifty-three keratoconus patients were compared with the MBHI age-matched norms, generated from medical and nonmedical samples of adults. Subgroups of keratoconus patients were compared based on their self-reported rating of the daily burden of keratoconus. Keratoconus patients scored significantly lower (chi, P <0.05) compared with the normative population on the respectful coping style scale, and their scores were not significantly associated with a history of penetrating keratoplasty or their rating of the effect of keratoconus on their lives. This suggests that keratoconus patients are less respectful of practitioners, uncooperative, and noncompliant with treatment plans. Practitioners may look unfavorably on patients who exhibit these characteristics. This would also explain why the clinical perception of keratoconus patients persists, but other personality inventories have not defined a distinct keratoconus profile. These data from the MBHI, showing that keratoconus patients score lower on the respectful coping style scale, may explain eye care practitioners' perceptions about these patients' personality characteristics.

Psychosocial effects in long‐term head and neck cancer survivors

To identify and rate the importance of several psychosocial and physiologic influences on quality of life (QOL) among a cohort of 5-year head and neck cancer survivors, we conducted a cross-sectional study of a convenience sample that used both questionnaires and physiologic evaluations. QOL was assessed by the Functional Assessment of Cancer Therapy (FACT) and the FACT Head and Neck additional concerns (FACT-H&N) questionnaires. Psychosocial characteristics (or risk factors) potentially influencing QOL were measured by the Millon Behavioral Health Inventory (MBHI) and the Social Support Questionnaire (SSQSR). Physiologic risk factors were measured in examinations that included shoulder and neck range of motion, whole and stimulated saliva measurements, and oropharyngeal swallowing efficiency. We evaluated the association of selected QOL measures with three groups of potential risk factors: psychosocial factors, consisting of selected MBHI and SSQSR scales; physiologic factors, consisting of selected physical ability measures; and a combination of psychosocial/physiologic factors. The entire study population of 105 subjects completed the FACT and FACT-H&N questionnaires; 86 of these completed the physiologic tests as well. Combined psychosocial/physiologic models best predicted all QOL measures considered. Psychosocial models alone, compared with physiologic models alone, better predicted FACT physical and social/family well-being measures. Physiologic models alone, compared with psychosocial models alone, better predicted FACT-H&N additional concerns measures. Premorbid pessimism (MBHI) was consistently the best predictor of QOL measures. Both psychosocial and physiologic factors influence QOL in patients with head and neck cancer, but many QOL measures are most strongly influenced by psychosocial considerations. Physicians and surgeons caring for long-term head and neck cancer survivors should be cognizant of the importance of psychosocial risk factors in the QOL of their patients.

Inhibited interpersonal coping style predicts poorer adherence to scheduled clinic visits in human immunodeficiency virus infected women at risk for cervical cancer.

One of the most common gynecologic conditions among HIV+ women is cervical dysplasia, the precancerous phase of cervical cancer. Therefore, adherence to gynecology visits may be among the most important health care practices for HIV+ women. However, no research has evaluated the psychosocial factors associated with health care practices among HIV+ women at risk for cervical cancer. This study examined the relationship between inhibited interpersonal coping style and adherence to primary care and obstetrics/gynecology visits in HIV+ women with Human Papillomavirus (HPV) infection. Twenty-eight HIV-1 seropositive Black, non-Hispanic women underwent a psychosocial interview, blood draw, and gynecologic examination. The Millon Behavioral Health Inventory was used to assess coping style. Medical chart review was used to assess adherence to scheduled special immunology clinic visits for 24 months following study entry. Results suggested that greater inhibited coping style significantly predicted greater nonadherence to clinic visits during 1-year (beta = .45, p = .04) and 2-year (beta = .58, p = .02) follow-up, even after controlling for the possible confounding effects of recent depressed mood on adherence. Social support satisfaction did not mediate the relationship between inhibited coping style and nonadherence. These findings suggest that interpersonal coping style assessment may be a useful tool in predicting adherence in HIV+ women with HPV. Future research should assess the effect of psychosocial interventions on coping style, adherence, and cervical dysplasia in HIV+ women with HPV.

Treatment outcome varies with coping style in chronic pain management

Coping styles are generally recognized as impacting health-related outcomes among persons with chronic illnesses. The current study examined the differential treatment outcomes of three coping style groups undergoing pain management treatment in a multidisciplinary pain center. A total of 66 patients suffering from chronic pain disorders were assessed with the Multidimensional Pain Inventory and the Beck Depression Inventory before, during, and after multidisciplinary pain management treatment. Coping style groups derived from the Millon Behavioral Health Inventory consisting of Amplie ers, Repressors, and Social Copers were compared with regard to reductions in pain, functional impairment, and depression levels. Repeated measures ANOVA revealed that all three of the coping style groups reported signie cantreductions in pain and functional impairment. However, only Amplie ers and Social Copers reported signie cant reductions in depression levels. Hierarchical linear modeling analyses revealed the coping style groups to have signie cantly different depression change curves from pre- to post-treatment. These preliminary results support the value of tailoring treatments in pain management programs toward patients’ coping styles. Patients who are high on Repression qualities do not appear to respond to therapies focused on alleviating depression. Thus, treatment methods that utilize modalities specie cally suited to help Repressors, Amplie ers, and Social Copers manage their chronic pain are likely to maximize their response to treatment. summary

Millon Behavioral Health Inventory Scores of Patients With Chronic Pain Associated with Myofascial Pain Syndrome

Normative data for the coping styles and psychogenic attitudes of the Millon Behavioral Health Inventory (MBHI) for male and female chronic pain patients (CPPs) with mixed pain diagnoses have previously been reported and compared with normative MBHI manual data. However, results from other studies have suggested that CPPs with myofascial pain syndrome (MPS) may need to be considered as a distinct group in psychiatric/psychological studies. The purpose of the present study was then to provide normative data for each MBHI scale for male and female CPPs with MPS and to compare these data with MBHI manual norms for similarities and differences. Multidisciplinary pain facility. CPPs with an associated diagnosis of MPS. MBHI base rate scores. CPPs with an associated diagnosis of MPS were first broken down into two groups: males and females. Analyses were then performed using the MBHI base rate scores of these two groups. For each group, the percentages of CPPs who had a base rate of 75 or above were calculated for each individual coping style and psychogenic attitude. These percentages were then compared by chi square with percentages of patients with base rate scores of 75 or above for each coping style and psychogenic attitude to the MBHI Manual normative sample. Female CPPs with MPS differed from MBHI Manual normative counterparts on two of the six psychogenic attitude scales (future despair and somatic anxiety); no differences were found in any of the eight coping style scales. Male CPPs with MPS differed from MBHI Manual normative counterparts on one coping style scale (sociable) and three psychogenic attitude scales (premorbid pessimism, future despair, and somatic anxiety). The pattern of the results indicated that CPPs with MPS, especially males, differ from the MBHI Manual normative data counterparts. These differences appear to be greater than those for CPPs with mixed pain diagnoses. Differences in MBHI scale scores between CPPs with MPS and MBHI Manual normative data counterparts may be related to a number of issues, such as whether differences in state factors reflecting depression and anxiety might affect trait factors purportedly measured by the MBHI.

Personality predictors of mortality in cardiac transplant candidates and recipients

Objectives: Emotional factors are generally recognized as impacting the care of end-stage heart disease and mortality following cardiac transplants. Equally important, however, are predictors of pretransplant mortality. The current study examined the utility of the Millon Behavioral Health Inventory (MBHI) as a predictor of pre- and posttransplant mortality. Methods: A total of 103 cardiac transplant candidates were assessed with the MBHI as part of a pretransplant evaluation that included baseline demographic variables and cardiac status. Time to transplant and mortality status at 1 and 5 years was also obtained. Results: Cluster analysis of MBHI response scores elicited two clusters characterized by high and low distress. Cluster membership predicted survival status at 1-year and 5-year follow-up, with high distress cluster patients having significantly higher mortality in both the total sample and a subgroup of patients who did receive a heart transplant. Conclusions: These results support the value of the MBHI for assessing personality attributes that may dispose toward unfavorable outcome in heart transplant candidates. Further understanding of psychosocial contributions to illness course and outcome may enable more effective selection of treatment interventions with cardiac patients.

Psychological and demographic predictors of successful weight loss following silastic ring vertical stapled gastroplasty.

To identify psychological factors involved in obesity 45 individuals (40 women and 5 men), ranging in age from 21 to 54 years (M age = 41 yr.), who were candidates for silastic ring vertical stapled gastroplasty were assessed on the Millon Behavioral Health Inventory and the Millon Multiaxial Clinical Inventory-III. In addition, a number of demographic variables such as education, marital status, and age of onset of obesity were considered. Analysis indicated that significant predictors of weight loss at a 6-mo. postoperative assessment include age of onset of obesity and scores on the Schizoid scale of the Millon-III. These findings may be of assistance in identifying personality variables associated with changes in weight if replicated in a larger sample.

The Millon Behavioral Health Inventory Life Threat Reactivity Scale as a predictor of mortality in patients awaiting heart transplantation.

This study examined the Millon Behavioral Health Inventory Life Threat Reactivity Scale (LTRS) as a predictor of mortality in patients awaiting heart transplantation. The one-year mortality while awaiting cardiac transplantation was more than double for the high-risk group based on the LTRS scores. The high-risk group had a 42% mortality rate versus an 18% mortality rate in the low-risk group. Mortality for those patients that received transplants was similar for both groups. A review of the medical literature regarding the role of personality traits in cardiac mortality and the findings of this study are discussed.

Detection of a Psychiatric Diagnosis in Heart Transplant Candidates with the MBHI

The utility of the Millon Behavioral Health Inventory (MBHI) in screening for the formal diagnosis of a psychiatric disorder was investigated in a sample of 90 heart transplant candidates, a population at risk for psychiatric disturbance. Psychiatric disorders were identified in 71% of patients, the majority being adjustment disorder. Sensitivity and specificity rates of >70% were determined in discriminant function analyses, for presence or absence of a psychiatric condition. When Axis I conditions were differentiated as “mild” (adjustment reaction only) or “severe” (all other Axis I conditions, including comorbid Axis II disorders), the MBHI correctly identified every severe case as a probable psychiatric diagnosis. The rate of “clinically significant” elevations on certain MBHI scales and severity of Axis I psychiatric condition was also significantly associated. These findings suggest that the MBHI may have potential utility in identifying high-risk patients with diagnosable psychiatric conditions and help justify mental health consultation referrals at a time when managed care entities are vigorously rationing ancillary services with medically ill populations.

Self-report evaluation of health behavior, stress vulnerability, and medical outcome of heart transplant recipients.

The purpose of this study was to explore the value of patient self-report assessment in heart transplant candidacy evaluation, utilizing the Millon Behavioral Health Inventory (MBHI). Patient's MBHI measures were related to important pretransplant patient characteristics and posttransplant measures of health behavior, medical morbidity, and mortality. Ninety heart patients with end-stage cardiac disease completed the MBHI during pretransplant candidacy evaluations, and also were interviewed concerning their coping effectiveness, support resources, and compliance history. Postransplant follow-up of 61 living and 29 deceased patients included measures of survival time, postsurgical medical care, rejection and infection episodes, and nurse ratings of medication compliance and problematic interpersonal health behaviors. The MBHI coping scales were found to significantly discriminate good and poor pretransplant compliance, and interview judgments of good and poor coping and support resources, with modest accuracy. The MBHI also was superior to these interview judgments in predicting posttransplant survival time and medical care used. Certain scales were also positively associated with physical parameters of pretransplant and posttransplant status. Patient self-report with the MBHI can contribute to identification of patients at risk for a problematic outcome with transplant, by providing information pertinent to clinical decision making and outcome management analysis with this special population of cardiac patients.

Negotiating the Reality of Visual Impairment: Hope, Coping, and Functional Ability

A consecutive sample of 63 adventitiously blinded American military veterans in a interdisciplinary inpatient rehabilitation program participated in this study examining the relation of hope to self-reported functional ability level. Scores from a modified oral administration of the Hope Scale and the Millon Behavioral Health Inventory basic coping styles were used as predictor variables to test regression-based models of mediation and moderation relations to functional ability level. Results support a mediating role for hope in the relation between a proactive sociable style and perceived level of functional ability.

Use of Drugs, Coping Styles, Mental Absorption and Some Outcomes Related to Health and Social Activity

We examined basic coping styles, mental absorption, sensation seeking, use of alcohol, contacts with the health care system and the level of social activity and physical exercise in two drug groups, a hashish/marihuana group (n = 46) and a heroin etc. group (n = 19), and a comparison group (n = 46) with no drug use. Compared to the comparison group, the drug groups had elevated scores on Tellegen’s Absorption Scale and on the novelty subscale of the Arnett Inventory of Sensation Seeking. The hashish/marihuana group had elevated scores on the Millon Behavioral Health Inventory (MBHI) sociable, confident and forceful style. The heroin etc. group had elevated scores on the inhibited coping style. The heroin etc. group also had elevated anxiety scores on the MBHI psychogenic attitude scales. This group drank almost 5 times more alcohol than the comparison group. The hashish/marihuana group drank almost twice as much as the comparison group. There were also differences between the groups in beverage preferences. There were no differences between the drug users and the comparison group in frequency of contacts with the health care system and no differences in level of social activity and physical exercise or participation in sports.

Symptom improvement from prokinetic therapy corresponds to improved quality of life in patients with severe dyspepsia.

Prokinetic therapy has been shown to improve patients' symptoms associated with gastrointestinal motility disorders and quality of life. This study investigated the correlation between clinical improvement and quality of life after 12 months of treatment with cisapride or domperidone in patients with severe dyspepsia. Psychological and quality-of-life measures were assessed at baseline and after 12 months of therapy using three patient-administered, standardized questionnaires: the Minnesota Multiphasic Personality Inventory, the Millon Behavioral Health Inventory, and the Sickness Impact Profile. Changes in clinical symptoms were correlated with changes in these measures. Twenty-seven patients with symptoms of severe dyspepsia were treated with cisapride or domperidone (60-80 mg/day) for 12 months. Symptoms and quality-of-life measures were improved at the end of therapy. There were significant correlations between improvement in clinical symptoms and improvement in quality of life parameters. Patients with more marked symptom improvement had more significant improvements in quality of life measures. We conclude that prokinetic therapy improved symptoms and quality of life. Standardized questionnaires can be used to quantify response to prokinetic therapy and to individualize treatment regimens for patients with dyspepsia who have specific psychologic or behavioral characteristics.

A prospective psychological evaluation of patients with dysphagia of various etiologies

We hypothesized that patients who complain of dysphagia without demonstrable organic abnormality may have an underlying psychological dysfunction. We thus conducted a comprehensive assessment in three groups of patients with dysphagia. Dysphagia was classified as obstructive (Obst) when an obstructive lesion was present on esophagoscopy or barium swallow, motility-related (Mot) when abnormal motility was shown on esophageal manometry in the presence of normal esophagoscopy or barium swallow, or nonobstructive, nonmotility-related (NONM) when manometry and esophagoscopy or barium swallow were both normal. We prospectively evaluated 71 patients with Obst-dysphagia, 15 patients with Mot-dysphagia and 10 patients with NONM-dysphagia with a battery of standardized psychological tests including the Minnesota Multiphasic Personality Inventory (MMPI), the Symptom Checklist-90-Revised (SCL-90-R), and the Millon Behavioral Health Inventory (MBHI). The results indicate that patients with NONM-dysphagia have psychological attributes similar to those found in patients with Obst-dysphagia or Mot-dysphagia. Combination of scores for parameters such as somatization, depression, and anxiety could not distinguish among the three groups of dysphagia patients. We thus conclude that patients with NONM-dysphagia, as a group, have similar psychological profiles compared to patients with dysphagia due to organic causes.

Basic Coping Styles and Consumption of Alcohol

In a sample of adults (n = 357, mean age 23.5 years), the present study investigates the differences in alcohol consumption between high and low scorers on the basic coping scales of the Millon Behavioral Health Inventory (MBHI) and on the Tellegen Absorption Scale (ABS). In terms of the total yearly consumption of alcohol (calculated into liters of ethanol), high scorers on the cooperative and the respectful scales drank significantly less alcohol than low scorers. High scorers on the forceful style and the sensitive styles, on the other hand, drank significantly more than low scorers. High scorers on the ABS consumed significantly more wine than low scorers. During the last 12 months, high scorers on the forceful style were significantly more intoxicated, while high scorers on the respectful scale were significantly less intoxicated.

Relationship between the Millon Behavioral Health Inventory and the minnesota multiphasic personality inventory (MMPI) in low-back pain patients

The Millon Behavioral Health Inventory (MBHI) is being used with increasing frequency for the assessment of chronic pain, although there is a relative lack of evidence as to its utility, and prior studies have not examined low back pain. This investigation compared the MBHI to the MMPI in a sample of low-back pain patients and analyzed subgroups of pain patients based upon their MBHI responses. Subjects were 60 patients who had been admitted to outpatient multidisciplinary pain clinics of two Chicago-area hospitals. Patients completed both the MMPI and the MBHI and provided demographic information. Results of correlational analyses indicated strong relationships between the MBHI psychogenic attitude, psychosomatic correlate, and prognostic index scales and the validity scales of the MMPI. The MBHI Pain Treatment Responsivity scale (PP) correlated with 16 of the other 19 MBHI scales. PP did not demonstrate specificity with low back pain patients. The results of both the scale comparisons and the exploratory two-group cluster subgroup analysis support the notion that responses to the MBHI are largely affected by the respondent's tendency to deny psychopathology or to admit emotional distress.

Altered pain perception and psychosocial features among women with gastrointestinal disorders and history of abuse: A preliminary model

objectives: To evaluate the relationships between sexual/physical abuse, pain perception, environmental events, coping strategies, and psychiatric morbidity in a sample of female patients with painful gastrointestinal disorders. patients: Fifty paid volunteers from a tertiary care center including 13 patients with gastroesophageal reflux disease (GERD), 26 with noncardiac chest pain (NCCP), and 11 with irritable bowel syndrome (IBS). measurements: (1) Sexual and physical abuse interview questions; (2) Structured psychiatric interview; (3) Self-report questionnaires: demographics, clinical pain measurement, Millon Behavioral Health Inventory, Hassles and Uplifts Scales, Sickness Impact Profile, Life Experiences Survey, Pain Beliefs and Perceptions Inventory, and Coping Strategies Questionnaire; (4) Pain Perception and Sensory Decision Theory tasks. results: Fifty-six percent of the sample reported a history of sexual/physical abuse. Abuse was significantly more prevalent among patients with GERD (92%) and IBS (82%) compared with those with NCCP (27%). Abused patients, relative to nonabused patients, had significantly lower pain threshold levels in response to finger pressure stimuli and significantly lower cognitive standards for judging stimuli as noxious. Abused patients reported significantly higher levels of functional disability and a significantly greater number of psychiatric disorders, minor daily hassles, and pain syndromes unrelated to gastrointestinal disorders. In addition, abused patients more frequently blamed themselves for their pain and reported significantly greater use of maladaptive pain coping strategies than nonabused patients. conclusion: These data suggest that the relationships between abuse, disability, multiple pain syndromes, and health care seeking behavior are mediated by abnormal pain perception, psychiatric disorders, disruption of physical function, and environmental stressors