Pearlin Mastery Scale Research Articles

The psychometric properties of the Pearlin Mastery Scale in persons living with restless legs syndrome.

Restless Legs Syndrome (RLS) is a neurological disorder characterized by an urge to move arms and legs, commonly combined with distress, pain and motor restlessness. It can cause fragmented sleep, daytime symptoms, and decreased quality of life. Pharmacological treatment can suppress symptoms, but not cure. When challenged with illness, people may turn to their inner psychological resources such as self-esteem and mastery. The Pearlin Mastery scale was developed to study stress and coping, is commonly used in people with chronic illnesses, however, not yet validated in people with RLS. The aim was to test reliability and construct validity of the Pearlin Mastery Scale in persons with RLS. A cross-sectional postal survey including the Pearlin Mastery Scale, Restless Legs Syndrome-6 Scale, Pittsburgh Sleep Quality Index and Patient Health Questionnaire was sent out to members (n = 1500) of the national RLS association and 788 (52.5%) agreed to participate. Data were analyzed using classical test theory, Confirmatory factor analysis and Rasch measurement theory analysis. Hypothesis testing for construct validity was done by bivariate correlation analyses. Most respondents were women (65%), retired (71%) and had a mean-age of 70.8 years (SD 11.4). The 7-item version of the Pearlin Mastery Scale showed poor fit to the one factor model. After omitting the two positively worded items (i.e., item 4 and 6), the 5-item version was found to be unidimensional, with satisfactory internal consistency. However, all items showed considerable ceiling effects. No measurement variance was seen regarding age-groups or sex. Higher level of mastery was moderately correlated with less depressive symptoms but only weakly correlated to RLS-related sleep problems. The 5-item version of the Pearlin Mastery Scale is suggested to be used in persons with RLS due to its acceptable psychometric properties. The instrument could be applied as an outcome measure for behavioral change interventions aiming to support mastery in RLS.

Disaggregating between- and within-person associations of mastery and cognitive function: age as a moderator

BackgroundMastery may shape the way individuals cope with life challenges and influence cognitive function in later life. Mastery grows out of traumatic experience and could change over the life course. This study examined the within-person and between-person associations of mastery and cognitive function, and if these associations were moderated by age in the United States.MethodData were derived from three time points (2006–2008, 2010–2012, and 2014–2016) of the Health and Retirement Study, with 14,461 adults (aged 51 or above). Cognitive function was measured through a 27-point Telephone Interview Cognitive Screen (TICS). Mastery was measured by a modified Pearlin Mastery Scale. Multilevel modeling was employed to analyze the data.ResultsBoth within-person (β\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\beta$$\\end{document}=0.124, SE = 0.023, p < 0.001) and between-person (β\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\beta$$\\end{document}=0.089, SE = 0.029, p = 0.002) mastery were significantly associated with cognitive function. Older adults with higher between-person mastery tended to have slower cognitive decline (β\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\beta$$\\end{document}=0.063, SE = 0.021, p < 0.001). Moreover, age moderated the within-person (β\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\beta$$\\end{document}=0.013, SE = 0.003, p < 0.001) associations between mastery and cognition with a stronger association observed among individuals with older age.ConclusionsThe current study provides evidence for within-person and between-person associations between mastery and global cognition in the United States as well as the moderating role of age. The design of the current study did not directly assess the causal direction between mastery and cognitive function. Future studies could test the directionality of associations between mastery and cognitive function.

Post-Donation Regret and Anxiety Among Family Living Liver Donors: The Mediating Roles of Family Relationships and Sense of Mastery.

BACKGROUND Post-donation regret in family living liver donors can impact their mental well-being. This study examined whether the relationship between post-donation regret and anxiety is mediated by family relationships and a sense of mastery. MATERIAL AND METHODS We conducted a secondary analysis of de-identified cross-sectional data from a prior study that included 124 living liver donors. These donors underwent partial hepatectomy between January 2011 and March 2021 at a tertiary hospital in Seoul, South Korea. The data included demographic and clinical characteristics, along with the results from administering the following measures: the Post-Donation Regret Scale, Family Relationships Index, Pearlin Mastery Scale, and the Generalized Anxiety Disorder-2 scale. RESULTS Among family living liver donors, 5.6% had anxiety after donation. The total effect of post-donation regret on anxiety was significant (B=0.41, p<0.05). However, the direct effect of regret on anxiety was not significant (B=-0.05, p=0.733). Post-donation regret had indirect effects on anxiety, solely through family relationships (B=0.329, 95% CI=0.130, 0.563) and sequentially through family relationships and mastery (B=0.088, 95% CI=0.008, 0.232), even after controlling for sex, age, postoperative complications, years since donation, and recipient's death. In addition, postoperative complication was a predictor of anxiety (B=0.64, p<0.05). CONCLUSIONS Providing family-centered and mastery-enhancing interventions may help alleviate the anxiety of family living liver donors.

Fulfilled Mind, Healthy Gut? Relationships of Eudaimonic Psychological Well-Being With the Gut Microbiome in Postmenopausal Women.

Eudaimonic facets of psychological well-being (PWB), like purpose in life and sense of mastery, are associated with healthy aging. Variation in the gut microbiome may be one pathway by which mental health influences age-related health outcomes. However, associations between eudaimonic PWB and the gut microbiome are understudied. We examined whether purpose in life and sense of mastery, separately, were associated with features of the gut microbiome in older women. Participants were from the Mind-Body Study ( N = 206, mean age = 61 years), a substudy of the Nurses' Health Study II cohort. In 2013, participants completed the Life Engagement Test and the Pearlin Mastery Scale. Three months later, up to two pairs of stool samples were collected, 6 months apart. Covariates included sociodemographics, depression, health status, and health behaviors. Analyses examined associations of PWB with gut microbiome taxonomic diversity, overall community structure, and specific species/pathways. To account for multiple testing, statistical significance was established using Benjamini-Hochberg adjusted p values (i.e., q values ≤0.25). We found no evidence of an association between PWB and gut microbiome alpha diversity. In multivariate analysis, higher purpose levels were significantly associated with lower abundance of species previously linked with poorer health outcomes, notably Blautia hydrogenotrophica and Eubacterium ventriosum ( q values ≤0.25). No significant associations were found between PWB and metabolic pathways. These findings offer early evidence suggesting that eudaimonic PWB is linked with variation in the gut microbiome, and this might be one pathway by which PWB promotes healthy aging.

Senso de domínio de cuidadores de pessoas que vivem com demência: tradução e adaptação cultural da Pearlin Mastery Scale

ABSTRACT The sense of mastery is conceptualized as a positive aspect of care targeted at people living with dementia, a coping mechanism to reduce burden, and may represent a protective factor for caregivers’ mental and physical health. Objective: To translate and culturally adapt the Pearlin Mastery Scale for Brazil. Methods: A methodological study was conducted at the Federal University of São Carlos in which the initial translation stages were followed; synthesis; back-translation; review by the committee of judges by analyzing the Content Validity Index (CVI); and test of the pre-final version. Results: Two specialists translated the scale into Brazilian Portuguese and defined a consensus version with the researchers. Subsequently, another two specialists back-translated the consensus version, which was reviewed by three judges who are PhDs in the area, considering all scale items as very equivalent (CVI=1.0), and maintaining them in the pre-final version of the instrument. This was tested in a first group of caregivers for them to point out adjustments. The suggestions were accepted by modifying three items and, afterward, the scale was tested in a second group, which did not present difficulties answering the instrument. Conclusion: The Pearlin Mastery Scale was translated and culturally adapted for Brazil, showing equivalence. However, future psychometric analyses of the instrument are required to make it available for use in this population.

Digital peer-to-peer support programme for informal caregivers of people living with motor neuron disease: study protocol for a multi-centre parallel group, single-blinded (outcome assessor) randomised controlled superiority trial

BackgroundPeer support is effective in improving psychological well-being of family caregivers of people with conditions such as dementia, cancer, and brain injury. However, there are limited data on effective psychological interventions for family caregivers of people living with motor neurone disease. Our objective is to evaluate the efficacy of a virtual peer support programme for improving caregiver psychological wellbeing and caregiving related outcomes.MethodsWe will conduct a multi-centre parallel group randomised controlled superiority trial. Using a multi-modal recruitment strategy, we will recruit informal caregivers from UK MND clinics, in-patient units, and hospices. We will randomise (1:1, stratified by gender) participants to either a 12-week virtual peer support programme or usual care comprising provision of online information resources publicly available via the MND Association website. Peer support programme elements will be delivered via a secure digital e-platform aTouchAway™ (Aetonix, Canada). Our target sample size is 160 (80 each arm). Our primary outcome is the Hospital Anxiety and Depression Scale (HADS) assessed at 12 weeks (primary endpoint). Secondary outcomes that will also be assessed at 12 weeks include the Zarit Burden Interview, Pearlin Mastery Scale, Personal Gain Scale, Positive Affect Scale, and the Brief COPE. Outcome assessors will be blinded to allocation. Tertiary outcomes include perceived usability (1 item 9-point Likert scale) and acceptability (semi-structured qualitative interviews) of the peer support programme. Intervention fidelity measures will comprise frequency, type (text, audio, video), and duration (audio and video) of peer support contact downloaded from the aTouchAway AWS server. We will use a mixed-effects linear model to test the effect of the intervention on the primary outcome. Secondary outcomes will be analysed using linear regression. We have ethical approval (21/NW/0269) from the North-West Research Ethics Committee, UK.DiscussionThis single-blinded randomised controlled trial will determine the effect of a virtual peer support programme on caregiver psychological wellbeing and caregiver burden. This study will examine the impact of a virtual peer support intervention on quality-of-life measures in informal caregivers of individuals with MND living in the community.Trial registrationClinicalTrials.gov: NCT04695210

Preditores do Ajustamento na Aposentadoria: Estudo Comparativo Entre Ocupações

Abstract This research investigated differences in retirement adjustment among workers in occupations classified by the RIASEC typology. The literature reports that this adjustment varies depending on individual access to resources such as health, finances, and personal attributes. The participants were 469 retirees, 65% women, aged between 47 and 88 years, who responded to the Retirement Resources Inventory, the Pearlin Mastery Scale and reported demographic data. The analysis revealed that retirees from social and investigative occupations have more resources and greater adjustment in retirement. Retirees from realistic occupations revealed an unfavorable perspective. Mastery proved to be the most important predictor of adjustment. The results indicate that retirement adjustment resources vary among workers from different occupational types.

Longitudinal Association of Physical Activity, Mastery and Psychological Distress in Mid-Aged Adults over 9-Years.

Psychological distress is highly prevalent and associated with significant adverse health outcomes and economic burden. Mastery and physical activity are potential resources to reduce distress and promote wellbeing; however, previous research has not examined their potential interactive relationship over time. The purpose of this study was to explore associations between mastery, physical activity, and distress in mid-aged adults over nine years. Data from a longitudinal mail survey study including the Kessler 6, Pearlin Mastery Scale, and items assessing time spent in physical activity were examined in a sample of 4404 adults aged 40 to 54 years at baseline. Group-Based Trajectory Models identified two distinct trajectories of psychological distress (elevated and low). Generalized Estimating Equations were used to assess mastery and physical activity, adjusting for sociodemographic and health variables, as predictors for the probability of distress group membership. The odds of elevated distress over time were significantly reduced in people with higher mastery (OR = 0.13; 95% 0.11-0.15) and doing at least 150 min/week of physical activity (OR = 0.81; 95% 0.68-0.96). There was no significant interaction between mastery and physical activity. Mastery and physical activity may be important resources to mitigate distress and further research is needed to evaluate interventions promoting these resources and the impact on mid-aged adults experiencing psychological distress.

Housing and supportive services for substance use and self-efficacy among young mothers experiencing homelessness: A randomized controlled trial

AimsHomeless mothers with young children in their care contend with high rates of substance use and low self-efficacy. However, a limited number of studies have examined these outcomes associated with housing and supportive services. DesignParticipants were randomly assigned to: (1) housing + support services (n = 80), (2) housing-only (n = 80), or (3) services as usual (SAU) (n = 80) and were re-assessed at 3-, 6-, 9- and 12-months postbaseline. SettingsThe study recruited a community-based sample from homeless service agencies and advertisements in a large Midwestern city. ParticipantsThe study recruited two hundred forty (N = 240) women between the ages of 18 to 24 years, experiencing homelessness and with a substance use disorder (SUD) who also had a biological child under the age of 6 years in their care. MeasurementsWe measured frequency of alcohol and drug use using the Form 90 semi-structured interview, and self-efficacy using Pearlin and Schooler's (1978) 7-item Mastery Scale. FindingsOverall, mothers showed significant improvement in substance use and self-efficacy over time in each condition. However, as expected, patterns of change differentiated intervention groups with more mothers showing better substance use and self-efficacy outcomes in housing + supportive services than in SAU. Unexpectedly, more mothers in SAU showed better outcomes than those in housing-only. ConclusionsSubstance use decreased and self-efficacy increased over time, but patterns of change characterized the intervention groups. In particular, findings suggest that when providing housing to this population, supportive services should also be offered.

The interaction between depressive mood and mastery among men and women aged 55-years at baseline with a diagnosis of arterial hypertension: a 13-year follow-up study

Abstract Funding Acknowledgements Type of funding sources: None. Background Arterial hypertension is well-established risk factor which causes morbitity and premature mortality. Estonia has one the highest case rate of arterial hypertension among European countries. According to several scientific research the presence of arterial hypertension reduces health related quality of life (1) and causes higher level of depressive mood (2). Mastery is a self-belief which refers to the extent of which individual see himself/herself as being in control of the forces that importantly affect his/her live (3). A higher level of mastery is associated with lower level of depressive mood (3), higher level of quality of life among individuals with a diagnosis of chronic disease (1,4). Purpose The purpose of this study was to evaluate the interaction of quality of life, depressive mood and mastery among individuals with a diagnosis of hypertension compared individuals without a diagnosis of arterial hypertension. Methods 330 55-years-old participants from Estonia formed the sample basis in the second wave of the study. 44 participants passed away before the second wave. The initial sample size of the follow-up study was 286. In total, 219 subjects (46.6% of them were male) participated in the second wave. Arterial hypertension was defined as systolic blood pressure of ≥140 mm Hg, diastolic blood pressure of ≥90 mm Hg or use of antihypertensive medications. Study subjects with a diagnosis of arterial hypertension (I10, I11 by ICD-10) were divided into the group of hypertension (Group I, 52.9% of participants) and the rest participants into the group of non-hypertension (Group II). A self-reported questionnaire were used. The influence of psychosocial factors were assessed by Depression Model, Gothenburg Quality of Life Instrument, and personality traits by Pearlin Mastery Scale. Cronbach´s alpha was for the Depressive Model 0.72, Gothenburg Quality of Life Instrument 0.99, and the Pearlin Mastery Scale 0.77 in the second wave of this study. Results After 13 years, in the group I (study subjects with arterial hypertension) the total score of depressed mood score was higher (p&amp;lt;0.05), total score of quality of life was lower (p&amp;lt;0.05), and the level of mastery was lower (p&amp;lt;0.05) compared to the group II (Table 1). After adjustment for gender, age, marital status, and educational level, the linear regression analysis showed that the level of mastery and quality of life score were related to depressive mood (R Square = 0.101, F 3, 115 = 6.331, p&amp;lt;0.01) among individuals with a diagnosis of arterial hypertension. Conclusions Among 55-year-old men and women with diagnosis of arterial hypertension depressed mood was linked with mastery and quality of life score. Personal resource as mastery is, as a buffer, influencing individual responses to depressive mood. The study results are usable in clinical practise to understand the psychosocial background of the patient in order to achieve productive health intervention.

Mastery Is Associated With Weight Status, Food Intake, Snacking, and Eating Disorder Symptoms in the NutriNet-Santé Cohort Study.

Mastery is a psychological resource that is defined as the extent to which individuals perceive having control over important circumstances of their lives. Although mastery has been associated with various physical and psychological health outcomes, studies assessing its relationship with weight status and dietary behavior are lacking. The aim of this cross-sectional study was to assess the relationship between mastery and weight status, food intake, snacking, and eating disorder (ED) symptoms in the NutriNet-Santé cohort study. Mastery was measured with the Pearlin Mastery Scale (PMS) in 32,588 adults (77.45% female), the mean age was 50.04 (14.53) years. Height and weight were self-reported. Overall diet quality and food group consumption were evaluated with ≥3 self-reported 24-h dietary records (range: 3–27). Snacking was assessed with an ad-hoc question. ED symptoms were assessed with the Sick-Control-One-Fat-Food Questionnaire (SCOFF). Linear and logistic regression analyses were conducted to assess the relationship between mastery and weight status, food intake, snacking, and ED symptoms, controlling for sociodemographic and lifestyle characteristics. Females with a higher level of mastery were less likely to be underweight (OR: 0.88; 95%CI: 0.84, 0.93), overweight [OR: 0.94 (0.91, 0.97)], or obese [class I: OR: 0.86 (0.82, 0.90); class II: OR: 0.76 (0.71, 0.82); class III: OR: 0.77 (0.69, 0.86)]. Males with a higher level of mastery were less likely to be obese [class III: OR: 0.75 (0.57, 0.99)]. Mastery was associated with better diet quality overall, a higher consumption of fruit and vegetables, seafood, wholegrain foods, legumes, non-salted oleaginous fruits, and alcoholic beverages and with a lower consumption of meat and poultry, dairy products, sugary and fatty products, milk-based desserts, and sweetened beverages. Mastery was also associated with lower snacking frequency [OR: 0.89 (0.86, 0.91)] and less ED symptoms [OR: 0.73 (0.71, 0.75)]. As mastery was associated with favorable dietary behavior and weight status, targeting mastery might be a promising approach in promoting healthy behaviors.Clinical Trial Registry NumberNCT03335644 at Clinicaltrials.gov.

Undertaking specific stress-reducing activities are associated with reduced fatigue and depression, and increased mastery, in people with multiple sclerosis

BackgroundMultiple sclerosis is a demyelinating autoimmune disease, presenting with heterogenous symptoms that impact daily living. Undertaking stress-reducing activities may reduce symptoms including depression and fatigue, and enhance mastery, the sense of control of one's life. We assessed cross-sectional associations of undertaking stress-reducing activities or meditation on depression, fatigue, and mastery, and 5-year prospective relationships between meditation and these outcomes. MethodsData were extracted from the longitudinal Health Outcomes and Lifestyle In a Sample of people with Multiple sclerosis (HOLISM) study. Stress-reducing activities were categorised to relaxation, physical, mind-body, and spiritual. Meditation was analysed as a dichotomous term, and for duration and frequency of practice. Depression, fatigue, and mastery were assessed by Patient's Health Questionnaire-9, Fatigue Severity Scale, and Pearlin Mastery Scale, respectively. Associations with depression, fatigue and mastery were assessed by log-binomial regression. Models were adjusted for age, sex, symptoms due to relapse, socioeconomic status, employment status, and antidepressant and anti-fatigue medication use, as appropriate. ResultsCross-sectionally, physical and relaxation activities were associated with 40% and 33% lower frequencies of depression, respectively. Physical activities were additionally associated with 19% lower frequency of fatigue. Meditation was associated with 30% lower frequency of depression and 17% higher mastery. Prospectively, meditation was associated with 28% decreased depression, and 48% reduction of developing depression at 5-year follow-up. ConclusionPotential benefits of undertaking stress-reducing activities, or meditation, on depression, fatigue, and mastery are promising and should be further assessed prospectively. Meditation practice should be encouraged as a safe and inexpensive intervention for prevention of depression.

Psychometrics of the Pearlin Mastery Scale among Family Caregivers of Older Adults Who Require Assistance in Activities of Daily Living.

This study examined the psychometric properties of the seven-item mastery scale among 392 family caregivers of care dependent older adults in a tertiary hospital in Singapore. Item response theory (IRT) analysis and confirmatory factor analysis (CFA) were used to assess the scale’s psychometric properties. Construct validity was assessed based on correlations between mastery and caregiver burden, depression, and quality of life. Data from the seven-item mastery scale showed acceptable reliability and model fit while IRT analysis showed that response categories were ordered but reflected poor fit for the two positively worded items. Without these two items, responses on the five-item version showed acceptable model fit and had acceptable reliability and high correlation with those on the seven-item version. Item responses on both the seven- and five-item versions show logical correlations with carer self-report on burden, depression, and quality of life. Further psychometric studies of the seven-item mastery scale are warranted. For practical applications such as caregiver screening during hospital admissions, the five-item mastery scale is fit for purpose.

Relationship Between Cognitive Appraisal of Control and Cardiac Vagal Regulation During an Unsupported Ski Crossing of Greenland.

PurposeThe aim of the present study was to investigate the relationships between Perceived Control (PC) and Heart rate variability (HRV) during a 27-day expedition, during which an unsupported crossing was made from the west coast to the east coast of Greenland (across the Ice Sheet); and that therefore a high PC represents a favourable factor for recovery and stress management.MethodsFour subjects participated in the study. PC was measured on alternated days in the evening at the end of the day, using the Pearlin Mastery Scale; and the next day, upon waking, heart rate using a wrist heart rate monitor and a chest strap. Together with the PC, the perceived effort was measured through the CR-100 Borg scale and each subject was asked to indicate the most emotionally significant event of the day.Time and frequency domain indices for heart rate variability were calculated.ResultsSeveral correlations were observed between PC and HRV indices. In particular two indices in the time domain, standard deviation of all NN intervals (SDNN) (rrm = 0.51) and root mean square of successive (RMSSD) (rrm = 0.46), showed a significant and strong positive correlation.ConclusionThe existence of a positive correlation between PC and cardiac vagal regulation is of great interest to individuals immerged into extreme situations, because it can affect performance or prevents maladaptive states or injuries. To improve stress management, it could be convenient for members of extreme expeditions to adopt forms of cognitive training that modify their cognitive appraisal in order to raise their perception of control.

Taking care of older caregivers who lose control: The association between mastery and psychopathology

ObjectiveIn Europe there is a growing number of informal caregivers above 55 years of age, some of whom experience high levels of psychological distress. Our aim is to investigate the prevalence of psychological distress and its association with perceived mastery among elderly informal caregivers. MethodsIn a large representative random sample of citizens from four cities in the Netherlands, we compared psychological distress among older and younger informal caregivers. Next, we selected informal caregivers aged 55 years and older (n = 2663). Mastery was measured by means of the Pearlin Mastery Scale and psychological distress by means of the Kessler psychological distress scale (K10). We presented weighted percentages and conducted multivariate logistic regression analyses. ResultsThe prevalence of psychological distress was 41.9% among elderly informal caregivers, as opposed to 52.6% among younger informal caregivers. Among the older informal caregivers there was an association between insufficient sense of mastery and psychological distress (OR = 21.3; 95% CI = 12.8–35.5), which persisted after correction for covariates (OR = 4.9; 95% CI = 2.8–8.6). ConclusionThe association between insufficient sense of mastery and psychological distress in elderly caregivers is strong. Mastery should be considered a point of engagement for preventive interventions on caregiver distress.

The Transitions to Long-term In Home Ventilator Engagement Study (Transitions to LIVE): study protocol for a pragmatic randomized controlled trial

Background overview and rationaleWe co-developed a multi-component virtual care solution (TtLIVE) for the home mechanical ventilation (HMV) population using the aTouchAway™ platform (Aetonix). The TtLIVE intervention includes (1) virtual home visits; (2) customizable care plans; (3) clinical workflows that incorporate reminders, completion of symptom profiles, and tele-monitoring; and (4) digitally secure communication via messaging, audio, and video calls; (5) Resource library including print and audiovisual material.Objectives and brief methodsOur primary objective is to evaluate the TtLIVE intervention compared to a usual care control group using an eight-center, pragmatic, parallel-group single-blind (outcome assessors) randomized controlled trial. Eligible patients are children and adults newly transitioning to HMV in Ontario, Canada. Our target sample size is 440 participants (220 each arm). Our co-primary outcomes are a number of emergency department (ED) visits in the 12 months after randomization and change in family caregiver (FC) reported Pearlin Mastery Scale score from baseline to 12 months. Secondary outcomes also measured in the 12 months post randomization include healthcare utilization measured using a hybrid Ambulatory Home Care Record (AHCR-hybrid), FC burden using the Zarit Burden Interview, and health-related quality of life using the EQ-5D. In addition, we will conduct a cost-utility analysis over a 1-year time horizon and measure process outcomes including healthcare provider time using the Care Coordination Measurement Tool. We will use qualitative interviews in a subset of study participants to understand acceptability, barriers, and facilitators to the TtLIVE intervention. We will administer the Family Experiences with Care Coordination (FECC) to interview participants. We will use Poisson regression for a number of ED visits at 12 months. We will use linear regression for the Pearlin Mastery scale score at 12 months. We will adjust for the baseline score to estimate the effect of the intervention on the primary outcomes. Analysis of secondary outcomes will employ regression, causal, and linear mixed modeling. Primary analysis will follow intention-to-treat principles. We have Research Ethics Board approval from SickKids, Children’s Hospital Eastern Ontario, McMaster Children’s Hospital, Children’s Hospital-London Health Sciences, Sunnybrook Hospital, London Health Sciences, West Park Healthcare Centre, and Ottawa Hospital.DiscussionThis pragmatic randomized controlled single-blind trial will determine the effectiveness and cost-effectiveness of the TtLIVE virtual care solution compared to usual care while providing important data on patient and family experience, as well as process measures such as healthcare provider time to deliver the intervention.Trial registrationClinicalTrials.gov NCT04180722. Registered on November 27, 2019.

Greater mastery is associated with lower depression risk in a large international cohort of people with multiple sclerosis over 2.5 years

BackgroundMastery is the extent to which an individual perceives their life circumstances as being under their control and not predominantly influenced by external factors. The relationship of mastery with clinical outcomes in people with multiple sclerosis (pwMS) has not been well-researched. We assessed the relationships of mastery with fatigue, disability, relapse number, and depression risk among pwMS over 2.5 years’ follow-up.MethodsData from the Health Outcomes and Lifestyle in a Sample of people with Multiple sclerosis study, among 839 participants who completed the 2.5 and 5-year reviews, were analysed. Mastery was measured by the Pearlin Mastery Scale, fatigue by Fatigue Severity Scale, depression risk by Patient Health Questionnaire-9, and disability by Patient-Determined Disease Steps, and diagnosed relapse number in the previous 12 months was queried. Cross-sectional and prospective analyses were undertaken by log-binomial, log-multinomial, and Poisson regression, as appropriate, adjusted for relevant confounders.ResultsCross-sectionally, pwMS with the highest quartile mastery (> 25/28) had 90% lower frequency of depression risk, 60% lower frequency of clinically significant fatigue, and 77% fewer had severe disability, all largely robust to adjustment. Prospectively, those in the top two quartiles of mastery (> 21–25, > 25/28) had 66% and 74% lower subsequent depression risk, robust to adjustment. No significant associations were seen prospectively for change in fatigue, disability, or relapse number, however, and no robust associations of mastery with relapse number were evident.ConclusionsProspectively, a protective relationship of mastery with subsequent risk of depression was observed, suggesting this may be a point of intervention to improve wellbeing in pwMS.

Symptoms of depression, anxiety, and perceived mastery in older adults before and during the COVID-19 pandemic: Results from the Longitudinal Aging Study Amsterdam

ObjectiveGovernmental measures to protect older adults from COVID-19 are hypothesized to cause anxiety and depression. Previous studies are heterogeneous and showed small effects. This study aims to assess depressive and anxiety symptoms and perceived mastery just after the first wave of the COVID-19 pandemic compared to previous years in community-dwelling older adults and to identify potential risk groups according to the comprehensive geriatric assessment framework. MethodsData were used from 1068 Dutch older adults (aged 55–93 at baseline in 2011–2013) participating in the Longitudinal Aging Study Amsterdam, including 4 follow-ups spanning 9 years. Depressive symptoms, anxiety symptoms and feelings of mastery were assessed with the short Center for Epidemiologic Studies Depression scale (CES-D-10), the Hospital Anxiety Depression Scale - Anxiety subscale (HADS-A) and the Pearlin Mastery Scale. Linear mixed regression was used to compare outcomes in June-August 2020 to previous years and to examine predictors to identify risk groups. ResultsSlight increases in CES-D-10 (1.37, 95% Confidence interval [CI] 1.12;1.62), HADS-A (0.74, 95% CI 0.56;0.94) and mastery (1.10, 95% CI 0.88;1.31) occurred during the COVID year compared to previous years. Older adults with functional limitations or with frailty showed a smaller increase in feelings of mastery in the COVID-year. ConclusionOur results suggest limited mental health effects on older adults from the first COVID-19 wave. Older adults have perhaps better coping strategies than younger adults, or preventive measures did not have extensive consequences for the daily life of older adults. Further monitoring of depression, anxiety and perceived mastery is recommended.

Socioeconomic Inequalities in Mortality After Age 67: The Contribution of Psychological Factors.

Diverging trends of longer lives and increased inequalities in age-at-death invite to updated research on late-life mortality. Earlier studies have identified health behavior, childhood, psychosocial, and material conditions as key determinants of life expectancy, but the role of psychological factors remains a topic of debate. The current study is framed in a life course developmental perspective and assesses the mediating role of secondary control strategies (subjective age) and primary control capacity (perceived control) to socioeconomic (wealth and education) inequality in mortality after age 67. Data are derived from the second wave of the Norwegian Life Course, Ageing and Generation study (N=1,432 and age 67–85). All in all, 366 deaths were observed over a mean follow-up of 9.6years. Perceived control was measured by the Pearlin and Schooler Mastery Scale. SA was measured with proportional discrepancy scores in felt age and ideal age. Stepwise Cox proportional hazards regression analyses were conducted to analyze the relative contribution of SES (education and accumulated wealth), felt age, and ideal age discrepancies and perceived control on 11-year mortality. Findings show that lower levels of wealth and perceived control independently predict increased elderly mortality over an 11-year period. Feeling younger and smaller ideal age discrepancies are positively associated with perceived control, but do not account for additional variability in longevity among older adults. Findings add to the interdisciplinary field of socioeconomic inequalities in elderly mortality and underline the specific importance of structural conditions (wealth) and the continued importance of (perceived) primary control capacity for longevity also after age 67. Future research may assess in more detail how wealth and perceived control complement each other in contributing to healthy aging and longevity, for example, by longitudinal research including the role of significant life events in the second half of life in different welfare state contexts.

The Mediating Role of Psychological Distress in Excessive Gambling among Young People: A Four-Country Study.

Background and aims: Loneliness and a low sense of mastery are associated with excessive gambling, but the underlying processes of these relationships remain unstudied. Because psychological distress can increase vulnerability to excessive gambling, we investigated its mediating role in these relationships among young people. To meet the need for cross-country research, we also observed how these relationships occur in four countries with different cultures. Design, setting, and participants: Demographically balanced cross-sectional survey data were collected from 15–25-year-olds in Finland (n = 1200; 50% male), the United States (n = 1212; 49.8% male), South Korea (n = 1192; 49.6% male), and Spain (n = 1212; 51.2% male). Measurements: Excessive gambling was measured with the South Oaks Gambling Screen, psychological distress was assessed with the 12-item General Health Questionnaire, loneliness was measured with the three-item Loneliness Scale, and low sense of mastery was assessed with the Pearlin Mastery Scale. Associations were examined first using zero-inflated negative binomial regression analyses with excessive gambling as the outcome. In addition, path analyses were performed to study how loneliness and low sense of mastery relate to excessive gambling, with psychological distress as the mediating variable. Findings: Loneliness and low sense of mastery were associated indirectly with excessive gambling via psychological distress in all country samples. Low sense of mastery was also directly associated with excessive gambling. There was a direct association between loneliness and excessive gambling only in samples from South Korea and Spain. Conclusions: Psychological distress is an important factor in understanding how loneliness and sense of mastery relate to gambling.