Symptom Rating Test Research Articles

Comparison of stress and coping mechanisms among family members of patients abusing licit and illicit substances

Introduction Addiction has long been recognized as a disease that may have a dramatic influence on the addicted individual’s family members, manifesting as stress or trauma-related physical and psychological symptoms, resulting in increase in the usual family’s use of health-care services. There is little research available to identify and explore problems of families associated with such patients. In this study, we will evaluate stress among family members of substance abuse patients and try to focus on how these family members are dealing with these stress factors. The study will also compare different types of coping mechanisms among family members of patients taking licit and illicit substances.ObjectivesTo identify stress among families of patients abusing licit and illicit drugs and assess and compare their coping mechanisms.Methods 175 family members of patients with licit substance abuse cases and 175 family members of patients with illicit substance abuse were taken for study after informed consent. Stress among participants was evaluated using Symptom Rating Test and The Depression Anxiety and Stress Scales (DASS). Coping Questionnaire (CQ) and Breif COPE was used to assess coping among them.Results The study demonstrated that the total number and severity of symptoms, including psychological and physical symptoms, are found lesser in caregivers (participants) of patients abusing licit substances than in patients abusing illicit drugs. These symptoms among family members grow as the patient’s age rises. Symptoms in participants are more if their patient is female as compared to male. And also, total symptoms are more if they are living in nuclear family (Table 1). In our results, total coping and engaged coping mechanisms in family members are found to be not significant as per drug type and remains the same for both licit and illicit drugs abusing patients’ families. Avoidant coping mechanisms in family members are more if their patient is female and in nuclear family. Table 1symp1CoefficientsStd. Err.P Valueage0.005*0.0010.000drug_type-0.114*0.0270.000female_d0.230*0.0280.000nuclear_d0.124*0.0270.000ConclusionsIn our study, it was clearly noticed that the total symptoms, both physical and psychological, were found more in family members of patients abusing illicit drugs. Impact of substance abuse related problems is found more in female members compared to male members of family.Disclosure of InterestNone Declared

Supporting addiction affected families effectively: a feasibility randomised controlled trial of a psychosocial intervention delivered by lay counsellors in Goa, India.

Despite evidence of the burden of alcohol use on families, there is a lack of adequate and targeted support. We aimed to examine the feasibility, acceptability and impact of Supporting Addiction Affected Families Effectively (SAFE), a brief lay counsellor-delivered intervention for affected family members (AFMs). Parallel arm feasibility randomised controlled trial [1:1 allocation to SAFE or enhanced usual care (EUC)]. The primary outcome was mean difference in symptom score assessed by the Symptom Rating Test and secondary outcomes were difference in coping, impact and social support scores measured by the Coping Questionnaire, Family Member Impact Questionnaire, and Alcohol, Drugs and the Family Social Support Scale. Process data examining feasibility and acceptability were also collected. The primary analysis was intention to treat at the 3-month endpoint. In total, 115 AFMs were referred to the trial, and 101 (87.8%) consenting participants were randomised to the two arms (51 SAFE arm and 50 EUC arm). Seventy-eight per cent completed treatment, with the mean number of sessions being 4.25 sessions and mean duration being 53 min. Ninety-five per cent completed outcome assessment. There were no statistically significant differences between SAFE and EUC on any of the outcome measures, except for the between-group adjusted mean differences for social support scores (AMD -6.05, 95% CI -10.98 to -1.12, p = 0.02). Our work indicates that it is possible to identify AFMs through community networking, and have high rates of participation for lay counsellor-delivered psychosocial care. Nevertheless, there is a need for further intervention development to ensure its contextual relevance and appropriateness.

A study of stress, coping and strain among family members living with individuals with substance use disorder in India

Background and aims: Living with a patient with substance use disorder imposes its own stresses and strain, and individuals use their own coping methods to deal with this stress. The Stress Strain Coping Support (SSCS) model has been developed to understand how certain coping styles mediate stress and strain. This study aimed to assess the applicability of the SSCS model in India.Methods: The family members of patients with alcohol and/or opioid dependence were evaluated using Family Member Impact (FMI) scale for stress, the Symptom Rating Test (SRT) for strain, the Coping Questionnaire (CQ) for coping and the Hopefulness–Hopelessness (HOPE) scale. Multiple linear regression and hierarchical linear analysis were used to assess the effect of stress on strain.Results: Thirty eight out of 89 recruited relatives were females. The mean total scores on FMI was 38.9 (±8.5), SRT was 26.5 (±12.8), CQ was 64.4 (±13.5) and HOPE was 34.0 (±5.4). Hierarchical linear regression suggested add-on effect on coping in explaining the relationship of stress and strain.Conclusion: The study presents observations of SSCS model in India, and suggests that the types of coping that leads to experience of strain might be different in this setting.

Validation of the Italian Version of the Cognitive Distortion Scale as a Measure of Cognitive Bias in a Non-clinical Sample

The Cognitive Distortions Scale is a reliable scale assessing cognitive distortions as defined by Beck and Burns. The present study tested the psychometric properties (i.e., internal consistency, factor structure, homogeneity, concurrent, convergent, and discriminant validity) of the Italian version of the CDS in a non-clinical sample. One-hundred subjects, aged between 18 and 64 years, were recruited from the general population of Florence (Italy) and assessed via the Symptom Rating Test, the State-Trait Anxiety Inventory (STAI—form Y), the Anxiety Sensitivity Index 3, the Personal Need for Structure, the White Bear Suppression Inventory, and the Stroop Color and Word Test, Short Version. Internal consistency of the CDS was tested via the Cronbach’s alpha coefficient, the factor structure was analyzed via the principal component analysis, homogeneity was tested via the Mokken analysis, concurrent, convergent, discriminant validity was examined via Spearman correlations. The CDS showed a one-factor structure, satisfactory homogeneity for all items (ranging from 0.43 to 0.57) and total score (0.50), excellent internal consistency (Cronbach’s α = 0.96), statistically significant concurrent, convergent, and discriminant validity. The Italian version of the CDS showed good psychometric properties, similarly to the original English version.

Measuring stress, coping, strain and hopefulness of Brazilian family members of substance misusers: Factor structure of a set of measures

ABSTRACTObjectives: We evaluated the psychometric properties of the Brazilian version of a set of measures designed to assess four psychological constructs associated with having a substance misusing relative in the family: the Family Member Impact (FMI), the Symptom Rating Test (SRT), the Coping Questionnaire (COPE) Hopefulness-hopelessness scale (HOPE). Methods: Secondary data from 3056 affected family members (AFMs) was analyzed. Factor structure of the measures and group invariance across gender were assessed using confirmatory factor analysis. Results: The Brazilian version of COPE showed that a four-factor model with 24 items fit the data better than the original three-factor model with 30 items. The FMI measure showed that a three-factor model is more appropriated to the Brazilian version of the scale than the original two-factor model. HOPE and SRT (29 items) Brazilian’s version had the same two-factor model structure. This set of measures presented full measurement and structural invariance for both male and female. Conclusions: Findings provide support for the structural validity of the Brazilian version of a set of standard measures for the assessment of stress, coping, strain and hopefulness of AFMs by their relatives’ substance misuse. As this is the first study to explore the factorial model of the measures, it provides further support for the use of these instruments for future studies aiming to explore means on supporting AFMs in Brazil and elsewhere.

12-Month follow-up after brief interventions in primary care for family members affected by the substance misuse problem of a close relative

Following the publication of initial and 3-month data from a prospective cluster randomised comparative trial [Copello, A., Templeton, L., Orford, J., Velleman, R., Patel, A., Moore, L., … , Godfrey, C. (2009). The relative efficacy of two levels of a primary care intervention for family members affected by the addiction problem of a close relative: A randomised trial. Addiction, 104, 49–58.], an opportunistic 12-month follow-up was undertaken. The trial compared two brief interventions for use by primary health care professionals with family members (FMs) affected by the problematic substance use of a close relative. Ninety out of 143 (63%) FMs in the trial were followed up at 12 months. Three validated self-completion questionnaires were re-administered: Symptom Rating Test, Coping Questionnaire and Family Member Impact Scale. At 12 months there were still no significant differences between FMs depending on which of the two brief interventions received. The initial improvements at 12 weeks on all of the measures (symptoms, coping and impact) were maintained, and further improved (FMs reported that their symptoms, their coping behaviours and the impact on them of their relatives’ substance misuse problem all continued to reduce). These improvements were unrelated to a range of demographic variables. FMs also reported a gradual improvement in their relatives’ misusing behaviour over the three time periods. In conclusion, following a brief intervention for affected FMs, either delivered in full via professional intervention or via a self-help manual following a brief introduction from a professional, both groups improve equally; there are significant and positive changes which are both maintained and further increased over a 12-month period, without any further formal delivery of the intervention.

Italian families living with relatives with alcohol or drugs problems

Purpose: To examine the overall impact of alcohol and drug problems on a sample of Italian family members.Sample: 113 family members affected by and concerned about the problem drinking or drug-taking of close relatives recruited from the North (N = 37), the Centre (N = 26) and the South (N = 50) of Italy.Measurements: Family Member Impact scale (FMI), Symptom Rating Test (SRT), Coping Questionnaire (CQ) and Hopefulness–Hopelessness scale (HOPE).Findings: There is a high level of impact on family members; the greater the impact, the higher the symptom levels; and the greater both the impact and symptoms are, the more types of coping behaviour are used. Multiple regression showed that the most important variables relating to overall symptom levels reported by family members were total coping, gender and impact. These data lend further support to the Stress-Strain-Coping-Support model (Orford et al., 2005a, b).

The relative efficacy of two levels of a primary care intervention for family members affected by the addiction problem of a close relative: a randomized trial

A randomized trial to compare two levels of an intervention (full versus brief) for use by primary health-care professionals with family members affected by the problematic drug or alcohol use of a close relative. A prospective cluster randomized comparative trial of the two interventions. A total of 136 primary care practices in two study areas within the West Midlands and the South West regions of England. A total of 143 family members affected by the alcohol or drug problem of a relative were recruited into the study by primary health-care professionals. All recruited family members were seen on at least one occasion by the professional delivering the intervention and 129 (90 %) were followed-up at 12 weeks. Two validated and standardized self-completion questionnaires measuring physical and psychological symptoms of stress (Symptom Rating Test) and behavioural coping (Coping Questionnaire) experienced by the family members. It was predicted that the full intervention would show increased reduction in both symptoms and coping when compared to the brief intervention. The primary analysis adjusted for clustering, baseline symptoms and stratifying variables (location and professional group) showed that there were no significant differences between the two trial arms. The symptom score at follow-up was 0.23 [95% confidence interval (CI): -3.65, +4.06] higher in the full intervention arm than in the brief intervention arm, and the coping score at follow-up was 0.12 (95% CI: -5.12, +5.36) higher in the full intervention arm than in the brief intervention arm. A well-constructed self-help manual delivered by a primary care professional may be as effective for family members as several face-to-face sessions with the professional.

Nicotine dependence, psychological distress and personality traits as possible predictors of smoking cessation. Results of a double-blind study with nicotine patch

Aim Nicotine replacement therapy (NRT) is an effective treatment for smokers who want to quit, however, the rates of successful quitting can be improved even more. In this context, nicotine dependence (assessed via the Fagerström Tolerance Questionnaire, FTQ), psychological distress (measured via the Symptom Rating Test, SRT), and personality traits (evaluated via the Adult Eysenck Personality Inventory, AEPI) were evaluated as possible predictors of smoking cessation. Results A total of 297 cigarette smokers were followed for one year as part of a NRT double-blind, parallel group, randomized trial. Baseline nicotine dependence (weeks 12 and 26: p < 0.05), AEPI neuroticism (weeks 12 and 52: p < 0.05), and AEPI psychoticism (weeks 12 and 52: p < 0.05) scores significantly influenced the outcome of smoking cessation during one-year of follow-up. An increase in psychological distress during follow-up was associated with a lower probability of quitting smoking ( p = 0.000). Conclusions Nicotine dependence, neuroticism, psychoticism and, over time, psychological distress were the main factors influencing the long-term outcome (i.e., up to 12 months) of smoking cessation under NRT.

Personality characteristics and quality of life in patients treated for Cushing's syndrome

Psychological distress does not always disappear upon proper endocrine treatment of Cushing's syndrome, and quality of life may still be compromised. Little is known on the personality correlates that may be involved. The aim of this study was to provide a controlled assessment of personality characteristics and quality of life in patients successfully treated for Cushing's syndrome. A single-centred, controlled, prospective study. Twenty-four consecutive outpatients who were in remission upon proper treatment of Cushing's syndrome for at least 1 year and no more than 3 years (20 with pituitary-dependent Cushing's disease and four with a cortisol-secreting adrenal adenoma; 5 M/19 F; mean age 34.5, SD = 10.6; range 18-57 years) were compared with 24 healthy control subjects matched for sociodemographic variables. Both patients and controls were administered two self-rating scales: (a) tridimensional personality questionnaire (TPQ), a 100-item inventory that yields three scales: novelty seeking, harm avoidance and reward dependence. (b) symptom rating test (SRT), a 46-item scale for assessing psychological distress and quality of life with six subscales (anxiety, depression, somatic symptoms, anger-hostility, cognitive symptoms, psychotic symptoms). There were no significant differences in personality dimensions, as measured by the TPQ, between patients and controls. The results did not change when the four patients with an adrenal adenoma were excluded and only the 20 with pituitary-dependent Cushing's disease were considered. As to the SRT scale, patients with Cushing's syndrome displayed significantly higher scores in anxiety (P= 0.046), depression (P= 0.013), and psychotic symptoms (P= 0.006), with a generalized compromised quality of life (P= 0.02). Again, no differences were found in evaluating the 20 patients with Cushing's disease separately. Even though personality traits other than those explored here may be involved, the results seem to exclude the presence of latent dysfunctional attitudes and beliefs contributing to long-standing psychological disturbances, even in the pituitary-dependent form of Cushing's syndrome. Data from larger populations might provide further insight in this field. The findings of a compromised quality of life are in agreement with the recent literature and have implications for the long-term management of patients.

Coping with a problem drinker: A therapeutic intervention for the partners of problem drinkers, in their own right

Aims: To describe the development and preliminary evaluation of an intervention for partners of problem drinkers in their own right.Design: A series of case studies (n = 15 partners, all women) leading to the development of guidelines for an intervention. A before‐and‐after study of the intervention offered to partners (n = 50, all but three women) by the first author and volunteer counsellors, with follow‐up to six months plus comparison with a small waiting list group and partial follow‐up to 12 months.Measures: Main outcome measure: Symptom Rating Test (SRT). Additional measures: Short Coping Questionnaire (SCQ: sacrificing and engaged coping); Self‐esteem (SE); Independence (IND); Drinking Related Behaviour (DRB); and Outcome for the Problem Drinker (OPD).Results: There were significant changes from initial assessment to three month follow‐up, and between three and six month follow‐up, in the case of SRT and SCQ sacrificing coping. In addition there were initial to three months changes on SE and IND, and three to six months changes for SCQ engaged coping. The small waiting list comparison suggested that changes in SRT and sacrificing coping occurred after the start of the intervention, and the partial 12 month follow‐up suggested that changes could be maintained. Most partners had sought help in order to try to change their relatives' drinking. Those who had sought help principally for themselves were more likely to have experienced violence, were more likely to have partners whose drinking was episodic and were more likely to drop out of treatment.Conclusion: The present study demonstrates the possibility of delivering an effective intervention for partners of problem drinkers in their own right.

Family members of relatives with alcohol, drug and gambling problems: a set of standardized questionnaires for assessing stress, coping and strain

To describe a set of standard questionnaire measures for the assessment of the needs of family members of relatives with alcohol, drug or gambling problems, and to present evidence of their reliability and validity from a series of related studies. Includes cross-sectional and repeated-measurement studies. Family members affected by and concerned about the problem drinking or drug-taking of close relatives in treatment and non-treatment samples in the United Kingdom (white and Sikh) and Mexico City; family members of untreated heavy drinkers; and family members of problem gamblers. Four measures derived from a stress-strain-coping-support model of alcohol, drugs and gambling problems and the family: Family Member Impact scale (FMI), Symptom Rating Test (SRT), Coping Questionnaire (CQ), and Hopefulness-Hopelessness scale (HOPE). FMI, SRT and CQ assess stress, strain and coping, respectively. The exact role of HOPE in the model remains to be determined. The support component remains unmeasured. Results from a number of studies support the internal reliability, discriminant and construct validity and sensitivity to change of the SRT and its two constituent scales (psychological and physical symptoms) and at least two subscales of the CQ (engaged and tolerant-inactive coping). Although showing evidence of satisfactory reliability and some evidence of discriminant validity, further work may be required on the CQ withdrawal coping subscale. Evidence suggests that the FMI is reliable and valid and may have a factor structure that will support future research (distinguishing worrying behaviour from active disturbance). HOPE is a new measure showing promising characteristics. A set of standard measures is available for helping to assess the needs of concerned and affected family members, derived from an explicit model of the family in relation to excessive drinking, drug taking or gambling. It may have a role to play in correcting the current neglect of the needs of such family members, estimated to be in the region of nearly a million adults in Britain alone.

Assessing mother‐to‐infant attachment: the Italian adaptation of a self‐report questionnaire

The mother‐to‐infant relationship is usually assessed by behavioural observation. In order to evaluate mothers' emotional and cognitive response to their infants, Condon and Corkindale [(1998) The assessment of parent‐to‐infant attachment: development of a self‐report questionnaire instrument, Journal of Reproductive and Infant Psychology, 16, 57–76] have developed a self‐administered questionnaire. The aim of the present study is the Italian validation of the scale. The questionnaire contains 19 items each rated on a 5‐point scale. A sample of women with infants between 2 and 4 months of age were recruited at two postnatal wards in Genoa (Italy). Construct validity was assessed by administering two additional questionnaires: the Symptom Rating Test by Kellner and Sheffield and the Early Infancy Temperament Questionnaire by Medoff‐Cooper, Carey and Mc Devitt. A total of 210 women were evaluated. The distribution of scores tended to be skewed towards higher attachment scores and the range was 59 to 95. The mean of the total scale was 81.5 (SD=6.5) and Cronbach's alpha was 0.77. Attachment scores were negatively correlated with all the Symptom Rating Test subscales (r between −0.23 and −0.37; p<0.01). Mothers of children with difficult temperament had lower attachment scores (t=−2.780; p<0.01). Factor analysis revealed six factors which accounted for 57% of the variance. The psychometric properties of the Italian version of the scale were similar to those of the original version. The three‐factor structure found by Condon and Corkindale was not confirmed in the Italian version. The scores on the scale relate to other variables in a way that is consistent with attachment literature.

Psychological group support attenuates distress of waiting in couples scheduled for assisted reproduction

The aim of the study is to determine whether a cognitive-behavioral group treatment could lead to a decrease of psychological distress in couples waiting for assisted reproduction. Fifty consecutive couples included in the waiting list for IVF-ET or ICSI were randomly allocated either to receive Cognitive-Behavioral Treatment (CBT Group) or just waiting (Observation Group). The group is formed by 8-10 couples; 12 meetings are provided for a period of 4 months. Two psychometric test have been administered (Symptom Rating Test and Westbrook Coping Scales) at baseline and after 4 months. At baseline, females showed a higher level of SRT than males (F = 16.6 ± 14.1; M = 10.2 ± 9.0; <emph type="7">p</emph> = 0.01). This became evident for anxiety (F = 5.6 ± 4.9; M = 3.3 ± 3.0, <emph type="7">p</emph> = 0.004), somatization (F = 3.0 ± 2.5; M = 1.8 ± 2.1, <emph type="7">p</emph> = 0.01) and feelings of inadequacy (F = 3.9 ± 3.7; M = 2.3 ± 2.7, <emph type="7">p</emph> = 0.01). After 4 months in the males of Observation Group (from 2.3 ± 2.0 to 4.0 ± 2.8, <emph type="7">p</emph> = 0.01) there was an increase of the level of anxiety. No other meaningful differences in other variables were found. In females of CBT Group a trend towards a significant decrease in the total value of psychological uneasiness (the SRT) (from 17.7 ± 13.7 to 14.1 ± 14.0, <emph type="7">p</emph> = 0.07) was found. A long wait before the scheduled intervention of assisted reproduction increased anxiety levels, namely in male partners. CBT avoids such a 'waiting stress' and could be useful for stimulating discussion and awareness inside the couple. Shortening the waiting list and psychological support would be provided by infertility centres

Effect of long-term local or systemic hormone replacement therapy on post-menopausal mood disturbances.: Influences of socio-economic and personality factors

Objectives: To clarify the effect exerted by hormone replacement therapy (HRT) versus socio-economic and personality factors in improving postmenopausal mood disorders. Study design: The effect of the 1-year administration of systemic hormone replacement therapy (HRT; n=22) or a vaginal cream of estriol ( n=14) versus no treatment ( n=26) was evaluated on mood states of anxiety, depression, somatization and inadequacy, as evaluated by the symptom rating test (SRT) scale. Results were correlated with the woman socio-economic status, and her capability to cope with daytime distresses, as evaluated by the Coping Style questionnaire. Results: A spontaneous decline of all SRT scores, except that of inadequacy, was observed in the group with no treatment. In comparison HRT induced a greater improvement of only the SRT score of inadequacy ( P<0.01) and to a lesser extent of anxiety ( P<0.06). Similarly, vaginal estriol induced a greater decline of the SRT score of inadequacy ( P<0.01). Multiple regression analysis showed that modifications of the total SRT score and the SRT score of anxiety were related mainly to socio-economic factors, while those of the SRT score of depression were related only to the coping style of the woman. The decline of somatization was related only to time since the menopause while, the reduction of the SRT score of inadequacy was only the consequence of therapy, either systemic or local. Conclusions: In a 1-year period improvement of post-menopausal psychological discomfort, is spontaneous and independent of therapy. Only symptoms of inadequacy are improved by the hormonal therapy. Likely, the perceived menopausal `losses' make the woman to feel inadequate and the use of sex-related hormones is capable to improve this feeling.

Hormonal treatment and psychological function during the menopausal transition: An evaluation of the effects of conjugated estrogens/cyclic medroxyprogesterone acetate

Objective To investigate the effect of hormone treatment on psychosocial distress of women during the menopausal transition (aged 40-52 years, still menstruating and with minor symptoms), in a study carefully designed to reduce bias and placebo effect.Methods The study was randomized, controlled by placebo, blinded to the subject, investigators and biostatistician, crossed-over after 6 months, and evaluated by a 77-item questionnaire every month for 12 months. The medication tested was continuous conjugated estrogens (Premarin®) and cyclic medroxyprogesterone acetate (Provera®).Results Of an eligible 105 apparently healthy women, recruited by advertisement, 83 completed the questionnaires for the study. Randomization was successful. While there was a substantial variation over time in the change of scores for all the psychosocial outcomes, there was no significant difference between active and placebo treatment when order of treatment allocation was ignored. However, a strong and consistent effect of the order of treatment allocation for many of the scores was found; in particular, the effect of active treatment was substantially stronger when it was administered second. Positive effects of active treatment were found for the score for the overall symptom rating test (p < 0. 009) and its components of depression and feeling of inadequacy (p = 0. 011; p = 0. 001, respectively).Conclusions The use of hormones, given as a continuous estrogen and cyclic progestogen formulation after a formal calibration/run-in period, may have a beneficial effect on psychosocial distress experienced by women towards the end of their reproductive function.

Fluvoxamine, placebo, and cognitive behaviour therapy used alone and in combination in the treatment of panic disorder and agoraphobia

One hundred and ninety patients meeting DSM-III-R criteria for panic disorder with or without agoraphobia were randomly allocated to (a) Fluvoxamine, (b) placebo, (c) Fluvoxamine + cognitive behaviour therapy, (d) placebo + cognitive behaviour therapy, or (e) cognitive behaviour therapy alone. Patients were treated over 13 weeks and all participated in nine sessions plus follow-up at 6 months. Numbers in each group were as follows—(a) Fluvoxamine: entered n = 36, completed n = 29, attended follow-up n = 23; (b) placebo: entered n = 37, completed n = 28, attended follow-up n = 21; (c) Fluvoxamine + cognitive behaviour therapy: entered n = 38, completed n = 29, attended follow-up n = 24; (d) placebo + cognitive behaviour therapy: entered n = 36, completed n = 33, attended follow-up n = 30; (e) cognitive behaviour therapy: entered n = 43, completed n = 30, attended follow-up n = 28. A balance across treatments for therapist contact was attempted. A fixed-dose medication regimen was used with patients taking 150mg Fluvoxamine per day. A range of process and outcome measures both therapist- and patient-rated was used. Outcome at treatment end point and at 6-month follow-up was assessed in terms of both statistical and clinical significance and revealed that all active treatments showed improvement over time. This improvement was better preserved over follow-up in those groups receiving cognitive behaviour therapy (Groups c, d, and e) with these groups showing larger proportions of patients continuing to achieve predetermined criteria of clinically significant change on the Hamilton Anxiety Scale, Kellner and Sheffield Symptom Rating Test, and the Fear Questionnaire-Agoraphobia Scale at 6-month follow-up than those of the medication-alone groups (Groups a and b). The largest and most consistent treatment gains were evidenced by the cognitive behaviour therapy (Group e) and the Fluvoxamine + cognitive behaviour therapy (Group c) groups, with the latter showing these gains 2 weeks earlier in treatment, at Day 28 rather than Day 42.

A study of symptom distress, health locus of control, and coping resources of aging post-polio survivors.

Nearly one-half of the estimated 1.63 million American patients who survived the polio epidemics of the 1940s and 1950s are re-experiencing symptoms of the acute illness. This exploratory study of 125 aging post-polio survivors examined the differences of symptom distress, health locus of control, and coping resources for survivors who had and those who had not incurred a chronic physical disability following the acute phase of poliomyelitis. The Symptom Rating Test, the Multidimensional Health Locus of Control Scale, and the Coping Resources Inventory were used. No significant differences were found between disability groups concerning symptom distress, health locus of control, or coping resources. However, significant negative correlations were found between coping resources and both the quantity and severity of symptom distress. The differences found between perceived health locus of control and both coping resources and symptom distress were marginally significant.

Quality-of-life instruments in hypertension.

This review considers the choice of dimensions to be assessed and the practical problems of measuring quality of life in hypertensive patients. The dimensions of symptomatic well-being, psychological well-being, sleep, sexual function and cognitive function should be assessed. Symptomatic well-being may be measured by many different instruments, and that devised by the authors has been used extensively. The results in different trials may therefore be examined for consistency and sensitivity. Psychological well-being has been assessed by the Psychological General Well-Being Index, the Symptom Rating Test and the Profile of Mood States. The response of these instruments is discussed. The assessment of sleep, sexual function and cognitive function is also described. It is recommended that quality-of-life instruments to be employed in trials of antihypertensive drugs are known to be sensitive to the effects of such drugs.

A comparison of three quality of life instruments in subjects with angina pectoris: the sickness impact profile, the Nottingham health Profile, and the quality of well being scale

Three instruments for the assessment of quality of life, the Quality of Well Being index (QWB), the Nottingham Health Profile (NHP) and the Sickness Impact Profile (SIP) were assessed in 59 patients with angina pectoris. The NHP showed increased statistically significant impairment with higher New York Heart Association (NYHA) class in 4 out of 6 subscales but not in single responses to questions on daily life. In the SIP 9 out of 11 dimensions increased with NYHA grade as did the physical and psychooocial subscores and the total score. There were statistically significant increases in six of the eleven dimensions. In the QWB an increase was observed only for two out of four categories employed in this instrument. The QWB was the most difficult to administer and thought likely to be insensitive to changes in anginal pain. There was a high level of agreement in similar dimensions of NHP and SIP. A psychological distress score was evaluated using the Symptom Rating Test and correlated with all summary dimensions of both instruments. The coefficients of variation were lower in SIP than in NHP categories. In conclusion quality of life instruments like NHP and SIP may be able to identify treatment effects in angina patients and so yield a useful addition to the traditional measures employed for the assessment of their condition.