The association between dispositional optimism and mental health problems among disaster victims and a comparison group: a prospective study.

BACKGROUND: It is unclear whether the associations between the level of dispositional optimism on the one hand, and depression symptoms and other health problems on the other hand among disaster victims differ from the associations among non-affected residents. METHODS: To assess the associations between the level of dispositional optimism and health problems among disaster victims and non-affected residents, data of the longitudinal Enschede Fireworks Disaster Study was analyzed. Participants in the present study consisted of adult native Dutch victims of the disaster (N=662) and a non-affected comparison group (N=526). Both groups participated 18 months (T1) and almost four years post-disaster (T2). Multivariate logistic regression analyses were applied to examine the association between optimism and health problems among both groups. RESULTS: Results showed that pessimistic victims were more at risk for severe depression symptoms and obsessive-compulsive symptoms than optimistic victims when controlling for demographic characteristics, life events, smoking, and existing health problems at T1. However, pessimistic participants in the comparison group were also more at risk for severe anxiety symptoms, sleeping problems, somatic problems, and problems in social functioning than optimistic control participants. LIMITATIONS: We had no information on dispositional optimism before 18 months post-disaster. CONCLUSIONS: Pessimists at baseline are more at risk for health problems after 27 months than optimists. However, among non-affected residents pessimism is a stronger independent risk factor than among victims. Results suggest that professional helpers such as general practitioners, psychologists and psychiatrists should not rely too much on optimistic views of disaster victims.

Does optimism affect symptom report in chronic disease? What are its consequences for self-care behaviour and physical functioning?

OBJECTIVE: The aim of the present study was to examine whether optimistic chronically ill patients [50 multiple sclerosis (MS) patients and 65 Type 1 diabetes mellitus (IDDM) patients] overestimate their health status by decreased symptom report, and to what extent such an optimistic interpretation of health status affects self-care behaviour and physical functioning. METHOD: Hierarchical regression analyses were employed to determine the relationship of three concepts of optimistic beliefs (positive outcome expectancies, positive efficacy expectancies and unrealistic optimism) with symptom report, controlling for objective measures of health status; and whether this relationship was mediated by negative affectivity or denial. Hierarchical regression analyses were also employed to assess the impact of optimistic beliefs on self-care behaviour and physical functioning 6 months later. RESULTS: Optimistic beliefs did not affect symptom report with the exception of positive outcome expectancies relating to decreased fatigue report in IDDM patients, a relationship that was mediated by decreased negative affectivity. In addition, positive efficacy expectancies contributed to more self-care behaviours in both MS and IDDM patients. CONCLUSION: Optimistic chronically ill patients do not tend to have a biased perception of their health status, and positive efficacy expectancies appear to encourage self-care behaviour 6 months later.

Optimism and adaptation to chronic disease: The role of optimism in relation to self-care options of type 1 diabetes mellitus, rheumatoid arthritis and multiple sclerosis.

OBJECTIVES: To determine the role of optimistic beliefs in adaptation processes of three chronic diseases different in controllability by self-care. It was expected that optimism towards the future would relate to adaptation independently of the controllability of disease. Optimism regarding one's coping ability should be beneficial in controllable diseases. Unrealistic optimism was expected to be beneficial in uncontrollable disease. DESIGN: The cross-sectional design involved 104 patients with type 1 diabetes, 95 patients with rheumatoid arthritis and 98 patients with multiple sclerosis, recruited via their physician at the out-patient department of five hospitals. METHOD: Confirmatory Factor Analysis (LISREL) was employed to confirm a three-dimensional approach of optimism: outcome expectancies, efficacy expectancies and unrealistic thinking. Multi-sample analysis by path modelling was used to examine whether the relationship of the three optimistic beliefs with coping (CISS-21), depression and anxiety (HADS), and physical functioning (SF-36) differs with the controllability based on the self-care options of chronic disease. RESULTS: These show that when chronic disease must be controlled by self-care, physical health depends more strongly on positive efficacy expectancies. In contrast, when self-care options for controlling chronic disease are limited, physical health depends more strongly on positive unrealistic thinking and relates negatively to positive efficacy expectancies. The impact of the three optimistic beliefs on mental health is independent of the controllability by self-care. CONCLUSION: Optimistic beliefs are differently beneficial for physical health dependent on the controllability of chronic disease. Unrealistic beliefs are helpful when patients are confronted with moderately to largely uncontrollable disease where self-care options are limited, in contrast to positive efficacy expectancies that are helpful when patients deal with largely controllable disease where self-care is required.