Dimensions of Resilience and Their Predictive Utility Among Clients With Anxiety Disorders or Depressive Disorders: A Factor Analytic Study.

The Connor-Davidson Resilience Scale is a commonly used measure of resilience. However, while resilience is considered multidimensional, the specific dimensions embedded within this scale remain equivocal. The aim of this article was to contribute to this debate by analyzing responses from a large sample obtained within a mental health setting. Baseline data from 672 consecutive referrals to a publicly funded outpatient service for adults with anxiety and depression were subjected to exploratory factor analysis. Outcome data from 349 of these participants who had completed treatment were analyzed using confirmatory factor analysis. Both analytical strategies suggested that two dimensions were evident (Adaptability and Tenacity), although comparisons of Adaptability and Tenacity across sociodemographic, diagnostic, psychological distress, and functional impairment variables provided little support for their discriminability. The practical utility to mental health nurses of subcomponents of resilience remains clinically persuasive yet empirically elusive with current instrumentation.

A novel method for the translation and cross-cultural adaptation of health-related quality of life patient-reported outcome measurements.

BACKGROUND: This paper presents a novel methodology for translation and cross-cultural adaptation of health-related quality-of-life patient-reported outcome measures, incorporating the Delphi method. Specifically, we describe the process of translating the Pelvic Floor Distress Inventory-20 and Pelvic Floor Impact Questionnaire-7 from English to Norwegian using this method. METHODS: The multistep translation method combined the European Organization for Research and Treatment of Cancer Quality of Life guidelines, an Expert Panel review, and the Delphi method. It comprised two independent forward- and back-translations. While the bilingual pelvic floor Expert Panel ensured rigorous cross-checking and effective cross-cultural adaptation, the addition of the Delphi method (comprising the attributes of anonymity, controlled feedback, and statistical group response) further established consensus on translated items. OUTCOMES: The application of the Delphi method in the Expert Panel phase proved adequate in producing comprehensible intermediate Norwegian versions ready for pilot testing. The Expert Panel reviewed the comments made by patients completing the instruments and offered advice to allow final translated versions to be produced and tested for measurement properties. This iterative approach, internal logic, and anonymity between rounds improved the evaluations that the panel members provided, which in turn enhanced the final translated Patient Reported Outcome Measures (PROMs). CONCLUSIONS: To our knowledge, this work represents the first demonstration of the application of an Expert Panel review incorporating a Delphi method to assess health-related quality-of-life instruments. The controlled feedback approach, iterative nature, internal logic, and anonymity of the Delphi consensus method appeared to ensure a good cross-cultural adaptation of these PROMs.

Does Illness Behavior Contribute to the Understanding of Self-Efficacy and Quality of Life Among People With Hearing Loss? A Test of Concept.

PURPOSE: The study sought to first confirm the mediating role of self-efficacy (SE) in the link between hearing loss and reduced quality of life (QOL) and introduce the construct of illness behavior (IB) as a further correlate of self-reported QOL that may itself be mediated by SE. METHOD: Cross-sectional data were attained using a questionnaire that was completed by 61 adults with self-reported acquired hearing loss. RESULTS: Support was provided for low SE being a barrier to QOL, with hearing loss only predictive of emotional QOL when SE was an intermediary (mediating) variable. Cognitive and affective indices of IB also predicted QOL. Those participants with elevated emotional distress and, to a lesser extent, exaggerated concerns for their health, were found to have both lower SE and poorer QOL. CONCLUSIONS: Attempts to replicate these findings longitudinally and with larger and more diverse samples (e.g., congenital or illness-derived hearing loss) are encouraged. A more objective assessment of hearing loss may also reduce the potential for spurious associations that may arise from the use of self-reported data. Nevertheless, the analytical results provide encouragement for the continued consideration of IB in the evaluation of the well-being of individuals with hearing loss. It is proposed that IB could be a useful supplement to the study of motivation among this cohort, such as an addition to the commonly used Health Belief Model, to improve the predictive validity of appropriate health behaviors.

Predictive Validity of Resilience in the Treatment of Individuals With Anxiety and Depressive Disorders.

The current study sought to evaluate the predictive validity of resilience among individuals with anxiety and/or depressive disorders. Receiver operating characteristics were calculated for each of the 25-item and 10-item versions of the Connor-Davidson Resilience Scale, evaluated against psychological distress and treatment response, at screening and post-treatment. New referrals to an anxiety and related disorders clinic were recruited for this purpose (N = 672 at screening, N = 349 post-treatment). Robust cross-sectional associations between resilience and psychological distress and treatment response were noted and were strongest at post-treatment. However, the related sensitivity (63% to 66% at screening, 69% to 76% post-treatment), specificity (78% to 83% at screening, approximately 73% post-treatment), and areas under the curve (AUC; approximately 73% at screening, 78% to 82% post-treatment) were modest. Furthermore, there was minimal support for resilience as a predictor of recovery using the longitudinal data (sensitivity and specificity could not be determined, with AUC of approximately 68% for psychological distress and 56% for treatment response). Although a relatively large homogeneous sample was available for this study, analyses of specific diagnostic subgroups may offer valuable further insight. [Journal of Psychosocial Nursing and Mental Health Services, 59(7), 35-41.].

Pathways to psychological wellbeing for patients with bladder cancer and their partners-in-care.

PURPOSE: The goal of the current analyses was to describe pathways through which Psychological Wellbeing might be better understood for clinical participants with bladder cancer and their partners. This was achieved by applying Roy's Adaptation Model that provides a framework with which to understand responses to challenging circumstances that has proved useful in the study of a range of chronic conditions. METHODS: The sample comprised 119 patients with a diagnosis of bladder cancer, and 103 supportive partners. Participants completed a self-report questionnaire comprising the Bladder Cancer Index, Mini-Mental Adjustment to Cancer Scale, Psychosocial Adjustment to Illness Scale, and sociodemographic details. For each sample, structural equation modelling was used to determine goodness of fit, guided by Roy's Adaptation Model. RESULTS: For patients, increasing age and disease duration, the negative appraisal of health care, perceived poor functioning and elevated burden of disease provided pathways to Psychological Wellbeing. For partners, increasing age, being male, a negative health care experience, and perceived burden of disease were significant. However, for both groups a positive evaluation of family and social support was the key indicator of lower Psychological Wellbeing. CONCLUSIONS: The models presented describe a suite of issues that could inform a nursing model of care to enhance the experience of living with bladder cancer for both patients and their supportive partners.

Toward an Understanding of Patients' and Their Partners' Experiences of Bladder Cancer.

BACKGROUND: Bladder cancer is characterized by recurrence and progression, ongoing surveillance and treatment, adverse effects, and complications and is associated with chronic ill health that may compromise relationships, social activities, and employment. OBJECTIVE: The aim of this study was to gain an understanding of quality of life disruptions among both those diagnosed with bladder cancer and their supportive partners (spouses or other family members). INTERVENTIONS/METHODS: Couples were recruited from a tertiary care public hospital database. Nine heterosexual couples (married/de facto) and another comprising a clinical participant and her daughter-in-law were interviewed for approximately 60 minutes. Interviews were audio recorded and transcribed, with qualitative description used to gain an in-depth understanding of participants' experiences without previous agenda or knowledge, allowing their viewpoints to be summarized in everyday terms. RESULTS: Thematic analysis highlighted 4 themes: psychical responses, cognitive and emotional reactions, survival techniques and the importance of partner support and its assistance for clinical participants acceptance of, and adaptation to their bladder cancer, surveillance, and treatment protocols. CONCLUSION: A key finding was the value of a supportive partner in dealing with the effects of bladder cancer daily. From a health service perspective, the need for clear information provision and counseling/support to assist patient management was also evident. IMPLICATIONS FOR FUTURE PRACTICE: Health professionals need to appreciate the quality of life implications for patients and partners, thus understanding the needs of couples. Greater collaboration with and by health professionals who assist in care may allow couples to move more confidently toward adaptation to bladder cancer.

Medical student selection criteria and junior doctor workplace performance.

BACKGROUND: Medical school selection decisions have consequences beyond graduation. With generally low attrition rates, most medical students become junior doctors. Universities are therefore not just selecting students into a medical course; they are choosing the future medical workforce. Understanding the relationship between selection criteria and outcomes beyond the successful completion of a medical degree may inform approaches to student selection. METHODS: A retrospective data matching study was conducted involving 39 interns employed by a South Australian local health network in 2017 who had originally entered Flinders University's medical school through a graduate pathway. Student selection data were matched with internship workplace performance scores (measured by supervising consultants' reports across five clinical rotations using a standardised assessment). Correlational analyses then examined associations between these two sets of variables. RESULTS: An overall selection rank (equal thirds of weighted Grade Point Average from a prior degree, a panel interview, and a national selection test) was moderately associated with all performance measures, accounting for up to 25% of variance. Both weighted Grade Point Average and the interview had multiple and mostly moderate correlations with performance. An increasing number of years taken to complete the course was associated with poorer workplace performance across multiple outcome measures (moderate to strong negative associations with 31 to 62% of shared variance), as was age to a lesser extent (7 to 14%). The national selection test contributed a single and small relationship accounting for 5% of variance with one outcome measure. CONCLUSIONS: Selection into medicine is a critical assessment given that most students become doctors. This study found multiple associations between selection scores and junior doctor workplace performance measures in the internship year, with weighted Grade Point Average from a prior degree and an interview appearing more important than the national selection test. Future collaborative research should map desired workplace performance outcomes to initial student selection and explore the impact of changes to selection which focus on assessment of these domains. The association between slower course progression and poorer workplace performance should also be examined.

E-health: psychosocial challenges for South Australian rural mental health consumers.

INTRODUCTION: Rates of mental health issues are increasing, coupled with insufficient resources to provide appropriate support. This is a particular challenge for rural areas in Australia that face significant social inequities including a scarcity of health resources. E-health initiatives are often proposed to maximise the number of rural mental health consumers able to receive support. The Australian Government has prioritised e-health within the remit of the Australian Digital Health Agency and the National Digital Health Strategy. However, despite increasing interest in e-health in policy and practice settings, uptake has been underwhelming. This study investigated the factors affecting the likely engagement with the internet, both for general and e-health purposes, within the context of South Australian rural mental health consumers. The focus was on psychosocial predictors, which embraced intrinsic (motivation), as well as extrinsic factors concerning equity, such as income, occupation, education and geographic location. METHODS: Participants in this quantitative study included 208 mental health consumers in rural South Australia who had recently accessed a local health network mental health service. Data were sourced from the service's clinical management database and a questionnaire constructed for the study. The questionnaire included measures of personal characteristics, motives, equity and internet use. RESULTS: Motives and equity-related variables were directly linked to general internet use, which subsequently affected the likelihood of using the internet for health purposes. Intrinsic rather than extrinsic factors were the most significant drivers of internet use; that is, higher levels of general internet use were associated with being younger, having stronger motivation, greater trust, higher education, being employed, having a higher income and having home internet access. For health internet use, the identified significant associations were more modest and included only being younger, having stronger motivation, and greater trust. The model indicated that there were no direct predictors of internet use for health beyond use of the internet for general purposes. However, key study variables provided significant indirect paths to health internet use. General internet use was strongly influenced by motivation, and age and equity to a lesser extent. Motivation was influenced by trust, and age and equity, with trust also influenced by age and equity. CONCLUSION: This quantitative investigation sought to describe the barriers to and enablers of internet use generally, based on the assumption that before people will use the internet for health, they need to be prepared to use it for general purposes. The model proposed in the current research offers an indication of some of the factors that may influence rural mental health consumers' use of the internet for both general and health purposes. To appropriately design future e-health initiatives, the initial focus must be on consumers' individual capacity and willingness to use the internet generally. Policymakers and service providers are acutely interested in leveraging internet use to facilitate positive health outcomes. Understanding the factors that affect rural mental health consumers' use of the internet in general is beneficial in informing the efficient allocation of resources and the appropriate design of e-health initiatives to produce innovative solutions.

A pilot study: Can the UFOV assessment be used as a repeated measure to determine timing of on-road assessment in stroke?

BACKGROUND/AIMS: Useful Field of View scores are predictive of on-road performance post-stroke. No objective data exist to determine if the Useful Field of View (UFOV) assessment can be used as a repeated measure in the post-stroke population to determine timing of occupational therapy on-road assessment as recovery occurs. The aims of this study were to determine whether there is a practice effect if the UFOV is administered at one, two and three months' post-stroke and to assess optimal time post-stroke to refer to an on-road assessment. METHOD: Forty-two participants, 17 men (40.5%), with a mean age of 71 years (SD 9.33) were randomly allocated to 1. Assessment group - UFOV at one, two and three months' post-stroke, 2. Control group-UFOV at three months' post-stroke. Parametric and non-parametric tests were utilised depending on data distribution. RESULTS: No significance was found between; three months' subtest 1 (P = 0.463), three months' subtest 2 (P = 0.729) and three months' subtest 3 (P = 0.534) between the assessment and control groups. Both group's scores were combined to examine pass/fail rates of UFOV assessment to indicate timing of referral to on-road assessments. At one month, 16.9% stroke survivors passed the UFOV, when reassessed at three months 69.1% passed and 28.6% again failed. CONCLUSION: Improvements in scores at one month intervals over three months are due to improvements in abilities assessed by the UFOV as no practice effect was found to influence scores. UFOV scores performed at monthly intervals post-stroke can be used to guide the timing of an occupational therapy on-road assessment, with an increased likelihood of passing, as recovery occurs. This repeated use of the UFOV assessment can assist referral practices that best utilise driving rehabilitation programmes. Larger studies need to be conducted to confirm these results.

The Role of Negative Affect in the Assessment of Quality of Life among Women with Type 1 Diabetes Mellitus.

BACKGROUND: The purpose of this study is to determine the impact of negative affect (defined in terms of lack of optimism, depressogenic attributional style, and hopelessness depression) on the quality of life of women with type 1 diabetes mellitus. METHODS: Participants (n=177) completed either an online or paper questionnaire made available to members of Australian diabetes support groups. Measures of optimism, attributional style, hopelessness depression, disease-specific data, and diabetes-related quality of life were sought. Bivariate correlations informed the construction of a structural equation model. RESULTS: Participants were 36.3±11.3 years old, with a disease duration of 18.4±11.2 years. Age and recent glycosylated hemoglobin readings were significant contextual variables in the model. All bivariate associations involving the components of negative affect were as hypothesized. That is, poorer quality of life was associated with a greater depressogenic attributional style, higher hopelessness depression, and lower optimism. The structural equation model demonstrated significant direct effects of depressogenic attributional style and hopelessness depression on quality of life, while (lack of) optimism contributed to quality of life indirectly by way of these variables. CONCLUSION: The recognition of negative affect presentations among patients, and an understanding of its relevance to diabetes-related quality of life, is a valuable tool for the practitioner.

Patterns of 'Abnormal' Illness Behavior among Healthy Individuals.

OBJECTIVES: We extend the seminal work of Professor Issy Pilowsky by presenting a contemporary re-conceptualization of abnormal illness behavior (AIB) as a general psychological phenomenon evident among healthy community members. METHODS: Participants (N = 344) completed a self- report questionnaire comprising health information and well-validated psychological measures from the field of somatization (eg, AIB, attributional style for physical symptoms, cognitive distortion of somatic information, illness likelihood, maladaptive coping). RESULTS: Cluster analysis of illness behavior responses resulted in 3 unique groupings distinguished by key health and psychological variables. Cluster 1 reflected 'normal' responses, Cluster 2 'atypical' and Cluster 3 'maladaptive'. Cluster 3 may represent a personality attribute indicative of a general style of interpreting illness in a more extreme way (trait AIB) whereas Cluster 2 may reflect a transient response to a specific illness event (state AIB). CONCLUSIONS: The construct of 'abnormal' illness behavior may usefully be extended to include individual differences in responses regardless of current health status. Furthermore, the potential to further characterize illness behavior as either dispositional (trait) or situational (state) emerges as a fruitful area for future analyses. Specifically, longitudinal studies are recommended to determine the causal links between health events and illness behavior profiles.

Predicting wellbeing among people with epilepsy using illness cognitions.

OBJECTIVE: This study sought to examine the synergistic contribution of illness-related perceptions (stigma, severity, and threat) and illness behavior to wellbeing among people with epilepsy. Poorer wellbeing was expected among those who perceived greater stigma, illness severity, and threat and had more extreme illness behavior. METHODS: Individuals with a diagnosis of epilepsy (N=210), recruited through local and online support groups, completed a questionnaire comprising demographic and epilepsy-specific information, and validated measures of illness perceptions and behavior, epilepsy-related quality of life, and general psychological health. RESULTS: Bivariate associations among illness cognition, illness behavior, and wellbeing were all as expected. Structural equation modeling highlighted the strong, direct effect of illness threat on quality of life, with other contributions from perceived stigma and an abnormal illness behavior syndrome (i.e., maladaptive illness responses). Significant variance was accounted for in both quality of life (64%) and psychological health (34%). CONCLUSION: Preliminary evidence of the contributions of illness threat and maladaptive illness responses to wellbeing highlights the need for longitudinal research to examine the dynamic nature of such findings. Clinicians are encouraged to consider the potential value of screening for both illness threat and abnormal illness behavior to facilitate interventions.

Norwegian translation, and validation, of the Pelvic Floor Distress Inventory (PFDI-20) and the Pelvic Floor Impact Questionnaire (PFIQ-7).

INTRODUCTION AND HYPOTHESIS: The goal was to translate into Norwegian, and validate, short versions of the Pelvic Floor Distress Inventory (PFDI-20) and the Pelvic Floor Impact Questionnaire (PFIQ-7) using a sample of women with symptomatic pelvic organ prolapse and pelvic floor dysfunction. METHODS: Modified European Organization for Research and Treatment of Cancer Guidelines were used for translation and cultural adaptation. Of 212 eligible Norwegian women who consented to participate, 205 completed the questionnaires, of whom 50 were retested after 1 - 3 weeks, and 76 were tested 6 months after surgery. Reliability, validity and responsiveness were evaluated. Additionally, interpretability, the smallest detectable change, the standard error of measurement, floor and ceiling effects, and the percentages of missing items are reported. RESULTS: Reliability ranged from 0.66 to 0.93 and intraclass correlation coefficients from 0.85 to 0.94. Both construct validity and responsiveness were found to be adequate. The responsiveness of the PFDI-20 was further supported by areas under the curve above 0.70. Estimates were lower for the PFIQ-7. The smallest detectable changes at the individual level were 15 - 21 % and 17 - 27 % for the PFDI-20 and PFIQ-7, respectively. The absolute values of the minimal important changes in the total scores were 48 and 47, respectively. No floor or ceiling effects were evident in the distributions of the PFDI-20 and PFIQ-7 total scores. CONCLUSIONS: The translated questionnaires provided adequate reliability, validity and good responsiveness to change. These short versions of the PFDI and PFIQ are robust measuring instruments that will enable symptom severity and health-related quality of life to be evaluated in the Norwegian context.

Predicting success in medical school: a longitudinal study of common Australian student selection tools.

BACKGROUND: Medical student selection and assessment share an underlying high stakes context with the need for valid and reliable tools. This study examined the predictive validity of three tools commonly used in Australia: previous academic performance (Grade Point Average (GPA)), cognitive aptitude (a national admissions test), and non-academic qualities of prospective medical students (interview). METHODS: A four year retrospective cohort study was conducted at Flinders University Australia involving 382 graduate entry medical students first enrolled between 2006 and 2009. The main outcomes were academic and clinical performance measures and an indicator of unimpeded progress across the four years of the course. RESULTS: A combination of the selection criteria explained between 7.1 and 29.1 % of variance in performance depending on the outcome measure. Weighted GPA consistently predicted performance across all years of the course. The national admissions test was associated with performance in Years 1 and 2 (pre-clinical) and the interview with performance in Years 3 and 4 (clinical). Those students with higher GPAs were more likely to have unimpeded progress across the entire course (OR = 2.29, 95 % CI 1.57, 3.33). CONCLUSIONS: The continued use of multiple selection criteria to graduate entry medical courses is supported, with GPA remaining the single most consistent predictor of performance across all years of the course. The national admissions test is more valuable in the pre-clinical years, and the interview in the clinical years. Future selections research should develop the fledgling research base regarding the predictive validity of the Graduate Australian Medical School Admissions Test (GAMSAT), the algorithms for how individual tools are combined in selection, and further explore the usefulness of the unimpeded progress index.

Comparisons of the utility of researcher-defined and participant-defined successful ageing.

AIM: To investigate the impact of different approaches for measuring 'successful ageing', four alternative researcher and participant definitions were compared, including a novel measure informed by cluster analysis. Rates of successful ageing were explored, as were their relative associations with age and measures of successful adaptation, to assess construct validity. METHOD: Participants, aged over 65, were recruited from community-based organisations. Questionnaires (assessing successful ageing, lifestyle activities and selective optimisation with compensation) were completed by 317 individuals. RESULTS: Successful ageing ranged from 11.4% to 87.4%, with higher rates evident from participant definitions. Though dependent upon the definition, successful agers were typically younger, reported greater engagement with lifestyle activities and more frequent optimisation. CONCLUSIONS: While the current study suggested an improved classification algorithm using a common research definition, future research should explore how subjective and objective aspects of successful ageing may be combined to derive a measure relevant to policy and practice.

Appearance Investment, Quality of Life, and Metabolic Control Among Women with Type 1 Diabetes.

BACKGROUND: Concomitants of Type 1 diabetes management include weight gain and dietary restraint. Body image concerns, particularly among women, are therefore common. PURPOSE: The study evaluated associations between the appearance investment component of body image, age, quality of life and self-reported metabolic control were examined, along with the practice of insulin restriction as a weight control strategy. METHOD: A questionnaire comprising demographic and diabetes-related information, the Appearance Schemas Inventory, and Diabetes Quality of Life Brief Clinical Inventory was completed by Australian women diagnosed with type 1 diabetes (N = 177). RESULTS: Self-evaluative salience was higher among younger participants, those with a lower quality of life, and those with better metabolic control of their diabetes, with the relationships between metabolic control and all of age, quality of life, and self-evaluative salience noted to be non-linear. Among participants who reported restricting insulin for weight control, self-evaluative salience was particularly relevant. Motivational salience was not related to other study variables. CONCLUSION: Clinically, the provision of information regarding appearance changes that might arise in order to mitigate later body image difficulties is a potentially beneficial adjunct to standard diabetes management protocols that may lead to more successful disease adjustment.

Transition from the spouse dementia caregiver role: A change for the better?

One in 15 Australians over 65 experience dementia, and are commonly supported by spouses. Evidence demonstrates declining wellbeing for these caregivers as their role continues. There are indications of improvement once caregivers transition out of the role (recovery) but alternate suggestions that caregiving stress may be too damaging to be appeased (wear and tear). It seems plausible that reason for transition (care recipient's move into residential care or death) will affect caregivers' outcomes. A synthetic cohort method compared caregivers' stress and wellbeing prior to, and one and two years post-transition. There was evidence of wear and tear for physical wellbeing but recovery for psychological wellbeing over time; with little difference based on reason for transition. Caregiver outcomes seem to be a function of the action rather than the reason for transition, but factors such as age must be considered when designing methods to support post-transition wellbeing.

The relative contributions of function, perceived psychological burden and partner support to cognitive distress in bladder cancer.

OBJECTIVE: Bladder cancer is a genitourinary disease of increasing incidence. Despite improvements in treatment, outcomes remain equivocal with high recurrence rates. It is associated with poor psychosocial outcomes due to reduced functioning of the genitourinary system. The objective of these analyses was to query whether reported loss of function or the perception of psychological burden caused by this functional impedance was the key to understanding psychosocial outcomes. METHODS: The sample comprised 119 participants with a confirmed diagnosis of bladder cancer. They completed a self-report questionnaire comprising the Bladder Cancer Index, Mini-mental Adjustment to Cancer Scale, Psychosocial Adjustment to Illness Scale and standard sociodemographic details. Simple mediation and serial mediation were used to explore the potential for psychological burden to mediate associations between loss of function and cognitive distress, and the potential additional contribution of positive partner support on these relationships. Age and duration of cancer were considered as covariates. RESULTS: Simple mediation demonstrated that the association between function and cognitive distress was fully mediated by perceived psychological burden. Serial mediation, which allowed for the addition of partner support, again demonstrated full mediation, with partner support being the key predictive variable. CONCLUSIONS: These analyses emphasise the importance of an appreciation of individuals' interpretation of the burden occasioned by bladder cancer and the role of a supportive partner. The implications for management discussions and support services in alleviating negative psychological outcomes in bladder cancer are highlighted. Copyright © 2015 John Wiley & Sons, Ltd.

My mother told me: the roles of maternal messages, body image, and disordered eating in maladaptive exercise.

PURPOSE: The current study examined the relevance of familial environment (negative maternal messages) to the phenomenon of maladaptive (obligatory) exercise, defined as exercise fixation. Weight/shape concerns and exercise frequency were examined as potential mediators, evaluated both with and without eating disorder symptoms as a covariate. METHOD: Self-report data comprising sociodemographic details and measures of parental weight messages, body image, obligatory exercise, and disordered eating symptoms were completed by 298 young female attendees of health and fitness centres. RESULTS: The frequency of negative maternal messages demonstrated significant associations with all of weight/shape concerns, exercise frequency, exercise fixation, and eating disorder symptoms. In the initial model, partial mediation of maternal messages to exercise fixation was evident as negative maternal messages continued to have a direct effect on exercise fixation. In the second model, with the inclusion of eating disorder symptoms as a covariate, this direct effect was maintained while mediation was no longer evident. CONCLUSIONS: The data provide further support for the association between disordered eating symptoms and maladaptive exercise, as defined by exercise fixation. Nevertheless, the importance of negative maternal messages as a key environmental enabler of exercise fixation has been demonstrated, even after the effects of weight/shape concerns and exercise frequency were accounted for. Clinically, addressing weight-related talk in the family home may reduce the incidence of problematic cognitions and behaviours associated with both maladaptive exercise and disordered eating symptoms.