Exploration of how valued living relates to resilience among people with spinal cord injury.

PURPOSE/OBJECTIVE: We lack critical information regarding promoting resilience in people with spinal cord injury (SCI). Living according to one's values may increase resilience. The aims of this study were to: (a) determine whether the degree to which individuals with SCI are living according to their values is associated with resilience; (b) identify values endorsed as most important; and (c) examine whether the importance of these values differs significantly by high vs. low resilience. RESEARCH DESIGN: Individuals with SCI (N = 202, Mage = 47.32) completed an online survey. Two linear regression analyses were performed to evaluate the extent to which domains of valued living (measured using the Valuing Questionnaire [VQ] and its subdomains, progress and obstruction, and the Valued Living Questionnaire [VLQ]) were associated with resilience. To explore whether resilience was associated with ratings of the perceived importance of specific types of values, we identified the top 10 most important values endorsed in the sample and performed independent sample t tests to analyze whether high (top quartile) versus low (bottom quartile) resilience groups differed on their importance ratings of specific types of values. RESULTS: Successful pursuit of values (VQ-progress) positively predicted resilience (B = 0.67, p < .001) while barriers in pursuit of values (VQ-obstruction) negatively predicted resilience (B = -0.16, p < .05). The VLQ score (living according to particular values) positively predicted resilience (B = 0.18, p < .001). Participants with high resilience levels rated the following values as significantly more important relative to those low in resilience: caring, respect, compassion, gratitude, responsibility, and contribution. CONCLUSIONS: Individuals with SCI who are able to pursue their values with intention had higher levels of resilience. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Psychometric Properties of the Spinal Cord Injury-Quality of Life (SCI-QOL) Resilience Short Form in a Sample With Spinal Cord Injury.

OBJECTIVE: To explore the psychometric properties (eg, data distribution characteristics, convergent or discriminant validity, internal consistency reliability) of the Spinal Cord Injury-Quality of Life measurement system (SCI-QOL) Resilience 8-item short form (SF) in comparison to the criterion standard resilience measure, Connor Davidson Resilience Scale (CD-RISC) in a sample of individuals with spinal cord injury (SCI). DESIGN: Descriptive statistics were calculated to examine variable data distribution characteristics. Correlation analyses were conducted for convergent and discriminant validity. Reliability statistics were calculated for resilience and other validity measures. SETTING: General community. PARTICIPANTS: Individuals with SCI (N=202; 51.5% male, 48% female). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Patient-Reported Outcomes Measurement Information System measures (depression, anxiety, ability to participate in social roles and activities, pain intensity, fatigue, sleep disturbance), SCI-QOL short forms (SF) (resilience, positive affect and well-being, mobility), CD-RISC, National Institutes of Health Toolbox for Assessment of Neurological and Behavioral Function - perceived stress (NIH Toolbox-perceived stress), and the Satisfaction with Life Scale were administered. RESULTS: The mean and SD for the SCI-QOL Resilience SF (mean=48.60; SD=8.20) approximated the normative mean (mean=50, SD=10). The SCI-QOL Resilience SF scores were essentially normally distributed though somewhat kurtotic, with skew=-0.17 and excess kurtosis=1.4; internal consistency reliability was good (Cronbach's alpha=0.89). Convergent validity was supported by significant moderate correlations in expected directions between the SCI-QOL Resilience SF and measures of CD-RISC resilience, depressive symptoms, anxiety, social participation, positive affect and well-being, stress, and satisfaction with life. Discriminant validity was supported by small non-significant correlations between the SCI-QOL Resilience SF and age, sex, injury level, time since injury, pain intensity, mobility, sleep disturbance, and fatigue. CONCLUSION: The SCI-QOL Resilience SF demonstrated good convergent and discriminant validity. Our study showed that the SCI-QOL Resilience SF is a psychometrically valid tool that can reliably estimate levels of resilience in the SCI population.

Temporal associations between use of psychoactive substances and somatic symptoms in the daily lives of people with fibromyalgia.

OBJECTIVE: Consumption of psychoactive substances-alcohol, nicotine, caffeine, opioids, and cannabis-is common among people with fibromyalgia. Associations between the use of substances and somatic symptoms could reflect efforts to cope with symptoms, aggravation or alleviation of symptoms after the use of substances, or a combination of these. To date, no study has provided insight into temporal associations between the consumption of psychoactive substances and fluctuations in somatic symptoms. We explored whether changes in ratings of pain and fatigue (mental and physical) predicted the later use of psychoactive substances or vice versa (substance use predicting later change in symptoms). DESIGN: Micro-longitudinal design. SETTING/SUBJECTS: Fifty adults (88% female, 86% White, mean age of 44.9 years) with fibromyalgia. METHODS: Participants completed ecological momentary assessments of substance use, pain intensity, and physical/mental fatigue 5 times per day for 8 days. RESULTS: Results of multilevel models indicated that momentary increases in fatigue showed a consistent association with greater odds of later use of psychoactive substances, whereas momentary increases in pain were related to lower odds of later cannabis and nicotine use and higher odds of later alcohol use. Only nicotine use predicted later mental fatigue. CONCLUSION: Findings highlight the importance of individualized interventions for symptom management or problems related to the use of psychoactive substances. We observed that although somatic symptoms predicted later use of substances, use of substances did not show appreciable effects with regard to alleviating somatic symptoms in people with fibromyalgia.

The Affiliate Stigma Scale: Psychometric refinement and validation of a short form in Turkish spinal cord injury/disorder caregivers.

BACKGROUND: Despite the widespread international use of the Affiliate Stigma Scale in the context of disability, much research on its psychometric properties has taken dubious statistical approaches. OBJECTIVE: The aim of this study was to examine the psychometric properties of the Affiliate Stigma Scale in a sample of Turkish spinal cord injury/disorder (SCI/D) caregivers. METHODS: Participants completed the Affiliate Stigma Scale, Zarit Burden Interview, and Generalized Anxiety Disorder-7. This study conducted a series of confirmatory factor analyses (CFAs) of the Turkish Affiliate Stigma Scale using its originally theorized 3-factor structure and a 1-factor structure, as well as an exploratory factor analysis (EFA) to refine the scale items to create a short form, with a final CFA of the items in the short form. RESULTS: The 3-factor and 1-factor CFAs of the 22 items from the Affiliate Stigma Scale suggested poor fit to the data across every fit index. An EFA yielded four factors, although the patterns of item loading onto the factors did not map in any discernible way to the original subscales theorized by the scale creators. A 1-factor CFA with the six items loading onto factor 1 of the EFA showed much better fit indices, with most achieving good or adequate fit. CONCLUSION: The current study supports a 1-factor solution with a short form comprised of six items, at least in Turkish and with SCI/D caregivers.

Coping as a Moderator of Associations Between Symptoms and Functional and Affective Outcomes in the Daily Lives of Individuals With Multiple Sclerosis.

BACKGROUND: Pain and fatigue are highly prevalent in multiple sclerosis (MS) and are associated with adverse physical, social, and psychological outcomes. There is a critical need to identify modifiable factors that can reduce the impact of these symptoms on daily life. PURPOSE: This study examined the moderating role of dispositional coping in the relationships between daily fluctuations (i.e., deviations from a person's usual level) in pain and fatigue and same-day functional/affective outcomes. METHODS: Adults with MS (N = 102) completed a self-report measure of dispositional coping (Brief COPE), followed by 7 days of ecological momentary assessment of pain and fatigue and end-of-day diaries assessing same-day pain interference, fatigue impact, social participation, upper extremity and lower extremity functioning, depressive symptoms, and positive affect and well-being (PAWB). Multilevel models tested interactions between daily symptom fluctuations and dispositional coping (avoidant/approach) in predicting same-day outcomes. RESULTS: Higher approach coping mitigated the same-day association between pain and pain interference, whereas higher avoidant coping augmented this association. Daily PAWB benefits were seen for those who reported high approach coping and low avoidant coping; effects were only observed on days of low pain (for approach coping) and low fatigue (for avoidant coping). Avoidant coping was associated with worse fatigue impact, social participation, lower extremity functioning, and depressive symptoms. CONCLUSIONS: When faced with pain and fatigue, avoidant coping is associated with increased, and approach coping with decreased, functional/affective difficulties in the daily lives of individuals with MS. Altering coping strategy use may reduce the impact of pain and fatigue.

People with multiple sclerosis (MS) commonly experience fluctuations in pain and fatigue severity. These fluctuations correspond with changes in physical, social, and psychological functioning. It is thus important to identify ways of reducing the impact of MS symptom exacerbations on daily functioning, such as by modifying individuals' use of coping strategies. We tested whether the relationships between fluctuations in pain/fatigue severity and same-day functioning in MS differ based on coping tendencies. Individuals with MS completed a questionnaire about how they generally cope with stress. They also provided ratings of their pain and fatigue severity 5 times daily for 7 days using a wrist-worn electronic diary, and they completed end-of-day questionnaires about their same-day functioning and emotional health. The results showed that coping tendencies influence the relationships between fluctuations in symptom severity and same-day pain interference and positive emotions/moods and well-being. Specifically, avoidant coping, like disengagement and denial, was related to worse outcomes, whereas approach coping, like problem-solving and seeking social support, was associated with better outcomes. These findings suggest that reducing frequency of avoidant coping and fostering use of approach coping strategies related to pain and fatigue might reduce the impact of these symptoms on functioning and quality of life in MS.

Psychometric investigation of the affiliate stigma scale in Mexican Parkinson's disease caregivers: Development of a short form.

BACKGROUND: Parkinson's disease (PD) caregivers, particularly in Latin America, may experience high levels of affiliate stigma due to their association with a person having a disability. The most common measure used of this construct in the literature, the Affiliate Stigma Scale, was validated using non-standard and questionable methods. OBJECTIVE: The purpose of this study was to investigate the factor structure and psychometric properties of the Spanish version of the Affiliate Stigma Scale with PD caregivers in Mexico using more widely accepted psychometric approaches including confirmatory and exploratory factor analyses (CFAs, EFAs). METHODS: A sample of 148 PD caregivers from Mexico completed this measure, as well as indices of caregiver burden and anxiety. RESULTS: Initial CFAs revealed that the data did not fit either the originally proposed one-factor or three-factor structures. An EFA was then conducted which was unable to discern any factor structure. Upon instituting a stepwise removal alpha-if-item-deleted process, a 5-item Affiliate Stigma Scale Spanish Short Form was retained with an adequate Cronbach's alpha, good convergent validity, and a Short Form CFA generally indicating adequate fit. CONCLUSIONS: The new Spanish Affiliate Stigma Scale Short Form holds promise for more appropriately measuring affiliate stigma likely in general but particularly in Spanish and among PD caregivers. The Short Form can assist not only in assessing levels of caregiver affiliate stigma, but in creating novel interventions to help support caregivers and decrease stigma.

Active or passive pain coping: Which predicts daily physical and psychosocial functioning in people with chronic pain and spinal cord injury?

PURPOSE/OBJECTIVE: Despite medical and psychotherapeutic treatments, chronic pain is one of the most challenging and disabling conditions for individuals with spinal cord injury (SCI). A growing body of research has demonstrated that pain coping strategies are effective for the adjustment of pain. However, we still lack an understanding of how passive pain coping and active pain coping relate to daily physical and psychosocial functioning for people with chronic pain and SCI. The current study used end-of-day (EOD) diary data to examine associations of passive and active pain coping with same-day independence, positive affect and well-being, social participation, pain catastrophizing, depressive symptoms, and pain interference in adults with chronic pain and SCI. RESEARCH METHOD/DESIGN: This observational study in N = 124 individuals with SCI (mean age = 47.53 years; 74.2% male, 25.8% female) used a combination of baseline surveys and seven consecutive days of end-of-day (EOD) diaries. RESULTS: Results of multilevel modeling showed that, beyond the effects of key demographic variables, clinical variables (e.g., time since injury, mobility) and daily pain intensity, increased daily passive coping (from that person's average) related to increased same-day depressive symptoms (B = .29; p < .001), pain catastrophizing (B = .28; p < .001) and decreased same-day positive affect and well-being (B = -.31; p = .02). Increased daily active coping was related to higher same-day catastrophizing (B = .09; p < .05). CONCLUSIONS/IMPLICATIONS: Behavioral interventions for pain often emphasize adoption and practice of new active coping strategies. Findings highlight the potential importance of also addressing passive coping strategies in services of improvement in physical and psychosocial outcomes in individuals with chronic pain and SCI. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Pain, mental health, life satisfaction, and understanding from others in veterans with spinal cord injury.

PURPOSE/OBJECTIVE: This study evaluated the relationships among pain, mental health symptom severity, life satisfaction, and understanding from others in veterans with spinal cord injury (SCI). RESEARCH METHOD/DESIGN: A sample of 221 individuals with SCI were interviewed by a psychologist during their annual evaluation in a Veterans Affairs medical center in an urban Mid-Atlantic region. Participants completed single-item, Likert-scale measures of life satisfaction (McGuire Health Impact on Participation [M-HIP]), pain severity (M-HIP), and understanding of others (from a modified Appraisals of DisAbility Primary and Secondary Scale-Short Form [ADAPSS-sf]), along with the Patient Health Questionnaire-4 (PHQ-4), a measure of mental health symptom severity. RESULTS: In linear regression models, pain (ß = .29, p < .001) and understanding from others (ß = -.28, p < .001) were significantly associated with mental health symptom severity with a marginally significant interaction effect (ß = -.32, p = .099). Pain (ß = -.33, p < .001) and understanding from others (ß = .32, p < .001) were also significantly associated with life satisfaction; however, there was no significant interaction (ß = .22, p = .234). CONCLUSION/IMPLICATIONS: This study showed that understanding from others and pain are important factors related to mental health and life satisfaction for veterans with SCI and highlights interventions targeting these relations. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Psychometric properties of the spinal cord injury-quality of life (SCI-QOL) Resilience item bank in a sample with spinal cord injury and chronic pain.

PURPOSE: To describe the psychometric properties (e.g., data distribution characteristics, convergent/discriminant validity, internal consistency reliability, and test administration characteristics) of the spinal cord injury quality of life measurement system (SCI-QOL) Resilience item bank delivered as a computer adaptive test (CAT) in a sample of individuals with chronic pain and spinal cord injury (SCI). METHODS: Descriptive statistics were calculated to investigate variable data distribution characteristics. Correlation analyses were conducted for convergent and discriminant validity. Item response theory-derived reliability was calculated for the SCI-QOL Resilience CAT. RESULT: One hundred thirty-three adults with SCI (N = 133; 73.5% male, 26.5% female) were enrolled. Sample mean T score on the SCI-QOL Resilience measure was 48.40, SD = 8.60 (min = 29.4; max = 70.0). The CAT administered between 4 (most common, 41.4% of cases) and 12 (9% of cases) items with the Mean#items = 5.73, SD = 2.45. The SCI-QOL Resilience CAT scores were normally distributed, with very low ceiling (0%) and floor (3%) effects. The SCI-QOL Resilience CAT had a reliability of 0.89, and the mean length of time for respondents to complete the SCI-QOL Resilience CAT was 44.34 s. SCI-QOL Resilience CAT validity was supported by significant moderate correlations with pain acceptance, depressive symptoms, pain catastrophizing, positive affect and well-being, and pain interference (convergent validity) and small non-significant correlations with age, sex, injury level, pain intensity, mobility level, and years since injury (discriminant validity). CONCLUSION: The SCI-QOL Resilience CAT demonstrated good convergent and discriminant validity. The CAT administration characteristics were impressive: With few items (low response burden), the scale achieved good reliability.

How Do Fluctuations in Pain, Fatigue, Anxiety, Depressed Mood, and Perceived Cognitive Function Relate to Same-Day Social Participation in Individuals With Spinal Cord Injury?

OBJECTIVE: This study aimed to examine same-day associations of pain, fatigue, depressed mood, anxiety, and perceived cognitive function with social participation in the daily lives of adults with spinal cord injury (SCI). DESIGN: Observational study used a combination of baseline surveys and 7 end-of-day (EOD) diaries. SETTING: General community. PARTICIPANTS: Individuals with SCI (N=168; mean age, 49.8y; 63% male, 37% female). MAIN OUTCOME MEASURES: Patient-Reported Outcomes Measurement Information System short form measures (Ability to Participate in Social Roles and Activities, Pain Intensity, Depression, Anxiety, Cognitive Function Abilities) were adapted for daily administrations as EOD diaries. RESULT: Results of multivariable model showed that daily increases in fatigue (B=-0.10; P=.004) and depressive symptoms (B=-0.25; P=<.001) and decreases in perceived cognitive function (B=0.11; P=<.001) were significantly related to worse same-day social participation. Daily fluctuations in anxiety and pain were unrelated to same-day social participation. CONCLUSIONS: This is the first study that shows within-person associations of common SCI symptoms with social participation in the daily lives of adults with SCI. Results from the current study may help to develop more effective individualized treatments of symptoms and symptom effect aimed at improving social participation.

Suicidal ideation after acute traumatic brain injury: A longitudinal actor-partner interdependence model of patients and caregivers in Latin America.

PURPOSE/OBJECTIVE: Traumatic brain injury (TBI) is associated with depression, anxiety, and even suicidality in individuals with TBI and in caregivers. Moreover, emotional functioning in individuals with TBI is linked with caregiver functioning. However, no known studies to date have examined linkages in suicidal ideation in individuals with TBI and family caregivers. This is especially important in Latin America, where TBI rates are high, and where cultural norms influence family caregiving. This study examined associations among self-reported suicidal ideation in individuals with TBI and their primary caregivers over time in Mexico and Colombia. Research Method/Design: A total of 109 individuals and their primary caregivers completed measures during hospitalization for TBI and at 2- and 4-months posthospitalization. The primary outcome was Item 9 from the Spanish version of the Patient Health Questionnaire-9, assessing for thoughts of death or suicide in the previous 2 weeks. RESULTS: Patients and caregivers reported high levels of suicidal ideation (18.3%-22.4% and 12.4%-15.7%, respectively) at each time point, and suicidal ideation at one time point strongly predicted ideation at the next. When patients endorsed suicidal ideation in the hospital, their caregivers tended to endorse suicidal ideation 2 months later. Although unaccounted for variables could be driving these relationships, they may also provide possible evidence of causal preponderance between patient and caregiver suicidal ideation post-TBI. CONCLUSIONS/IMPLICATIONS: Clinicians and rehabilitation specialists can use these findings to inform suicide risk assessment by expanding these practices to caregivers of patients who endorsed suicidal ideation. Interventions after TBI should incorporate caregivers given this study showed significant interdependence of suicidality between patients and caregivers. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Spinal Cord Injury/Disorder Function, Affiliate Stigma, and Caregiver Burden in Turkey.

BACKGROUND: The association among spinal cord injury and disorder (SCI/D) function, caregiver affiliate stigma, and caregiver depression and burden has not been adequately studied. In Turkey, a region with a developing healthcare infrastructure, SCI/D caregivers may have a higher responsibility of care given limited resources and may experience greater psychological distress associated with caregiving than in more developed healthcare systems. OBJECTIVE: To examine whether SCI/D function, caregiver affiliate stigma, and caregiver burden and depression in Turkey are associated with each other. DESIGN: Cross-sectional survey design. SETTING: Participants were recruited from the Turkish Spinal Cord Injury Foundation and from the SCI/D service at Istanbul Physical Rehabilitation Hospital. PARTICIPANTS: A total of 82 SCI/D caregivers in Turkey. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Barthel Index, Affiliate Stigma Scale, Zarit Burden Interview, and Patient Health Questionnaire-9. RESULTS: In an initial path model using bootstrapping, SCI/D function did not predict affiliate stigma, and once this path was trimmed, a final path model suggested that SCI/D function and affiliate stigma predicted caregiver burden, which in turn predicted caregiver depression. Burden partially mediated the effects of both SCI/D function and affiliate stigma on caregiver depression. All paths in the final model were statistically significant, and the fit indices suggested good fit. CONCLUSIONS: Because affiliate SCI/D function and stigma exerted a cascade of statistical effects across caregiver burden and depression, interventions should be developed and tested to help caregivers cope with low SCI/D function and combat affiliate stigma, preventing it from exerting harmful effects. Previously developed caregiver interventions should be translated and culturally adapted for a Turkish context, given that the burden and depression outcomes these interventions target are highly relevant for Turkish SCI/D caregivers.

Reliability and Validity of the Turkish Version of the Body Image Disturbance Questionnaire-Scoliosis.

STUDY DESIGN: It is cross-cultural adaptation and validation of the Body Image Disturbances Questionnaire. OBJECTIVE: The purpose of the study was to adopt the English version of the Body Image Disturbance Questionnaire-Scoliosis (BIDQ-S) into Turkish language. SUMMARY OF BACKGROUND DATA: BIDQ-S is originally adopted from BIDQ scale which is designed to be used for healthy subjects in order to assess concerns and distress about physical appearance, and impairment on daily functioning. However, there is no culturally adopted and validated BIDQ-S for the Turkish population. METHOD: Translation and back translation method was used to guide the translation process of the BIDQ-S from English to Turkish. In order to determine and confirm the factor structure of the Turkish BIDQ-S exploratory and confirmatory factor analysis were performed. Convergent validity of the Turkish BIDQ-S- was determined by calculating the correlations of BIDQ-S, and the factors emerged, with the indicators of subjective well-being which consists of three components: positive affect (PA), negative affect (NA), and satisfaction with life (SWL) and of health related quality of life measured by Scoliosis Research Society Questionnaire (SRS-22). RESULTS: The data from the present study demonstrated that different from the original, German and Chinese versions two factor solutions were found. The Turkish BIDQ-S also showed satisfactory internal consistency value with Cronbach α equals to 0.88 construct validity. CONCLUSION: In conclusion, current study shows that Turkish BIDQ-S is a valid and reliable questionnaire for assessing the body image concerns in patients with scoliosis in Turkish population. LEVEL OF EVIDENCE: 4.

Relationship Satisfaction and Depression After Traumatic Brain Injury: An Actor-Partner Interdependence Model of Patients and Caregivers in Mexico and Colombia.

OBJECTIVE: Traumatic brain injury represents a major public health concern, particularly in low- and middle-income countries like in Latin America. Family members are often caregivers for individuals with traumatic brain injury, which can result in significant stress. Research is needed to examine depression and quality of the caregiving relationship in these dyads. This study examined relationship quality and depression longitudinally after traumatic brain injury within the caregiving relationship. DESIGN: Dyads (N = 109) composed of individuals with traumatic brain injury and their caregivers were recruited from three hospitals in Mexico and Colombia. They self-reported depression and relationship satisfaction during hospitalization and at 2 and 4 mos after hospitalization. RESULTS: A 2-lag Actor Partner Interdependence Model demonstrated that patients and caregivers reporting high relationship satisfaction at baseline experienced lower depression 2 mos later, which then predicted higher caregiver relationship satisfaction at 4 mos. Moreover, patients with high relationship satisfaction at baseline had caregivers with lower depression at 2 mos, which was then associated with patients' higher satisfaction at 4 mos. CONCLUSIONS: Within individuals with traumatic brain injury and caregivers, depression and relationship satisfaction seem to be inversely related. Furthermore, patients' and caregivers' depression and relationship satisfaction impact each other over time, demonstrating interdependence within the caregiving relationship.

Social approach and avoidance behaviour for negative emotions is modulated by endogenous oxytocin and paranoia in schizophrenia.

Patients with schizophrenia suffer from dysfunctional social behaviour. Social approach and avoidance (AA) has been associated with motor responses, as the affective valence and gaze direction of facial stimuli can bias push and pull motor tendencies. The aim of this study was to investigate the role of endogenous oxytocin in social AA behaviour in schizophrenia. Basal plasma oxytocin levels were collected from 28 patients who were then given a joystick-based Approach-Avoidance Task (AAT). Reaction times were recorded and AAT effect scores calculated for responses to happy and angry faces, which either had direct or averted gaze. Individual differences in basal oxytocin had a significant relationship with AAT responses, and patients with higher levels of oxytocin tended to avoid angry faces more. Furthermore, greater avoidance of angry faces was correlated with more severe psychotic (positive and general) symptoms and greater paranoia. This suggests that the endogenous effects of oxytocin may be specific to the interpretation of negative threatening emotions in schizophrenia patients, and also provides evidence that psychotic symptoms and paranoia can impact on social AA behaviour by heightening threat avoidance.

The expression of anger amongst Turkish taxi drivers.

The present study tested the four factor structure of the DAX on a sample of Turkish taxi drivers and the relationship these factors had with a number of other variables. Confirmatory Factor Analysis found that the data broadly fit the four factor solution of the DAX. These factors included three aggressive expressions: Verbal Aggressive Expression; Personal Physical Aggressive Expression; Use of a Vehicle to Express anger, and one Adaptive/Constructive factor. Driving experience was negatively related to the three types of aggressive expression. The Total Aggressive Expression was positively related to annual mileage and preferred driving speed, but negatively related to age and experience. The present research also found that the three aggressive types of anger expression were significantly related to potentially crash related conditions, such as losing control of the vehicle, loss of concentration and near-misses. However, none of the DAX factors was significantly related to either minor or major crashes.