Measuring euthymia within the Neuroticism Scale from the NEO Personality Inventory: A Mokken analysis of the Norwegian general population study for scalability.

BACKGROUND: Whereas the Eysenck Neuroticism Scale only contains items covering negative mental health to measure dysthymia, the NEO Personality Inventory (NEO-PI) contains neuroticism items covering both negative mental health and positive mental health (or euthymia). The consequence of wording items both positively and negatively within the NEO-PI has never been psychometrically investigated. The aim of this study was to perform a validation analysis of the NEO-PI neuroticism scale. METHODS: Using a Norwegian general population study we examined the structure of the negatively and positively formulated items by principal component analysis (PCA). The scalability of the identified two groups of euthymia versus dysthymia items was examined by Mokken analysis. RESULTS: With a response rate of 90%, 1082 individuals with a completed NEO-PI were available. The PCA identified the neuroticism scale as the most distinct where 14 items had acceptable loadings for the euthymia subscale, another 14 items for the dysthymia subscale. However, the Mokken analysis coefficient of homogeneity only found acceptable scalability for the euthymia subscale. LIMITATIONS: A comparison with the Eysenck Neuroticism Scale was not performed. CONCLUSION: The NEO-PI neuroticism scale contains two subscales consisting of items worded in an opposite direction where only the positive euthymia items have an acceptable scalability.

Predicting the long-term impact of acquired severe injuries on functional health status: the role of optimism, emotional distress and pain.

STUDY DESIGN: Longitudinal. OBJECTIVE: To investigate the relative importance of personality traits, emotional distress and pain as predictors of functional health status in patients with spinal cord injury (SCI) or multiple traumas (MTs). SETTING: Sunnaas Rehabilitation Hospital, Norway. METHODS: Data were obtained from SCI and MT patients at admission (n=101) and at discharge (n=87) from rehabilitation, as well as 4 years post injury (n=75). The primary outcome measure was the sickness impact profile (SIP). Personality traits, that is, dispositional optimism and positive/negative affectivity, were measured using the Life Orientation Test-Revised and the Positive Affect and Negative Affect Schedule, respectively. RESULTS: Using hierarchical regression analysis, dispositional optimism and pain emerged as the most robust predictors of functional health status. Generally, these two variables accounted for a substantial part of the variance (that is, 20-40%) in the SIP scales. Significant correlations between pain and anxiety/depression were found in all phases of the study, and at follow-up depression level appeared as an independent predictor of functional health. CONCLUSION: The substantial predictive power, in terms of explained variance, of dispositional optimism, pain and depression/anxiety, indicates that these variables may be of practical-clinical importance in a rehabilitation setting. Specifically, patients characterized by low optimism, combined with presence of pain and depression/anxiety, may constitute a high-risk group for disability and reduced quality of life. On the other hand, high optimism should be regarded as a resilience characteristic, protecting the individual against long-term sequelae of severe physical injury.

A comparison of cognitive therapy, applied relaxation, and nitrous oxide sedation in the treatment of dental fear.

The aim of this study was to investigate the short-term efficacy of cognitive therapy and applied relaxation in dental fear treatment and to compare these methods with conventional pharmacological sedation (nitrous oxide sedation). Patients (n = 65) with severe dental fear were randomly assigned to the different treatment methods and received 10 weekly sessions of individual therapy. Dropout rates were low, and all patients who completed the therapy sessions were able to receive dental treatment. Scores on dental fear tests were significantly reduced compared with pretreatment level for all treatment groups. There were no major differences between treatment methods in this short-term perspective.

One-year follow-up of patients treated for dental fear: effects of cognitive therapy, applied relaxation, and nitrous oxide sedation.

The effects of dental fear treatments were assessed in a 1-year follow-up study. Sixty-two patients had finished a controlled study in which they were randomly allocated to nitrous oxide sedation (NO), cognitive therapy (CT), or applied relaxation (AR). During the trial highly significant reductions in dental fear and general distress were observed. One year later a majority (95%) of the participants had attended dental treatment in general practice. On the whole, continued favorable effects with regard to dental fear and general distress were observed. Patients in the applied relaxation group evidenced the largest reductions on the dental fear measures. All patients judged the dental fear treatment to have been beneficial, and 80% judged the treatment given in the year after the dental fear treatment successful. All three treatment groups scored in the normative range for general distress both at the end of treatment and at follow-up.

Effects of dental fear treatment on general distress. The role of personality variables and treatment method.

This study aimed to clarify the effects of applied relaxation, cognitive therapy, and nitrous oxide sedation on dental fear and general emotional distress symptoms. Relationships among outcome measures and the Big Five personality dimensions (i.e., Neuroticism, Extraversion, Openness, Agreeableness, and Conscientiousness) were also investigated. After treatment, a highly significant decline in a broad range of emotional distress symptoms as well as dental fear was found. No main treatment method effect or treatment x phase interaction effect with regard to dental fear or distress symptoms was found. Thus, the three treatment methods had highly similar effects, at least on a short-term basis. Significant correlations between neuroticism, extraversion, and agreeableness on one hand, and emotional distress symptoms on the other, were demonstrated. However, when initial symptom level was controlled for in multiple regression analysis, the statistical effects of personality variables generally disappeared.

The problem of structural indeterminacy in multidimensional symptom report instruments. The case of SCL-90-R.

The factor structure of SCL-90-R items and scales was analyzed using both exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Results of CFA studies at the item-level failed to support the original nine-factor model, as well as several alternative models and EFA suggested very different dimensionality, depending on which criteria were used. Analyses at the scale-level (i.e. the nine original symptom dimensions) suggested that a one- or two-factor model was satisfactory according to descriptive goodness of fit criteria. However, using the likelihood ratio test, specification of four factors was necessary to avoid rejection. According to the likelihood ratio test in a multi-group analysis, a lack of factorial invariance across gender was indicated. Moreover, the factorial structure of the instrument was clearly different across levels of negative affectivity (NA); the dimensionality was substantially higher in the low-NA group as compared to the high-NA group. It is concluded that we are confronted with a profound structural indeterminacy problem and that factor analytic methods and model acceptance criteria alone are insufficient to solve this problem. The indeterminacy problem can be accounted for, at least in part, by the complex logical-semantical structure of SCL-90-R items and scales and the role of the NA trait as a structure generating factor.

The Role of Negative Affectivity in Self assessment of Health: A Structural Equation Approach.

The relationship between negative affectivity (NA, i.e. the Neuroticism trait and transient distress), self-reported medical condition and somatic complaints was assessed in structural equation models also including personality (the Big Five personality domains), socio-demographic, and health behaviour variables. The results indicated that the individual's current distress level and medical condition were by far the strongest predictors of somatic complaints. Compared to the other Big Five domains, Neuroticism was clearly the most important variable in all the models tested; it evidenced substantial direct effects on both distress level and medical condition, and a significant indirect effect on somatic complaints. On the whole, the effects of the sociodemographic and health behaviour variables were of only marginal importance as compared to NA.

Psychological Distress, Coping, and Disease Progression in HIV-positive Homosexual Men.

The objectives of the study were (1) to examine the role of coping styles in disease progression in models controlling for initial CD4+ cell counts, distress, and health behavior in a sample of HIV- positive homosexual men (n = 65), and (2) to investigate the relationship between coping styles and distress (e.g. depression, anxiety, negative ruminations). A consistent association between planful problem-solving coping and disease progression was demonstrated. Distress was positively correlated with indicators of passive-defensive coping style (e.g. self- controlling, escape-avoidance), and negatively correlated with planful problem-solving and positive reappraisal. The results suggest that coping styles may merit a specific focus in future research of psychological factors in HIV infection, particularly as they may relate both to medical outcome and to the social/emotional aspects of being HIV-infected.

The reporting of pain, somatic complaints, and anxiety in a group of patients with TMD before and 2 years after treatment: sex differences.

The aim of this study was to assess possible gender differences regarding the reporting of pain, somatic complaints, and anxiety in a group of patients suffering from temporomandibular disorders (TMD). The group consisted of 40 females and 13 males who received conservative TMD treatment comprising counseling, muscle exercises, and a stabilization splint. Before and 2 years after treatment, the patients answered three questionnaires (McGill Pain Questionnaire [Norwegian version] including a six-point scale, the Present Pain Intensity; a Somatic Complaints Questionnaire; and the trait part of Spielberger's State-Trait Anxiety Inventory. Before treatment, females reported greater present pain intensity than did males. Two years after treatment, females reported less sensory and emotional pain than at the initial stage; males presented no reduction in these pain scores. There were no gender differences at either stage regarding somatic complaints or anxiety level scores.

Relationships between risk factors and treatment outcome in a group of patients with temporomandibular disorders.

The aim of this study was to compare somatic complaints, anxiety, and pain related to temporomandibular disorders (TMD) in a group of TMD patients who had high scores for headache and muscle palpation compared with that of a group of TMD patients who had low or medium scores for headache and palpation before and 2 years after conservative TMD treatment, consisting of counseling, muscle exercises, and a stabilization splint. The high-score group consisted of 23 patients who had headaches several times a week or daily and had more than three muscles graded as severely tender to palpation. The low/medium-score group comprised 28 patients who had headaches hardly ever, once or twice a month, or several times a month, and with muscles graded as slightly or medium tender to palpation. The patients answered three questionnaires (McGill Pain Questionnaire [Norwegian version], a somatic complaints questionnaire, and the trait part of Spielberger Stait-Trait Anxiety Inventory) before and 2 years after treatment. The findings showed differences between the two groups concerning pain description, general muscle complaints, and anxiety both before and after the treatment, with the high-score group showing the highest values. In general, the treatment outcome had improved in the low/medium-score group but remained unchanged in the high-score group.

Negative affectivity, somatic complaints, and symptoms of temporomandibular disorders.

This study examined the relationship between trait anxiety, subjective somatic symptoms, and pain associated with temporomandibular disorders (TMD) in a combined cross-sectional and prospective study. Compared with the initial measurements, a significant reduction in anxiety and pain was observed in the follow-up phase (two years after evaluation and therapy). No change in general somatic complaints was found. In both the initial phase and the follow-up phase, a consistent relationship between anxiety, somatic complaints, and TMD-related pain was demonstrated. The results are in agreement with a conceptualization of negative affectivity (e.g., anxiety, distress, tension) as a general dimension of somatopsychic distress. The best predictors of later TMD pain were general somatic complaints, followed by initial pain, and trait anxiety. Significant moderate correlations between anxiety, somatic complaints, and response to muscle palpation (feelings of tenderness) were also found. It is concluded that studies of TMD should incorporate measures of negative affectivity and general somatic complaints because these factors are important predictors of TMD pain, response to treatment, and chronicity.

Dental anxiety, utilisation of dental services, and DMFS status in Norwegian military recruits.

The aim of the study was to assess the association between dental anxiety, oral health (evaluated by clinical and radiographic examinations), and utilisation of dental services. Results from correlation and regression analyses confirmed the generally held expectation that high dental anxiety would be associated with poorer oral health measured as numbers of decayed or filled surfaces. Significant, but weak, relationships were found between dental anxiety and utilisation measures, i.e. number of dental visits during the last year and time since last dental visit. Taken together, the data indicated that dental anxiety was a facet of more general negative oral health/preventive oral health related behaviour. Thus, high scores on this dimension were characterised by high dental anxiety, more oral health problems, inadequate dental attendance, slightly less frequent toothbrushing and larger intake of sweet soft drinks. However, the study also demonstrated that non-selected dentally anxious individuals as a group did not exhibit the almost complete avoidance pattern typical of patients seeking special treatment for dental fear. Even in the subgroup with particularly high dental anxiety, several individuals reported having been to the dentist during the last one or two years.

Negative affectivity and intellectual ability: a study of their relation to self-reported physical symptoms, perceived daily stress and mood, and disciplinary problems in military recruits.

In this study we examined the relationship between cognitive ability and Negative Affectivity (NA) (measured as cognitive and behavioral aspects of anxiety) on the one hand, and somatic complaints, symptom attribution (i.e. subjective evaluation of psychological vs somatic symptom causes), perceived daily stress/mood, and disciplinary problems on the other hand, in a sample of military recruits. As expected, cognitive and behavioral anxiety correlated with measures of somatic complaints and with perceived stress/negative mood in the daily service, as well as with symptom attribution. General ability correlated negatively with three of the five somatic complaint scales as well as with presence of disciplinary problems after controlling for NA. However, the effect of the ability factor on these dependent variables was very weak and difficult to interpret. On the whole, cognitive ability does not seem to be an interesting variable in research on the NA-somatic complaints relationship, at least as conceptualized on the trait level. Thus, cognitive ability appears to be of less importance as an explanatory factor in theories of symptom perception and symptom attribution.

Anxiety, pain and discomfort associated with dental treatment.

The aims of the study were to describe the level of anxiety and pain/discomfort associated with dental treatment in two samples (N = 1288 and N = 2382) representative of an adult population, and to assess the statistical effects of these variables on utilization of dental services (dental attendance measures, expenditure, and items of dental treatment received during the last year). The prevalence of high dental anxiety in the samples as measured by Corah's Dental Anxiety Scale, the Dental Fear Scale, and the Dental Anxiety Question was 4.2%, 7.1% and 5.4%, respectively. Rather large proportions of the respondents judged dental treatment to be painful or uncomfortable: between 20 and 30% rated their last dental visit as moderately painful or worse; about 60% reported having had at least one very painful experience, and 5-6% experienced dental treatment in general to be very painful. Dental anxiety was significantly related to pain reports (correlations in the 0.32-0.48 range). There were no differences between the youngest age group (15-19 yr) and the rest of the respondents in Study II with regard to dental pain ratings. Possible explanations for these findings are discussed. The effects of dental pain and anxiety on utilization measures, although attaining significance in several of the analyses, were generally weak. Both studies demonstrated few significant differences between individuals with high dental anxiety and the rest of the study samples with respect to type and extent of dental treatment received during the last year. Thus, these data seem to show that many dentally anxious patients seek out and undergo dental treatment despite high fear levels.

Dimensions of negative affectivity, self-reported somatic symptoms, and health-related behaviors.

This study focused on the relationship between personality dispositions, self-reported somatic symptoms, and health-related behaviors in undergraduate students. Findings are presented which indicate systematic correlations between health complaints and negative affectivity (NA), a common and pervasive mood disposition. Generally, there was a stronger relationship between NA and self-reported somatic symptoms than between NA and variables reflecting health-related behaviors, lifestyle, and general fitness. Significant correlations between health complaints and capacity for imaginative involvement (absorption), as well as self-reported measures of emotional inhibition, were also demonstrated. However, it is uncertain whether absorption and emotional inhibition properly belong to the NA construct. The results also indicated differences with respect to the strength of the associations between various dimensions of NA and particular types or classes of health complaints. For example, cognitive anxiety (e.g. worry, ruminations, disturbing thoughts) was more strongly related to somatic complaints than behavioral (social avoidance) components of anxiety. Moreover, diffuse and widespread symptoms (e.g. weakness and fatigue) were more strongly associated with NA than more specific and localized symptoms, particularly musculo-skeletal complaints, although complaints belonging to the musculoskeletal category obtained the highest group mean score. The results strongly suggest that a differentiated approach to the study of NA-symptom connections should be adopted.

Personality, imaginative involvement, and self-reported somatic complaints: relevance to the concept of alexithymia.

Forty-five undergraduate students were investigated to determine the relationship between personality dispositions, capacity for imaginative involvement, and self-reported physical symptoms. The results showed that somatic complaints were associated with variables reflecting psychological vulnerability and dysphoric affect (e.g. anxiety and worry/depression). Imaginative involvement, and especially the Absorption Scale, correlated positively with self-reported somatic symptoms. Factor analyses revealed that Absorption Scale and the Creative Imagination Scale loaded on a general psychological distress factor. Moreover, self-reported somatic symptoms correlated negatively with 'inner directedness' and 'sociable' coping style, and positively with the coping styles 'sensitive' and 'inhibited', thus suggesting a link between emotional expressiveness and somatic complaints. The relevance of these results to the concept of alexithymia is discussed.