The system of belief inventory (SBI-15): a validation study in Israel.

This study focused on the validation of measures assessing religiosity by means of three self-report instruments: the System of Belief Inventory (SBI-15R), the Religious Orientation Inventory (ROI), and the Index of Core Spiritual Experiences (INSPIRIT). These instruments were developed and validated previously in the United States. The study measured the extent to which the self-reports maintain their validity when administered in a different country with its own distinct language, culture and religion (e.g. Israel). It was found that all three self-reports have very good external validity and high convergent reliability, with the SBI demonstrating extremely high internal reliability.

Transmission of response to trauma? Second-generation Holocaust survivors' reaction to cancer.

OBJECTIVE: Opinions differ about the effects of the Holocaust on the adult offspring of survivors. The authors studied cancer patients who were second-generation Holocaust survivors in an attempt to determine whether they react to their illness with the high distress found to be a characteristic of Holocaust survivors. METHOD: In a study population of women with breast cancer, 106 second-generation Holocaust survivors were compared to 102 women whose parents were not in the Holocaust. Background information was obtained by interviews. In addition, all patients completed three self-reports: the Mental Attitude to Cancer Scale, the Brief Symptom Inventory, and the Impact of Event Scale. RESULTS: The two groups had identical mean scores on the Mental Attitude to Cancer Scale. The offspring of Holocaust survivors had scores on the Brief Symptom Inventory and the Impact of Event Scale that were substantially and significantly higher and in the range of psychopathology. Within the group, married women and women whose mothers were still alive were even more distressed. Other independent variables shed little light on why the second-generation Holocaust survivors suffered from extreme distress. CONCLUSIONS: Second-generation Holocaust survivors are particularly vulnerable to psychological distress and, when faced with a trauma such as breast cancer, react with extreme psychological distress.

Childhood imaginary companionship and mental health in adolescence.

An imaginary companion (IC) is a frequently encountered childhood fantasy, invisible to anyone but the child, who may be named, addressed or played with. Whether the presence of an IC is a normal developmental feature has not been determined. We examined psychometric measures and the presence/absence of childhood IC in a sample of 850 mentally healthy adolescents. 17.6% of our subjects, more often females, reported having had such a companion. Subjects who reported having had an IC in childhood exhibited higher levels of distress and emotional discontrol, displayed prolonged transitional object attachment and immature modes of coping with stress. Thus, although childhood imaginary companionship is not indicative of psychopathology, it may denote a vulnerability for adolescent perturbation and difficulty in coping with emotionally laden situations.

Psychological distress in patients with chronic, nonalcoholic, uncomplicated liver disease.

To study whether the presence of significant disease in a major organ, possibly with minimal or no clinical symptoms, would be associated with psychological disturbance, 80 subjects suffering from chronic hepatitis or cirrhosis, of nonalcoholic etiology were interviewed. Of these, 64 had either minimal or no physical symptoms. Patients completed the Brief Symptom Inventory (BSI) and the Impact of Event Scale (IES), questionnaires, which measure symptoms of psychological distress. It was found that 50% of the liver subjects were defined as cases by the BSI criteria including 15% who were defined as severe cases. There were no gender differences. Forty-five percent of asymptomatic liver subjects were defined as cases. Psychological distress was significantly pronounced in subjects with less than 12 years of education. This study points to a significant incidence of psychological distress, even in clinically asymptomatic subjects, suffering from chronic, nonalcoholic, uncomplicated liver disease.

Prospective study of cancer patients and their spouses: the weakness of marital strength.

In a prospective study, 133 married cancer patients and their spouses were interviewed within a month of diagnosis and administered three self-reports: The Brief Symptom Inventory (BSI) to assess psychological distress, the Impact of Events Scale (IES) to assess coping, and the Family Adaptability and Cohesion Scales (FACES III) to assess family relations. Patients and spouses were moderately distressed. The patient's psychological distress was explained by the level of intrusion, by the spouse's psychological distress and cohesion which had a protective effect (R2.41). The spouse's distress was explained by intrusion, gender and, to some extent, by the patient's distress (R2.41); but cohesion had no influence. Only half of the group (as couples) reached the last follow-up nearly 2 years later. A disassociation seems to have occurred; family relations, as well as partner's distress, did not have an influence on either the patient's or spouse's distress. The information gathered at the beginning of the study explained about 25% of the distress 2 years later of male patients and their wives, and that of female patients but not of their husbands.

Pre-adolescent chumship as a buffer against psychopathology in adolescents with weak family support and weak parental bonding.

This study examines the degree to which the existence of a pre-adolescent "chum" interacts with family and social environments to buffer mental distress in adolescents. 831 high school students participated in this study, (male: 355; female: 476; mean age 16.7 +/- 1.0). Subjects were administered questionnaires assessing psychopathology and support systems. A pathway analyses model was used to investigate pathways and their interrelationships from chum to psychopathology and from social and family support to psychopathology. Only when adolescents experience weak parental bonding does chumship have a role in buffering distress.

Parental bonding and mental health in adolescence.

Attachment between parent and child plays a crucial role in the healthy development of the child. Accordingly disturbances in parental bonding will be linked with the development of mental disorders later in life. The present study examines the relationship between parental bonding and mental health in healthy adolescents. Participants were 847 Israeli high school students who completed the Parental Bonding Instrument (PBI), the Brief Symptom Inventory (BSI), the General Well-Being (GWB), the Perceived Social Support (PSS), and the Social Desirability scale (SDS). In general, Israeli adolescents reported more parental care and less control than did Australian adolescents and adults. Female subjects reported more maternal care than did males. Subjects who reported high care and low control (optimal bonding) reported less distress, better general well-being and better social support that did all other groups. In contrast, those who reported low care and high control (affectionless control bonding) had the highest BSI scores and the lowest GWB and PSS scores. These results are in line with Bowlby's theory of attachment. They also show that specific configuration of parental bonding are linked with distress and isolation in adolescents.

Personality traits and long-term health status. The influence of neuroticism and conscientiousness on renal deterioration in type-1 diabetes.

Stringent long-term control of blood glucose concentration in patients with insulin-dependent diabetes mellitus (IDDM) can decrease albuminuria, presumably forestalling development of renal insufficiency. Personality characteristics may influence a diabetic patient's ability and willingness to follow a prescribed regimen to achieve glycemic control. This study investigated the relationship of 2 personality factors to renal deterioration time (from initiation of insulin therapy to renal failure) in 85 patients with IDDM and end-stage renal disease. Persons moderate in the personality trait of neuroticism and high in conscientiousness had renal deterioration times that were 12 years longer than persons with either high or low neuroticism and low conscientiousness, presumably because of better self-care. The implications of this study's findings are discussed.

Rhinoplasty patients' critical self-evaluations of their noses.

Many applicants for cosmetic rhinoplasty do not appear to have grossly deformed noses. This study was undertaken to determine the accuracy of nasal evaluations in a group of 20 female cosmetic rhinoplasty patients, before and after surgery, relative to a matched nonrhinoplasty control group composed of 25 subjects. Self-assessments and surgeon assessments were obtained for both groups. Compared with those of controls, the noses of patients were found to be more deformed before and better shaped after the operation, according to both self-assessments and surgeon assessments. Rhinoplasty patients, in contrast to controls, tended to downgrade the shape of their noses compared with surgeon assessments both before and 4 months after surgery. Faulty evaluation was not associated with sociodemographic parameters, brief symptoms index (BSI) scores, or the degree of patient satisfaction from surgical outcome. Replication and longer-term follow-up studies are needed and are anticipated.

Pathogenesis of cognitive complaints in patients on hemodialysis.

Memory-concentration complaints are a common symptom among end-stage renal disease patients receiving hemodialysis. However, assuming an organic basis for these complaints might lead to unnecessary and expensive testing. To further explore the etiology of cognitive complaints, this study examined the contribution of demographic, neuropsychological, medical, affective, and personality variables to memory-concentration complaints in 426 hemodialysis patients. Following stepwise multiple regression to identify the best predictor variables within each domain, hierarchical multiple-regression analysis determined the significant predictors of memory-concentration complaints. Education, digit symbol score, and hemoglobin jointly accounted for approximately 7% of the variance. Cognitive (psychological) symptoms of depression explained an additional 9% of variance. Somatic symptoms of depression did not significantly contribute, whereas state anxiety did. Finally, personality variables collectively accounted for another 9% of variance. Overall, the model accounted for 28% of explained variance in memory-concentration complaints. These findings demonstrate that affect and personality factors are more predictive of memory-concentration complaints in hemodialysis patients than are neuropsychological or medical factors. The clinical implication is that the initial response to memory-concentration complaints in these patients should be evaluations of psychological condition.

The impact of culture on perceptions of patient-physician satisfaction.

One of the focal points of the present study was to gain further understanding about whether cultural differences among cancer patients influence the satisfaction of patients with their physicians. The study population comprised randomly selected ambulatory cancer patients at the Sharett Institute of Oncology. Of the 450 patients in the study, 200 were veteran Israelis and most of the other 250 patients were immigrants from the former Soviet Union who arrived in Israel during the past 4 years. Patients were asked to describe their physicians using an eight-item questionnaire, and then to describe their ideal physician using the same questionnaire. The discrepancy between the two descriptions--actual and ideal--represents patient satisfaction. Our findings show that satisfaction among the Russian patients was very high, with scarcely any discrepancy between actual and ideal physician. In the Israeli group, however, a substantial discrepancy was noted in all items. It can be concluded that the Israeli patients were far less satisfied with their physicians than were the Russian patients.

Psychological distress in female cancer patients with Holocaust experience.

This study examined whether severe emotional and physical trauma in the past affects the psychological condition of female patients currently afflicted with cancer. Using the Brief Symptom Inventory (BSI), 41 women with cancer, who had sustained extreme trauma during the Nazi Holocaust of the midcentury, were compared with three different groups: a matched group of cancer patients without Holocaust experience, a physically healthy group of female Holocaust survivors, and healthy women without a Holocaust past. Although psychological distress was comparable in the two healthy groups, it was far higher in Holocaust cancer patients than in either their non-Holocaust counterparts or in the group of healthy Holocaust survivors. These results may suggest that the severe trauma of the Holocaust could be responsible for markedly diminished psychological response when such patients are confronted with new stress.

Progressive muscle relaxation and guided imagery in cancer patients.

The aim of this study was to gather information on the immediate and long-term effects of six sessions of group Progressive Muscle Relaxation with Guided Imagery on the psychological distress of self-referred cancer patients. Patients' psychological distress and coping with cancer were assessed by three self-reports: the Multiple Locus of Control, the Impact of Events Scale (IES), and the Brief Symptom Inventory (BSI). Of the 123 patients who started group therapy, 37 dropped out during its course. The 86 patients who completed the intervention showed marked improvement on both BSI and IES, an improvement maintained over the next 6 months in 58 patients who continued assessment through the followup period.

Israeli adolescents' norms of the Brief Symptom Inventory (BSI).

The internal consistency and concurrent validity of a Hebrew version of Derogatis' Brief Symptom Index (BSI) were assessed in a sample of 840 high school students from three different towns in Israel. The results show high levels of internal consistency and good concurrent validity of the Hebrew version. The type of high school and the country of origin of the subjects' parents had no significant effect on BSI scores. Differences between Israeli and US subjects are reported. BSI norms presented in this study might be used in further studies in Israel.

Holocaust cancer patients: a comparative study.

There is as yet no consensus on the long-term effects of severe life-threatening stresses. In an earlier study (Baider et al. 1992), we gained some understanding of this issue by addressing a specific question: How do individuals who have undergone severe stress in the past cope with a current stress? We investigated whether severe stress occurring in the past had a long-term effect on present coping capabilities. We addressed the question by studying a group of Holocaust survivors (severe past stress) who were diagnosed as having cancer (current stress) and compared them to a matched group of cancer patients with no past history of trauma. The matching was done on most demographic variables (gender, age, marital status, and education), as well as on disease variables (site and stage of cancer, time since cancer diagnosis, previous and present treatments). The results were unequivocal.

Adolescent attitudes toward suicide.

Jewish Israeli adolescent attitudes toward suicide were studied and overall demonstrated a positive approach. Adolescents related to suicide as representing a crisis rather than a mental disorder. Nearly half the subjects did not regard suicide as a shameful act, and approximately two-thirds considered it justifiable under certain conditions. The majority stated they would not punish a suicidal person, nor expel a suicidal adolescent from school. Approximately two-thirds said they would not change their attitude toward a suicidal friend. Female subjects consistently demonstrated a more accepting attitude, regardless of their religious beliefs, however, religious male adolescents consistently demonstrated a more negative attitude than nonreligious males.

Gender and adjustment to chronic disease. A study of couples with colon cancer.

The adjustment of 39 couples in which one partner has cancer of the colon was assessed. The main findings were that the adjustment of male patients was superior to that of female patients. In the spouses' group the opposite was found, namely the adjustment of husbands was far worse than that of wives of cancer patients.

Adjustment to illness and dropout of chemotherapy.

The study compares the adjustment to illness of a group of 53 cancer patients who dropped out of chemotherapy with a matched group of 53 cancer patients who completed their treatment. The patients were treated in five oncological institutes in Israel. We found differences both in the Psychosocial Adjustment to Illness Scale (PAIS) and Brief Symptom Inventory Scale (BSI). In both scales we found significant differences indicating that the degree of adjustment and the psychosocial distress of patients who dropped out of treatment was worse than that of patients who completed treatment.