Do Misconceptions About Health-Related Quality of Life Affect General Population Valuations of Health States?

OBJECTIVES: Healthcare resource allocation decisions are often informed by the expected gains in patients' quality-adjusted life-years. Misconceptions about ill-health's consequences for quality of life (QOL) may however affect evaluations of health states by the general population and hence affect resource allocation decisions informed by quality-adjusted life-years. We examine whether people selectively misestimate the QOL consequences of moderate anxiety or depression compared with other dimensions of health, and we test whether informing people of actual changes in QOL associated with health states changes appraisals of their relative undesirability. METHODS: UK general population participants (N = 1259; in 2017) expressed preferences over moderate problems: anxiety or depression, self-care, and pain or discomfort. A randomized control trial design was used whereby a control group was given a functional description of each health state, and 2 intervention groups were additionally given information on the actual differences in either life satisfaction (LS) or day affect (DA) associated with experiencing each health state. RESULTS: The LS (DA) group reported a higher preference for avoiding living with moderate anxiety or depression, being 13.4% (13.9%) more likely to choose it as most undesirable. CONCLUSION: Informing people of the change in LS or DA associated with health states before they appraise them is a feasible way to obtain informed preferences.

How to Do a Systematic Review: A Best Practice Guide for Conducting and Reporting Narrative Reviews, Meta-Analyses, and Meta-Syntheses.

Systematic reviews are characterized by a methodical and replicable methodology and presentation. They involve a comprehensive search to locate all relevant published and unpublished work on a subject; a systematic integration of search results; and a critique of the extent, nature, and quality of evidence in relation to a particular research question. The best reviews synthesize studies to draw broad theoretical conclusions about what a literature means, linking theory to evidence and evidence to theory. This guide describes how to plan, conduct, organize, and present a systematic review of quantitative (meta-analysis) or qualitative (narrative review, meta-synthesis) information. We outline core standards and principles and describe commonly encountered problems. Although this guide targets psychological scientists, its high level of abstraction makes it potentially relevant to any subject area or discipline. We argue that systematic reviews are a key methodology for clarifying whether and how research findings replicate and for explaining possible inconsistencies, and we call for researchers to conduct systematic reviews to help elucidate whether there is a replication crisis.

Income and Social Rank Influence UK Children's Behavioral Problems: A Longitudinal Analysis.

Children living in low-income households face elevated risks of behavioral problems, but the impact of absolute and relative income to this risk remains unexplored. Using the U.K. Millennium Cohort Study data, longitudinal associations between Strengths and Difficulties Questionnaire scores and absolute household income, distance from the regional median and mean income, and regional income rank were examined in 3- to 12-year-olds (n = 16,532). Higher absolute household incomes were associated with lower behavioral problems, while higher income rank was associated with lower behavioral problems only at the highest absolute incomes. Higher absolute household incomes were associated with lower behavioral problems among children in working households, indicating compounding effects of income and socioeconomic advantages. Both absolute and relative incomes therefore appear to influence behavioral problems.

A rank based social norms model of how people judge their levels of drunkenness whilst intoxicated.

BACKGROUND: A rank based social norms model predicts that drinkers' judgements about their drinking will be based on the rank of their breath alcohol level amongst that of others in the immediate environment, rather than their actual breath alcohol level, with lower relative rank associated with greater feelings of safety. This study tested this hypothesis and examined how people judge their levels of drunkenness and the health consequences of their drinking whilst they are intoxicated in social drinking environments. METHODS: Breath alcohol testing of 1,862 people (mean age = 26.96 years; 61.86 % male) in drinking environments. A subset (N = 400) also answered four questions asking about their perceptions of their drunkenness and the health consequences of their drinking (plus background measures). RESULTS: Perceptions of drunkenness and the health consequences of drinking were regressed on: (a) breath alcohol level, (b) the rank of the breath alcohol level amongst that of others in the same environment, and (c) covariates. Only rank of breath alcohol level predicted perceptions: How drunk they felt (b 3.78, 95 % CI 1.69 5.87), how extreme they regarded their drinking that night (b 3.7, 95 % CI 1.3 6.20), how at risk their long-term health was due to their current level of drinking (b 4.1, 95 % CI 0.2 8.0) and how likely they felt they would experience liver cirrhosis (b 4.8. 95 % CI 0.7 8.8). People were more influenced by more sober others than by more drunk others. CONCLUSION: Whilst intoxicated and in drinking environments, people base judgements regarding their drinking on how their level of intoxication ranks relative to that of others of the same gender around them, not on their actual levels of intoxication. Thus, when in the company of others who are intoxicated, drinkers were found to be more likely to underestimate their own level of drinking, drunkenness and associated risks. The implications of these results, for example that increasing the numbers of sober people in night time environments could improve subjective assessments of drunkenness, are discussed.

The interactive role of income (material position) and income rank (psychosocial position) in psychological distress: a 9-year longitudinal study of 30,000 UK parents.

PURPOSE: Parents face an increased risk of psychological distress compared with adults without children, and families with children also have lower average household incomes. Past research suggests that absolute income (material position) and income status (psychosocial position) influence psychological distress, but their combined effects on changes in psychological distress have not been examined. Whether absolute income interacts with income status to influence psychological distress are also key questions. METHODS: We used fixed-effects panel models to examine longitudinal associations between psychological distress (measured on the Kessler scale) and absolute income, distance from the regional mean income, and regional income rank (a proxy for status) using data from 29,107 parents included in the UK Millennium Cohort Study (2003-2012). RESULTS: Psychological distress was determined by an interaction between absolute income and income rank: higher absolute income was associated with lower psychological distress across the income spectrum, while the benefits of higher income rank were evident only in the highest income parents. Parents' psychological distress was, therefore, determined by a combination of income-related material and psychosocial factors. CONCLUSIONS: Both material and psychosocial factors contribute to well-being. Higher absolute incomes were associated with lower psychological distress across the income spectrum, demonstrating the importance of material factors. Conversely, income status was associated with psychological distress only at higher absolute incomes, suggesting that psychosocial factors are more relevant to distress in more advantaged, higher income parents. Clinical interventions could, therefore, consider both the material and psychosocial impacts of income on psychological distress.

Explaining the income and suicidality relationship: income rank is more strongly associated with suicidal thoughts and attempts than income.

PURPOSE: Low income is an established risk factor for suicidal thoughts and attempts. This study aims to explore income within a social rank perspective, proposing that the relationship between income and suicidality is accounted for by the rank of that income within comparison groups. METHODS: Participants (N = 5779) took part in the Adult Psychiatric Morbidity Survey across England. An income rank variable was created by ranking each individual's income within four comparison groups (sex by education, education by region, sex by region, and sex by education by region). Along with absolute income and demographic covariates, these variables were tested for associations with suicidal thoughts and attempts, both across the lifetime and in the past year. RESULTS: Absolute income was associated with suicidal thoughts and attempts, both across the lifetime and in the past year. However, when income rank within the four comparison groups was regressed on lifetime suicidal thoughts and attempts, only income rank remained significant and therefore accounted for this relationship. A similar result was found for suicidal thoughts within the past year although the pattern was less clear for suicide attempts in the past year. CONCLUSIONS: Social position, rather than absolute income, may be more important in understanding suicidal thoughts and attempts. This suggests that it may be psychosocial rather than material factors that explain the relationship between income and suicidal outcomes.

Money, well-being, and loss aversion: does an income loss have a greater effect on well-being than an equivalent income gain?

Higher income is associated with greater well-being, but do income gains and losses affect well-being differently? Loss aversion, whereby losses loom larger than gains, is typically examined in relation to decisions about anticipated outcomes. Here, using subjective-well-being data from Germany (N = 28,723) and the United Kingdom (N = 20,570), we found that losses in income have a larger effect on well-being than equivalent income gains and that this effect is not explained by diminishing marginal benefits of income to well-being. Our findings show that loss aversion applies to experienced losses, challenging suggestions that loss aversion is only an affective-forecasting error. By failing to account for loss aversion, longitudinal studies of the relationship between income and well-being may have overestimated the positive effect of income on well-being. Moreover, societal well-being might best be served by small and stable income increases, even if such stability impairs long-term income growth.

Beliefs in being unlucky and deficits in executive functioning.

The current paper proposes the Dysexecutive Luck hypothesis; that beliefs in being unlucky are associated with deficits in executive functioning. Four studies suggest initial support for the Dysexecutive Luck hypothesis via four aspects of executive functioning. Study 1 established that self-reports of dysexecutive symptoms predicted unique variance in beliefs in being unlucky after controlling for a number of other variables previously reported to be related to beliefs around luck. Studies 2 to 4 demonstrated support for the Dysexecutive Luck hypothesis via assessment of executive functioning via: (1) two fundamental executive functions (shifting and inhibition), (2) emotional processes related to executive functioning as described by the Somatic Marker hypothesis, and (3) higher executive functions as accessed via divergent thinking. The findings suggest that individuals' beliefs in being unlucky are accompanied by a range of deficits in executive functioning.

Flexible and tenacious goal pursuit lead to improving well-being in an aging population: a ten-year cohort study.

BACKGROUND: Previous research has shown that tendencies to tenaciously pursue goals and flexibly adapt goals independently relate to well-being in adults in mid-to-late life, but research has not tested whether these tendencies interact. For example, tenacity may only predict well-being in combination with flexibility. This research tests whether these tendencies interact to predict changes in health-related outcomes. METHODS: A large cohort of people (n = 5,666), initially aged 55-56, completed measures of flexibility, tenacity, health-related outcomes (physical health, depression, hostility), as well as demographics. Participants provided follow-up data on all measures ten years later. Moderation analysis was used to test whether flexibility and tenacity interacted to predict changes in the health-related outcomes over the period. RESULTS: The interaction between tenacity and flexibility significantly predicted changes in depression, hostility, and physical ill-health symptoms over ten years, such that highly flexible and tenacious individuals experienced the largest decreases in symptoms of depression, hostility, and physical ill-health. CONCLUSIONS: The interaction between flexibility and tenacity predicts greater well-being, such that one is most protective when an individual also scores highly on the other. The combination of flexibility and tenacity in the pursuit of personal goals may mean individuals can enjoy gains associated with goal pursuit without the detrimental effects of persevering in blocked goals.

Discrepancies in parental and self-appraisals of prosocial characteristics predict emotional problems in adolescents.

OBJECTIVES: Parental appraisals of an adolescent may have an effect upon the adolescent's well-being and likelihood of emotional problems. However, the impact of these parental appraisals is likely to be partly determined by the young person's self-appraisal. It was predicted that a discrepancy in self- and parent appraisals of positive, prosocial qualities would be associated with an increased risk of emotional problems. DESIGN: The study employed a cross-sectional design within a large sample of adolescent and caregiver dyads (N = 3,976, aged 11-17 years), drawn from the 'Mental health of children and young people in Great Britain, 2004' survey. METHOD: Two separate measures of prosociality were used to ensure that effects were not specific to one measure. The analysis explored the discrepancy in parent and self-ratings on these measures via interactions within a logistic regression framework. Potential confounds, including gender, parental mental health, conduct and hyperkinetic problems were controlled for in the analysis. RESULTS: The logistic regression analyses demonstrated significant interactions between self- and parent ratings of prosocial qualities in predicting the odds of emotional disorder (i.e., depression and anxiety). This effect occurred across both measures of prosocial qualities whilst controlling for confounds. The pattern of the interactions suggested that low parental appraisals had a more detrimental effect on well-being when self-appraisals were highly positive. CONCLUSIONS: The results suggest that moderately high self-appraised positive traits may carry a cost of leaving young people more vulnerable to discrepant, negative parental appraisals. This has important implications for the meaning attributed to self-appraised positive traits in clinical contexts. PRACTITIONER POINTS: Clinicians should be aware that the association between parental perceptions of a child's prosociality and emotional disorder may be influenced by the adolescents' self-perceptions. Clinicians should therefore endeavour to assess both parental and adolescent appraisals. Discrepancies may be clinically meaningful, in terms of the risk of emotional problems, rather than simply being a nuisance. This study is cross-sectional, so although discrepancies may be linked to risk of emotional problems, the direction of this effect requires elucidation. The current study only focusses on the parent-adolescent dynamic and so may not extend to discrepancy effects in other areas of positive functioning or in other relational contexts.

The role of perceived social norms in non-suicidal self-injury and suicidality: A systematic scoping review.

Social norms are an important influence on health-related behaviours and intention formation. As both suicidal behaviour and non-suicidal self-injury (NSSI) can be motivated by intentions, perceived social norms may have an important role in suicide and NSSI outcomes, although no existing reviews of this association exist. Following the PRISMA Scoping Review extension guidance, a scoping review based on systematic searches of key databases was conducted to identify published English language studies investigating the role of perceived social norms in suicidality and NSSI. Information regarding the types of social norms studied, their relationship to suicidality/NSSI outcomes, study samples and designs was charted. Thirty-six eligible studies (31 quantitative, 4 qualitative, 1 mixed methods) sampling various populations across mostly non-clinical settings were identified and narratively synthesised. Studies varied in how social norms were operationalised, measured, and investigated/explored. Most studies focused on the role of conformity to perceived masculine social norms or to some form of subjective, descriptive, or injunctive norms; there were limited studies on female/feminine norms, pro-social/protective norms, or broader gender/sexuality norms. Most studies (n = 31) were cross-sectional (quantitative) in design, few were based on existing theories of suicide/NSSI or social norms, and none concurrently tested theories of social norms and NSSI/suicidality. Perceived social norms and stronger conformity to norms were generally associated with worse NSSI/suicidality, although some pro-social norms appeared to be protective (e.g., perceived parental norms for adolescents). Whilst conformity to restrictive perceived social norms may be related to poorer suicide and NSSI outcomes, there is a lack of consistency in the literature in how social norms are defined and measured, a lack of theory-based hypothesis testing, and few longitudinal studies. There is a need for more nuanced, theory-based, investigations of how, when, where, why, and for whom, perceived norms have a causal role in NSSI and suicidality outcomes.

The perceived personal control (PPC) questionnaire: reliability and validity in a sample from the United Kingdom.

Outcome measures are important assessment tools to evaluate clinical genetics services. Research suggests that perceived personal control (PPC) is an outcome valued by clinical genetics patients and clinicians. The PPC scale was developed in Hebrew to capture three dimensions of PPC: Cognitive, decisional, and behavioral control. This article reports on the first psychometric validation of the English translation of the PPC scale. Previous research has shown that the Hebrew and Dutch translations have good psychometric properties. However, the psychometric properties of the English translation have not been tested, and there is disagreement about the factor structure, with implications for how to score the measure. A total of 395 patients attending a clinical genetics appointment in the United Kingdom completed several measures at baseline, and a further 241 also completed measures at 2-4 weeks follow-up. The English language PPC has (a) a one-factor structure, (b) convergent validity with internal health locus of control (IHLC), satisfaction with life (SWL), depression, and authenticity, (c) high internal consistency (α = 0.83), and (d) sensitivity to change, being able to identify moderate changes in PPC following clinic attendance (Cohen's d = 0.40). These properties suggest the English language PPC measure is a useful tool for both clinical genetics research and for use as a Patient Reported Outcome Measure (PROM) in service evaluation.

Social norm influences on evaluations of the risks associated with alcohol consumption: applying the rank-based decision by sampling model to health judgments.

AIMS: The research first tested whether perceptions of other people's alcohol consumption influenced drinkers' perceptions of the riskiness of their own consumption. Second, the research tested how such comparisons are made-whether, for example, people compare their drinking to the 'average' drinker's or 'rank' their consumption amongst other people's. The latter untested possibility, suggested by the recent Decision by Sampling Model of judgment, would imply different cognitive mechanisms and suggest that information should be presented differently to people in social norm interventions. METHODS: Study 1 surveyed students who provided information on (a) their own drinking, (b) their perceptions of the distribution of drinking in the UK and (c) their perceived risk of various alcohol-related disorders. Study 2 experimentally manipulated the rank of 'target' units of alcohol within the context of units viewed simultaneously. RESULTS: In both studies, the rank of an individual's drinking in a context of other drinkers predicted perceptions of developing alcohol-related disorders. There was no evidence for the alternative hypothesis that people compared with the average of other drinkers' consumptions. The position that subjects believed they occupied in the ranking of other drinkers predicted their perceived risk, and did so as strongly as how much they actually drank. CONCLUSIONS: Drinking comparisons are rank-based, which is consistent with other judgments in social, emotional and psychophysical domains. Interventions should be designed to work with people's natural ways of information processing, through providing clients with information on their drinking rank rather than how their drinking differs from the average.

How are personality judgments made? A cognitive model of reference group effects, personality scale responses, and behavioral reactions.

This article suggests that personality judgments are wholly relative, being the outcome of a comparison of a given individual to a reference group of others. The underlying comparison processes are the same as those used to judge psychophysical stimuli (as outlined by range frequency theory and decision by sampling accounts). Five experimental studies show that the same person's personality is rated differently depending on how his or her behavior (a) ranks within a reference group and (b) falls within the overall range of behavior shown by other reference group members. Results were invariant across stimulus type and response options (7-point Likert scale, 990-point allocation task, or dichotomous choice). Simulated occupational scenarios led participants to give different-sized bonuses and employ different people as a function of context. Future research should note that personality judgments (as in self-report personality scales) only represent perceived standing relative to others or alternatively should measure personality through behavior or biological reactivity. Personality judgments cannot be used to compare different populations when the population participants have different reference groups (as in cross-cultural research).

Positive and negative appraisals of the consequences of activated states uniquely relate to symptoms of hypomania and depression.

Individuals may appraise internal states positively or negatively. Positive appraisals involve desiring or pursuing the state or experience, while negative appraisals involve dreading or avoiding the experience. The extent to which individuals make extreme positive or negative appraisals of high, activated, energetic states might determine whether they experience symptoms of high or low mood. This study extends the existing literature by considering the role of opposing appraisals and beliefs about the same internal states and by controlling for the potential correlation between depression and activation symptoms. Extreme, positive and negative appraisals of activated mood states related distinctly to experiences of activation and depression symptoms respectively, in an analogue sample (n=323). Positive appraisals of activated internal states were uniquely associated with elevated activation and hypomania symptoms. Negative appraisals of the same states were uniquely associated with elevated depression symptoms. Opposing appraisals of internal states may underlie mood swing symptoms.

Contextual effects on the perceived health benefits of exercise: the exercise rank hypothesis.

Many accounts of social influences on exercise participation describe how people compare their behaviors to those of others. We develop and test a novel hypothesis, the exercise rank hypothesis, of how this comparison can occur. The exercise rank hypothesis, derived from evolutionary theory and the decision by sampling model of judgment, suggests that individuals' perceptions of the health benefits of exercise are influenced by how individuals believe the amount of exercise ranks in comparison with other people's amounts of exercise. Study 1 demonstrated that individuals' perceptions of the health benefits of their own current exercise amounts were as predicted by the exercise rank hypothesis. Study 2 demonstrated that the perceptions of the health benefits of an amount of exercise can be manipulated by experimentally changing the ranked position of the amount within a comparison context. The discussion focuses on how social norm-based interventions could benefit from using rank information.

Personality prior to disability determines adaptation: agreeable individuals recover lost life satisfaction faster and more completely.

Personality traits prior to the onset of illness or disability may influence how well an individual psychologically adjusts after the illness or disability has occurred. Previous research has shown that after the onset of a disability, people initially experience sharp drops in life satisfaction, and the ability to regain lost life satisfaction is at best partial. However, such research has not investigated the role of individual differences in adaptation to disability. We suggest that predisability personality determines the speed and extent of adaptation. We analyzed measures of personality traits in a sample of 11,680 individuals, 307 of whom became disabled over a 4-year period. We show that although becoming disabled has a severe impact on life satisfaction, this effect is significantly moderated by predisability personality. After 4 years of disability, moderately agreeable individuals had levels of life satisfaction 0.32 standard deviations higher than those of moderately disagreeable individuals. Agreeable individuals adapt more quickly and fully to disability; disagreeable individuals may need additional support to adapt.

Inequality and Social Rank: Income Increases Buy More Life Satisfaction in More Equal Countries.

How do income and income inequality combine to influence subjective well-being? We examined the relation between income and life satisfaction in different societies, and found large effects of income inequality within a society on the relationship between individuals' incomes and their life satisfaction. The income-satisfaction gradient is steeper in countries with more equal income distributions, such that the positive effect of a 10% increase in income on life satisfaction is more than twice as large in a country with low income inequality as it is in a country with high income inequality. These findings are predicted by an income rank hypothesis according to which life satisfaction is derived from social rank. A fixed increment in income confers a greater increment in social position in a more equal society. Income inequality may influence people's preferences, such that in unequal countries people's life satisfaction is determined more strongly by their income.

Does the CES-D measure a continuum from depression to happiness? Comparing substantive and artifactual models.

The Center for Epidemiologic Studies-Depression scale (CES-D) is one of the five most frequently used measures of depressive experiences. Previous research has suggested that the scale may consist of two separate factors of happiness and depression, respectively. However, recent methodological research has demonstrated that standard factor analysis cannot be used in this situation to demonstrate such factors are substantive. The substantive factor structure of the CES-D was therefore tested with two samples of younger (N=8857; age range 27-35) and older (N=6125; age range 64-65) people. Using a recent correction to CFA, we demonstrate that a two factor structure arises through purely artifactual reasons, and that the CES-D actually has only one substantive factor, providing evidence for a single continuum ranging from happiness to depression.