Type of Home Care-Informal Versus At Least Some Formal-Matters for Recipients' Perceived Control

BACKGROUND AND OBJECTIVES

Perceived control is an important psychological resource for middle-aged and older adults. Aging in place may help foster feelings of control, yet many community-dwelling older adults must rely on others-whether family, friends, or professionals-for physical assistance. This study investigated how receiving home care from different sources was associated with two facets of perceived control (mastery and perceived constraints) among adults with varying levels of physical disability.

RESEARCH DESIGN AND METHODS

Data were drawn from the 2012 and 2014 waves of the Health and Retirement Study. Community-dwelling adults aged 50 years and older receiving help for at least one activity of daily living (ADL) impairment (N = 884) reported their relationship to each respective caregiver (formal professional and/or informal family or friend), level of ADL impairment, and ratings of perceived control. Ordinary least squares regression was used to examine the association between type of support and perceived control, as well as the moderating effect of physical disability on that relationship.

RESULTS

Compared to receipt of informal support alone, receiving a combination of formal and informal support was related to perceptions of greater control over one's life, but only in terms of mastery. The level of one's ADL impairment did not have a moderating effect on the relationship between support type and perceived control.

DISCUSSION AND IMPLICATIONS

Findings suggested that the type of instrumental support adults receive in their home has implications for specific facets of perceived control. These findings can help inform home care program development.

Steering the energy with music: hermeneutic phenomenological study of user perspectives of music and music therapy for co-occurring ADHD and substance use problems

BACKGROUND

User perspectives and involvement are crucial for improving substance use treatment service provision. First-hand accounts provide rich perspectives on how users experience change within therapeutic approaches like music therapy. People with substance use problems have a higher incidence of experiencing challenges with impulsivity, hyperactivity and inattention. Such challenges can negatively affect social functioning and outcomes of substance use treatment. Music therapy can offer people a means to regulate emotions and facilitate social relationships. There is a lack of research on user perspectives of music therapy in substance use treatment, and we could identify no studies that explore user perspectives of music therapy for adults with substance use problems and co-occurring impulsivity, hyperactivity and inattention.

METHODS

The aim of this phenomenological study was to center the voices of people living with co-occurring attention deficit hyperactivity disorder (ADHD) and substance use disorder (SUD) to understand how they experience music and music therapy in their process of recovery. We used a hermeneutic phenomenological approach to qualitative analysis of transcripts from in-depth interviews with 8 adult service users from a Norwegian substance use treatment facility.

RESULTS

Our main finding was that music and music therapy enabled experiences of motivation and mastery that ultimately afforded social belonging. The participants demonstrated detailed and nuanced understanding of how they use music to steer the energy and restlessness that are characteristic of ADHD, to change mood, and to shift negative thought patterns. These forms of music-centered regulation served as pre-requisites for more active and gratifying participation in social communities. For several participants, musicking offered a means of establishing drug-free identity and fellowship. The motivation and mastery experienced during musicking lowered the threshold for social engagement, and served as an incentive for continuing substance use treatment for some participants.

CONCLUSIONS

The nuanced descriptions from our participants illustrate the importance of motivation, and how music therapy can contribute to motivation in substance use treatment. In particular, the context surrounding musicking, adaptations from the music therapist, and social affordances of such musicking contributed to pleasure, mastery, participation, development of identity and social belonging, which in interaction generated motivation.

Decisional conflict, caregiver mastery, and depression among Chinese parental caregivers of children with leukemia

BACKGROUND

Informal caregivers of children with leukemia can be emotionally and psychiatrically vulnerable when facing difficult treatment decisions (e.g., chemotherapy, targeted therapy, radiation, transplantation). A common behavioral manifestation of decisional conflict is the verbalized expression of uncertainty about which medical treatment plan to take. The study aims to examine the associations between decisional conflict, mastery, and depressive symptoms among parental caregivers of children with leukemia in China. It explored the mediating role of mastery in the relationship.

METHODS

A cross-sectional survey design was adopted. A total of 386 parental caregivers were recruited, and 325 valid questionnaires remained. The mean age of caregivers was 37.7 years, and 61.5% caregivers were female. We used Question Format Decisional Conflict Scale to assess decisional conflict, Pearlin's Mastery Scale to assess mastery, and Center for Epidemiological Studies Depression 10 to assess depressive symptoms. We used mediation analyses to test the mediating effect of mastery.

RESULTS

The total score of decisional conflict scale, along with its dimensions of uncertainty, support, and effective decision were found negatively associated with depressive symptoms. In contrast, the dimension of information and value were not significantly associated with depressive symptoms. Mediation analyses demonstrated the direct effects of overall decisional conflict and uncertainly were fully mediated by mastery, while the direct effect of support and effective decision were partially mediated.

CONCLUSIONS

Efforts should be made to alleviate parental caregivers' decisional conflict and enhance sense of mastery. Particular attention should be paid to the psycho-social support to relieve uncertainties and ineffectiveness in decision making.

Two sides of the same coin? Absolute income and perceived income inadequacy as social determinants of health

BACKGROUND

Absolute income is commonly used in studies of health inequalities, however it does not reflect spending patterns, debts, or expectations. These aspects are reflected in measures concerning perceived income inadequacy. While health inequities by absolute income or perceived income inadequacy are well established, few studies have explored the interplay of absolute income and perceived income inadequacy in relation to health.

METHODS

Multiple data sources were linked into a nationally representative dataset (n = 445,748) of Dutch adults (18 +). The association between absolute income, perceived income inadequacy and health (self-reported health, chronic disease and psychological distress) was tested using logistic and Poisson regressions, controlling for various potential confounders (demographics, education) and mastery. Interactions were tested to check the association between perceived income inadequacy and health for different absolute income groups.

RESULTS

Perceived income inadequacy was reported at every absolute income group (with 42% of individuals in the lowest income group and 5% of individuals in the highest income group). Both absolute income and perceived income inadequacy were independently associated with health. The adjusted relative risk (RR) for lowest absolute income group is 1.11 (1.08-1.1.14) and 1.28 (1.24-1.32) for chronic disease and self-reported health respectively, and the Odds Ratio (OR) for psychological distress is 1.28 (1.16-1.42). For perceived income inadequacy the RR's were 1.41 (1.37-1.46) and 1.49 (1.44-1.54) and the OR for psychological distress is 3.14 (2.81-3.51). Mastery appeared to be an important mediator for the relationship between perceived income inadequacy, poor self-rated health and psychological distress.

CONCLUSIONS

Absolute income and perceived income inadequacy reflect conceptually different aspects of income and are independently associated with health outcomes. Perceived income inadequacy may be accounted for in health inequality studies, alongside measures of absolute income. In policy-making, targeting perceived income inadequacy might have potential to reduce health inequalities.

Intersectional Identities: Making Sense of Skill Development on Clinical Placements

OBJECTIVE

Little is known about the influence of personal experiences on learners' trajectories toward mastery. Newell's theory of constraints articulates the relationship between environmental, individual, and task-related factors for skill development. This study explores how undergraduate pharmacy students experience skill development on placements and what the barriers and facilitators are within Newell's framework.

METHODS

Year 3 undergraduate pharmacy students were invited to take part in focus groups exploring Newell's theory relative to skill development. Verbatim transcripts were analyzed using an interpretive phenomenological approach.

RESULTS

Five focus groups were conducted with 16 students. The placement task provided structure through entrustable professional activities (EPAs). The resulting skill development varied but included EPA expected behaviors and also skills for mastery, eg, self-reflection. Students' personal identities acted as both barriers and facilitators. For example, expecting or experiencing racial microaggressions limited participation; having a local accent facilitated rapport with patients. Students worked toward integration into the community of practice (the ward), where the staff was critical to inclusion. Where students had barriers related to their identities, they found it more difficult to access the community of practice.

CONCLUSION

Factors related to the community of practice (environment), students' identities (individual), and the EPA behaviors (task) can influence skill development during placement. For some students, these factors will be more prevalent, and elements of their identities may intersect and conflict, acting as both barriers and facilitators to skill development. Educators can consider the influence of intersectionality on student identity when designing and preparing new placements and assessing students.

Experiential aspects of employment and their relationship with work outcomes: A cross-sectional study using a novel measure of participation in workers with and without physical disabilities

BACKGROUND

People with disabilities often report restrictions to employment participation. Recent theorising emphasises the need for broadened conceptualisations of participation, incorporating subjective participation experiences.

OBJECTIVE

To examine relationships between subjective, experiential aspects of employment participation and work-specific outcomes in adults with and without physical disabilities.

METHODS

Using a cross-sectional study design, 1624 working Canadian adults with and without physical disabilities completed (a) the recently-developed Measure of Experiential Aspects of Participation (MeEAP) to assess six experiential aspects of employment participation: autonomy, belongingness, challenge, engagement, mastery and meaning and (b) work-outcome measures of perceived work stress, productivity loss, health-related job disruptions and absenteeism. Forced entry multivariable regression analyses were conducted.

RESULTS

Among respondents with and without disabilities, greater autonomy and mastery were associated with less work stress (ps < .03); greater belongingness was associated with less productivity loss (p < .0001). Greater engagement was associated with fewer job disruptions (p = .02) but only for respondents with physical and non-physical disability. This sub-group scored lower on all experiential aspects of participation than workers with no disability or physicaldisability only (ps < .05).

CONCLUSIONS

Results provide some support for the hypothesis that people with more positive employment participation experiences also report better work outcomes. The concept and measurement of experiential aspects of participation have value for advancing understanding of factors related to employment outcomes in workers with disabilities. Research is needed to determine how positive participation experiences manifest in workplace settings, and antecedents and consequences of positive and negative employment participation experiences.

Financial hardship and change in emotional well-being before to during COVID-19 pandemic among middle-aged and older Americans: Moderating effects of internal coping resources

OBJECTIVE

The purpose of this study was to investigate associations between financial hardship and change in emotional well-being-positive and negative affect-before to during the COVID-19 pandemic among middle-aged and older Americans and to examine the extent to which associations were moderated by internal coping resources-dispositional mastery and optimism.

METHOD

Data derived from the Leave-Behind Questionnaire in the 2016 and 2020 waves of the Health and Retirement Study, a nationally representative longitudinal survey of U.S. adults aged 51 and older (N = 1312). We estimated multivariate ordinary least squares regression models with interaction terms to evaluate prospectively the benefits of mastery and optimism as internal coping resources for middle-aged and older adults.

RESULTS

Dispositional mastery moderated the effects of financial hardship on changes in negative and positive affect, respectively, before to during the COVID-19 pandemic; however, optimism did not significantly moderate the effects of financial hardship on change in negative and positive affect before to during the COVID-19 pandemic.

CONCLUSIONS

Our findings have implications for interventions aimed at improving middle-aged and older adults' emotional well-being by promoting internal coping resources. Specifically, interventions should focus on financial hardship and mastery for vulnerable middle-aged and older adults in the context of public health crises.

Mindfulness-Based Stress Reduction for Coronary Artery Disease Patients: Potential Improvements in Mastery and Depressive Symptoms

Depressive symptoms after coronary events are associated with a worse prognosis. When changing the focus from psychopathology towards a resilience framework, treatments such as mindfulness meditation could offer novel ways to address psychological distress among coronary artery disease (CAD) patients. We studied the feasibility of mindfulness-based stress reduction (MBSR) for CAD patients with depressive symptoms. Seventy-nine CAD patients with elevated depressive symptoms were invited to an 8-week MBSR course. Twenty-four patients (30%) accepted and 16 (20%) completed MBSR. Depressive symptoms decreased immediately after the course (p = .006). After 12 months, this improvement remained, and Mastery scores increased (p = .005). A reference group of 108 CAD patients did not show any significant changes in depressive symptoms or Mastery between 1 and 12 months after a coronary event. MBSR thus appears to be a feasible alternative for CAD patients with elevated depressive symptoms. Future studies are warranted to study if MBSR can improve psychological functioning in CAD patients.Clinicaltrials.gov (Registration Number: NCT03340948).

Previous trauma exposure and self-mastery as moderators of psychiatric effects of home isolation during the Covid-19 pandemic: a field study

BACKGROUND

Limiting contagion during the Covid-19 pandemic has necessitated employment of drastic measures ranging from complete lockdown to home isolation and quarantines. This study examined the psychiatric effects of home isolation, the effects of interacting previous traumatic events and the moderating effect of self-mastery as a resilience factor that could mitigate negative effects.

METHODS

Six hundred forty-five adults aged 18-67 completed an online survey during the first wave lockdown during the Covid-19 outbreak in Israel. Participants completed a demographic questionnaire including measures of strictness of adherence to home isolation, a traumatic life events measure, the Mastery Scale, and the Brief Symptom Inventory. Data was analyzed using Structural Equation Model.

RESULTS

Findings showed positive relations between strictness of home isolation adherence and psychiatric symptoms, and between previous trauma exposure and psychiatric symptoms. A negative relation between self-mastery and psychiatric symptoms emerged. During home isolation, effects of previous trauma exposure on psychiatric symptoms was moderated by self-mastery. Individuals with high self-mastery showed less psychiatric symptoms than those with low self-mastery, at both high and low levels of previous trauma exposure.

CONCLUSIONS

Home isolation adherence is associated with significant psychological distress and symptomatology and, thus, should be of great concern for public mental health service providers. The present study offers a new slant on appropriate clinical interventions during this period with a focus on strengthening resilience factors that can moderate mental health decline. Therapy and interventions based on promoting self-mastery could exert a significant effect on lowering psychiatric symptoms during stressful periods of home isolation.

TRIAL REGISTRATION

Not relevant.

Modeling the association between and predictors of two constructs of resilience

PURPOSE

Resilience serves as a protective factor against adverse outcomes following exposure to traumatic events. The extant literature focuses on psychiatric resilience in the context of internalizing symptoms, though resilience is also important in relation to externalizing symptoms. Research is needed to clarify the predictors of resilience across contexts. The aims of the current study are twofold: 1. Determine the association between psychiatric resilience (PR) and alcohol resistance (AR) and 2. Test for differential prediction of each form of resilience by exogenous predictors.

METHODS

The sample (n = 7585) was drawn from the Virginia Adult Twin Studies of Psychiatric and Substance Use Disorders (VATSPSUD). Participants completed measures of internalizing symptoms, exposure to stressful life events, DSM alcohol abuse and dependence symptoms, maximum alcohol consumption, personality variables, and social support. All cross-sectional, structural equation modeling (SEM) analyses were conducted using Mplus software version 8.2.

RESULTS

A single common factor model provided adequate fits for both PR and AR. In the full measurement model the correlation between the two resilience factors was estimated (r = 0.28, SE = 0.018, p < 0.001). Neuroticism and mastery predicted AR and PR, but differentially, with a stronger effect size for PR (neuroticism: B = 0.35, p < 0.001; mastery: B = - 0.36, p < 0.001). The positive social support factor did not predict either resilience variable, while interpersonal conflict was associated with both (AR = 0.09, p < 0.001; PR = 0.07, p < 0.001).

CONCLUSIONS

Findings extend the current literature on resilience in two ways. First, rigorous measurement model based definitions of two resilience variables are specified. Second, external validation of the AR and PR constructs is carried out using latent variable modeling techniques. The modest correlation suggests resilience may not be well-characterized by a single general attribute. Findings provide further evidence for predictors of resilience by way of displaying differential patterns of prediction effect sizes of PR and AR.

Path analysis from COVID-19 perceptions to psychological health: The roles of critical distance and mastery

OBJECTIVE

The Coronavirus disease 2019 (COVID-19) pandemic was previously associated with psychopathological symptoms. However, the psychological mechanisms underlying these associations are largely unexplored. Previous studies suggested associations between metacognitive abilities (e.g., mastery) and symptomatology, which may have impacts on COVID-19 perceptions. This study aims to explore, using path analysis, the mediational role of Critical Distance (differentiation and decentration abilities) and Mastery on the relationships between COVID-19 perceptions and psychological well-being and distress.

METHODS

In a cross-sectional design, 227 participants (M = 34.21, SD = 10.9) filled self-report questionnaires.

RESULTS

Metacognitive abilities were negatively correlated with psychopathological symptoms. Both Critical Distance and Mastery mediated the path from COVID-19 perceived severity and anxiety to psychological distress and well-being. Critical Distance seems to augment Mastery which tends to increase psychological well-being and limited psychological distress.

CONCLUSIONS

Metacognition seems to play a mediational role on the relationship between COVID-19 perceptions and mental health. Clinical psychologists and psychotherapists may enhance psychological interventions regarding COVID-19 psychopathological symptomatology by working on metacognitive Critical Distance and Mastery abilities.

Physical activity related to mastery and vitality in a Swedish adult population with economic difficulties

Background

People with low socio-economic status report lower levels of physical activity (PA). There is insufficient knowledge about the availability of psychological resources for those who are physically active despite having a low socio-economic status. The aim of this study is to investigate the association between PA level and mastery and vitality, respectively, within an adult population with self-reported economic difficulties.

Method

Data from a cross-sectional, population-based study (n = 817) were used. Linear regression was used to estimate the unstandardised regression coefficient (β) with 95% confidence intervals (95% CI), describing associations between PA levels (independent variable) and scale scores of psychological resources in terms of mastery and vitality (outcome variables). Three models were constructed: Model I unadjusted; Model II adjusted for sex and age; and Model III adjusted for sex, age, smoking and food quality.

Result

After adjusting for sex, age, smoking and food quality and using low-level PA as the reference, high-level PA, but not intermediate-level PA, was related to higher scale scores of mastery (β = 0.72 [95% CI 0.08 to 1.37]). For vitality, both high-level PA and intermediate-level PA were related to higher scale scores (β = 9.30 [95% CI 5.20 to 13.40] and β = 6.70 [95% CI 1.40 to 12.00] respectively).

Conclusion

In an adult population with self-reported economic difficulties, higher levels of physical activity were related to higher mastery and vitality. Our results support that the association between physical activity and psychological resources in terms of mastery and vitality should be considered in the context of targeted health dialogues.

Trial registration number

Not applicable.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-12194-6.

Greater mastery is associated with lower depression risk in a large international cohort of people with multiple sclerosis over 2.5 years

Background

Mastery is the extent to which an individual perceives their life circumstances as being under their control and not predominantly influenced by external factors. The relationship of mastery with clinical outcomes in people with multiple sclerosis (pwMS) has not been well-researched. We assessed the relationships of mastery with fatigue, disability, relapse number, and depression risk among pwMS over 2.5 years’ follow-up.

Methods

Data from the Health Outcomes and Lifestyle in a Sample of people with Multiple sclerosis study, among 839 participants who completed the 2.5 and 5-year reviews, were analysed. Mastery was measured by the Pearlin Mastery Scale, fatigue by Fatigue Severity Scale, depression risk by Patient Health Questionnaire-9, and disability by Patient-Determined Disease Steps, and diagnosed relapse number in the previous 12 months was queried. Cross-sectional and prospective analyses were undertaken by log-binomial, log-multinomial, and Poisson regression, as appropriate, adjusted for relevant confounders.

Results

Cross-sectionally, pwMS with the highest quartile mastery (> 25/28) had 90% lower frequency of depression risk, 60% lower frequency of clinically significant fatigue, and 77% fewer had severe disability, all largely robust to adjustment. Prospectively, those in the top two quartiles of mastery (> 21–25, > 25/28) had 66% and 74% lower subsequent depression risk, robust to adjustment. No significant associations were seen prospectively for change in fatigue, disability, or relapse number, however, and no robust associations of mastery with relapse number were evident.

Conclusions

Prospectively, a protective relationship of mastery with subsequent risk of depression was observed, suggesting this may be a point of intervention to improve wellbeing in pwMS.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11136-021-03033-7.

Integrating instructional design principles into surgical skills training models: an innovative approach

OBJECTIVE

Surgical training programmes are evolving from time-based to competency-based schedules, which define expected learning outcomes in surgical knowledge, clinical and technical skills according to training levels. This article aims to review current models in surgical skills acquisition and to propose an integrative process-driven, outcomes-based model for surgical skills acquisition and mastery.

DESIGN

A literature review was conducted on the theories of motor skills acquisition using PubMed, Web of Science and Google Scholar from 2010 to February 2020. The review was limited to theories and models on surgical skills acquisition and mastery. Four models of surgical skills acquisition were included: Fitts and Posner's three-stage model of motor skills acquisition, Bandura's social learning theory, Ericsson's deliberate practice model and Jeannerod's motor simulation theory. These models are deficient in that there is no universally accessible opportunity to practise the surgical procedure outside of the operating theatre and without access to physical simulators.

RESULTS

We propose an innovative model that allows deliberate practice of the procedure without the need for expensive physical simulators, and provides an on-demand, self-directed practice by the trainees to achieve the level of mastery. This new model, which incorporates motor imagery and mental practice, augmented by deliberate practice, will provide an alternative training path for expert performance in surgical procedures.

CONCLUSIONS

The innovative model provides a solution to the reduced opportunity for practice by surgical trainees to achieve mastery in surgical motor skills.

The moderating role of resilience resources in the association between stressful life events and symptoms of postpartum depression

BACKGROUND

One in seven women experience postpartum depression, posing a serious public health concern. One of the most robust predictors of elevated postpartum depressive symptoms is major stressful life events that occur during pregnancy. Having greater resilience resources that promote successful adaptation to stressful demands may be protective in the face of stress during pregnancy. The current study tested whether three resilience resources- mastery, dispositional optimism, and spirituality- each predicted early symptoms of postpartum depression and moderated the hypothesized association between experiencing stressful life events during pregnancy and symptoms of postpartum depression.

METHODS

The sample included 233 women who participated in a prospective longitudinal study from pregnancy through postpartum. Depressive symptoms were assessed at approximately 4 to 8 weeks after birth, whereas resilience resources and stressful life events were measured in pregnancy. Multiple linear regressions were used to test hypotheses.

RESULTS

Stressful life events predicted greater symptoms of depression postpartum. Mastery and optimism predicted fewer symptoms of depression postpartum. Mastery moderated the association between stressful life events and symptoms of depression when controlling for previous psychiatric history, t(231) = -1.97, p=.0497.

LIMITATIONS

There was some attrition among study participants across timepoints, which was accounted for in analyses with multiple imputation.

CONCLUSIONS

These findings point to the protective nature of a mother's sense of mastery in the face of major life stressors during pregnancy and suggest this is an important construct to target in interventions addressing postpartum depression.

Individual differences in professional sport narrative experience during basketball players club mutation

Due to the growing competitive challenges, athletes' mutation between clubs has emerged an area of interest within career development. However, studies aimed at analysing this specific process of adaptation to clubs that lead to success or failure in such career mutations are seldom. We developed a comprehensive understanding of the psychological mutation processes to clubs using a narrative level of McAdams’ model of personality. The qualitative method approach used in the Big Three narrative framework (McLean et al., 2019) and good life stories standards (McAdams, 1996) were applied to uncover the components of the narratives of twenty professional basketball players during mutation between clubs. The current study sort to test the links between these narrative components and athlete successful club to club mutation (CCM-successful). On average, the results showed that the participants experienced richer narratives as compared to general population t (17.08) = -1.48, p < .05. Narratives in the CCM-successful were also richer (Mean = 2.83, SD = .16) as compared to narratives of the CCM-unsuccessful (Mean = 1.63, SD, = .36). The overall club mutation success correlated positively with exploratory processing, meaning-making and agency narrative components. These results suggest that when athletes develop active attitudes seeking for solution and sharing their experience with others, they may build the conditions of adaptability that corresponds to a successful outcome for their mutation. The participants exhibited flexible and proactive behaviours which rendered possible the appropriation of the elements in the environment that favour a positive experience of mutation.

Practise till you drop: Trialing an online intervention for late-career medical practitioners to promote planning for retirement

Many medical practitioners in Australia work beyond the traditional retirement age. Transitioning to retirement is important, however, because the likelihood of poorer clinical outcomes increases with practitioner age. The objective of the present study was to develop and trial an online educational intervention to promote planning for a smoother transition to retirement using a non-randomized control group pre- and post-test design. Medical practitioners aged 55 or over (N = 262, Mage = 61.9) and working 30 or more hours per week were recruited to complete four online modules that addressed a range of topics (physical, health, financial, social, cognitive, and emotional well-being) and encouraged planning for retirement resources. Outcome measures included work centrality, mastery, and goal perceptions across the aforementioned resource domains. Eighty-one doctors completed post-training measures; a control group who completed only the measures (n = 23) and a training group (n = 58). Pre-post comparisons showed no significant changes for the control group. However, the training group at Time 2 showed lower work centrality t(57) = 2.12, (p = .036), and changes to social t(57) = 2.35, (p = .022), emotional t(57) = 3.18, (p = .002) and health goal perceptions t(57) = -2.02, (p = .049). Controlling for baseline scores and self-selection bias determinants, Generalized Linear Model (GLM) analyses indicated a training group increase in mastery scores (β = 0.87, p = .045) and decrease in negative perception of the consequence of not meeting emotional goals (β = -0.37, p = .043). Although not significant, GLM results also showed an increase in resources, three of four health goal domains and financial goals, indicating the potential for positive training effects in future applications of the program. The online retirement planning resource showed promise in promoting a sense of mastery and a reassessment of retirement plans, taking into consideration resource accumulation and goal setting across five specific goal domains. We discuss the theoretical and practical implications of our findings.

Mastery and Marital Processes: Mechanisms Linking Midlife Economic Adversity and Later-Life Loneliness for Husbands and Wives in Enduring Marriages

Research has documented that loneliness is a major public health concern, particularly for older adults in the United States. However, previous studies have not elucidated the mechanisms that connect family economic adversity to husbands' and wives' loneliness in later adulthood. Thus, using prospective dyadic data over 27 years from 254 enduring couples, the present study investigated how spouses' mastery, as an intraindividual process, and marital functioning, as a couple process, link midlife family economic adversity to spouses' later-life loneliness. The results provided support for three linking life course pathways: an adversity-mastery-loneliness pathway, an adversity-marital functioning-loneliness pathway, and a mastery-marital functioning-loneliness pathway. The results also showed spousal contemporaneous dependencies in mastery and loneliness. These findings demonstrate the persistent influence of midlife family economic adversity on husbands' and wives' loneliness nearly three decades later and elucidate linking mechanisms involving mastery and couple marital functioning. Findings are discussed as they relate to life course and family systems theories. Implications address multiple levels including national- and state-policies and couple-level clinical interventions.

"My goal is to do the best that I can in this class": Relevance of potential-based achievement goals for intrinsic motivation and course performance

Goals are a core aspect of motivation. Elliot et al. (2015) introduced potential-based goals as a type of self-based goals that are conceptualised as seeking to do as well as one possibly could (potential approach goals) or seeking to avoid doing worse than one possibly could (potential avoidance goals). We follow up on this construct by examining its factorial structure and investigating its associations with intrinsic motivation and performance. We assessed 436 Iranian university students' potential-based goals at the beginning of an English course, intrinsic motivation during the semester and end-of-course performance. Results attested factional separability similar to the original work, supporting generalisability concerning more collectivistic contexts. Potential approach goals were positively associated with intrinsic motivation and performance, while potential avoidance goals were negatively associated with performance, also after controlling for demographics. Overall, this affirms the relevance of potential-based goals for a comprehensive understanding of how goals motivate individuals.

On the Adaptive Value of Paranormal Beliefs - a Qualitative Study

Ten female and five male participants (age range 28-50 years) were recruited at esoteric fairs or via esoteric chatrooms. In a guided face-to-face interview, they reported origins and contents of their beliefs in e.g. esoteric practices, supernatural beings, rebirthing, channeling. Transcripts of the tape-recorded reports were subjected to a qualitative analysis. Exhaustive categorization of the narratives' content revealed that paranormal beliefs were functional with regard to two fundamental motives - striving for mastery and valuing me and mine (striving for a positive evaluation of the self). Moreover, paranormal beliefs paved the way for goal-setting and leading a meaningful life but, on the negative side, could also result in social exclusion. Results are discussed with reference to the adaptive value of paranormal beliefs.

Learning Curves of Laparoscopic Roux-en-Y Gastric Bypass and Sleeve Gastrectomy in Bariatric Surgery: a Systematic Review and Introduction of a Standardization

BACKGROUND

The most commonly performed bariatric procedures are laparoscopic Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (LSG). Impact of learning curves on operative outcome has been well shown, but the necessary learning curves have not been clearly defined. This study provides a systematic review of the literature and proposes a standardization of phases of learning curves for RYGB and LSG.

METHODS

A systematic literature search was performed using PubMed, Web of Science, and CENTRAL databases. All studies specifying a number or range of approaches to characterize the learning curve for RYGB and LSG were selected.

RESULTS

A total of 28 publications related to learning curves for 27,770 performed bariatric surgeries were included. Parameters used to determine the learning curve were operative time, complications, conversions, length of stay, and blood loss. Learning curve range was 30-500 (RYGB) and 30-200 operations (LSG) according to different definitions and respective phases of learning curves. Learning phases described the number of procedures necessary to achieve predefined skill levels, such as competency, proficiency, and mastery.

CONCLUSIONS

Definitions of learning curves for bariatric surgery are heterogeneous. Introduction of the three skill phases competency, proficiency, and mastery is proposed to provide a standardized definition using multiple outcome variables to enable better comparison in the future. These levels are reached after 30-70, 70-150, and up to 500 RYGB, and after 30-50, 60-100, and 100-200 LSG. Training curricula, previous laparoscopic experience, and high procedure volume are hallmarks for successful outcomes during the learning curve.

Impact of childhood cancer on the family: evidence from Bangladesh

Background

The care of children with cancer creates emotional, financial, and social impacts for their families. Information on the impact of childhood cancer (CC) on the family is scarce in Bangladesh. Thus, the study was set out to assess the impact of CC on the families in the local context.

Methods

This cross-sectional study was conducted from January to June 2018 in three purposively selected tertiary hospitals. All the children diagnosed and treated at those hospitals during the study period were eligible for this study. Children undergoing bone marrow transplantation, or those who were seriously ill, or those transferred to another hospital, or those who died were excluded or whose parents were not willing to participate. A total of 242 children were enrolled in the study and their parents were included in the interview. Measures included socio-demographic attributes, financial burden, personal strain, social impact, mastery, and treatment cost. Informed written consent was obtained from the parents and a face-to-face interview was conducted using a semi-structured questionnaire based on (i) About you and your-family and (ii) the Impact-On-Family (IOF) scale. High scores of the scale correlated to high impact. Medical records were reviewed to collect data on the pattern of CC and treatment costs.

Results

Major CCs included leukemia (36.0%), blastoma (18.2%), sarcoma (14.9%), and lymphoma (12.4%). The weighted score was highest for mastery (3.63) followed by financial burden (3.33), personal strain (3.27), and social impact (3.21) domains. The difference of IOFS score was significant by family type (p < 0.05), father's occupation (p < 0.05), type (p < 0.01) and duration of cancer (p < 0.01), and treatment cost (p˂0.01). Families adopted diverse coping strategies including changed lifestyle (98.3%), sought social support (86.0%), rely more on religion (98.8%), and reduced family investment (83.9%) to adjust the impact.

Conclusion

The impact of CC on the family is evident at many levels. In particular, mean scores of financial burden, personal strain, social impact, and mastery domains of the IOF scale were significantly associated with the employment status of parents, residing place, treatment cost, type, and duration of cancer. The study findings could contribute to devising impact-reducing intervention programs in Bangladesh.

Results of a Randomized Trial Testing the Efficacy of Tele-Savvy, an Online Synchronous/Asynchronous Psychoeducation Program for Family Caregivers of Persons Living with Dementia

BACKGROUND AND OBJECTIVES

Family caregivers will grow in number as dementia prevalence increases, underscoring the continued importance of equipping these individuals for their new roles and ameliorating the adverse effects of caregiving.

RESEARCH DESIGN AND METHODS

A three-armed, waitlist, randomized trial design tested Tele-Savvy, an online adaptation of a successful in-person psychoeducation program, the Savvy Caregiver. Tele-Savvy is delivered over 43 days to groups of 6-8 caregivers in 7 weekly synchronous sessions accompanied by 36 brief asynchronous video lessons. We enrolled 23 cohorts of 15 eligible caregivers (N = 261), randomized 2:2:1 to active, attention control, and usual care arms. We assessed caregiver psychological well-being and caregiving mastery at baseline and 3, 6, 9, and 12 months. Multilevel linear models assessed outcomes over the 3 time points examined. The trial was slightly truncated, with Data and Safety Monitoring Board approval, because of the apparent confounding psychological effects of coronavirus disease 2019 restrictions.

RESULTS

Study findings indicate statistically and clinically significant benefits to Tele-Savvy arm caregivers (with moderate to large effect sizes) in the areas of depression, perceived stress, reaction to care recipients' behaviors, and enhancement of caregiver mastery. Expected benefits for caregiver burden and anxiety were not found.

DISCUSSION AND IMPLICATIONS

Findings attest to program efficacy and the viability of employing distance means to improve family caregivers' emotional well-being and sense of mastery in the caregiving role over a 6-month period. Next steps entail finding alternate ways to deliver the program to those with connectivity and/or time constraint problems.

The Effects of Aerobic Exercise on Psychological Functioning in Family Caregivers: Secondary Analyses of a Randomized Controlled Trial

BACKGROUND

The responsibility and stress of being a family caregiver are associated with reduced physical and mental health.

PURPOSE

To examine whether a 24-week aerobic exercise program improves multiple aspects of psychological functioning in family caregivers.

METHODS

Family caregivers of patients with Alzheimer's disease and other dementias (n = 68) were recruited and randomized into either an aerobic exercise group (n = 34) or a waitlist control group (n = 34). The exercise group was assigned a 24-week aerobic training program that incrementally increased the intensity, duration, and frequency of the exercise program until 150 min of moderate to vigorous activity were completed per week by the ninth week. Twelve measures of psychological functioning were administered at baseline and compared with responses completed following the intervention.

RESULTS

Multilevel modeling revealed significant decreases in caregiver burden (β = -4.60, 95% confidence interval [CI] = [-8.82, -0.38], RLMM2 = 0.11) and depression (β = -2.59, 95% CI = [-4.79, -0.38], RLMM2 = 0.13), as well as increases in mastery (β = 1.78, 95% CI = [0.09, 3.46], RLMM2 = .04) in the exercise intervention group compared to the control group.

CONCLUSION

Family caregivers report high levels of depression and caregiver burden. Engagement in a 24-week exercise intervention can ameliorate the perceived burden of caregiving, symptoms of depression, and their sense of mastery.

Improving imagery rescripting treatments: Comparing an active versus passive approach

BACKGROUND AND OBJECTIVES

In imagery rescripting (ImRs), aversive mental images are modified to reduce symptoms in a variety of psychological disorders. However, uniform guidelines on how to optimally implement ImRs do currently not exist. It remains unclear whether therapists should stimulate patients to imagine themselves to actively intervene within the new image, or whether they may imagine helpers to change the situation. We aimed to compare these two variants of ImRs within an analogue experimental setting.

METHODS

After having watched an aversive film, one-hundred participants were randomly assigned to active ImRs (ImRs-A), passive ImRs (ImRs-P), imagery rehearsal (IRE), or no-intervention control (NIC). Participants were either instructed to rescript the film by imagining themselves intervening in the new script (ImRs-A) or encouraged to imagine helpers to intervene in the imagined situation (ImRs-P).

RESULTS

Both ImRs increased mastery and elicited less distress than IRE with ImRs-P being experienced as less distressing than ImRs-A. Only ImRs-A led to a stronger increase in positive affect than IRE, whereas groups did not differ with respect to negative affect and self-efficacy. Conditions did not differ regarding the number of film-related intrusive memories.

LIMITATIONS

As a convenience sample was investigated, results cannot be generalized to clinical samples.

CONCLUSION

Even though differences regarding symptomatic outcome could not be detected, ImRs-P was experienced as less distressing than ImRs-A. Results suggest that both ImRs lead to different processes during the intervention than mere exposure. Compared to IRE, ImRs increases mastery with ImRs-A and ImRs-P being equally effective.

Mastery and self-esteem mediate the association between visual acuity and mental health: a population-based longitudinal cohort study

BACKGROUND

With deteriorating eyesight, people often become dependent on others for many aspects of their daily lives. As a result, they feel less 'in control' and experience lower self-esteem. Lower sense of mastery and self-esteem are known to predict depression, but their roles in people with visual impairment have only marginally been investigated. Therefore, this study aimed to determine the influence of mastery and self-esteem on the relationship between visual acuity and mental health.

METHODS

A longitudinal cohort study was performed using data from the Longitudinal Aging Study Amsterdam (LASA), collected between 2001 and 2012. A community-based population of 2599 older adults were included, who were randomly selected from population registers. Outcomes of interest were the Pearlin Mastery Scale, Rosenberg Self-Esteem Scale, Center for Epidemiologic Studies - Depression scale and the Hospital Anxiety Depression Scale - Anxiety subscale. Linear mixed models were used to establish the association between visual acuity and mental health over time.

RESULTS

Mean age was 72 years, 56% was female and 1.2% qualified as having low vision. Visual impairment was associated with a lower sense of mastery (β = - 0.477, p < 0.001), lower self-esteem (β = - 0.166, p = 0.008) and more depression (β = 0.235, p < 0.001). No significant association between visual acuity and anxiety was found. The relationship between visual acuity and depression was mediated by self-esteem (25%) and sense of mastery (79%).

CONCLUSIONS

Vision loss was associated with depression. This association was mediated by self-esteem and sense of mastery. This provides us with new possibilities to identify, support and treat those at risk for developing depression by aiming to increase their self-esteem and sense of mastery.

Psychological Resources, Constructive Conflict Management Behaviors, and Depressive Symptoms: A Dyadic Analysis

This study investigated the longitudinal associations between mastery, conflict management behaviors, and depressive symptoms using an actor-partner interdependence model with 371 middle-aged couples over a span of 24 years. Results indicated that for both husbands and wives, individuals who possessed higher levels of mastery generally displayed more constructive conflict management behaviors during marital conflicts in middle years. In turn, individuals with more constructive behaviors averaged fewer depressive symptoms in their later adulthood. A partner effect was also noted, as individuals' constructive behaviors were linked to their spouse's depressive symptoms. This finding emphasizes the importance of utilizing a dyadic context to understand intra-individual and inter-individual (or crossover) influences between husbands and wives in enduring marriages. A better understanding of how couples affect each other's mental health can inform the development and implementation of health promotion interventions and prevention efforts targeting middle-aged couples.

Mastery and Longevity in Spousal Caregivers of Persons with Dementia

OBJECTIVE

Researchers have consistently shown that providing care in a gradually deteriorating situation, such as dementia, can be stressful and detrimental to the caregiver's (CG) health. Although stressor appraisal is important in understanding variability in CG outcomes, the role of personal mastery, a coping resource, in shaping CG's health outcomes has not been considered. The primary goal of this paper was to determine whether personal mastery is associated with a survival advantage for spousal CGs of persons with dementia.

METHODS

This study assessed the association of CG burden and personal mastery with longevity over a 10-year period in 71 spousal CGs of persons initially diagnosed with mild cognitive impairment.

RESULTS

Over the 10 years, 16 of 71 CGs (23%) died. Cox regression models with right censoring of CGs' time to death showed that after adjusting for the health of family CG, spousal CGs who reported high levels of burden had an 83% reduced risk of death when they also reported high personal mastery (hazard ratio [HR] = 0.17, 95% confidence interval [CI] 0.04, 0.65).

CONCLUSIONS

Findings have implications for support programs that help build personal mastery.

Psychological Resilience and Health Among Older Adults: A Comparison of Personal Resources

OBJECTIVES

Research on life course inequality and successful aging has sought to understand how events and challenges may lead to poor outcomes in later life for some individuals, while others fare well in the face of adversity. Among internalized resources, research suggests psychological resilience is protective in the face of challenges, but little is known about the predictive efficacy of this measure compared to other resources such as mastery. This paper examines connections between psychological resilience and later life health compared to other internalized resources.

METHOD

Standardized associations between 4 resources (resilience, mastery, optimism, hopelessness) and 5 health outcomes were tested using short-term health transitions and longer term health trajectories in a structural equation modeling (SEM) framework using the Leave Behind Questionnaire (LBQ) and linked Health and Retirement Study (HRS) between 2006/2008 and 2014/2016 (n = 11,050-12,823).

RESULTS

Psychological resilience had consistent and robust associations with health transitions and trajectories. Further, the effects of this resource were generally 4-10 times greater than for mastery, optimism, and hopelessness in combined models. Trajectory analyses replicate these findings and suggest the beneficial associations of resilience over time were persistent for some health outcomes, and cumulative for others.

DISCUSSION

The results suggest that psychological resilience is powerfully associated with health in later life, with substantially greater predictive efficacy than other commonly used resource measures. Future research should establish how this intrapersonal resource works alongside structural and interpersonal resources to promote and protect health and functioning in the face of challenges and adversity.

Achieving expert performance through simulation-based education and application of mastery learning principles

Medical education has undergone significant change as we have moved from a purely apprenticeship model to one of competence. Simulation-based education can and does play a significant role in the development of an expert surgeon. Proven concepts of simulation-based education include distributed deliberate practice, content that challenges the learner, formative and summative feedback. The application of mastery learning principles is critical to achieve the best retention and outcomes related to an educational program. In this manuscript, we explore the methodology and justification for Mastery Learning as the gold standard of surgical education.

Longitudinal impacts of an online safety and health intervention for women experiencing intimate partner violence: randomized controlled trial

Background

Responding to intimate partner violence (IPV) and its consequences is made complex by women’s diverse needs, priorities and contexts. Tailored online IPV interventions that account for differences among women have potential to reduce barriers to support and improve key outcomes.

Methods

Double blind randomized controlled trial of 462 Canadian adult women who experienced recent IPV randomly were assigned to receive either a tailored, interactive online safety and health intervention (iCAN Plan 4 Safety) or a static, non-tailored version of this tool. Primary (depressive symptoms, PTSD symptoms) and secondary (helpfulness of safety actions, confidence in safety planning, mastery, social support, experiences of coercive control, and decisional conflict) outcomes were measured at baseline and 3, 6, and 12 months later via online surveys. Generalized Estimating Equations were used to test for differences in outcomes by study arm. Differential effects of the tailored intervention for 4 strata of women were examined using effect sizes. Exit survey process evaluation data were analyzed using descriptive statistics, t-tests and conventional content analysis.

Results

Women in both tailored and non-tailored groups improved over time on primary outcomes of depression (p < .001) and PTSD (p < .001) and on all secondary outcomes. Changes over time did not differ by study arm. Women in both groups reported high levels of benefit, safety and accessibility of the online interventions, with low risk of harm, although those completing the tailored intervention were more positive about fit and helpfulness. Importantly, the tailored intervention had greater positive effects for 4 groups of women, those: with children under 18 living at home; reporting more severe violence; living in medium-sized and large urban centers; and not living with a partner.

Conclusion

This trial extends evidence about the effectiveness of online safety and health interventions for women experiencing IPV to Canadian women and provides a contextualized understanding about intervention processes and effects useful for future refinement and scale up. The differential effects of the tailored intervention found for specific subgroups support the importance of attending to diverse contexts and needs. iCAN is a promising intervention that can complement resources available to Canadian women experiencing IPV.

Trial registration

Clinicaltrials.gov ID NCT02258841 (Prospectively Registered on Oct 2, 2014).

Psychological well-being as part of the public health debate? Insight into dimensions, interventions, and policy

BACKGROUND

Increasing evidence suggests that psychological well-being (PWB) is associated with lower disease and mortality risk, and may be enhanced with relatively low-cost interventions. Yet, dissemination of these interventions remains limited, in part because insufficient attention has been paid to distinct PWB dimensions, which may impact physical health outcomes differently.

METHODS

This essay first reviews the empirical evidence regarding differential relationships between all-cause mortality and multiple dimensions of PWB (e.g., life purpose, mastery, positive affect, life satisfaction, optimism). Then, individual-level positive psychology interventions aimed at increasing PWB and tested in randomized-controlled trials are reviewed as these allow for easy implementation and potentially broad outreach to improve population well-being, in concert with efforts targeting other established social determinants of health.

RESULTS

Several PWB dimensions relate to mortality, with varying strength of evidence. Many of positive psychology trials indicate small-to-moderate improvements in PWB; rigorous institution-level interventions are comparatively few, but preliminary results suggest benefits as well. Examples of existing health policies geared towards the improvement of population well-being are also presented. Future avenues of well-being epidemiological and intervention research, as well as policy implications, are discussed.

CONCLUSIONS

Although research in the fields of behavioral and psychosomatic medicine, as well as health psychology have substantially contributed to the science of PWB, this body of work has been somewhat overlooked by the public health community. Yet, the growing interest in documenting well-being, in addition to examining its determinants and consequences at a population level may provoke a shift in perspective. To cultivate optimal well-being-mental, physical, social, and spiritual-consideration of a broader set of well-being measures, rigorous studies, and interventions that can be disseminated is critically needed.

Psychosocial Factors and Personality Traits and the Prevalence of Arterial Hypertension Among 35- and 55-Year-Old Men and Women in Sweden and Estonia: a SWESTONIA Longitudinal Study

INTRODUCTION

Psychosocial factors influence the risk of developing hypertension. Personality traits have a modulating effect against the harmful influences of psychosocial factors.

AIM

Through a longitudinal clinical study consisting of men and women aged 35 and 55 at the baseline in Estonia and Sweden, to assess the influence of psychosocial factors and personality traits resulting in arterial hypertension.

METHODS

Data analysis based on the cross-sectional study with 2 assessments over 13 years of a sample comprising 158 individuals from Estonia and 213 individuals from Sweden. The Pearlin Mastery Scale, Rosenberg Self-esteem Scale, Depression Model and Gothenburg Quality of Life Instrument were used.

RESULTS

Throughout the follow-up period, a higher depressive mood and lower self-assessed quality of life score prevailed among the 35-year-old and 55-year-old Estonians compared with the Swedish study participants (p < 0.001). Among the 55-year-old Estonian study participants with diagnosed hypertension, but not among the Swedish, negative stressful life events had a significantly stronger effect (p < 0.001) on the risk of developing hypertension. In addition, lower mastery (p < 0.05) dominated among study participants diagnosed with hypertension.

CONCLUSIONS

The combined effects of psychosocial factors and personality traits are important variables in predicting the risk of developing arterial hypertension. The study results are relevant to clinical practice and provide suggestions for employing successful preventive measures.

Mastery is associated with greater physical and mental health-related quality of life in two international cohorts of people with multiple sclerosis

BACKGROUND

Mastery is the sense of being in control of one's life and improvement in mastery may help to enhance quality of life. Little research has explored mastery in people with multiple sclerosis (MS), including its association with quality of life.

OBJECTIVE

To explore the association between mastery and health-related quality of life (HRQOL) in people with MS.

METHOD

Two cross-sectional cohorts of adults with MS (n = 1401 and n = 573), recruited through convenience sampling, completed an online survey which measured mastery using the Pearlin Mastery Scale, physical and mental HRQOL via physical and mental health composite scores of MSQOL-54, along with other covariates, including demographics, clinical characteristics and lifestyle factors. Linear regression assessed associations between mastery and physical HRQOL adjusting for age, sex, education, disability and depression, and between mastery and mental HRQOL adjusting for age, sex, education, disability and clinically significant fatigue.

RESULTS

Greater mastery score was associated with higher physical and mental HRQOL in both cohorts, such that a one-point increase in the PMS was associated with an increase of 2.9 (95% Confidence Interval (CI): 2.6, 3.1) and 2.8 points (95% CI: 2.4, 3.2) in the means of physical HRQOL score in the first and second cohorts respectively, and a 2.9-point (95% CI: 2.7, 3.1) and 3.1-point (95% CI: 2.7, 3.4) increase in the means of mental HRQOL score. A dose-dependent relationship was demonstrated between a quartile categorical mastery variable and both physical and mental HRQOL in both cohorts. Mastery was associated with all subscores of both physical and mental HRQOL.

CONCLUSIONS

Greater mastery is associated with better physical and mental quality of life. Efforts to improve the sense of self control and agency of people with MS may have benefits for their quality of life, even despite clinical features of the illness.

Linking Mastery Across the Life Course to Mobility Device Use in Later Life

OBJECTIVES

Mastery in older ages is shaped by earlier-life experiences. Prior research has demonstrated that mastery is associated with health-promoting behaviors; however, little research has examined whether mastery histories influence health behaviors such as mobility device use in later life.

METHOD

Using 25 years of data from the Americans' Changing Lives Survey (N = 1,427), this research explores whether different trajectories of life course mastery influence the odds that an older adult will use a mobility device when experiencing functional impairment. We used growth mixture models with a distal outcome and examined the relationship between functional limitations and mobility device use as it varies across latent classes of life course mastery, controlling for social and health factors.

RESULTS

The odds of device use in the face of functional limitations were significantly higher among those with a history of high life course mastery, relative to those with low life course mastery, all things being equal.

DISCUSSION

Our findings suggest that mastery over the life course is a source of psychological human capital that is associated with health-promoting behaviors in later life among those with functional limitations.

Association between General Sense of Mastery and Income in White- and African-American Adults

BACKGROUND

Some research has shown that general sense of mastery (i.e., sense of control over the forces that impact one's life) does not have universal causes and consequences in racial groups. For instance, sense of mastery better predicts depression and mortality for non-Hispanic Whites (NHWs) than that of African-Americans (AAs).

OBJECTIVES

The objective of this study was to test the heterogeneity in the association between the sense of mastery and income by race in a nationally representative sample of NHW and AA adults.

METHODS

This study included a total of 3570 AA and 891 NHW adults who were enrolled to the National Survey of American Life. Variables included race/ethnicity, age, gender, socioeconomic status (SES and household income), and sense of mastery. Linear regression models were applied in the overall sample and also by race.

RESULTS

Overall, high sense of mastery was associated with high household income. In race-specific models, higher levels of sense of mastery were associated with high household income in AAs but not NHWs.

CONCLUSIONS

Racial differences exist in how sense of mastery and income are correlated. It is not clear whether high income generates more sense of mastery for AAs or high sense of mastery is more essential for generating high income for AAs. Policy-makers and clinicians should be aware that SES and sense of mastery are differently linked in AAs and NHWs.

Differential associations of locus of control with anxiety, depression and life-events: A five-wave, nine-year study to test stability and change

BACKGROUND

The locus of control (LOC) construct has been associated with onset, course, and severity of anxiety and depression. We investigated the stability of LOC, the bidirectional relationships between LOC and symptom severity of anxiety and depression over nine years, and the influence of intermediate positive and negative life-events on these associations.

METHODS

Data came from five assessment waves over nine years of 2052 subjects with an anxiety or depressive disorder or healthy controls. First, the stability of LOC (assessed with 5-item Mastery Scale) was tested. Next, associations between LOC, anxiety severity (Beck Anxiety Inventory), depression severity (Inventory of Depressive Symptomatology), and intermediate positive and negative life-events (20-item List of Threatening Experience Questionnaire) were determined with structural equation modeling.

RESULTS

LOC was rather stable over nine years (r = 0.62), and scores increased slightly with age (i.e. became more internal). LOC yielded equal stability estimates as symptom levels of anxiety and depression did over nine years. A more external LOC predicted higher anxiety and depression severity, but did not influence the incidence of positive and negative life-events. Higher depression severity and more negative life-events predicted the development of a more external LOC, whereas more positive life-events predicted a more internal LOC. Anxiety severity had no effect on LOC.

LIMITATIONS

Life-events were assessed with self-report measures.

CONCLUSIONS

The prospective associations between LOC and meaningful changes in anxiety and depressive symptom severity and experienced life-events may yield important new insights for clinical interventions.

Development and evaluation of the Parenting to Reduce Child Anxiety and Depression Scale (PaRCADS): assessment of parental concordance with guidelines for the prevention of child anxiety and depression

BACKGROUND

Involving parents in the prevention of mental health problems in children is prudent given their fundamental role in supporting their child's development. However, few measures encapsulate the range of risk and protective factors for child anxiety and depression that parents can potentially modify. The Parenting to Reduce Child Anxiety and Depression Scale (PaRCADS) was developed as a criterion-referenced measure to assess parenting against a set of evidence-based parenting guidelines for the prevention of child anxiety and depressive disorders.

METHODS

In Study 1, 355 parents of children 8-11 years old across Australia completed the PaRCADS and measures of parenting, general family functioning, child anxiety and depressive symptoms, and parent and child health-related quality of life. Their children completed measures of parenting, anxiety and depressive symptoms, and health-related quality of life. In Study 2, six subject-experts independently evaluated the PaRCADS items for item-objective congruence and item-relevance. Item analysis was conducted by examining item-total point-biserial correlation, difficulty index, B-index, and expert-rated content validity indices. Reliability (or dependability) was assessed by agreement coefficients for single administration. Construct validity was examined by correlational analyses with other measures.

RESULTS

Four items were removed to yield a 79-item, 10-subscale PaRCADS. Reliability estimates for the subscale and total score range from .74 to .94. Convergent validity was indicated by moderate to strong correlations with other parenting and family functioning measures, and discriminant validity was supported by small to moderate correlations with a measure of parents' health-related quality of life. Higher scores on the PaRCADS were associated with fewer anxiety and depressive symptoms and better health-related quality of life in the child. PaRCADS total score was associated with parental age, parent reported child's history of mental health diagnosis and child's current mental health problem.

DISCUSSION

Results showed that the PaRCADS demonstrates adequate psychometric properties that provide initial support for its use as a measure of parenting risk and protective factors for child anxiety and depression. The scale may be used for intervention and evaluative purposes in preventive programs and research.

Coping While Black: Chronic Illness, Mastery, and the Black-White Health Paradox

Prior research indicates that there is a black-white paradox in the relationship between physical health and mental health among American adults. However, none have considered black-white differences in psychosocial coping and depressive symptoms during the transitional stages from health to chronic illness. Using a nationally representative sample of chronically ill adults from the American Changing Lives study, this study builds on literature on chronic illness and the black-white paradox to examine if (1) growth in depressive symptoms across 16 years differs for black and white adults as they transition from healthy to chronically ill and (2) if the protective coping resource, mastery, provides an equal benefit to black and white chronically ill adults during that transition. Findings indicate that among chronically ill adults, not only do black-white disparities exist in how much mastery each group possesses, but that mastery's utility as a protective resource against depressive symptoms differs by race, with black ill adults experiencing a poorer return on their mastery than white adults. Moreover, findings that black adults maintain the same level of depressive symptoms as white adults despite this mastery disadvantage provide additional support for Minorities' Diminishing Returns Theory and some support for an emerging theory of collective resilience with regard to black American mental health.

Resilience and Coping in Cancer Survivors: The Unique Effects of Optimism and Mastery

Optimism and mastery are two cognitive traits that involve positive expectations for the future and that have been demonstrated to be important predictors of reduced anxiety as well as superior coping and physical health in many populations, including cancer survivors. There is limited research, however, examining the unique effects of these traits when examined simultaneously. The present cross-sectional study used structural equation modeling to examine the unique effects of optimism and mastery on emotion, coping, and health in 603 adult cancer survivors, and whether results were consistent in men and women. Results indicated that both optimism and mastery were associated with improved emotion, coping, and health and together accounted for a small to moderate amount of variance. Although the effects of optimism were generally greater, mastery also uniquely predicted most dependent variables and there was some evidence that gender influenced these effects, with optimism predicting health control more so in women and mastery predicting health control more so in men. These results demonstrate that it is important to examine both generalized positive expectancies such as optimism and positive expectancies regarding mastery when investigating resilience and emotional well-being in cancer survivors.

High sense of mastery reduces psychological distress for African American women but not African American men

Recent research has suggested that relative to Whites, African Americans (AAs) may be at a systemic disadvantage regarding the health effects of socioeconomic position (SEP) indicators as well as psychological assets (e.g., sense of mastery). However, less is known about how these diminished returns differ between AA men and women. This study tested whether AA men and women differ in the mental health effects of high sense of mastery. The National Survey of American Life (NSAL, 2003) recruited 3570 AA adults who were either female (n = 2299) or male (n = 1271). Dependent variable was psychological distress. Independent variable was sense of mastery. Gender was the focal moderator. Age and educational attainment were the covariates. Multiple linear regression model was applied for statistical analysis. Overall, high sense of mastery was associated with lower psychological distress. Significant interaction was found between gender and sense of mastery on psychological distress suggestive of a stronger association for AA women compared to men. A smaller mental health gain of high sense of mastery for AA men compared to AA women is indicative of within race heterogeneity regarding diminished returns. Racism and discrimination may be why high sense of mastery does not translate to mental health gain for AA men.

Local fast-food environment, diet and blood pressure: the moderating role of mastery

Purpose

To examine the moderating role of mastery in the association of local fast-food restaurants (FFR) with diet quality and systolic blood pressure (SBP).

Methods

We used cross-sectional data from 1543 adults participating in wave six of the Netherlands Study of Depression and Anxiety (NESDA). Data were collected between 2013 and 2016. Diet quality was defined by adherence with the dietary approaches to stop hypertension (DASH) diet. Individuals reported on their food consumption through a food frequency questionnaire and SBP was measured. Density of FFR in 1600 m, 800 m and 400 m circular buffers around the home postal code was calculated using Geographic Information Systems. We assessed the association between density of FFR, diet and SBP using linear regression analyses, testing for moderation by mastery.

Results

Mean age was 52 years and 32.2% of the sample were men. Exposure to FFR ranged from 0 to 35 FFR per km². Density of FFR was not significantly associated with DASH adherence or SBP. Only one out of the six interaction terms was significant, suggesting that for individuals with lower levels of mastery, higher density of FFR in an 800-m buffer was negatively associated with DASH adherence, while for individuals with higher levels of mastery, this association was positive.

Conclusions

Exposure to FFR was not associated with diet quality and SBP, and we observed little evidence for moderation by level of mastery. This research question should be further explored in a large sample of healthy adults.

Fundamental movement skills: Where do girls fall short? A novel investigation of object-control skill execution in primary-school aged girls

Fundamental movement skill (FMS) proficiency is positively associated with a range of health outcomes, and is a predictor of lifelong participation in physical activities and sport. Yet low FMS proficiency levels in children prevail, particularly among girls performing object-control skills (e.g., kicking, catching). To identify where girls require the most support and inform future teaching resources and interventions, this cross-sectional study investigated proficiency levels of object-control skills and their specific performance components (subskills) in girls; and aimed to determine whether patterns in subskill mastery were evident in girls from two different developmental stages. This study included 153 girls (aged 4–12 years; mean age = 7.7, SD = 1.8) from the Hunter Region, Australia. Six object-control skills were video-assessed using the Test of Gross Motor Development (TGMD-2, TGMD-3); overall skill proficiency levels and mastery levels of subskills were determined. In summary, <5% (of the total group, 4–8 years or 9–12 years) demonstrated mastery or advanced skill level in the strike, stationary dribble, overhand throw or kick. Mastery levels were also poor for the majority of the 24 subskills, with mastery levels below 40% for the total group for 17 of the 24 subskills. Deficiencies in specific subskills were evident in the preparation, action and recovery phases of the six object-control skills. Only 6 of the 24 subskills mastery levels were significantly higher in the older age-group. Our investigation provides new evidence that may be useful for practitioners and researchers looking to support the optimal development of FMS proficiency among girls.

Australian New Zealand Clinical Trials Registry: ACTRN12615000022561.

Identifying Critical Errors: Addressing Inhaler Technique in the Context of Asthma Management

Medication use has always played a highly significant role in the overall management of asthma, with appropriate use being linked to good asthma control. However, while patients with asthma enjoy the 'luxury' of having medications delivered directly to the lungs via inhaler devices, with that comes the additional challenge of ensuring that inhaler devices are used correctly. Research and practice provides evidence to the challenges associated with inhaler use and the particular steps that patients perform incorrectly. While this problem is well documented, acknowledged and reported, little has changed in 40 years, and the proportion of patients using inhaler devices remains unacceptably high. This review focuses on aspects specific to the errors that patient's make, the significance of these errors, and the important considerations for health care practitioners in supporting patients in correctly using their inhalers. This review highlights the complexities associated with patient's making inhaler technique errors and highlights the opportunities that lie in future technological developments of inhaler devices. Now more than ever, in the era of precision medicine, it is important that we address inhaler technique use once and for all.

Social support, mastery, sleep-related problems and their association with functional status in untreated obstructive sleep apnoea patients

BACKGROUND

Social support and mastery are important aspects in the treatment of chronic diseases, however their role in connection with Obstructive Sleep Apnoea (OSA) remains unclear.

OBJECTIVES

The study examined the associations between social support, mastery, sleep-related problems and functional status in untreated OSA patients.

METHODS

All patients in this cross-sectional study completed the Multidimensional Scale of Perceived Social Support, the Pearlin Mastery Scale, the Pittsburgh Sleep Quality Index, the Epworth Sleepiness Scale and the Functional Outcomes of Sleep Questionnaire. Multiple linear regression and mediation analyses were used to analyse the data.

RESULTS

Participants were 150 newly diagnosed OSA patients (Apnoea-Hypopnoea Index-AHI≥5; 68% male; mean age 48.9 ± 9.5years). Compared with social support, mastery was more strongly associated with functional status. The indirect effects of sleep-related problems on functional status via mastery varied between 17.7% and 23.3%.

CONCLUSIONS

Supporting OSA patients' sense of mastery may significantly contribute to better disease management.

Disentangling the effects of primary and secondary international migration on psychological distress: the role of mastery

OBJECTIVES

This study examined the effect of mode of migration-primary immigration (direct migration from origin country) and secondary immigration (migration from a country of residence other than the origin country)-by level of economic development of country of origin on psychological distress of immigrants to Canada. The study focused on the explanatory role of mastery in the relationship between mode of migration/level of economic development of origin country and distress. Mastery is the belief that one can and does master, control, and shape one's own life.

METHODS

Data from the Neighbourhood Effects on Health and Well-being study, which contains important measures such as the mode of migration, was used to assess the study objectives. The analytic sample included 1496 Canadian-born and 387 foreign-born (non-refugee) participants. Hierarchical linear modeling was used to address the study objectives.

RESULTS

Results point to a "healthy immigrant effect"-lower distress among the foreign-born than the native-born-but only among primary immigrants from less-developed countries. Secondary immigrants from less-developed countries report higher distress than the native-born and their primary-immigrant counterparts. The higher distress among secondary immigrants was due in part to lower mastery among this group. Immigrants from developed origin countries did not report different levels of distress than the native-born, irrespective of mode of migration.

CONCLUSION

This study fills an important gap in the literature on immigration and mental health and reveals that the healthy immigrant effect is not generalizable to all immigrants; it is contingent on the mode of migration/level of economic development of the country of origin.

Microsystems of Recovery in Homeless Services: The Influence of Service Provider Values on Service Users' Recovery Experiences

There is still much to learn about how aspects of the ecology of homelessness shape homeless adults' recovery experiences. In the present mixed-methods study, the relationship of service providers' work-related values to their service users' recovery experiences in the microsystem of homelessness were examined. Service providers completed semi-structured qualitative interviews about their service users, daily work activities, and work-related goals. At three time points, their service users completed quantitative measures of choice, mastery, and recovery in four life domains: physical health, psychiatric symptoms, substance use, and community integration. Service providers' interview transcripts were coded for three indicators of values: assumptions, actions, and end-states. Summative Content Analysis was used to transform qualitative codes into numeric data so they could be used to predict service users' recovery. In a series of growth curve models, the extent to which service providers' end-state values, as an indicator of consumer-led values, was shown to indirectly predict service users' recovery experiences, through their perceived choice and mastery. Findings confirm that providers' values are an important influence on service users' recovery. Results are discussed in terms of their implications for recovery-oriented theory and practice.

Financial circumstances, mastery, and mental health: Taking unobserved time-stable influences into account

This paper examines whether low income and subjective financial strain are associated with mental health, as well as whether mastery weakens this association. We analyze three waves of a large sample of Canadians and utilize random and fixed effects regression strategies to assess bias introduced by unobserved time-stable confounders. In random effects models, both low income and subjective financial strain are associated with distress and anger. In fixed effects models that control for all time-stable confounders, the effect of low income is reduced to non-significance for both outcomes. The effect of subjective strain is also reduced in fixed effects models, but remained statistically significant. Sobel tests indicated that the effect of subjective strain on mental health is transmitted through mastery, but this indirect path is modest in magnitude. When interactions are tested, mastery weakens the association between subjective strain and distress, and this effect is robust to the influence of time-stable controls, but mastery does not buffer the subjective strain-anger relationship in either random or fixed-effects models. Finally, moving below the low income threshold increases anger for low mastery individuals, but seems to reduce anger when moving below the low income threshold is coupled with increases in mastery. Collectively, our findings demonstrate the importance of assessing the influence of unobserved time-stable confounders in stress research. Further, discrepancies in the moderating role of mastery reinforce calls for the assessment of multiple outcomes in mental health research.

Relationship between Mastery and Caregiving Competence in Protecting against Burden, Anxiety and Depression among Caregivers of Frail Older Adults

OBJECTIVE

Studies suggest the protective effect of mastery and caregiving competence against psychological stressors of caregiving in the context of dementia, although the interplay between the two with caregiver outcomes is not well understood. This study examines the independent and moderating impact of mastery and caregiving competence on burden, anxiety and depression among caregivers of older adults with frailty-related care needs.

DESIGN, SETTING AND PARTICIPANTS

This is a cross-sectional study of 274 older adults-family caregiver dyads from a hospital in Singapore. Mean ages of the older adults and their caregivers were 85 and 59 years respectively.

MEASUREMENTS

We performed hierarchical linear regression models to examine the independent influence of mastery and caregiving competence on caregiver burden, anxiety and depression. We also examined the interaction effect between mastery and caregiving competence for each outcome.

RESULTS

Mastery and caregiving competence were independently negatively associated with caregiver burden, anxiety and depression. Mastery explained more variance than caregiving competence and had a stronger correlation with all outcomes. There was a statistically significant interaction between mastery and caregiving competence for depression (interaction term beta=.14, p<0.01), but not burden and anxiety. High levels of mastery are associated with less depression. particularly among caregivers with below-average levels of caregiving competence. Likewise, high levels of caregiving competence are associated with less depression. particularly among caregivers with below-average levels of mastery.

CONCLUSION

Our findings suggest potential benefits adressing targeted interventions for mastery and caregiving competence of caregivers to older adults as they independently influence caregiver outcomes and moderate each other's effect on depression. Mastery-based interventions should be incorporated into current caregiver training which traditionally has focused on caregiver competence alone.