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Study design: Triangulated mixed-methods validation study.

Objectives: To validate the Danish version of the Spinal Cord Lesion-related Coping Strategies Questionnaire (SCL-CSQ).

Setting: Community in Denmark.

Methods: Participants were invited via a patient organization and its specialized hospital. Eligibility criteria were having a spinal cord injury (SCI), being 18 years or older, and able to understand and respond in Danish. Quantitative data were collected to determine internal consistency and criterion validity of the three subscales of SCL-CSQ, i.e., acceptance, fighting spirit, and social reliance. The Three-Step Test-Interview approach was employed to determine whether items measured what they were intended to measure (i.e., construct validity based on response processes).

Results: The quantitative sample consisted of 107 participants, and the interview sample comprised 11 participants. The acceptance and fighting spirit subscales showed adequate internal consistency (Cronbach's alpha of 0.72 and 0.76 respectively) and satisfactory criterion validity (expected correlations with quality of life and depression). The social reliance subscale showed inadequate internal consistency (Cronbach's alpha of 0.58) and criterion validity. All fighting spirit items and all but one acceptance items were interpreted congruently by most participants. Conversely, two social reliance items were only interpreted congruently by 9 and 27%.

Conclusion: The acceptance and fighting spirit subscales of the Danish version of the SCL-CSQ showed good psychometric properties, while the social reliance subscale showed serious issues and should be revised. Researchers and clinicians are urged to reflect on these findings when revising the SCL-CSQ or adapting it to other languages, cultural contexts, and rehabilitation settings.

The aim of the present study was to investigate dental coping strategies, general anxiety, and depression in relation to regularity of dental treatment among persons with either regular dental care or phobic avoidance, whilst controlling for sociodemographic factors. Psychometric questionnaires on dental anxiety, dental coping strategies, general anxiety, and depression were delivered to 263 adult patients with dental phobic avoidance behavior who were seeking help from a specialized dental fear clinic and to 141 adult patients with dental anxiety who were receiving regular dental care from various public dental clinics. The results showed that the levels of dental and general anxiety and of depression were significantly higher among irregular attendees compared with regular attendees. Irregular attendees admitted fewer adaptive coping strategies. Predictive of irregular dental care were gender, dental anxiety, general anxiety, and the nonuse of the coping strategy 'optimism'. This study further confirms earlier preliminary results that the use of optimistic thinking is predictive for regular dental attendance habits and that male gender is a risk factor for irregular attendance. Moreover, this study adds that a high level of general anxiety indicates a higher risk for irregular dental care. © 2013 Eur J Oral Sci.

Objective. The aim of this study was to further develop and investigate a newly constructed 15-item questionnaire on strategies for coping with dental treatment, used by fearful adult patients undergoing regular dental care and those with phobic avoidance. Materials and Methods. The dental coping strategy questionnaire (DCSQ-15) was distributed to 77 individuals with dental phobic avoidance and 94 fearful patients undergoing regular dental care. Previous analyses of a 20-item coping questionnaire (DCSQ-20) revealed that 2 of 4 identified factors predicted regularity or phobic avoidance of dental care. However, one of these factors was considered related to catastrophizing thoughts and not to coping strategies and it was therefore removed in the present study. Results. The reduced 15-item questionnaire was analyzed to identify its factor structure and a 5-factor solution was found. The five factors were labeled (i) 'self-efficacy', (ii) 'self-distraction', (iii) 'distancing', (iv) 'praying' and (v) 'optimism'. The factors of 'praying' and 'optimism' correlated significantly with dental anxiety and were assessed significantly higher and lower respectively, among individuals with phobic avoidance. A logistic regression analysis revealed that 'optimism', together with gender and dental anxiety, was predictive of the regularity or phobic avoidance of dental care.

Dental fear is a common and widespread problem, which can cause severe stress. Even so, most patients with dental fear undergo regular dental treatment in spite of their fear and many enjoy good oral health. The aim of this study was to obtain a deeper understanding of how patients with dental fear manage to undergo dental treatment. Fourteen patients with dental fear, who undergo regular dental care, were interviewed. Qualitative analysis of the transcribed interviews was performed according to the principles of grounded theory. A conceptual framework was generated, and the main concern was identified as making dental care possible – a mutual affair. Four additional categories explained how patients handled their dental fear and how dental care became possible. The strategies were labelled taking part in a mental wrestling match, trust-filled interaction with dental staff, striving for control and seeking and/or receiving social support. The results showed that making dental care possible for patients with dental fear is a mutual challenge that requires interplay between dental staff and patients, involving verbal and non-verbal communication reflecting respect, attention, and empathy. Moreover, a balance between nearness and distance and between professional and personal treatment is required.

This investigation explored strategies to cope with dental treatment used by fearful adult patients undergoing regular dental care and those with phobic avoidance. A newly constructed 20-item questionnaire entitled The Dental Coping Strategy Questionnaire (DCSQ-20) was distributed consecutively to 171 individuals with self- and dentist-reported high dental fear, of whom 77 had dental phobic avoidance and were attending a dental fear clinic and 94 were undergoing regular care at one of three different public dental clinics. The level of dental fear was high in both groups, but significantly higher among avoidant individuals. Several of the DCSQ-20 items showed statistically significant differences between groups. Factor analysis of the DCSQ-20 yielded a four-factor solution explaining 52% of the total variance. The factors were labelled (i) 'self-efficacy statements', (ii) 'self distraction and distancing', (iii) 'catastrophizing', and (iv) 'praying and despair'. The DCSQ-20 displayed sound psychometric properties, and the reliability (Cronbach's alpha) for the factors was between 0.68-0.78. Factors (iii) and (iv) correlated significantly with dental anxiety and were rated significantly higher among individuals with phobic avoidance. In a logistic regression analysis, gender, dental anxiety, and three of the four factors (i, iii, iv) were predictive of regularity vs. phobic avoidance of dental care.

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Aim.

Design.

Results.

Conclusion.

Purpose/Objective: To investigate longitudinal trajectories of depression and anxiety symptoms following spinal cord injury (SCI) as well as the predictors of those trajectories. Research Method/Design: A longitudinal study of 233 participants assessed at 4 time points: within 6 weeks, 3 months, I year, and 2 years from the point of injury. Data were analyzed using latent growth mixture modeling to determine the best-fitting model of depression and anxiety trajectories. Covariates assessed during hospitalization were explored as predictors of the trajectories. Results: Analyses for depression and anxiety symptoms revealed 3 similar latent classes: a resilient pattern of stable low symptoms, a pattern of high symptoms followed by improvement (recovery), and delayed symptom elevations. A chronic high depression pattern also emerged but not a chronic high anxiety pattern. Analyses of predictors indicated that compared with other groups, resilient patients had fewer SCI-related quality of life problems, more challenge appraisals and fewer threat appraisals, greater acceptance and fighting spirit, and less coping through social reliance and behavioral disengagement. Conclusion/Implications: Overall, the majority of SCI patients demonstrated considerable psychological resilience. Models for depression and anxiety evidenced a pattern of elevated symptoms followed by improvement and a pattern of delayed symptoms. Chronic high depression was also observed but not chronic high anxiety. Analyses of predictors were consistent with the hypothesis that resilient individuals view major stressors as challenges to be accepted and met with active coping efforts. These results are comparable to other recent studies of major health stressors.

Chronic heart failure is a common and a serious condition. Research has shown that chronic heart failure has been associated with detrimental effects on wellbeing. Coping effectiveness training (CET) has been applied for patients with heart failure to improve stress appraisal and stress management skills. The aim of this study was to explore the experience of participating in CET for patients with heart failure one year after completion. Eleven patients were interviewed. The study adheres to the SRQR guidelines. A thematic analysis generated three themes: rewarding but challenging to meet other people with heart failure; improved conditions to cope with stress; and not relevant to me. Implications for further development of the intervention were to include existential aspects, recognize comorbidities, test follow-up sessions and apply a codesign.

Introduction: The Swedish version of the patient-reported Clinical Outcomes in Routine Evaluation Outcome Measures (CORE-OM) has demonstrated high reliability and acceptable convergent validity in explanatory factor analyses. However, the fundamental scale properties have not yet been validated according to item response theory. The aim of this study was to analyze the measurement properties of the Swedish CORE-OM in a cohort of psychiatric out-patients with depression and anxiety in a multicultural area and to explore combinations of items based on shorter versions of the scale (CORE-10, CORE-6D) to improve measurement properties.

Methods: Data from CORE-OM assessments of 337 patients were analyzed using Rasch analysis. The patients had a mean age of 30 +/- 14 years, the majority were women (72%). Requirements for measurement properties were checked: overall model fit, item fit residuals, targeting, internal consistency, differential item functioning and thresholds. Sensitivity to change was also analyzed.

Results: The CORE-OM showed high internal consistency (person separation index = 0.947) and adequate targeting, but there was overall model misfit (item trait interaction chi(2) = 917.53, p < 0.001), indication of local dependency, and differential item functioning in 9 items. The risk items showed problems with disordered thresholds. The emotional component of the shorter CORE-6D showed the best fit for our sample. Adding 3 items to include depressive and trauma-related content resulted in a unidimensional 8-item set with acceptable reliability, model fit, targeting and sensitivity to change.

Conclusion: For out-patients with diagnosed depression or anxiety in a multicultural area, the Swedish CORE-OM showed high internal consistency, but also validity problems. Based on the shorter CORE-6D version, a unidimensional 8-item set could be an alternative brief measure of psychological distress for this population, but further validity studies are required. Qualitative studies exploring the CORE-OM items in non-native speakers are also warranted.

Aim: To describe the systematic development of an evidence-based, tailored, interactive web application for self-management of work-related stress, and to test usability issues regarding how to proceed through the programme. Methods: Evidence from the fields of stress management, behaviour change and web-based interventions was the foundation for the theoretical framework and content. The next step was the development process of the web application and validation among experts and one possible end user. Last, a usability test with 14 possible end users was conducted. Results: The web-application, My Stress Control (MSC), was built on a solid theoretical framework. It consists of 12 modules including: introduction, psychoeducation, ambivalence, stress management strategies, lifestyle change, and maintenance. Self-monitoring, goal-setting, re-evaluating goals, feedback, and prompting formulation of intention to change are central techniques supporting behaviour change. The usability test revealed difficulties in understanding how to proceed through the programme. Conclusion: The development contributes to filling a gap in the literature regarding development of complex web-based interventions. MSC is dissimilar to existing programs in the field, considering the tailoring and multi-tracked opportunities. Although developed from the evidence in multiple fields, the web application would benefit from further development to support users in reaching the end module.

The aim of the current study was to investigate the feasibility of a Web-based program that promotes behavior change for stress-related problems in terms of the program’s acceptability, practicability, and any possible effects. In addition, the aim was also to study how appropriate and realistic the study’s process and resource management would be for conducting a randomized controlled trial. A convenience sample consisting of 14 individuals was recruited from a university in Sweden. The participants had access to the program for a duration of 9 weeks. Questionnaires were answered before accessing, during use of, and after completing the program. Both qualitative and quantitative data were collected and analyzed. The program was considered acceptable and practically feasible, though small adjustments have to be made. The program was considered time-consuming, extensive, and in need of some clarifications. Regarding process and resource management, the study participants required minimum support. It was difficult to identify the time point when to send out the process measures because the participants worked at their own pace. Also, one of the process measurements, the motivation to change, remained stable. With some adjustments to the instructions to the study participants and minor changes in the program, the intervention and study’s procedure were considered as feasible and can be carried out in a randomized controlled trial.

Objectives: To explore users’ experiences of a tailored, interactive web application that supports behaviour change in stress management and to identify if and in that case what in the web-based programme that needed further development or adjustment to be feasible in a randomised controlled trial.

Method: The design of this study was explorative with a qualitative approach. Nine individuals were recruited among the staff at a university. Semi-structured individual interviews were conducted and analysed using qualitative content analysis, after the participants had completed the web-based stress management programme.

Results: One theme was identified, Struggling with what I need when stress management is about me, describing the paradox in having a programme that is perceived as supporting stress management while also being perceived as extensive and time consuming. The theme was divided in two categories: Defining the needs, where the users expressed what they needed from the programme and their everyday environment, to be able to use the programme, and It is about me, where the programme was described as helping the users understand their own stress.

Conclusion: The participants expressed acceptance of using a web-based programme for stress related problems. The perceived extensiveness of the programme must be considered in further development.

Context: Stress preventive interventions should support behaviour change. Web-based programs are less resource demanding than face-to-face solutions. For the purpose of supporting behaviour change in persons with work related stress, the web-based program My Stress Control (MSC) was developed. The aim of this study was to evaluate the feasibility and effect of MSC.

Methods: MSC’s feasibility was tested with 14 end-users before evaluating its effect in a two-armed RCT with 95 persons. The same procedure as for the RCT was used in the feasibility study. Questionnaires were used as data collection method. The primary outcome was perceived stress.

Intervention: MSC was built on evidence regarding theoretical frame, content and informational design. MSC is tailored to each individual by Stages of Change and with a functional behaviour analysis (FBA) conducted by the users in interactive assignments, steering the user to stress-management strategies. Techniques supporting behavioural change are integrated throughout the program.

Results: The feasibility of MSC reached above the pre-set cut-off score. The results of the RCT revealed no significant differences between groups in the primary outcome, but a small effect size was shown between intervention and wait-list group. Adherence was low with 25% of the participants in the intervention group responding to post assessment. 

Conclusions: It is still uncertain if MSC is an effective method for supporting behaviour change in persons with work related stress. Further development must be conducted regarding adherence before next evaluation study. Nevertheless, the small effect size encourages further development and evaluation of MSC.

Objective

Sedentary behavior (SB) is defined as a mean of >6 hours of daytime sitting or lying down. SB has been shown to increase with older age and is a risk factor for disease. During the transition from working life to retirement, changes in daily life activities occur, risking increased SB. The aim of the present study was to gain a deeper understanding of SB in relation to the transition from working life to retirement as experienced by persons in retirement.

Methods

The study was grounded in a phenomenological life-world perspective. Fourteen semi-structured interviews were conducted with participants aged 64–75. Data were analyzed using the empirical phenomenological psychological method.

Results

The participants described that voluntary sedentary time was positively related to general health and well-being, while involuntary sedentary time was negatively related to health. Increased sedentary time was described as natural when aging. Retirement was expressed as a time for rest after hard work and the ability to choose a slower pace in life. Internal and external demands and daily routines interrupted SB, whereas loneliness was perceived to increase SB. Participants strived to find a balance between physical activity and sedentary time. The variations in the participants’ descriptions formed three typologies: in light of meaningful sedentary behavior, in the shadow of involuntary sedentary behavior, and a dual process – postponing sedentary behavior with physical activity.

Conclusions

Increased SB was perceived as natural when aging, but something that may be postponed by conscious choices. SB was perceived as associated with health, rest and recovery but also with the risk of deteriorating health.

Impact

This knowledge of the experienced meaning of SB could guide the design of health promotion interventions and may be helpful in targeting those in need of support and individualizing interventions to decrease SB in retirement.Lay SummaryThis study reveals how persons in retirement describe sedentary behavior as something healthy but also as unhealthy and that sedentary behavior is natural in aging and can be postponed by physical activity.

Background: Stress is one of the most common reasons for sick leave. Web-based interventions have the potential to reach an unlimited number of users at a low cost and have been shown to be effective in addressing several health-related problems. Handling stress on an individual level is related to behavior change. To support behavioral changes in stress management, My Stress Control (MSC) was developed. The development of MSC was based on several health psychology theories and models; however, central in the development were Social Cognitive Theory, Theory of Reasoned Action, Theory of Planned Behavior, Transactional Theory of Stress and Coping, and the Transtheoretical Model and Stages of Change. MSC is a fully automated program. The program is tailored to the user’s specific needs for stress management and behavior change.

Objective: In this study, we aim to conduct a randomized controlled trial to evaluate the extent to which MSC affects perceived stress in persons experiencing work-related stress.

Methods: This was a randomized controlled trial with 2 arms. Study participants were recruited by visiting the worksites and workplace meetings. Participants were assigned to the intervention or wait-list group. Web-based questionnaires were used before and after the intervention to collect data. Perceived stress measured using the Perceived Stress Scale-14 was the primary outcome measurement. Analyses were conducted for both between-group and within-group changes.

Results: A total of 92 participants were included in this study: 48 (52%) in the intervention group and 44 (48%) in the wait-list group. Overall, 25% (12/48) of participants in the intervention group and 43% (19/44) of participants in the wait-list group completed the postintervention assessment. There were no significant effects on perceived stress between the intervention and wait-list groups or within the groups. A small effect size (Cohen d=0.25) was found when comparing mean change over time on the primary outcome measure between the intervention and wait-list groups. In addition, a small effect size was found between pre- and postintervention assessments within the intervention group (Cohen d=0.38) as well as within the wait-list group (Cohen d=0.25).

Conclusions: The effect of MSC on perceived stress remains uncertain. As adherence was low in the intervention group, elements or features that facilitate adherence and engagement must be further developed before firmer conclusions regarding the effect of MSC can be made.

The purpose of this study was to perform an initial validation of a Swedish translation of the Clinical Outcomes in Routine Evaluation Outcome Measure (CORE-OM). The CORE-OM is a broad self-report instrument of psychological problems, designed as an outcome measure for evaluating the effects of psychological therapy. Participants included a non-clinical group of 229 university students and a clinical group of 619 persons from four primary care sites. The Swedish CORE-OM showed excellent acceptability, high internal consistency and test-retest reliability, as well as acceptable convergent validity. There was strong differentiation of the clinical and non-clinical samples, with the clinical group scoring significantly more psychological problems than the non-clinical group. Sensitivity to change was demonstrated in psychological treatments in primary care. Overall, the psychometric characteristics of the Swedish CORE-OM were very similar to the original UK data. Nevertheless, the validity of the Swedish version needs to be examined more in detail, in larger and more diverse samples. Our results so far, however, provide support for using the Swedish CORE-OM as a psychological problems measure. To our knowledge, there are few other relatively short measures in Swedish that are free to reprint that meet the demands for psychometric properties and utility in primary care settings in which patients typically present a broad range of psychological problems.

The purpose of this study was to examine what resource and coping variables that could predict emotional well being during the acute phase of spinal cord injury rehabilitation. All newly acquired injuries were approached in selected British, Swiss, Swedish, German, Austrian and Irish spinal centres. Participants were asked to complete a questionnaire booklet at 6 weeks post injury and again at 12 weeks. Stepwise hierarchical regression analyses were performed on data from 281 questionnaire packs from 14 European spinal centres. Gender, age and severity of impairment were controlled for. Sense of coherence, the coping strategy social reliance, threat and challenge appraisals, perceived manageability, and perceived quality of social support made significant contributions to the variance in measures of emotional well-being (anxiety, depression and a psychological subscale of a quality of life scale). Psychological assessment during acute stages may assist in identifying ‘at risk’ patients and provide guidance for therapeutic intervention.

Study design: Cross-sectional, questionnaire.

Objectives: Coping strategies employed to manage the consequences of a spinal cord lesion(SCL) have been found to be distinctly related to emotional well-being. However, research and clinical implications have been hampered by the lack of cross-validated measures that are directly related to the lesion and its consequences. This study investigates the psychometric performance of the SCL-related Coping Strategies Questionnaire in four different countries.

Setting: Austria, Germany, Switzerland and UK.

Methods: The study sample comprised 355 community residing persons with SCL. Multi-trait/multi-item analysis methods and non-parametric and parametric tests were used.

Results: The Acceptance coping scale showed satisfactory psychometric qualities, whereas there were some problems in the Fighting spirit scale and greater problems in the Social reliance scale. Compared with the Swedish developmental sample, Acceptance was used more in the four study countries. Consistent with the original sample, Acceptance and Fighting spirit coping correlated with fewer signs of emotional distress, persons lesioned 5 years or more tended to report more Acceptance than the newly lesioned and coping strategies were mainly unrelated to neurological status.

Conclusion: The English and German language versions of the Acceptance coping scale were valid and reliable, whereas some translated items in the Fighting spirit scale need to be revised. Translations of the Social reliance scale need to be thoroughly revised and retested. The results add further evidence to the literature on the stability of the link between adapting life priorities (ie Acceptance) and emotional well-being.  

STUDY DESIGN: Cross-sectional.

OBJECTIVES: In a previous study we found spinal cord lesion (SCL)-related coping factors to be distinctly related to levels of SCL-related psychological outcome. However, we did not control for other potentially confounding variables. In this study we investigated effects of coping strategies on psychological outcome reactions in traumatically spinal cord lesioned persons controlling for sociodemographic, disability-related and social support variables.

SETTING: The Gothenburg Spinal Injuries Unit in Sweden.

METHODS: The study sample comprised 255 persons and a subsample of 157 persons. A series of stepwise multiple regression analyses were performed.

RESULTS: SCL-related coping factors clearly predicted psychological outcome even when background variables were controlled. Higher levels of acceptance coping predicted decreased psychological distress and increased positive morale. Elevated social reliance coping predicted heightened distress. Higher levels of social support predicted lower feelings of helplessness. Sociodemographic and disability-related variables were weak predictors of psychological outcome with one exception: higher education predicted less bitterness and brooding.

CONCLUSION: SCL-related coping remained the most important predictor of psychological outcome even when a wide range of variables was controlled. Thus we conclude that psychosocial interventions aimed at helping individuals develop their coping strategies might be of substantial value in their adjustment to SCL.

Relations between locus of control, coping strategies and emotional well-being in persons with traumatically acquired spinal cord lesion (SCL) were examined. The sample included 132 community-residing adults. Structural equation modelling, including confirmatory factor analysis, was used. A model was hypothesized based on the transactional theory of stress and coping where coping strategies mediated the relation between locus of control and emotional well-being. The model showed acceptable fit to the data and was compared with five alternative models. The alternative models fitted the data less well or were difficult to interpret. In the preferred model, persons indicating internal control reported more coping strategies (Acceptance, Fighting spirit) related to increased well-being, whereas persons indicating external control reported a coping strategy (Social reliance) related to poorer well-being. The findings support the stress and coping framework in medical rehabilitation and illustrate why some persons need coping effectiveness training to enhance emotional adjustment.

We examined psychometric properties and validity of a general (Ways of Coping Questionnaire; WCQ) and a condition-specific (Spinal Cord Lesion-related Coping Strategies Questionnaire; SCL CSQ) measure of coping strategies. The sample included 181 community-residing traumatically spinal cord lesioned persons aged 16-85 years. Multi-trait/multi-item analysis, confirmatory factor analysis and multiple regression were used. Reliability and validity estimates were acceptable in most instances for the SCL CSQ, whereas the validity of the WCQ was inadequate. The SCL CSQ showed a significant relationship with the overall quality of life outcome measure, whereas the WCQ did not. We recommend condition-specific measures of coping strategies, and that the combination with coping style measures be tested in medical populations.

OBJECTIVES: In the assessment and treatment of persons with dental fear, there may be other psychological/behavioural factors than fear itself and traditional measures of psychopathology that should be considered. Longitudinal natural history studies are needed to find such variables. The present study investigated whether the same behavioural problem dimensions (internalizing, externalizing, attention) found among children and adolescents with behaviour management problems and/or dental fear could also be found among severely fearful adult patients.

METHODS: The participants were 230 consecutive adult patients applying for treatment for severe dental anxiety at a specialized clinic. Patients completed a version of the Rutter behaviour questionnaire that was adapted for adults. Comparison data were the Hospital Anxiety and Depression scale and self-rated anger evoked by dental fear. Background data, including dental fear, were also collected. Descriptive statistics, principal components analyses, group comparisons and correlations were calculated.

RESULTS: Of the three behaviour problems scales we adapted for adults, two (Internalizing and Attention) had acceptable psychometric properties and meaningful relations with the comparison variables. In contrast, the third problem scale (Externalizing) proved to have less satisfactory properties and relations, especially for men. Patients with severe phobia had higher levels of problem behaviours than patients with less severe phobia.

CONCLUSIONS: Internalizing and Attention scales for adults seem promising for use in future prospective studies of the natural history of dental fear. The Externalizing scale, however, needs to be studied with a wider range of comparison variables and measures of social desirability.

STUDY DESIGN: Cross-sectional.

OBJECTIVES: To investigate relationships between coping and mental well-being with clinical relevance to spinal cord lesion (SCL).

SETTING: The Gothenburg Spinal Injuries Unit in Sweden.

METHODS: The study sample comprised 274 persons. From in-depth interviews, literature reviews, and the transactional theory of stress and coping, items reflecting coping and psychological outcome, respectively were generated. Principal components factor analysis, multi-trait analysis, and structural equation modelling were used.

RESULTS: The coping scale comprised three factors: Acceptance (i.e. revaluation of life values); Fighting spirit (i.e. efforts to behave independently); Social reliance (i.e. a tendency towards dependent behaviour). The outcome scale included the factors: Helplessness (i.e. feeling perplexed, out of control and low self-esteem); Intrusion (i.e. bitterness and brooding); Personal growth (i.e. positive outcomes of life crisis). Acceptance showed a positive relation to Personal growth and was inversely related to both Helplessness and Intrusion. Fighting spirit had a weak negative association to Helplessness and a weak positive association to Personal growth. Social reliance was positively related to Helplessness and Intrusion. Only Social reliance showed any association to neurological status. Those lesioned 1-4 years reported more Helplessness, Intrusion, Social reliance, and less Acceptance than those lesioned >or=5 years.

CONCLUSION: Coping is related to psychological outcome in SCL. Our situational coping measure may be a candidate to assess intervention effects.

Other psychological/behavioral factors in addition to fear and traditional measures of psychopathology should possibly be considered in the assessment and treatment of dental fear. The present study investigated fear and personality profiles among severely fearful adult patients. Participants were 230 consecutive adults applying for treatment of severe dental anxiety at a specialized clinic. Background data included dental treatment and dental fear history, general anxiety and depression assessments. Cluster analyses were performed. Four different fear and personality subgroups were judged to best represent data: (I) Fearful, extrovert, outgoing, (II) Highly fearful, extrovert, outgoing, (III) Fearful, inhibited, and (IV) Highly fearful, multiple problems. The view that adults with dental fear comprise a heterogeneous group was strengthened. Apart from different levels of dental fear, there seems to be varying temperamental and behavioral characteristics that need to be further studied and that may lead to a better match of treatment for these patients.

OBJECTIVE: Although the use of appropriate coping strategies has been suggested to be a key factor in determining successful adjustment to severe physical illness/disability, little systematic support for this link has been found. We investigated relationships between spinal cord lesion-related coping strategies and health-related quality of life when studying for sociodemographic, disability-related and social support variables.

DESIGN AND SUBJECTS: We studied 256 persons with traumatically acquired spinal cord lesion (=1 year) from a typical rural/urban Swedish area in a cross-sectional design.

METHODS: Coping measure was the Spinal Cord Lesion-related Coping Strategies Questionnaire. Outcome measures were the Spinal Cord Injury Quality of Life Questionnaire, the Short-Form 36 Health Survey version 2.0, and a standardized global question of overall quality of life. Multiple regressions were performed.

RESULTS: Coping strategies were clear correlates of health-related quality of life when sociodemographic, disability-related and social support variables were studied. The relationship between coping strategies and quality of life was: the more revaluation of life values (Acceptance) and the fewer tendencies towards dependent behaviour (Social reliance) the better the health-related quality of life.

CONCLUSION: Our results suggest that greater focus needs to be directed to coping strategies and to ways of facilitating adaptive outcomes in rehabilitation.

Persons with mental health problems often express a clear desire to work, although whatfactors that contribute to this healthy aspiration are less clear. The purpose of this study thuswas to explore person, healthcare, and work-related factors in relation to desire to work inpersons visiting psychiatric outpatient clinics. The sample consisted of 272 persons visitingone of four psychiatric outpatient centres from two county councils in the south of Sweden.The possible participants were asked if they wanted to participate in research while waitingfor their scheduled appointments. A comprehensive questionnaire consisting of factors inthe research literature as well as factors advocated by patient organisations was used. Theparticipants’ ratings were analysed using non-parametric group comparisons and logisticregressions. Free-text answers were analysed by content. Higher education, better mentalhealth self-efficacy, and more experiences of demands and conflicts at the workplace wereall significantly related to desire to work in bivariate analyses. However, fighting spirit andsocial support at work had the strongest associations with desire to work in the multivariatelogistic analyses. The Nagelkerke R2 was .34. Free text answers indicated the importanceof managers’ role for the psychosocial work climate, and for receiving help with structuringthe workday to allow recovery after sickness absence. In contrast to the traditional prevocationalrehabilitation approach, and in line with a supportive work environment approach,the results points to the possibility to influence a further improved desire to work throughsupportive leadership and an open and communicative psychosocial climate.

The aim is to evaluate the effects of intensive home rehabilitation regarding multidimensional health perceptions and other quality of life domains, physical ability and capacity among older people (65+). The design is a randomized controlled study of a reablement intervention with controls receiving traditional home care. The intervention is goal- and user oriented, home-based, time limited (3 months), and organized by an interprofessional team consisting of the professions nurse, enrolled nurses, physiotherapists, social worker, and occupational therapists. The effects of the intervention are measured by self-reported health and quality of life (EQ-5D-5L, HACT) including psychological well-being (GP-CORE), physical capacity (SPPB, hand dynamometer test), activity performance (COPM), and home care hours needed. Data are collected at inclusion (T1; applying for home care), after the three months intervention (T2), and at six months (T3). Primary outcome analyses will be performed according to intention to treat; 2 x 3 mixed design (group x time) ANCOVA with each dependent variable at T1 as covariate. Based on a medium effect size in favour of the intervention in the pilot study, and a dropout of 20%, the power calculation indicated that 240 persons should be included. The project will contribute with evidence of the effects of interprofessional home rehabilitation for reablement, and consequences for older persons’ bio-psycho-social health. The project is ongoing with more than 120 persons included. The intervention may result in reduced costs for care, but especially individual gains in relation to reduced care needs, maintained independence and good health.

The increased number of older adults who experience longevity requires increased investment in healthcare services. Short-term goal-directed reablement is expected to strengthen the functional capacity and quality of life of older adults, while homecare hours, and thus municipal expenditures, decrease. Facilitation of successful interprofessional collaboration includes not only enhancing coordination structurally, but also establishing a commitment regarding culture that overcomes professionally differentiated attitudes. Nurses have an obvious role in these multi-professional teams and the study explores some aspects' of working in this type of collaboration. The aim was to illuminate the meaning of working with short-term goal-directed reablement of older adults as experienced by an interprofessional team. Data were collected after an intervention with goal-directed time-limited reablement of older people. Written narratives from an interprofessional team were analyzed using a phenomenological-hermeneutic approach. Findings identified four major thematic structures that characterized the meaning: 1) Reliable relationship; including the aspects ‘Confidence between the older adult and staff’, ‘A sense of security’ and ‘Continuity’, 2) Empowered participation, including the following aspects: ‘Listen to the older adult’s desires’ and ‘Put the person in control’, 3) Team with a negotiated approach, including the aspects: ‘Closeness’, ‘Same direction and overarching goal’, ‘Learning from interprofessional dialogue’, 4) Time for growth with the aspects ‘Creating harmony’ and ‘Building the older adult’s self-confidence’. The process of reablement seemed strengthened by the collaborative approach of different professions and their combined efforts. The present study argues that teamwork gives confidence both in terms of general knowledge of reablement but also specific confidence in one’s profession.

This paper reports a study conducted to illuminate older adults’ perceptions of multiproffesional team's caring skills as success factors for health support in short-term goal-directed reablement. The fact that older adults are given perquisites to live in their own homes puts great demands on the professional care given them at home. An option offered could be short-term goal-directed reablement delivered by an interprofessional team. This means after periods in hospitals to strengthen their multidimensional health, older adults’ reablement processes are supported to return to their daily life as soon as possible. Crucial in making these intentions a reality seems to be identifying the professional's approach that works as success factors for health support in the reablement process. A descriptive qualitative design with a phenomenographic approach based on interviews with 23 older persons who had received short-term goal-directed reablement at home after a period at hospital was used. The study was approved by an ethical board. The analysis revealed four major referential aspects of multiproffesional team's caring skills as success factors for health-support in short-term goal-directed reablement: a motivating caregiver, a positive atmosphere-creating caregiver, a human fellowship-oriented caregiver and a caregiver that goes beyond the expected. In this study, all caring skills in the continuum are perceived as positively loaded necessities in different situations during the reablement process. Caring skills as success factors are initially shown at a practical level, such as how the professional caregivers encourage and motivate the older persons in different training situations. At a deeper level, the caregivers open their hearts and have the capacity to go beyond the expected in the professional caregiver–patient relationship. The multiproffesional team's best fit caring skills during the home reablement process need to be addressed as evidence base in the area of elderly home care.

Background 

Sedentary behavior (SB) increases during cancer treatment, which may have deteriorating effects on long-term health. Few studies exploring patients' experience of SB during neo- or adjuvant cancer treatment have been conducted, and this information may be crucial in developing effective support for patients to reduce SB.

Purpose 

To explore the lived experiences of SB in patients undergoing neo- or adjuvant cancer treatment and to explore the impact of the COVID-19 pandemic.

Methods

Individual interviews were conducted with patients undergoing treatment for breast, prostate and colorectal cancer recruited from the oncological department of a university hospital in Sweden. Interviews were analyzed phenomenologically and results presented as descriptions of the phenomenon SB. 

Results 

Preliminary results are that patients describe SB by depicting physical activity and awareness of its health benefits. Also, being inactive or sedentary is stigmatized. The type and phase of treatment, life circumstances (COVID-19 pandemic, sick leave) as well as motivation, social support, and self-image can impact SB during treatment.

Conclusions 

The results indicate that SB is difficult for patients to discern. This suggests that SB is an unimplemented concept in the cancer context and needs to be addressed in a way that does not stigmatize patients. The coronavirus pandemic had both negative and positive impacts on SB for these patients. Furthermore, developing support that targets periods with more side-effects and helping patients reduce SB throughout changed life circumstances may be helpful. 

Purpose: Increased sedentary behavior during cancer treatment is common, which may have negative long-term health effects. Understanding patients' experience of sedentary behavior during neo- or adjuvant cancer treatment may be crucial in developing effective support for patients to reduce sedentary behavior. Therefore, the present study aimed to explore sedentary behavior in patients undergoing neo- or adjuvant cancer treatment. Methods: Eleven interviews were conducted with patients undergoing treatment for breast, prostate, and colorectal cancer. Participants were recruited from a university hospital in Sweden. Interviews were analyzed phenomenologically, and the results were presented as descriptions of the phenomenon sedentary behavior. Results: The overarching theme of sedentary behavior during cancer treatment was that sedentary behavior is experienced through being physically active or not. Furthermore, experiences of sedentary behavior increased with side effects and varied depending on the type and phase of cancer treatment, meaning that sedentary behavior is an adjustment to side effects. Additionally, sedentary behavior was influenced by life circumstances and social interaction, such as work status and having social support. Finally, sedentary behavior is influenced by strategies and motivations, such as the perceived benefits of physical activity and self-image. Conclusions: Sedentary behavior is difficult for patients to discern, which is why health care personnel may need to help patients by increasing awareness of the negative impact of sedentary behavior in a way that does not stigmatize patients. Furthermore, developing support that targets periods with more side effects and helping patients reduce sedentary behavior throughout changing life circumstances may be helpful.

BACKGROUND: The world's growing population of older adults is one population that needs to be focused more regarding subjective well-being. It is therefore important to evaluate self-report instruments that measures general well-being for this specific group - older adults. The aim of the present study was to investigate psychometric properties of the Swedish translation of the GP-CORE (general population - Clinical Outcomes in Routine Evaluation) in a group of older adults (> 65 years).

METHODS: In this study, a psychometric evaluation of the GP-CORE is presented for 247 Swedish older adults (> 65 years), 184 women and 63 men who applied for home care assistance for the first time.

RESULTS: The psychometric evaluation showed high acceptability; provided norm values in terms of means, standard deviations and quartiles; showed satisfactory reliability in terms of both internal consistency and stability; showed satisfactory validity in terms of convergent and discriminant validity; provided a very preliminary cut-off value and quite low sensibility and sensitivity and showed results which indicated that this scale is sensitive to changes. One gender difference was identified in that women without a cohabitant had a higher well-being than men without a cohabitant (as measured by GP-CORE).

CONCLUSIONS: The GP-CORE showed satisfactory psychometric properties to be used to measure and monitor subjective well-being in older adults (> 65 years) in the general population of community dwelling. Future studies should establish a cut-off value in relation to another well-being measure relevant for mental health in older adults.

Background: Sedentary behavior is highly prevalent in older adults transitioning to retirement. Sedentary time is all of the time spent in sedentary behavior, and prolonged sedentary time is associated with an increased risk of noncommunicable diseases. The aim of this study was to explore perceptions among older adults transitioning from working life to retirement regarding selfmanagement strategies for reducing sedentary time and adhering to the reduced sedentary time. Methods: Twenty-eight older adults, age 60-75 years, participated in one of four focus group interviews. Qualitative content analysis was used to analyze the data. Results: The analysis resulted in the theme " It has to be my way," and the three categories " Activities scattered with joyfulness," " Support for changes in everyday life," and " Health affects willingness and ability, and is affected by adherence." Conclusions: Interpreted from the perspective of self-determination theory, self-management strategies for reducing sedentary time should be adaptable as every individual is unique, indicating a need for autonomy. Sedentary time was said to be reduced by activities that evoked joyfulness, and joyfulness was considered to increase adherence. Support for changes to one's everyday life was considered necessary. The support that was mentioned primarily involved targeting cognitive determinants such as self-efficacy and attitudes. This new knowledge can be included when designing self-management interventions; however, more research is needed in order to evaluate whether self-management strategies targeting autonomous motivation and affective determinants, such as affective judgment and cognitive determinants, can reduce sedentary time in those who are in the transition to retirement.

Objectives: The cardinal symptom of burning mouth syndrome (BMS) is long-lasting pain and comprehensive health-related quality of life (HRQL) assessments may estimate how well patients with BMS live in relation to their health issues. The aims of the study were to explore general and BMS-specific HRQL based on an HRQL model and to compare HRQL in patients with BMS and age-matched controls. Methods: For this case-control study 56 female patients with BMS and 56 female controls completed the following: A general questionnaire with Global items for life satisfaction, general health and oral health; General Population-Clinical Outcomes in Routine Evaluation (GP-CORE); Hospital Anxiety and Depression Scale (HADS); and Oral Health Impact Profile-14 (OHIP-14). Patients with BMS completed additional questionnaires which included BMS-problem severity, a global item for ratings of overall severity perceptions measured by visual analog scale (VAS); and BMS-modified Multidimensional Pain Inventory-Swedish version (MPI-S). BMS-modified MPI-S includes the three subscales Pain severity, Interference and Social support. Results: Patients with BMS scored worse on all global items, GP-CORE, HADS and OHIP-14 compared to controls and the differences were large. Patients with severe BMS problems, as defined by a median split on BMS-problem severity, scored worse on the BMS-modified MPI-S subscale Pain severity and the difference was large. Conclusions: We found clearly impaired general HRQL in patients with BMS compared to controls. For specific HRQL, the severity of pain was worse among patients with higher overall BMS-problem severity. The HRQL model with global ratings together with physical, psychological and social concepts has capacity to increase comparability and validity of studies, however further evaluations of the measures are needed. The HRQL model may be used over time to increase the understanding of different HRQL aspects and their internal relationships. In clinical settings, with an increased knowledge of one´s own distinctive quality of life abilities and restrictions, the patients with BMS can be guided and supported to manage their long-lasting pain. The HRQL model may be an aid toward bridging distinctions between general and oral health to further encourage collaboration between medicine and odontology.

Objectives Burning mouth syndrome (BMS) is a long-lasting pain condition which is commonly associated with anxiety symptoms and experience of adverse, stressful life events have been reported by those diagnosed with the syndrome. Stress-related biomarkers have been related to personality traits in BMS and a personality with high stress susceptibility and perceived stress may be of importance. Although biopsychosocial approaches are suggested to manage long-lasting orofacial pain, to date little is known about physical activity in women with BMS. The aim of this study was to investigate if personality, perceived stress and physical activity distinguish women with BMS from controls. Methods Fifty-six women with BMS and 56 controls matched on age and gender completed Swedish universities Scales of Personality (SSP), Perceived Stress Questionnaire (PSQ) and a general questionnaire with an item on weekly physical activity frequency. In addition, health-related quality of life was explored by additional questionnaires and reported in a companion article (Jedel et al. Scand J Pain. 2020. PubMed PMID: 32853174). Results SSP subscales Somatic Trait Anxiety, Psychic Trait Anxiety, Stress Susceptibility and Verbal Trait Aggression differed between women with BMS and controls and the personality factor scores for Neuroticism and Aggressiveness were higher. Perceived stress measured by PSQ index was higher for women with BMS compared to controls. Women with BMS reported lower physical activity frequency compared to controls and those reporting physical activity <4 days/week scored higher on PSQ compared to those with weekly physical activity ≥4 days/week. Conclusions Personality distinguished women with BMS from controls in this study. Perceived stress was higher and weekly physical activity was lower in women with BMS compared to controls. Our findings suggest physical activity should be more comprehensively measured in future BMS studies and, by extension, physical activity may be a treatment option for women with BMS. Pain management aiming to restore function and mobility with stress reduction should be considered in clinical decision making for women with BMS who have a personality with stress susceptibility, especially if reporting high perceived stress and insufficient physical activity.

Background: Significant research has focused on psychological difficulties following spinal cord injury (SCI), and there is a small prevalence of individuals who experience distress after injury. However, the converse is that many adjust well to injury and rate their quality of life highly. Despite this, there has been a comparative dearth of research investigating positive psychological outcomes after SCI, perceived by individuals living with this disability. Objective: To explore individuals' perceptions of gain following the experience of SCI. Methods: Participants, who had sustained an SCI between the ages 16 and 83, responded to an open-ended written question: "What do you think you have gained from the experience of spinal cord injury?" This was administered at 4 time points post injury: 6 weeks, 12 weeks, 1 year, and 2 years. Results: Participants' responses were analyzed qualitatively using the framework of thematic analysis. Thirteen themes were identified: relationships, appreciation of relationships, perspective and appreciation of life, new goals or priorities, understanding of SCI or disability, appreciation of health or health care, changed personality, opportunity or challenge, knowledge of SCI or body, newly acquired skills, spirituality, acceptance, and nothing. Descriptive statistics were incorporated in the presentation of the data. Conclusions: This study provides evidence that a broad range of positive as well as negative psychological outcomes are possible following SCI. More research is needed to better understand the process through which these outcomes arise and to inform how such outcomes may be communicated to persons experiencing this type of injury.

Study Design: Longitudinal, multiple wave panel design.

Objectives: To investigate the degree to which current thinking in terms of early appraisals and coping, predicts adjustment and quality of life outcomes after spinal cord injury, and what degree social and demographic variables are involved.

Setting: Data from 281 patients recruited from specialist units in selected British, Swiss, Swedish, German, Austrian and Irish spinal centres as part of an ongoing study was analysed.

Method: Questionnaire booklets were administered as soon as possible after injury onset and after 12 weeks to patients with newly acquired spinal cord injuries.  Individuals included had sustained their injury between the ages of 16 and 83. 

Results: Significant improvements in outcome measures were found across the data set within the first 12 weeks following spinal cord injury and changes observed in the appraisals and coping strategies employed. Significant differences were found between participating centres on both outcome measures and in the coping and appraisal processes used. Coping and appraisal processes at 6 weeks post injury were found to contribute significantly to the variation in psychological well being at 12 weeks post injury.

Conclusion:  This study shows the process of adjustment to spinal cord injury to begin in the early stages of rehabilitation, and initial appraisals are important to how an individual will cope with their injury and to their long term psychological well being. Support is also given to the importance of psychological factors to functional outcomes.

One objective of this study was to replicate the air bag effect of persons with spinal cord injury and their close persons compared to a reference group of close persons of people with brain injury (BI) and a sample of the general population during the first year of rehabilitation.  The former psychological longitudinal study had been conducted from 1999 to 2001, the actual psychological longitudinal study from 2006 to current. The air bag effect is a creative adjustment process, characterised by a nonspecific mobilisation of coping resources which often occurs right at the onset of SCI.

All newly acquired injuries were approached in selected Swiss, German and Austrian spinal centres.  Participants were asked to complete a questionnaire booklet at 6 weeks post injury, at 12 weeks and again one year post injury. One hundred and thirty two participants completed the questionnaire pack from 13 German speaking spinal centres.

The air bag effect was mainly operationalized by the sense of coherence and stress related measures. The initial powerful air bag effect and its expected course could be replicated for people with SCI.  The distress of close persons of people with BI was reflected by the data.  A better development had been observed for close persons of people with SCI concerning the second and third assessment compared to the former study.

The air bag effect can be considered as a matter of fact.  The role of psychological support is discussed in respect of mobilising resources and buffering distress.

Study design: Longitudinal, multiple wave panel design.

Objectives: To investigate the degree to which current thinking in terms of early appraisals and coping predicts adjustment and quality of life outcomes after spinal cord injury, and to what degree social and demographic variables are involved.

Setting: Data were analysed from 266 patients recruited as part of an ongoing study from specialist units in selected British, Swiss, German and Irish spinal centres.

Method: Questionnaire booklets were administered as soon as possible after injury onset and after 12 weeks to patients with newly acquired spinal cord injuries. Individuals included had sustained their injury between the ages of 16 and 83.

Results: Significant improvements in outcome measures were found across the data set within the first 12 weeks after spinal cord injury and changes observed in the appraisals and coping strategies employed. Significant differences were found between participating centres on both outcome measures and in the coping and appraisal processes used. Coping and appraisal processes at 6 weeks after injury were found to contribute significantly to the variation in psychological well-being at 12 weeks after injury.

Conclusion: This study shows the process of adjustment to spinal cord injury to begin in the early stages of rehabilitation, and initial appraisals are important to how an individual will cope with their injury and to their psychological well-being. Support is also given to the importance of psychological factors to functional outcomes. 

Study design. Longitudinal, multi-wave design.

Objectives. To investigate the contribution of sense of coherence (SOC), appraisals, and behavioural responses when predicting psychological outcomes to spinal cord injury (SCI).

Method. Patients (N = 237) sustaining a SCI aged 17 or above were recruited from specialist spinal injuries centres across six European countries. Measures of SOC, appraisals, coping strategies, and psychological well-being were administered at 6 and 12 weeks post-injury and at a 1 year follow-up.

Results. People scoring high on SOC at 6 weeks post-injury showed significantly better psychological outcomes at 1 year post-injury and SOC showed significant relationships with appraisals at 12 weeks post-injury and coping strategies 1 year postinjury. Significant relationships were found between appraisals at 12 weeks post-injury and psychological outcomes, adaptive coping strategies were significantly related to psychological well-being at 1 year post-injury. Regression analyses found SOC, appraisals, and coping behaviours to explain 61.8% of the variance in psychological quality of life, 66.5% of the variance in depression, and 37.7% of the variance in anxiety at 1 year post-injury. 

Conclusion. This study provides further evidence in support of previous findings which suggest SOC to have a primary role in long-term psychological well-being. The relationship described here – from SOC to the appraisal of injury and subsequent behavioural responses – suggests SOC to be an influential factor in the long-term adjustment of people with SCI.

Study Design: Longitudinal, multi-wave panel design.

Objectives: To explore the changes in and the relationships between appraisals and coping with mood, functioning and quality of life pre and post rehabilitation for acute spinal cord injury.

Setting: The data collected was part of an ongoing study from specialist units in selected British, Swiss, German, and Irish spinal cord injury centres.

Method: Questionnaires (Functional Independence, Quality of Life, Mood, Appraisals, Coping & Support) were administered to 232 patients at 12 weeks post injury and sent to participants at 1 and 2 years post injury by post.

Results: Significant changes were observed in various outcome measures between 12 weeks and 1 year post injury, with little significant change occurring during the following year. Appraisals and coping at 12 weeks post injury were significantly related to outcome scores and also contributed significantly to the variance in quality of life, mood, and stress related growth at 2 years post injury.

Conclusion:  The study provides further evidence for the link between appraisals, coping and subsequent adjustment to injury. Suggestion is made for the potential benefit of early assessment and intervention for patients at risk of poor adjustment to SCI.

Objectives: To investigate the contribution of pre-rehabilitation appraisals of spinal cord injury and patient’s coping strategies to the variance in functional independence post discharge.

Design: Longitudinal, cohort study. Patients sustaining a spinal cord injury aged 16 or above were recruited from English and German speaking specialist spinal injuries centres. Measures of appraisals, coping strategies, mood and functional independence were administered on commencing active rehabilitation (12 weeks post injury) and following hospital discharge (1 year post injury).

Setting: Specialist spinal cord injury rehabilitation centres in England,Germany,Switzerland andIreland.

Participants: One hundred and twenty seven patients completed questionnaires at both time points. Sample age ranged between 17.5 and 64.5 with a mean age of 39.3. Demographic and injury characteristics were similar to those reported in international statistics databases.

Interventions: Not Applicable

Main Outcome Measure:  Functional Independence Measure (FIM; motor subscale).

Results: Injury characteristics, age, gender, current depression and the utilization of the coping strategy ‘social reliance’ at twelve weeks post injury explained 33.5% of the variance in motor FIM at one year post injury. Strong relationships were found between appraisals, coping styles, mood and functional outcomes.

Conclusion: The coping strategy ‘Social Reliance’ was found to contribute significantly when explaining the variance in functional outcomes. Suggestions are made to assess appraisals and coping strategies early in rehabilitation in order to provide effective interventions and additional support to those scoring highly on negative coping styles. Further research would be recommended to provide support for the relationship between dependent coping strategies and functional outcomes.

Purpose: To investigate the changes in quality of life (QOL) in persons with spinal cord injury (SCI) and their close persons during the first 2 years post injury. Method: Longitudinal, multiple sample, multiple wave panel design. Data included 292 patients recruited from Austrian, British, German, Irish, and Swiss specialist SCI rehabilitation centers and 55 of their close persons. Questionnaire booklets were administered at 6 weeks, 12 weeks, 1 year, and 2 years after injury to both samples. Results: Study 1 investigated the WHOQOL-BREF domains in individuals with SCI and found differences mostly in the physical domain indicating that QOL increases for persons with SCI from onset. An effect of the culture was observed in the psychological and environmental domains with higher QOL scores in the German-speaking sample. Study 2 compared individuals with SCI to their close persons and found differences in the physical, environmental, and social domains over time. The scores on the psychological dimension did not significantly differ between the persons with SCI and their close persons over time. Conclusion: QOL measured by the WHOQOL-BREF shows that QOL changes during rehabilitation and after discharge. Apart from the physical dimension, the persons with SCI and their close persons seem to experience a similar change in QOL. Further longitudinal research is suggested to clarify the mutual adjustment process of people with SCI and their close persons and to explore cultural differences in QOL between English- and German-speaking countries.

BACKGROUND: Temperament has been associated with dental fear (DF) and dental behavioural management problems (DBMP) in children, but little is known about what role temperament plays in the aetiology of DF. Thus, measures of temperament suitable for use among children, adolescents, and adults would be of value for longitudinal and family studies of DF, where relations between children's and parent's ratings are investigated.

AIM: Our aim was to explore the adapted EASI (emotionality, activity, sociability, and impulsivity) in adult patients, and to evaluate the instrument in comparison with established measures of DF and general emotional reactions in adults.

DESIGN: The subjects were 230 adult patients applying for treatment for DF and 41 nonfearful patients (reference group). Questionnaires investigated temperament (general and DF) and general anxiety and depression.

RESULTS: The previously described factor structure of the EASI among children was confirmed and the adapted EASI had acceptable psychometric qualities. Emotionality correlated with DF and with measures of general psychological distress. No differences were found in mean scores of EASI dimensions between DF group and the reference group, which was in contrast with studies in children.

CONCLUSIONS: The adapted EASI seem promising for use in future longitudinal and familial studies of development of DF and DBMP.

Background: Understanding young people's subjective well-being, such as how they experience equality, safety, and supportive environments, is particularly important for identifying possible preventive interventions in the school context. Aim: The aim of this study was to investigate similarities and differences between 15-year-old girls’ and boys’ subjective well-being, and its associations with psychosocial factors. Methods: The study was explorative and cross-sectional. A total of 195 adolescent girls and 116 boys in Grade 9 from four Swedish junior high schools completed a questionnaire on subjective well-being; emotional support opportunities; gender equality; experience of emotional, physical, and sexual violence in close relationships; insecurity due to harassment in the school environment or on social media; and pornography consumption. Results: Compared to boys, girls indicated worse subjective well-being and more harassment in school and on social media, and reported that boys received benefits based on gender. Boys reported higher pornography consumption compared with girls. Girls reporting decreased subjective well-being experienced more harassment on social media and in school, and more recent sexual violence. Among boys, with decreased subjective well-being, more psychological risks such as self-harm and suicidal thoughts was reported. Both girls and boys with decreased subjective well-being reported less availability of attachment and insecure close relations. Conclusion: The absence of a safe and supportive environment, such as feeling secure at school, and lack of close and trusting relationships are associated with 15-year-olds’ subjective well-being for the worse, regardless of gender. It is suggested that school personnel extend the relational possibilities in the school context. 

Study design: Representative community cross-sectional self-report survey of adults with spinal cordinjury (SCI).

Objectives: To establish semantic translation and validation of the Swedish scales -- the Spinal Cord Lesion Coping Strategies Questionnaire and the Spinal Cord Lesion Emotional Wellbeing Questionnaire.

Setting: Adults on the Victorian traumatic SCI register and attendees of the nontraumatic outpatient clinic were invited to participate.

Methods: Instruments were forward and backward translated to establish semantic equivalence. Principle components analyses were undertaken. Correlation and logistic regression analyses were conducted to demonstrate validity of the instruments using both positive (high quality of life) and negative (depression and anxiety) psychological outcomes.

Results: The final sample consisted of 443 adults with SCI living in the community. Both instruments demonstrated acceptable psychometric properties. Univariate correlation analyses showed most of the new scale components displayed medium to large relationships in the expected direction with the psychological outcomes and the other subscales. Health status and helplessness were significant predictors of both the positive and negative psychological outcomes in the logistic regression analyses. Acceptance was significantly related to the positive outcome only. Female and incomplete tetraplegia categories were significantly and positively related to depression only.

Conclusion: Notwithstanding a few issues with some of the subscales, the results support the usefulness of these easy to use instruments and point to ways for further development of the scales.