The Pain Response Inventory (PRI) was developed as a multidimensional instrument to assess children's coping responses to recurrent pain.  The PRI assesses 3 borad coping factors -- Active, Passive, and Accommodative -- each with subscales representing specific strategies for coping with pain.  Confirmatory factor analysis was used to derive and cross-validate the factor structure of the PRI in 3 different samples of children and adolescents:  school children, abdominal pain patients, and former abdominal pain patients.  The subscales were found to be internally consistent and reasonably stable.  Validity of the subscales was assessed by examining the relations of particular coping strategies to various outcome inicators, including functional disability, somatization symptoms, and depressive symptoms.  Results indicated that different types of health outcome were predicted by different patterns of PRI coping strategies, thus supporting the utility of a multidimensional approach to the assessment of coping responses to pain.
 

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This article examines the utility of using a multidimensional instrument to assess pain coping in 2 samples of persons with rheumatoid arthritis (total N = 378). The predictive validity of the newly developed Vanderbilt Multidimensional Pain Coping Inventory (VMPCI), which assesses 11 distinct coping strategies, was compared to that of the previously validated Vanderbilt Pain Management Inventory (VPMI), which assesses the 2 broad dimensions of active and passive coping. In both samples, the VMPCI demonstrated reliable incremental validity over the VPMI in predicting both positive and negative psychological adjustment, whereas the predictive ability of the VPMI was highly redundant with that of the VMPCI. Moreover, using the VMPCI, both positive and negative adjustment were related to multiple coping strategies in ways that could not be revealed by the VPMI. These results offer considerable validation to the VMPCI and illustrate the value of assessing coping multidimensionally.
 

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Obective.  This study examined the relationship of gender and psyhcological well-being (PWB) in community-dwelling persons with rheumatoid arthritis (RA).
 
Method.  Data from the first wave of two longitudinal panel studies of persons with RA were examined (93 men and 276 women in panel 1; 60 men and 147 women in panel 2).  Subjects conmpleted self-report questionnaires on behavioral aspects of RA.  Psychological well-being was assessed in both panels by the Center for Epidemiologic Studies-Depression Scale, using its 4 subcomponents, including positive and negative affect.  Panel 2 had additional measures of PWB, namely the Positive and Negative Affect Schedule and the Satisfaction With Life Scale.  Potential explanatory variables were then examined in an attempt to account for the observed gender differences.

Results.  Gender differences were found for negative indicators of PWB, while positive indicators of PWB showed no significant differences by gender.  As with other community samples, women reported higher levels of depressive symptoms and negative mood than men.  Quality of emotional support, passive pain coping, and physical functional impairment could only partially explain the observed gender differences in this study.
 
Conclusion.  The relationship of gender to negative indicators of PWB cannot easily be diminished or dismissed.  The mechanisms by which gender differentially affects PWB need to be further explored in order to intervene appropriately to help men and women with RA achieve and optimal quiality of life.
 
 
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The present study adopts a multivariate approach to the analysis of coping and adjustment to chronic illness using two different techniques. First, using the newly developed Vanderbilt Multidimensional Pain Coping Inventory (VMPCI; C. Smith et al., 1995), a cluster analysis indicated that a sample of 165 persons with RA could be classified into four groups, each characterized by a distinctive coping profile across the 11 coping strategies assessed by the VMPCI. After controlling for differences in arthritis-related pain, the four clusters differed reliably in psychological adjustment as assessed by measures of positive and negative affect, depressive symptoms, and life satisfaction. Second, regression analyses examined whether certain coping strategies interacted in their relations to adjustment when used together. Evidence for several interactions was obtained, and these interactions tended to be outcome specific. These results suggest the adaptational significance of individual coping strategies may often be highly context specific. Overall, the findings indicate considerable value to adopting a multidimensional perspective in the study of coping and adjustment.
 

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The utility of measuring both positive and negative affective states for assessing rheumatoid arthritis (RA) patients was examined in 3 independent samples of male and female RA patients (Sample A: 179 women, 48 men; Sample B: 177 women, 24 men; Sample C: 134 women, 38 men). Confirmatory factor analyses of each sample indicated that positive and negative affect constituted separate, negatively correlated factors. The relations among disease variables, coping, and affects were consistent with a model in which coping mediates the relationship between disease variables and positive and negative affect. Patients with higher pain and limitations from RA had higher levels of maladaptive coping and maladaptive coping was associated with lower positive affect and higher negative affect. Those RAs with higher activity limitation also reported less adaptive coping, which was associated with less positive affect.
 

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A sense of competence or self-efficacy is associated with many positive outcomes, particularly in the area of health behavior. A measure of a sense of competence in the domain of health behavior has not been developed. Most measures are either general measures of a general sense of self-efficacy or are very specific to a particular health behavior. The Perceived Health Competence Scale (PHCS), a domain-specific measure of the degree to which an individual feels capable of effectively managing his or her health outcomes, was developed to provide a measure of perceived competence at an intermediate level of specificity. Five studies using three different types of samples (students, adults and persons with a chronic illness) provide evidence for the reliability and validity of the PHCS. The eight items of the PHCS combine both outcome and behavioral expectancies. Results from the five studies indicate that the scale has good internal consistency and test-retest reliability. The construct validity of the scale is demonstrated through the support obtained for the substantive hypotheses regarding the correlates of perceived health competence, such as health behavior intentions, general sense of competence and health locus of control.
 

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The degree to which self-reports of health and functioning reflect "negative affectivity" (NA) -- a dispositional tendency to emphasize the negative -- was examined using data from a 7-year longitudinal study of adaptation to rheumatoid arthritis. Within waves of data, the first unrotated principal component was consistently defined by measures of pain, functional impairment, and health. In the final wave, "disease impact" (DI), a scale derived from this component, was directly compared to NA. The two scales demonstrated considerable discriminant validity, and most of the significant intercorrelations among DI and the other variables examined remained statistically significant after partialling out the influence of NA. These results suggest that reports of health, pain, impairment, and associated variables reflected disease-related outcomes and processes, and not simply NA. The implications of these findings are discussed.
 

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Form C of the Multidimensional Health Locus of Control (MHLC) scales is an 18 item, general purpose, condition-specific locus of control scale that could easily be adapted for use with any medical or health-related condition. Data from 588 patients with one of four conditions--rheumatoid arthritis, chronic pain, diabetes, or cancer--were utilized to establish the factor structure of Form C and to establish the reliability and validity of the resultant four subscales: internality; chance; doctors; and other (powerful) people. The alpha reliabilities of the subscales are adequate for research purposes. Data from the arthritis and chronic pain subjects established that the Form C subscales were moderately stable over time and possessed considerable concurrent and construct validity. Some discriminant validity of Form C with Form B of the MHLC was also demonstrated.
 

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Derived a model of appraisal, coping, and adaptation in patients with rheumatoid arthritis (RA) from the more general theory of Lazarus and Folkman (1984), and examined this model using a longitudinal data set spanning four years and involving 239 RA patients (of whom 157 contributed to the primary analyses, with the remainder contributing to various follow-up analyses). This model attempted to identify both the short- and long-term adaptational consequences of coping as well as the antecedents (appraisals, beliefs, social support, disease activity, etc.) that promote particular coping styles. Interrelationships among the variables were examined using path-analytic techniques. Many observed relationships were consistent with the model. Significant relationships were subjected to more stringent analyses examining the ability of hypothesized causal variables to predict changes in outcome variables a year later. These analyses provided additional support for many observed relationships and suggested the existence of a vicious cycle involving helplessness appraisals, passive pain coping, and psychosocial impairment that promotes maladaptation in the face of RA. Theoretical implications, strengths, and limitations of the study are discussed.
 

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Chronic illnesses such as rheumatoid arthritis (RA) have been linked to poor psychological adjustment, although individual differences in this relationship have been observed. This study examines the role of perceived competence as a mediator between RA and adjustment. Persons with RA (N = 208) were surveyed 3 times at 6 month intervals concerning several potential antecedents of adjustment (pain, psychosocial impairment, social support, and control beliefs), self-perceived level of competence, and level of adjustment (life satisfaction and depressive symptomatology). Within each observational period strong evidence was obtained for perceived competence as a mediator of adjustment. Longitudinally (across the year) the data were consistent with a mediational model, but strong evidence establishing mediation was not obtained. Implications of these findings, and the importance of examining the role of perceived competence in adaptation to chronic illness, are discussed.
 

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Mail:  Department of Psychology and Human Development
       Box 512 Peabody
       Vanderbilt University
       Nashville, TN 37203

Phone: (615) 322-8298

Fax:   (615) 343-9494

E-mail: craig.a.smith@vanderbilt.edu