Browsing by Author "Hirsh, Adam Todd"
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Item Child pain-related injustice appraisals mediate the relationship between just-world beliefs and pain-related functioning(Wiley, 2021) Daenen, Frederick; McParland, Joanna; Baert, Fleur; Miller, Megan Marie; Hirsh, Adam Todd; Vervoort, Tine; Psychology, School of ScienceBackground: Research among adult and paediatric samples suggests that pain-related injustice appraisals contribute to adverse pain-related functioning. However, a singular focus on pain-related injustice appraisals carries the risk of underestimating the role of broader concepts of justice. This study examined the unique roles of child pain-related injustice appraisals and just-world beliefs in understanding disability and physical, emotional, social and academic functioning, as well as the mediating role of injustice appraisals in the relationship between just-world beliefs and functioning. Methods: Participants comprised a school sample of 2,174 children (Study 1) and a clinical sample of 146 paediatric chronic pain patients (Study 2) who completed the Injustice Experience Questionnaire (IEQ), Personal and General Belief in a Just World scales (JWB-P/G), Functional Disability Inventory (FDI), Pain Catastrophizing Scale for Children (PCS-C) and Pediatric Quality of Life Inventory (PEDSQL). Results: For both samples, child pain-related injustice appraisals were associated with poorer functioning, after controlling for just-world beliefs, catastrophizing, pain intensity, age and sex. In the school sample, injustice appraisals mediated the associations of both personal and general just-world beliefs with functioning. In the clinical sample, injustice appraisals mediated the association of personal, but not general, just-world beliefs with all functioning scales. Conclusions: The current findings attest to the unique role of pain-related injustice appraisals in understanding child pain-related functioning and their explanatory value in understanding the relationship between fundamental just-world beliefs and child pain-related functioning. Significance: The present study adds to emerging literature on the adverse effects of child pain-related injustice appraisals in the context of pain, through showing that pain-related injustice appraisals are uniquely associated with pain-related functioning and mediate the relationship between just-world beliefs and pain-related functioning. These findings suggest that interventions may target pain-related injustice appraisals as a mechanism for change in children.Item Examining the influence of Hispanic ethnicity and ethnic bias on medical students’ pain decisions(2016-05-09) Hollingshead, Nicole A.; Hirsh, Adam Todd; Ashburn-Nardo, Leslie; Stewart, Jesse; Maupomé, Gerardo; Grahame, Nicholas J.Hispanic patients receive disparate pain care compared to non-Hispanic White (NHW) patients. Healthcare providers’ ethnic bias may be one reason for pain disparities. This investigation sought to determine the influence of Hispanic ethnicity and ethnic bias on chronic pain management decisions. During an online experiment, 97 medical students made pain assessment and opioid treatment decisions for Hispanic and NHW virtual human patients with chronic pain. They also completed explicit and implicit measures of ethnic bias. Individual-level analyses found that 31% and 36% of participants demonstrated large effect sizes (dz>.50), indicating that patient ethnicity strongly influenced their pain assessment and opioid treatment decisions, respectively. At the group level of analysis, participants’ decisions did not differ significantly between NHW and Hispanic patients (all p values >.05). Participants did not report significant explicit ethnic bias (t[96]=1.88, p=.06; dz=.19; Hispanic mean rating=77.6[SD=18.7]; NHW mean rating=75.2[SD=19.4]) but demonstrated a small-to-moderate implicit preference for NHWs relative to Hispanics (Mean=.31[SD=.41]). Patient ethnicity and implicit ethnic bias had an interactive effect on opioid treatment decisions (F[1, 95]=5.15, p<.05, generalized eta squared =.02); however, the direction of the effect was not as hypothesized. Participants with higher implicit ethnic bias gave significantly higher opioid ratings to Hispanics relative to NHWs (p=.05), whereas participants with lower bias gave marginally higher opioid ratings to NHWs relative to Hispanics (p=.20). Participants with higher vs. lower implicit ethnic bias differed only in their treatment ratings for NHW patients, such that participants with lower bias gave significantly higher opioid ratings to NHW patients than did participants with higher bias (p<.05). This investigation found that approximately one-third of participants made significantly different chronic pain management decisions for Hispanic vs. NHW patients. Participants’ implicit ethnic bias interacted with their opioid treatment decisions but not as expected. Future investigations should measure healthcare providers’ stereotypes about Hispanic patients with pain as this may better predict their pain decisions.Item HPA Axis Reactivity: Physiological Underpinnings of Negative Urgency?(2015-10-05) VanderVeen, John Davis; Cyders, Melissa Anne; Hirsh, Adam Todd; Lapish, Christopher C.; Grahame, Nicholas J.Hypothalamic-pituitary-adrenal (HPA) axis dysfunction is found in heavy alcohol users. Negative urgency is a personality trait reflecting the tendency to act rashly in response to negative emotional states, and is associated with problematic alcohol consumption. The current study examined the relationship between negative urgency and HPA axis functioning following (1) negative mood induction and (2) intravenous alcohol administration among heavy social drinkers (proposed n = 40). I hypothesized the following: (1) Negative mood induction would result in an increase of cortisol release as compared to neutral mood induction; (1a) Negative urgency would be related to increased cortisol release in response to negative mood induction; (1b) Negative urgency would partially mediate the relationship between mood induction and cortisol release; (2) Acute IV alcohol administration would result in increased cortisol levels in the neutral mood condition, but decreased cortisol levels in the negative mood condition; and (2a) Negative urgency would be related to the suppression of cortisol release in the negative mood condition in response to acute IV alcohol administration. Repeated measures analyses of variance, the PROCESS macro, and paired samples t-tests were used to examine study hypotheses. Hypotheses were largely unsupported. Writing mood induction procedures reduced salivary cortisol levels in negative mood (t(35)= 2.49, p= 0.02) and there was a trend decrease in neutral mood (t(35)= 1.87, p= 0.07). Alcohol administration also reduced salivary cortisol levels in both negative mood (t(35)= 3.99, p< 0.01) and neutral mood (t(35)= 2.60, p= 0.01). However, salivary cortisol changes were no different than typical circadian patterns in response to mood induction (t(231)= 0.37, p=0.71) or in response to acute alcohol administration (t(231)= 0.44, p= 0.64). Negative urgency had a trend main effect on salivary cortisol level in response to acute IV alcohol administration, such that those higher in negative urgency were more similar to typical circadian patterns (F(19,28)= 1.59, p=0.13). This could serve as preliminary support for a psychological mechanism for the alcohol sensitivity hypothesis. Overall these findings suggest the current study failed to sufficiently manipulate salivary cortisol levels. Future studies should consider methodological techniques when exploring these relationships, including IV compared to oral alcohol administration, mood compared to stress manipulations, and cortisol compared to other HPA axis biomarkers.Item Measures of Cancer-related Loneliness and Negative Social Expectations: Development and Preliminary Validation(2016-01-21) Adams, Rebecca N.; Kroenke, Kurt; Mosher, Catherine Esther; Hirsh, Adam Todd; Rand, Kevin L.; Grahame, Nicholas J.Loneliness is a known risk factor for poor mental and physical health outcomes in the general population, and preliminary research suggests that loneliness is linked to poorer health in cancer patients as well. Various aspects of the cancer experience (e.g., heightened existential concerns) lend themselves to making patients feel alone and misunderstood. Furthermore, loneliness theory suggests that negative social expectations, which may specifically relate to the cancer experience, precipitate and sustain loneliness. Thus, loneliness interventions in cancer should be tailored to address illness-related social conditions and negative social expectations. Prior to the development of loneliness interventions for cancer populations, cancer-specific tools are needed to assess: (1) loneliness attributed to cancer (i.e., cancer-related loneliness), and (2) negative social expectations related to cancer. In the current project I developed measures of cancer-related loneliness and cancer-related negative social expectations for use in future theory-based loneliness research. A mixed-methods study design was employed. First, I developed items for the measure of cancer-related loneliness (i.e., the Cancer Loneliness Scale) based on theory, prior research, and expert feedback. Second, I conducted a clinic-based qualitative study (n=15) to: (1) obtain cancer patient feedback on the Cancer Loneliness Scale items, and (2) inform development of the item pool for the measure of negative social expectations (i.e., the Cancer-related Negative Social Expectations Scale). Interviews were audiotaped, transcribed verbatim, and then transferred to Atlas.ti for analysis. Content analysis was used to analyze data regarding patient feedback and theoretical thematic analysis was used to analyze data regarding negative social expectations. Overall, patients said they liked the Cancer Loneliness Scale and no changes were made to the items based on patient feedback. Based on results, I also created five content domains of negative social expectations that were represented in the item pool for the Cancer-related Negative Social Expectations Scale. Third, I conducted a telephone and mail-based quantitative study (n=186) to assess psychometric properties of the two new measures. Dimensionality was determined using confirmatory factor analysis. Reliability was assessed by examining internal consistency coefficients and construct validity was assessed by examining theoretical relationships between the Cancer Loneliness Scale, the Cancer-related Negative Social Expectations Scale, and existing reliable and valid measures of health and social well-being. The final products of the project included a 7-item unidimensional Cancer Loneliness Scale and 5-item unidimensional Cancer-related Negative Social Expectations Scale. Excellent evidence for reliability and validity was found for both measures. The resulting measures have both clinical and research utility.Item Psychosocial aspects of chronic pain in a clinical pediatric sample(2015-04) Miller, Megan M.; Hirsh, Adam Todd; Rand, Kevin L.; Zapolski, Tamika C.; Grahame, Nicholas J.Chronic pain, defined as pain lasting more than 3 months, is a common and costly health condition. Thirty-three percent of adults and upwards of 35% of children report experiencing pain due to various diseases, disorders, or accidents. Recent research has identified perceived injustice and anger as important constructs in an adult’s pain experience and a possible focus for intervention efforts. The present study explored the extent to which perceived injustice and anger expression operate similarly in children with chronic pain as in adults. This was a retrospective analysis of data from 122 patients seeking treatment at a pediatric pain clinic. Results supported anger expression as a mediator in the relationship between perceived injustice and pain intensity but not psychological distress, suggesting that anger expression operates similarly in children as in adults with chronic pain. Unlike previous findings in adults with chronic pain, injustice did not moderate the relationship between pain intensity and psychological distress, suggesting that injustice operates differently in children with chronic pain compared to adults. The strong association between injustice and pain outcomes (i.e. pain intensity, quality of life, functional disability) suggests that injustice is an important construct to explore in the chronic pain experience of children.Item Symptom Severity and Importance in Metastatic Breast Cancer Patients: An Examination of Cognitive Complaints and Related Symptoms(2016-07) Tometich, Danielle B.; Rand, Kevin L.; Mosher, Catherine Esther; Hirsh, Adam Todd; Grahame, Nicholas J.Cognitive changes associated with cancer and its treatment have been well documented. However, the majority of research on cognitive symptoms in cancer has been conducted with early-stage breast cancer patients or survivors in remission. Little is known about cognitive symptoms in patients with late-stage or metastatic cancers. To address this gap in the literature, this study examines cognitive and related symptoms among metastatic breast cancer patients enrolled in a parent study of perceptions of symptom importance and interference. Eighty metastatic breast cancer patients were recruited from the Indiana University Simon Cancer Center to participate in this cross-sectional telephone interview study. The interview consisted of self-report measures, including measures of symptom severity, distress, and the importance of seeing improvement in specific symptoms post-treatment. I hypothesized that cognitive complaints would cluster with fatigue, sleep disturbance, depressive symptoms, anxiety, and pain. This hypothesis was tested using cluster analysis and was partially supported. Cognitive complaints were found to cluster with fatigue, sleep disturbance, depressive symptoms, and anxiety, but not pain. In addition, the extent to which ratings of symptom importance for cognitive symptoms differed from those of other symptoms (i.e., pain, fatigue, sleep problems, depressive symptoms, anxiety, nausea, lymphedema, hot flashes, and neuropathy) was explored using ANOVA and Tukey’s HSD tests. Cognitive complaints were rated as significantly more important than anxiety, depressive symptoms, neuropathy, swelling, nausea, and hot flashes. Importance ratings for cognitive complaints, pain, fatigue, and sleep problems were not significantly different. Developing patient-centered treatment approaches that take into account symptom clustering and patients’ treatment priorities may increase treatment adherence and optimize healthcare quality.