The impact of affectivity dispositions, self-efficacy and locus of control on psychosocial adjustment in patients with epilepsy
Introduction
Developing instruments to assess psychosocial problems in patients with epilepsy in a reliable and valid manner is an important issue (Bear and Fedio, 1977, Dodrill et al., 1980, Vickrey et al., 1992, Dilorio et al., 1992a, Baker et al., 1993, Devinsky et al., 1995, Tedeman et al., 1995, Cramer et al., 1996). As a supplement to the individual clinical evaluation, standardized questionnaires may contribute objective measures comparable to reference groups relevant to the parameters measured (Aldenkamp, 1993). Models of coping have been developed in social learning theory, and applied in studies of psychosocial adjustment and quality of life (Bandura, 1977, Schwarzer 1992). However, in the field of epileptology, these models and constructs have been integrated to a minor degree, and little is known about how existing questionnaires reflect these constructs.
Data from a mixed population of patients with epilepsy in western Norway is presented, with focus on specified dimensions of functioning, based on contemporary trait theory of personality, and social learning theory. The dimensions are: positive affectivity (PA), negative affectivity (NA), generalized self-efficacy (GSE), self-efficacy in epilepsy (ESE), and multidimensional health-related locus of control (MHLC).
Concepts of PA and NA are empirically derived, and refer to pervasive tendencies in individuals towards experiencing predominantly positive or negative effects (Watson and Clark, 1984). NA is closely connected to the concept of neuroticism, and constitutes one of five basic factors in a five-factor model of personality (McCrae and Costa, 1990). PA and NA are not opposites, but they are moderately negatively correlated (Watson et al., 1988). Both significantly influence presentation of oneself in questionnaires measuring psychological problems, and are important for the experience of anxiety and depression (Watson et al., 1988, Clark et al., 1994). In patients with epilepsy, neuroticism influences psychosocial adaptation after surgery (Rose et al., 1996) and responses to psychosocial and quality of life inventories (Zhu et al., 1998).
Self-efficacy, or expectations of successful coping, influences achievement both in health-related coping and in other areas of functioning (Bandura, 1977, Schwarzer 1992, Schwarzer, 1993). Self-efficacy is operative as a general attitude and in specific coping with particular problems. Specific self-efficacy scales have been constructed for various health-related behavior (Schwarzer 1992, Schwarzer, 1993), and for coping with epilepsy (Dilorio et al., 1992b, Gramstad et al., 1995, Tedeman et al., 1995, Amir et al., 1999).
The concept of locus of control refers to an individual tendency to perceive events either as controlled by personal influence or by external forces (Rotter, 1966). Specific scales have been developed to measure health-related locus of control (Wallston et al., 1978). In epilepsy, the repeated loss of personal control is a central problem, and may be important to address directly. In children with epilepsy, increased external locus of control has been shown (Matthews et al., 1982). Moreover, elevated external locus of control is associated with depression in adults with epilepsy (Hermann and Wyler, 1989).
The Washington psychosocial seizure inventory (Dodrill et al., 1980), was chosen to measure psychosocial adjustment in patients with epilepsy in this study. This instrument is well validated and considered comprehensive enough to be applied as a ‘stand-alone’ measure assessing psychosocial adjustment in epilepsy (Aldenkamp, 1993). Its validity for use in Norway has been supported by earlier studies (Ellertsen et al., 1993, Gramstad et al., 1995). It has also been extensively cross-cultural validated in other states of the USA and other countries (Dodrill et al., 1984a, Dodrill et al., 1984b, Tiberia and Froman, 1986, Trostle et al., 1989, Alvarado et al., 1992, Hosokawa et al., 1994). The construction of the scales of the WPSI were based on professional clinical judgement, and the selection of items was based on empirical correlations with such judgements (Dodrill et al., 1980).
In this study, we wanted to apply theory-based instruments measuring NA, PA, self-efficacy and health-related locus of control to validate or invalidate our hypothesis that these factors are important for the psychosocial adjustment of patients with epilepsy. The relative impact of these constructs on psychosocial adjustment was also investigated. We expected NA to show the largest general impact. Measures of this construct show high correlations with psychometric scales measuring general psychological adjustment, and the construct may reflect this common variance (Watson and Clark, 1984). We also expected other constructs to have unique contributions to psychosocial adjustment, even when NA is controlled for.
Preliminary data from a subgroup of patients in this study have been presented earlier (Gramstad et al., 1995).
Section snippets
Instruments and procedures
The following questionnaires were used:
Results
The mean scores on the clinical scales of the WPSI are expressed in Table 2. On the Lie scale, 74 subjects (73.3%) had a score of 3 or less, and 87 subjects (86.1%) had a score of 4 or less. On the Rare items scale, 99 subjects (98.0%) had a score of 5 or less. The two remaining subjects had a score of 6. In their original publication of the WPSI, Dodrill et al. (1980) defined that scores of 0–3 on the Lie scale and 0–5 on the Rare scale indicated acceptable validity, but that scores above
Discussion
The initial hypotheses regarding the intercorrelations between scales, were in general supported by the findings of this study. There were high correlations between NA, PA and GSE on one hand, and the WPSI scales emotional adjustment, overall psychosocial functioning and quality of life on the other hand (Table 5). These correlations were all of a magnitude over 0.45. In addition, there were high correlations between epilepsy self-efficacy and the WPSI scales adjustment to seizures and overall
Acknowledgements
We thank Professor Bjørn Ellertsen, who is responsible for the Norwegian translation of the WPSI, and Trude Belset, MD, for her contribution in the data collection.
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