Research

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Published Research

The following is a summary of journal publications by Dr Knowles. Click on the references below for further details.

Journal Articles

2017

Knowles, S.R., Graff, L.A., Wilding, H., Hewitt, C., Keefer, L., & Mikocko-Walus, A. Quality of life in inflammatory bowel disease: A systematic review and meta-analyses - Part I. (in press 22/11/2017). Inflammatory Bowel Diseases.

Abstract

Background: Quality of life (QoL) is commonly assessed in IBD; the relationship of QoL within IBD states and relative to others has not been comprehensively evaluated. This systematic review, published across two papers, evaluates 5 key QoL comparisons. Part I, presented here, examines between-disease comparisons: (1) IBD/healthy(general) population (2) IBD/other medically ill groups; Part II examines within-disease comparisons: (3) active/inactive disease (4) UC/CD and (5) change over time. Outcomes using generic versus IBD-specific QoL measures were also examined. Methods: Adult and paediatric studies were identified through systematic searches of 7 databases from the 1940s (where available) to October 2015. Results: Of 6,173 abstracts identified, 466 were selected for final review based on controlled design and validated measurement; 30 unique studies (23 adult, 7 paediatric) addressed the between-disease comparisons. The pooled mean QoL scores were: (1) lower in adult and paediatric IBD samples compared to healthy controls (n=19), and for both mental and physical QoL, where measured; and (2) higher but not significant for those with IBD compared to various medically ill controls (n=15). Findings were consistent across IBD-specific and generic QoL measures. Study quality was generally low to moderate. The most common measures of QoL were the disease-specific IBDQ and generic SF-36 (adults), and the generic PedsQL (children). Conclusions: There was robust confirmation that QoL for individuals with IBD was poorer than for healthy individuals, for both adults and children. QoL in IBD may be better relative to some other GI and non-GI medical conditions for children.

URL: TBA

Knowles, S.R., Keefer, L., Wilding, H., Hewitt, C., Graff, L.A., & Mikocko-Walus, A. Quality of life in inflammatory bowel disease: A systematic review and meta-analyses - Part II. (in press 22/11/2017).
Abstract

 

Background: There has been burgeoning interest in quality of life (QoL) in IBD in recent decades, with hundreds of studies each year now assessing this outcome. This paper is Part II of a systematic review evaluating 5 key QoL comparisons within IBD states and relative to others without IBD. Part I examined QoL comparing IBD and healthy/general population, and other medically ill groups. Part II, presented here, examines within-disease comparisons of active/inactive disease, UC/CD, and change over time. Outcomes using generic versus IBD-specific QoL measures were also examined. Methods: Adult and paediatric studies were identified through systematic searches of 7 databases from the 1940s (where available) to October 2015.  Results:  Of 6,173 abstracts identified, 466 were selected for final review based on controlled design and validated measurement, of which 83 unique studies (75 adult, 8 paediatric) addressed the within-disease comparisons. The pooled mean QoL scores were significantly lower in active versus inactive IBD (n=26) and for those with CD versus UC (n=37), consistently across IBD-specific and generic QoL measures, for almost all comparisons. There was significant improvement in QoL over time (n=37). Study quality was generally low to moderate. The most common measures of QoL were the disease-specific IBDQ and generic SF-36 (adults), and the IBD-specific IMPACT (children). Conclusions: For adults in particular, there was strong confirmation that QoL is poorer during active disease, and may be poorer for those with CD. The finding that QoL can improve over time may be encouraging for individuals with this chronic disease.

URL: TBA

Knowles, S.R., Apputhurai, P., & Bates, G. (in press). Development and Validation of the Brief Unhelpful Thoughts Scale (BUTs). Journal of Psychology and Psychotherapy Research, 2017, 4, 000-000.

Abstract

A key component of cognitive behaviour therapy (CBT) is to identify and challenge unhelpful thinking patterns (also known as cognitive distortions, thinking errors, or distorted automatic negative thoughts) in interventions that foster more reality-oriented thinking. This paper describes the development and validation of the Brief Unhelpful Thinking Scale (BUTs). Four studies were conducted of which three included mixed undergraduate and community samples (Studies 1-3) and one was a clinical sample of individuals diagnosed with Social Anxiety Disorder (SAD). An 11-item two-factor model of unhelpful thinking emerged in Study 1 (N=223), which was confirmed in Study 2 (N=203). The first factor focused on negative self-bias (e.g., generalised, negative, emotional), and the second factor focused on expectations of others (e.g., expectations others will act fairly, change, follow rules). Study 3 (N=23) established test-retest reliability for the BUTs and the final study (N=9) examined BUTs in a group-based CBT intervention for SAD. This study showed the BUTs to be sensitive to changes in unhelpful thinking after a CBT intervention. In conclusion, the BUTs is a brief psychometrically valid measure of unhelpful thinking that can be utilised by both clinicians and researchers who wish to measure individual unhelpful thinking patterns and relate them to changes in psychological distress in CBT-based interventions.

URL: TBA

Tribbick, D., Salzberg, M., Ftanou, M., Connell, W.R., Macrae, F., Kamm, M.A., Bates, G., Cunningham, G., Austin, D., & Knowles, S. R. (2017). Differences across illness perceptions in Inflammatory Bowel Disease and their relationships to psychological distress and quality of life. Gastroenterology Nursing, 40(4):291-299. doi: 10.1097/SGA.0000000000000225.

Abstract

Patients with greater inflammatory bowel disease activity readily identify poorer psychosocial outcomes; however, the role of gender, disease type, and individual illness perceptions facets are less well known. This study aimed to characterize the role of illness perceptions, gender, and disease type on anxiety, depression, and quality of life. Eighty-one patients diagnosed with inflammatory bowel disease (39 men, mean age 35 years) attending a tertiary hospital outpatient clinic were studied. Questionnaires used included the Manitoba Index, the Brief Illness Perceptions Questionnaire, Hospital Anxiety and Depression Scale, and the World Health Organization Brief Quality of Life Scale. Female patients with active disease tended to report increased anxiety, depression, and reduced quality of life. Regarding illness perceptions, patients with Crohn disease reported significantly more concerns about its chronicity, while female patients reported being significantly more concerned about the impact of their illness on identity, chronicity, overall concern, and having a greater emotional impact. Hierarchical regression indicated that 36% of depression, 42% of anxiety, and 57% of quality of life could be accounted for by disease activity and type, gender, and illness perceptions. The findings suggest that in addition to a patient’s perceived disease status, gastroenterology nurses should also be aware that patient gender and their perceptions of illness play a significant impact not only on anxiety and depression but also on quality of life. Increased disease activity is associated with more severe anxiety and depression and reduced quality of life. Female patients are also at a greater risk of reporting negative illness perceptions and increased levels of anxiety, depression, and lower quality of life.

URL: https://www.ncbi.nlm.nih.gov/pubmed/?term=28746114

Mikocka-Walus, A., Fielder, A., Prady, S. L., Esterman, A.J., Knowles, S, Andrews, J.M. (2017). Adjuvant therapy with antidepressants for the management of inflammatory bowel disease. Cochrane Database of Systematic Reviews, Issue 7. Art. No.: CD012680. DOI: 10.1002/14651858.CD012680.

Abstract

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows:

Primary objectives

1. To assess the efficacy and safety of antidepressants for managing anxiety and depression in IBD
2. To assess the efficacy and safety of antidepressants for managing quality of life in IBD
Secondary objectives
3. To assess the efficacy and safety of antidepressants for managing disease activity in IBD

URL: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD012680/full

Kuoch, K.L.J., Meyer, D., Austin, D.W., & Knowles, S.R. (2017). A systematic review of Paruresis: Clinical implications and future directions. Journal of Psychosomatic Research. 98:122-129. doi: 10.1016/j.jpsychores.2017.05.015.

Abstract

Objective: Paruresis refers to the inability to initiate or sustain urination where individuals are present due to the fear of perceived scrutiny from others. The aim of this systematic review was to evaluate four key questions: (1) What is the prevalence of paruresis and its associated demographic features; (2) What is the prevalence of psychopathology in paruresis cohorts, how does it compare to other chronic-health conditions, and what percentage of paruresis patients also have social anxiety disorder? (3) How does quality of life, and levels of anxiety and depression compare between those with and without paruresis; and (4) do psychological interventions for paruresis patients reduce paruresis symptoms, or, anxiety, or depression, or improve quality of life?
Method: A review was conducted using PRISMA protocol for search strategy, selection criteria, and data extraction. Searched databases included PubMed, CINAHL, and PsychINFO. Over the 1418 studies screened, ten were found relating to at least one review question.
Results: The prevalence of paruresis ranged between 2.8 and 16.4%, and around 5.1-22.2% of individuals with paruresis also had Social Anxiety Disorder. Paruresis symptoms were shown to reduce in one intervention study. Paruresis was also associated with poorer quality of life. A key limitation of the research to date has been the notable methodological problems and lack of standardisation relating to the measurement of paruresis.

Conclusion: Little is known about the prevalence of paruresis and more rigorous studies of paruresis are required. Recommendations in terms of clinical implications, diagnostic criteria and future research relating to paruresis are discussed.

URL: https://www.ncbi.nlm.nih.gov/pubmed/?term=28554367

Woodhouse, S., Hebbard, G., & Knowles, S. R. (2017). Exploration of the psychosocial issues associated with gastroparesis: a qualitative investigation. Journal of Clinical Nursing. 26 (21-22), 3553-3563. doi:10.1111/jocn.13725

Abstract

Aims and objectives: To build on the understanding of how individuals experience gastroparesis, how gastroparesis impacts on their lives and how they adapt to living with gastroparesis.

Background: Gastroparesis is a neurogastroenterological disorder associated with increased psychological distress and reduced quality of life. Research shows that gastroparesis poses a significant burden across many facets of life; however, less is known about how individuals cope and adapt to living with the condition.

Design: The study employed an interpretive phenomenological approach with semistructured interviews and thematic analysis.
Methods: Ten gastroparesis patients were interviewed over the telephone (n = 8), Skype (n = 1) or face-to-face (n = 1). All interviews were audio-recorded and transcribed.

Results: Key themes identified: (1) frustration, (2) identity and (3) coping and adaptation. Gastroparesis patients experience significant frustration around their diagnostic journey, being misunderstood and the burden of living with the illness. Patients differed in how they identified with the illness, and this appeared to be associated with adaptation and whether they remained socially engaged.
Conclusions: Gastroparesis is associated with significant frustration and burden; however, some patients adapt to living with the condition more effectively than others. Identity appears to play an important role in this relationship. Support aimed at fostering a health-focused and resilient identity may assist gastroparesis patients in adaptation.

Relevance to clinical practice: The findings of this study can help nurses and other healthcare professionals better understand the experience of living with gastroparesis and the factors that help patients best adapt to living with the condition. Nurses can help promote resilience in patients by discussing the importance of being health-focused rather than illness-focused. Nurses can also support patients by helping them problem-solve issues that may arise around social eating and remaining socially engaged.

URL: https://www.ncbi.nlm.nih.gov/pubmed/?term=28071866

Woodhouse, S., Hebbard, G., & Knowles, S. R. (2017). Psychological controversies in gastroparesis: A systematic review. World Journal of Gastroenterology, 23(7), 1298-1309. doi:10.3748/wjg.v23.i7.1298

Abstract

Aim: To systematically review literature addressing three key psychologically-oriented controversies associated with gastroparesis.

Methods: A comprehensive search of PubMed, CINAHL, and PsycINFO databases was performed to identify literature addressing the relationship between gastroparesis and psychological factors. Two researchers independently screened all references. Inclusion criteria were: an adult sample of gastroparesis patients, a quantitative methodology, and at least one of the following: (1) evaluation of the prevalence of psychopathology; (2) an outcome measure of anxiety, depression, or quality of life; and (3) evidence of a psychological intervention. Case studies, review articles, and publications in languages other than English were excluded from the current review.

Results: Prevalence of psychopathology was evaluated by three studies (n = 378), which found that combined anxiety/depression was present in 24% of the gastroparesis cohort, severe anxiety in 12.4%, depression in 21.8%-23%, and somatization in 50%. Level of anxiety and depression was included as an outcome measure in six studies (n = 1408), and while limited research made it difficult to determine the level of anxiety and depression in the cohort, a clear positive relationship with gastroparesis symptom severity was evident. Quality of life was included as an outcome measure in 11 studies (n = 2076), with gastroparesis patients reporting lower quality of life than population norms, and a negative relationship between quality of life and symptom severity. One study assessed the use of a psychological intervention for gastroparesis patients (n = 120) and found that depression and gastric function were improved in patients who received psychological intervention, however the study had considerable methodological limitations.

Conclusion: Gastroparesis is associated with significant psychological distress and poor quality of life. Recommendations for future studies and the development of psychological interventions are provided.

URL: https://www.ncbi.nlm.nih.gov/pubmed/?term=28275310

Knowles, S.R., Austin, D.W., Sivanesan, S., Tye-Din, J., Leung, C., Wilson, J., Castle, D., Kamm, M.A., Macrae, F., Hebbard, G. (2017.). Relations between symptom severity, illness perceptions, visceral sensitivity, coping strategies and well-being in irritable bowel syndrome guided by the common sense model of illness. Psychology, Health & Medicine. 22(5), 524-534. http://dx.doi.org/10.1080/13548506.2016.1168932

Abstract

Irritable Bowel Syndrome (IBS) is a common condition affecting around 10-20% of the population and associated with poorer psychological well-being and quality of life. The aim of the current study was to explore the efficacy of the Common Sense Model (CSM) using Structural Equation Modelling (SEM) in an IBS cohort. One hundred and thirty-one IBS patients (29 males, 102 females, mean age 38 years) participating in the IBSclinic.org.au pre-intervention assessment were included. Measures included IBS severity (Irritable Bowel Syndrome Severity Scoring System), coping patterns (Carver Brief COPE), visceral sensitivity (Visceral Sensitivity Index), illness perceptions (Brief Illness Perceptions Questionnaire), psychological distress (Depression, Anxiety and Stress Scale), and quality of life (IBS Quality of Life scale; IBS-QoL). Using SEM, a final model with an excellent fit was identified (χ2 (8) = 11.91, p = .16, χ2/N = 1.49, CFI > .98, TLI > .96, SRMR < .05). Consistent with the CSM, Illness perceptions were significantly and directly influenced by IBS severity (β = .90, p < .001). Illness perceptions in turn directly influenced maladaptive coping (β = .40, p < .001) and visceral sensitivity (β = .70, p < .001). Maladaptive coping and visceral sensitivity were significantly associated with psychological distress (β = .55, p < .001; β = .22, p < .01) and IBS-QoL (β = -.28, p < .001; β = -.62, p < .001). Based on these findings, we argue that to augment the adverse impact of IBS severity on IBS-QoL and psychological distress, psychological interventions will be best to target the mediating psychological processes including illness beliefs, visceral sensitivity and maladaptive coping.

URL: https://www.ncbi.nlm.nih.gov/pubmed/?term=27045996

2016

Knowles, S.R., & Skues, J. (2016). Development and Validation of the Shy Bladder and Bowel Scale (SBBS). Cognitive Behaviour Therapy, 45(4), 324-338. doi: 10.1080/16506073.2016.1178800 Impact factor: 2.402

Abstract

Currently research exploring paruresis and parcopresis, anxiety relating to urinating and having bowel motions in public respectively is limited. While there are several validated measures of paruresis, no valid measure assessing parcopresis is currently available. The present study investigates the development and validation of the Shy Bladder and Bowel Scale (SBBS) which assesses both paruresis and parcopresis. Two participant groups were utilised to validate this scale, a student psychology cohort (n = 387) and a public cohort (n = 334). An eight-item two-factor model was identified in the psychology cohort and confirmed in the public cohort. The two-factor SBBS was found to be a valid and reliable measure of paruresis and parcopresis. Paruresis and parcopresis-related concerns were associated with social anxiety in both cohorts. Subscales for both paruresis and parcopresis (i.e. difficulty, interference and distress) were positively correlated, suggesting individuals are likely to report similar levels of concerns across both conditions. Further, individuals self-identifying with either paruresis or parcopresis reported significantly higher scores on the respective SBBS subscales than non-identifying paruresis and parcopresis individuals. The SBBS also demonstrated strong test-retest reliability in a small sample of adults (n = 13). Overall, the developed scale provides clinicians and researchers with a valuable tool to evaluate both paruresis and parcopresis.

URL: https://www.ncbi.nlm.nih.gov/pubmed/?term=27216857

Knowles, S.R., Ski, C.F., Thompson, D. R., Lautenschlager, N. T., Gonzalez, G., Hsueh, Y., Moore, G., O’Brien, C., & Castle, D. (2016). Can collaborative therapy improve the health? patients undergoing dialysis? A randomized controlled trial, Trials. 17(1), 447.

Abstract

Background: Chronic kidney disease (CKD) and end-stage kidney disease (ESKD) are serious and growing health problems with enormous impact on psychological and social functioning. Despite high rates of comorbid depression and anxiety in these patient populations, and the adverse impact these have upon treatment adherence, quality of life, social connectedness and healthcare costs there has been little attention focused on the prevention or management of these problems. Thus, our aim was to evaluate the Dialysis Optimal Health Program (DOHP) that adopts a person-centred approach and engages collaborative therapy to educate and support those diagnosed with ESKD who are commencing dialysis.

Methods: The study design is a randomised controlled trial. Ninety-six adult patients initiating haemodialysis or peritoneal dialysis will be randomly allocated to either the intervention (DOHP) or usual care group. Participants receiving the intervention will receive nine (8 + 1 booster session) sequential sessions based on a structured information/workbook, psychosocial and educational supports and skills building. The primary outcome measures are depression and anxiety (assessed by the Hospital Anxiety and Depression Scale; HADS). Secondary outcomes include health-related quality of life (assessed by the Kidney Disease Quality of Life instrument; KDQOL), self-efficacy (assessed by General Self-Efficacy Scale) and clinical indices (e.g. albumin and haemoglobin levels). Cost-effectiveness analysis and process evaluation will also be performed to assess the economic value and efficacy of the DOHP. Primary and secondary measures will be collected at baseline and at 3-, 6-, and 12-month follow-up time points.

Discussion: We believe that this innovative trial will enhance knowledge of interventions aimed at supporting patients in the process of starting dialysis, and will broaden the focus from physical symptoms to include psychosocial factors such as depression, anxiety, self-efficacy, wellbeing and community support. The outcomes associated with this study are significant in terms of enhancing an at-risk population’s psychosocial health and reducing treatment-related costs and associated pressures on the healthcare system.

Trial registration: ANZCTR no. 12615000810516. Registered on 5 August 2015.

URL: https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-016-1558-z

O'Brien, C., Ski, C., Thompson, D., Moore, G., Mancuso, S., Jenkins, A., Ward, G., MacIsaac, R., Loh, M., Knowles, S., Rossell, S., &Castle, D. (2016). The Mental Health in Diabetes Service (MINDS) to enhance psychosocial health: study protocol for a randomized controlled trial. Trials, 17(1), 444.

Abstract

Background: After a diagnosis of diabetes mellitus, people not only have to cope with the physical aspects and common complications that require daily self-management, they are also faced with ongoing psychosocial challenges. Subsequently they find themselves having to navigate the health system to engage multidisciplinary supports; the combination of these factors often resulting in reduced health-related quality of life. To maintain optimal diabetes control, interventions need to incorporate psychosocial supports and a skill base for disease management. Therefore, our aim was to evaluate an ‘Optimal Health Program’ that adopts a person-centred approach and engages collaborative therapy to educate and support the psychosocial health of people diagnosed with type I or II diabetes.

Methods: This prospective randomised controlled trial will include 166 people diagnosed with diabetes: 83 in the intervention (Optimal Health Program) and 83 in the control (usual care) group. Participants with type diabetes mellitus will be recruited through hospital outpatient clinics and diabetes community organisations. Participants in the intervention group will receive nine (8 + 1 booster session) sequential sessions, based on a structured treatment manual emphasising educational and psychosocial support self-efficacy and skills building. The primary outcome measures will be generalised self-efficacy (GSE) and health-related quality of life (AQoL-6D and EQ-5D). Secondary measures will be anxiety and depression (HADS), social and workplace functioning (WSAS), diabetes-related quality of life (DQoL), diabetes-related distress (PAID), and type of coping strategies (Brief COPE). In addition, a health economic cost analysis and process evaluations will be performed to assess the economic cost and efficacy of the program’s operations, implementation and service delivery.

Discussion: We envisage that the Optimal Health Program’s emphasis on self-efficacy and self-management will provide participants with the skills and knowledge to achieve increased empowerment and independence in aspects of health, which in turn, will help participants deal more effectively with the physical and psychosocial complexities of diabetes.

TRIAL REGISTRATION: ACTRN12614001085662. Registered on 10 October 2014.

URL: https://www.ncbi.nlm.nih.gov/pubmed/?term=27612943

O'Brien, C., Ski, C., Thompson, Moore, G., Gonzales, G., Ya- Hsueh, Y., Knowles, S., Rossell, S., Haselden, R & Castle, D. (2016). The Stroke and Carer Optimal Health Program (SCOHP) to enhance psychosocial health: study protocol for a randomized controlled trial. Trials, 17(1), 446.

Abstract

Background: Stroke is a leading cause of disability and distress, and often profoundly affects the quality of life of stroke survivors and their carers. With the support of carers, many stroke survivors are returning to live in the community despite the presence of disability and ongoing challenges. The sudden and catastrophic changes caused by stroke affects the mental, emotional and social health of both stroke survivors and carers. The aim of this study is to evaluate a Stroke and Carer Optimal Health Program (SCOHP) that adopts a person-centred approach and engages collaborative therapy to educate, support and improve the psychosocial health of stroke survivors and their carers.

Methods: This study is a prospective randomised controlled trial. It will include a total of 168 stroke survivors and carers randomly allocated into an intervention group (SCOHP) or a control group (usual care). Participants randomised to the intervention group will receive nine (8 + 1 booster) sessions guided by a structured workbook. The primary outcome measures for stroke survivors and carers will be health-related quality of life (AQoL-6D and EQ-5D) and self-efficacy (GSE). Secondary outcome measures will include: anxiety and depression (HADS); coping (Brief COPE); work and social adjustment (WSAS); carer strain (MCSI); carer satisfaction (CASI); and treatment evaluation (TEI-SF and CEQ). Process evaluation and a health economic cost analysis will also be conducted.

Discussion: We believe that this is an innovative intervention that engages the stroke survivor and carer and will be significant in improving the psychosocial health, increasing independence and reducing treatment-related costs in this vulnerable patient-carer dyad. In addition, we expect that the intervention will assist carers and stroke survivors to negotiate the complexity of health services across the trajectory of care and provide practical skills to improve self-management.
Trial registration: ACTRN12615001046594. Registered on 7 October 2015.

URL: https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-016-1559-y

Knowles, S.R., Andrews, J., & Porter, A. Crohn’s & Colitis Australia, IBD Support Australia and the Australian Inflammatory Bowel Disease Association (in press; accepted 20/02/2016). Predictors of impaired mental health and support seeking in adults with inflammatory bowel disease: An online survey. Gastroenterology Nursing. 41(2) (Mar/Apr) of 2018.

Abstract

Objective: This study explored the possible factors associated with psychological distress in adults with Inflammatory Bowel Disease (IBD) and also engagement in mental health services (MHS) in those reporting distress in a large Australian cohort.

Methods: Participants with IBD completed an online survey assessing perceived IBD activity (Manitoba Index; MI), mental health status (K10), demographic details and engagement with MHS for IBD-associated issues.

Results: Of 336 participants, 76.5% perceived themselves as having active disease over the past 6 months, and on K10 scores, 51.8% had a mental health issue. Of participants with a mental health issue, only 21.3% were currently receiving mental health support. A stepwise logistic regression analysis correctly classified 78.7% of the status of receiving mental health support, with lower income (<$60,000p.a.) the only significant predictor. Paradoxically, the degree of psychological distress did not correlate with seeking mental health support.

Conclusions: The data show that in individuals with ongoing symptoms attributed to active IBD, mental health issues are highly prevalent, with older age and higher income being additional drivers of mental health issues. The greater challenge however, seems not to be identifying mental health issues, but in getting those in need to engage in MHS.

URL: TBA

Jackson, B.D., Gray, K., Knowles, S.R., & De Cruz, P. (2016). eHealth Technologies in Inflammatory Bowel Disease: A Systematic Review. Journal of Crohn’s and Colitis, 10(9), 1103-1121. http://dx.doi.org/10.1093/ecco-jcc/jjw059

Abstract

Background and Aims: Electronic-health technologies (eHealth) such as Web-based interventions, virtual clinics, smart-phone applications, and telemedicine are being used to manage patients with inflammatory bowel disease (IBD). We aimed to: (1) Evaluate the impact of eHealth technologies on conventional clinical indices and patient-reported outcome measures (PROs) in IBD; (2) assess the effectiveness, cost-effectiveness and feasibility of using eHealth technologies to facilitate the self-management of individuals with IBD, and; (3) provide recommendations for their design and optimal use for patient care.

Methods: Relevant publications were identified via a literature search, and 17 publications were selected based on predefined quality parameters.

Results: Six randomized controlled trials and nine observational studies utilizing eHealth technologies in IBD were identified. Compared with standard outpatient-led care, eHealth technologies have led to improvements in: Relapse duration [( n = 1) 18 days vs 77 days, p < 0.001]; disease activity ( n = 2); short-term medication adherence ( n = 3); quality of life ( n = 4); IBD knowledge ( n = 2); healthcare costs ( n = 4); the number of acute visits to the outpatient clinic due to IBD symptoms ( n = 1), and; facilitating the remote management of up to 20% of an IBD cohort ( n = 2). Methodological shortcomings of eHealth studies include heterogeneity of outcome measures, lack of clinician/patient input, lack of validation against conventional clinical indices and PROs, and limited cost–benefit analyses.

Conclusions: EHealth technologies have the potential for promoting self-management and reducing the impact of the growing burden of IBD on health care resource utilization. A theoretical framework should be applied to the development, implementation, and evaluation of eHealth interventions.

URL: https://academic.oup.com/ecco-jcc/article/10/9/1103/2605214

 

Knowles SR, Nelson EA, Castle DJ, Salzberg MR, Choong PFM, Dowsey. (2016). Using the common sense model of illness to examine interrelationships between symptom severity and health outcomes in end-stage osteoarthritis patients. Rheumatology, 55(6), 1066-1073, https://doi.org/10.1093/rheumatology/kew022 .

Abstract

Objective: The aim was to evaluate the utility of the common sense model (CSM) in characterizing contributors to psychological well-being and quality of life (QoL) in patients with end-stage OA.

Methods: One hundred and twenty patients [34 males, 86 females; mean (s.d.) age 65.52 (9.14) years] with end-stage OA (57.5% hip, 42.5% knee) were recruited. OA symptom severity was evaluated according to the WOMAC; coping styles were assessed with the Carver Brief COPE scale; illness perceptions were explored with the Brief Illness Perceptions Questionnaire; self-efficacy was assessed with the Arthritis Self-efficacy scale; anxiety, depression and overall distress were measured using the Hospital Anxiety and Depression Scale; and QoL was assessed using the WHO Quality of Life-short version. The CSM was used to explore the interrelationships between OA symptom severity, illness perceptions and coping strategies in patients.

Results: Two structural equation models were developed, with both found to have good fit. Consistent with the CSM, the standard model indicated that self-reported OA symptom severity directly influenced illness perceptions, which in turn had direct impacts upon maladaptive coping, distress and QoL. The addition of self-efficacy to the CSM resulted in a complex interaction, with OA severity directly influencing self-efficacy and self-efficacy influencing maladaptive coping, distress and QoL.

Conclusion: We found interrelationships amongst OA activity, illness perceptions, coping strategies, self-efficacy, psychological distress and QoL broadly consistent with the CSM. The CSM may help inform the approach to the psychological support that patients with end-stage OA often require.

URL: https://www.ncbi.nlm.nih.gov/pubmed/?term=26961745

Knowles, S.R., Castle, D., Biscan, S., Salzberg, S., O'Flaherty, E., & Langham, R. (2016). Relations between health status, illness perceptions, coping and psychological morbidity in kidney transplants patients. American Journal of the Medical Sciences. 351(3):233–238.

Abstract

Background: The aim of this study was to explore the effect of kidney transplantation (KT) on psychological distress and quality of life (QoL) in patients with end-stage kidney disease using the Common Sense Model of illness adjustment.

Materials and Methods: A total of 52 individuals (35 men and 17 women) with an average age of 53.54 years from a large metropolitan nephrology outpatient clinic participated.

Results: Poorer health status, illness perceptions and increased engagement in maladaptive coping were associated with psychological distress (specifically anxiety and depression) and poorer QoL. Hierarchical regression, after correcting for KT characteristics (years since most recent KT, number of transplants) indicated that poorer illness status and illness perception predicted QoL. After controlling for KT characteristics, poorer illness status and greater engagement in maladaptive coping predicted depression. In contrast, poorer illness perceptions and greater engagement in maladaptive coping predicted anxiety. Adaptive problem-focused and emotion-focused coping styles were not found to predict anxiety, depression or QoL.

Conclusions: The finding of the present study emphasize on the importance of exploring and understanding the effect of illness status, illness perceptions and coping patterns in patients who have underwent KT.

URL: http://www.amjmedsci.com/article/S0002-9629(15)00065-8/fulltext

Mikocka-Walus, A., Knowles, S.R., Keefer, L., Graff, L. (2016). Controversies revisited: A systematic review of the co-morbidity of depression and anxiety with inflammatory bowel diseases. Inflammatory Bowel Diseases, 22 (3), 752 - 762.

Abstract

Background: Although mental health concerns are known to occur commonly for those with inflammatory bowel diseases (IBD), the nature of this comorbid relationship has not been systematically reviewed to date. A review in 2007 identified 5 controversies regarding anxiety/depression rates and various comparators between and within IBD. We aimed to systematically analyze and critique the current evidence regarding this comorbidity, providing an update to the 5 controversies.

Methods: Ebscohost Medline, CINAHL, Embase, and PsychINFO were searched between 2005 and 2014 using systematic review methodology. Controlled quantitative studies examining either symptoms or diagnoses of anxiety and depression in IBD were included in the review, with study quality assessed using a scale developed a priori to evaluate observational research.

Results: (1) IBD versus healthy controls (pooled mean proportions) (n = 13 studies): anxiety 19.1% versus 9.6%, depression 21.2% versus 13.4%; (2) IBD inactive versus IBD active disease (n = 26): anxiety 28.2% versus 66.4%, depression 19.9% versus 34.7%; (3) ulcerative colitis versus Crohn’s disease (n = 28): anxiety 31% versus 37%, depression 22% versus 24.4%; (4) IBD versus other chronic medical conditions (n = 17): anxiety 41.9% versus 48.2%, depression 14.5% versus 28.4%; (5) onset of anxiety/depression before or after IBD onset (n = 2): adults more likely to develop anxiety/depression before IBD onset, but a substantial proportion develops depression after onset; an increased risk for children of developing anxiety/depression after IBD onset.

Conclusions: The high rates of anxiety and depression for those with IBD, particularly when disease is active, warrant a systemic approach to screening and treatment.

URL: https://www.ncbi.nlm.nih.gov/pubmed/?term=26841224

 

Neilson, K., Ftanou, M., Monshat, K., Salzberg, M., Bell, S., Kamm, MA., Connell, W., Knowles, S.R., Sevar, K., Mancuso, S.G., and Castle, D. (2015). A controlled study of a group mindfulness intervention for individuals living with inflammatory bowel disease. Inflammatory Bowel Diseases, 22(3): 694 – 701.

Abstract

Background: This study aimed to evaluate the feasibility, acceptability, and effectiveness of a mindfulness-based intervention for patients with inflammatory bowel disease (MI-IBD).

Design: Treatment-as-usual control versus mindfulness-based stress reduction intervention.

Methods: Sixty patients participated in either the MI-IBD (n = 33) or treatment-as-usual group (n = 27) conditions. The MI-IBD consisted of an 8-week mindfulness-based stress reduction training group. Outcome measures were administered at baseline (before intervention), immediately after intervention, and 6 months after intervention. Primary outcomes included measures of quality of life, psychological distress (depression and anxiety), and mindfulness. Data for MI-IBD group participants also included weekly attendance, daily minutes meditated, and satisfaction with the program.

Results: There were no baseline differences between intervention and control groups on demographic variables or inflammatory bowel disease severity. Compared with the control group, the MI-IBD group reported significantly greater improvements in anxiety, quality of life, and mindfulness at after intervention, with reduction in depression and improvements in quality of life and mindfulness maintained at 6 months after intervention.

Conclusions: Results demonstrate the feasibility, acceptability, and efficacy of a mindfulness intervention for patients with inflammatory bowel disease, with medium-to-large effects on psychological distress, quality of life, and mindfulness.

URL: https://www.ncbi.nlm.nih.gov/pubmed/?term=26529560

2015

Neilson, K., Ftanou, M., Monshat, K., Salzberg, M., Bell, S., Kamm, MA., Connell, W., Knowles, S.R., Sevar, K., Mancuso, S.G., and Castle, D. (2015). A controlled study of a group mindfulness intervention for individuals living with inflammatory bowel disease. Inflammatory Bowel Diseases, 22(3): 694 – 701.

Abstract

Background: This study aimed to evaluate the feasibility, acceptability, and effectiveness of a mindfulness-based intervention for patients with inflammatory bowel disease (MI-IBD).

Design: Treatment-as-usual control versus mindfulness-based stress reduction intervention.

Methods: Sixty patients participated in either the MI-IBD (n = 33) or treatment-as-usual group (n = 27) conditions. The MI-IBD consisted of an 8-week mindfulness-based stress reduction training group. Outcome measures were administered at baseline (before intervention), immediately after intervention, and 6 months after intervention. Primary outcomes included measures of quality of life, psychological distress (depression and anxiety), and mindfulness. Data for MI-IBD group participants also included weekly attendance, daily minutes meditated, and satisfaction with the program.

Results: There were no baseline differences between intervention and control groups on demographic variables or inflammatory bowel disease severity. Compared with the control group, the MI-IBD group reported significantly greater improvements in anxiety, quality of life, and mindfulness at after intervention, with reduction in depression and improvements in quality of life and mindfulness maintained at 6 months after intervention.

Conclusions: Results demonstrate the feasibility, acceptability, and efficacy of a mindfulness intervention for patients with inflammatory bowel disease, with medium-to-large effects on psychological distress, quality of life, and mindfulness.

URL: https://www.ncbi.nlm.nih.gov/pubmed/?term=26529560

Tribbick, D., Salzberg, M., Ftanou, M., Connell, W.R., Macrae, F., Kamm, M.A., Bates, G., Cunningham, G., Austin, D., & Knowles, S. R. (2015). Prevalence of Mental Health Disorders in Inflammatory Bowel Disease: An Australian Outpatients Cohort. Clinical and Experimental Gastroenterology, 8:197-204. doi: 10.2147/CEG.S77567.

Abstract

Background: This study aimed to characterize prevalence of anxiety and depressive conditions and uptake of mental health services in an Australian inflammatory bowel disease (IBD) outpatient setting.

Methods: Eighty-one IBD patients (39 males, mean age 35 years) attending a tertiary hospital IBD outpatient clinic participated in this study. Disease severity was evaluated according to the Manitoba Index. Diagnosis of an anxiety or depressive condition was based upon the Mini-International Neuropsychiatric Interview and the Hospital Anxiety and Depression Scale.

Results: Based on Hospital Anxiety and Depression Scale subscale scores >8 and meeting Mini-International Neuropsychiatric Interview criteria, 16 (19.8%) participants had at least one anxiety condition, while nine (11.1%) had a depressive disorder present. Active IBD status was associated with higher prevalence rates across all anxiety and depressive conditions. Generalized anxiety was the most common (12 participants, 14.8%) anxiety condition, and major depressive disorder (recurrent) was the most common depressive condition reported (five participants, 6.2%). Seventeen participants (21%) reported currently seeking help for mental health issues while 12.4% were identified has having at least one psychological condition but not seeking treatment.

Conclusion: We conclude that rates of anxiety and depression are high in this cohort, and that IBD-focused psychological services should be a key component of any holistic IBD service, especially for those identified as having active IBD.

URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4512611/

 

2014

Austin, D., Spolding, B., Gondalia, S., Shandley, K., Palombo, E., Knowles, S., & Walder, K. (2014). Genetic variation associated with hypersensitivity to mercury. Toxicology International, 21(3): 236–241, doi: 10.4103/0971-6580.155327.

Abstract

Objectives: Very little is known about mechanisms of idiosyncratic sensitivity to the damaging effects of mercury (Hg); however, there is likely a genetic component. The aim of the present study was to search for genetic variation in genes thought to be involved in Hg metabolism and transport in a group of individuals identified as having elevated Hg sensitivity compared to a normal control group.

Materials and methods: Survivors of pink disease (PD; infantile acrodynia) are a population of clinically identifiable individuals who are Hg sensitive. In the present study, single nucleotide polymorphisms in genes thought to be involved in Hg transport and metabolism were compared across two groups: (i) PD survivors (n = 25); and (ii) age- and sex-matched healthy controls (n = 25).

Results: Analyses revealed significant differences between groups in genotype frequencies for rs662 in the gene encoding paraoxanase 1 (PON1) and rs1801131 in the gene encoding methylenetetrahydrofolate reductase (MTHFR).

Conclusions: We have identified two genetic polymorphisms associated with increased sensitivity to Hg. Genetic variation in MTHFR and PON1 significantly differentiated a group formerly diagnosed with PD (a condition of Hg hypersensitivity) with age- and gender-matched healthy controls.

URL: https://www.ncbi.nlm.nih.gov/pubmed/25948960

 

Knowles, S. R., Tribbick, D., Connell, W.R., Castle, D., Salzberg, M., Kamm, M.A. (2014). Exploration of illness perceptions, coping strategies and psychological morbidity in stoma patients. Journal of Wound, Ostomy and Continence Nursing. 41(6):573-80.

Abstract

Purpose: We employed the Common Sense Model (CSM) of illness perceptions to examine the relative contribution of illness perceptions, stoma self-efficacy, and coping strategies in explaining anxiety and depression symptoms in patients with a fecal ostomy. The CSM suggests that the consequences of illness activity, such as psychological distress, are influenced by an individual’s illness perceptions as well as what coping strategies they engage in.

Design: Descriptive, cross-sectional questionnaire-based study.

Subjects and setting: One hundred fifty adults with a stoma (54 males, and 96 females; mean age 44 years) completed an online survey.

Methods: Several instruments were used to measure study outcomes, including the Health Perceptions Questionnaire, Brief Illness Perceptions Questionnaire, Carver Brief Coping Questionnaire, Stoma Self-Efficacy Scale, and the Hospital Anxiety and Depression Scale. Participants were advised of the study through online forums containing a link to the survey. Outcome measures used in the current study are valid and reliable and have been extensively used in medically ill patients.

Results: Using structural equation modeling, the final model provided an excellent fit to the data (χ23= 16.53, P = .22, χ/N = 1.27, SRMR < 0.03, RMSEA < 0.05, GFI > 0.97, CFI > 0.99). There was a direct pathway from health status to illness perceptions months since surgery directly influenced health status, illness beliefs, and adaptive emotion-focused coping (β= .81, P < .001). Several indirect (mediating) pathways were also identified. Illness perceptions mediated the relationship between health status and stoma self-efficacy and maladaptive and adaptive emotion-focused coping. Maladaptive coping mediated the relationship between illness perceptions and depression and anxiety, and adaptive emotion-focused coping mediated the relationship between illness perception and depression. The final model provided support for the CSM, in that illness perceptions were directly related to illness status, and that both illness perceptions and coping strategies directly influenced anxiety and depression. More specifically, maladaptive coping style (eg, ignore problems) exacerbated depression and anxiety symptoms, while self-efficacy and emotion-focused coping style (eg, seek advice) ameliorate depression, but not anxiety. Months since surgery was associated with improved health status, reduced poorer illness perceptions, and increased emotional-focused coping.

Conclusions: Illness perceptions and coping were found to mediate anxiety and depression. The results confirm that how individuals perceive their illness and what coping strategies they engage in impacts their psychological well-being. Study findings support the need for designing targeting psychological interventions based on individual illness perceptions and self-efficacy rather than exclusively focusing on coping strategies in patients with a stoma.

URL: https://www.ncbi.nlm.nih.gov/pubmed/25377108

Dowsey, M. M., Castle, D. J., Knowles, S. R., Monshat, K., Salzberg, M. R., Choong, P. F. M. (2014). The effect of mindfulness training prior to total joint arthroplasty on post-operative pain and physical function: study protocol for a randomised controlled trial. Trials, 15:208.

Abstract

Background: Osteoarthritis is a leading cause of disability in developed nations. In Australia it afflicts 16.5% of the adult population. Total joint arthroplasty is considered the treatment of choice for end stage osteoarthritis. The number of total joint arthroplasties undertaken in Australia has doubled over the last decade (more than 80,000 procedures in 2011). The incidence of pre-operative psychological distress in this group of patients is reported between 30% and 60% and pre-operative psychological distress is associated with poorer pain and functional outcomes after surgery. This study will use a mindfulness-based psychological intervention to enhance outcomes in people undergoing total joint arthroplasty and, in addition, will test hypotheses about coping with chronic illness in an aged population. This study is the first of its kind and will provide a greater understanding of the role of a mental health enhancement program on the physical recovery of total joint arthroplasty patients.

Methods/design: One hundred and fifty people with end-stage arthritis on the waiting list for total hip or knee arthroplasty will be recruited and randomly allocated to one of two groups using computer-generated block randomisation. A randomised controlled trial adhering to CONSORT guidelines will evaluate the efficacy of a mindfulness training program (weekly group-based classes in mindfulness practice, 2 ½ hours, for 8 weeks plus a 7-hour Saturday session in Week 6) prior to total joint arthroplasty, compared to a “standard care” group who will undergo routine total joint arthroplasty. Primary outcomes will be evaluated by a blinded examiner at baseline, 3 and 12 months post-surgery, using a validated self-reported pain and physical function scale. Secondary outcomes will include i) a range of validated measures of psychological wellbeing and ii) health economic analysis. All analyses will be conducted on an intention to treat basis using linear regression models. Health economic modelling will be applied to estimate the potential cost-effectiveness of mindfulness training and total joint arthroplasty.

Trial registration: Australian New Zealand Clinical Trials Registry (ANZCTRN12611001184965). Date of registration; 15th November 2011.

URL: https://www.ncbi.nlm.nih.gov/pubmed/?term=24899242

 

Knowles, S., Swan, L., Salzberg, S., Castle, D., & Langham, R. (2014). Exploring the Relationships Between Health Status, Illness Perceptions, Coping Strategies And Psychological Morbidity in A Chronic Kidney Disease Cohort. American Journal of the Medical Sciences. 348(4):271-6. doi: 10.1097/MAJ.0000000000000242.

Abstract

Background: Using the common sense model of illness adjustment, this study aimed to explore the impact of chronic kidney disease (CKD) on individual illness perceptions, coping styles and psychological well-being.

Methods: Eighty individuals (50 men and 30 women) with an average age of 62.66 years (standard deviation, 11.98) were included in the study. All participants were under the care of the Renal Unit of a metropolitan tertiary referral hospital. Twenty-nine patients (36%) had CKD stage 3b-4, and 51 (64%) had CKD stage 5 (or end stage kidney disease [ESKD]). Disease severity was evaluated using the health perceptions questionnaire, coping styles assessed with the Carver brief COPE scale, illness perceptions explored with the brief illness perceptions questionnaire and anxiety and depression measured using the hospital anxiety and depression scale.

Results: The hospital anxiety and depression scale assessment revealed 13 patients (16.3%) with moderate or severe anxiety and 6 (7.5%) with moderate depression. Consistent with the common sense model, disease activity had a significant direct influence on illness perceptions, while, in turn, illness perceptions had a significant direct influence on depression and anxiety. Adaptive and maladaptive coping were found to mediate the relationship between illness perceptions, and anxiety and depression.

Conclusions: The results provide evidence that it is the perception of an illness rather than the actual symptoms themselves that best account for adaption to CKD. These findings suggest that intervention strategies aimed at increasing psychological well-being need to focus on changing illness perceptions rather than improving symptoms of CKD or coping mechanisms.

URL: https://www.ncbi.nlm.nih.gov/pubmed/?term=24751421

 

2013

Knowles, S.R. & Mikocka-Walus, A. (2013) Utilization and efficacy of Internet-based eHealth technology in Gastroenterology: A systematic review. Scandinavian Journal of Gastroenterology, Vol. 49, no. 4, (Apr 2014), pp. 387-408. doi: 10.3109/00365521.2013.865259

Abstract

Objective: While there have been several reviews exploring the outcomes of various eHealth studies, none have been gastroenterology-specific. This paper aims to evaluate the research conducted within gastroenterology which utilizes internet-based eHealth technology to promote physical and psychological well-being.

Material and methods: A systematic literature review of internet-based eHealth interventions involving gastroenterological cohorts was conducted. Searched databases included: EbSCOhost Medline, CINAHL, and PsycINFO. Inclusion criteria were studies reporting on eHealth interventions (both to manage mental health problems and somatic symptoms) in gastroenterology, with no time restrictions. Exclusion criteria were non-experimental studies, or studies using only email as primary eHealth method, and studies in language other than English.

Results: A total of 17 papers were identified; seven studies evaluated the efficacy of a psychologically oriented intervention (additional two provided follow-up analyses exploring the original published data) and eight studies evaluated disease management programs for patients with either irritable bowel syndrome, inflammatory bowel disease (IBD) or celiac disease. Overall, psychological eHealth interventions were associated with significant reductions in bowel symptoms and improvement in quality of life (QoL) that tended to continue up to 12 months follow up. The eHealth disease management was shown to generally improve QoL, adherence, knowledge about the disease, and reduce healthcare costs in IBD, although the studies were associated with various methodological problems, and thus, this observation should be confirmed in well-designed interventional studies.

Conclusions: Based on the evidence to date, eHealth internet-based technology is a promising tool that can be utilized to both promote and enhance gastrointestinal disease management and mental health.

URL: https://www.ncbi.nlm.nih.gov/pubmed/?term=24494974

Nelson, A.E., Dowsey, M. M., Knowles, S.R., Castle, D. Salzberg, M, Monshat, K., Dunin, T., & Choong, P.F.M. (2013). Systematic Review of the Efficacy of Pre-surgical Mind-Body Based Therapies on Post-operative Outcome Measures. Complementary Therapies in Medicine, 21(6), 697–711.

Abstract

Objectives: A large body of research has demonstrated that patient factors are strong predictors of recovery from surgery. Mind-body therapies are increasingly targeted at pre-operative psychological factors. The objective of this paper was to evaluate the efficacy of pre-operative mind-body based interventions on post-operative outcome measures amongst elective surgical patients.

Methods: A systematic review of the published literature was conducted using the electronic databases MEDLINE, CINAHL and PsychINFO. Randomised controlled trials (RCTs) with a prospective before-after surgery design were included.

Results: Twenty studies involving 1297 patients were included. Mind-body therapies were categorised into relaxation, guided imagery and hypnotic interventions. The majority of studies did not adequately account for the risk of bias thus undermining the quality of the evidence. Relaxation was assessed in eight studies, with partial support for improvements in psychological well-being measures, and a lack of evidence for beneficial effects for analgesic intake and length of hospital stay. Guided imagery was examined in eight studies, with strong evidence for improvements in psychological well-being measures and moderate support for the efficacy of reducing analgesic intake. Hypnosis was investigated in four studies, with partial support for improvements in psychological well-being measures. Evidence for the effect of mind-body therapies on physiological indices was limited, with minimal effects on vital signs, and inconsistent changes in endocrine measures reported.

Conclusions: This review demonstrated that the quality of evidence for the efficacy of mind-body therapies for improving post-surgical outcomes is limited. Recommendations have been made for future RCTs.

URL: https://www.ncbi.nlm.nih.gov/pubmed/?term=24280480

 

Hyde, M. K., Knowles, S., & White, K. M. (2013). Donating blood and organs: Using an extended Theory of Planned Behavior perspective to identify similarities and differences in individual motivations to donate. Health Education Research, 28(6):1092-104; doi: 10.1093/her/cyt078.

Abstract

Due to the critical shortage and continued need of blood and organ donations (ODs), research exploring similarities and differences in the motivational determinants of these behaviors is needed. In a sample of 258 university students, we used a cross-sectional design to test the utility of an extended theory of planned behavior (TPB) including moral norm, self-identity and in-group altruism (family/close friends and ethnic group), to predict people’s blood and OD intentions. Overall, the extended TPB explained 77.0% and 74.6% of variance in blood and OD intentions, respectively. In regression analyses, common contributors to intentions across donation contexts were attitude, self-efficacy and self-identity. Normative influences varied with subjective norm as a significant predictor related to OD intentions but not blood donation intentions at the final step of regression analyses. Moral norm did not contribute significantly to blood or OD intentions. In-group altruism (family/close friends) was significantly related to OD intentions only in regressions. Future donation strategies should increase confidence to donate, foster a perception of self as the type of person who donates blood and/or organs, and address preferences to donate organs to in-group members only.

URL: https://www.ncbi.nlm.nih.gov/pubmed/?term=23943782

Knowles, S., Cook, S. I., & Tribbick, D. T. (2013). Relationship between health status, illness perceptions, coping strategies and psychological morbidity: a preliminary study with IBD stoma patients. Journal of Crohn's and Colitis. 7(10):e471-8. doi: 10.1016/j.crohns.2013.02.022. Epub 2013 Mar 28.

Abstract

Background and aims: Individuals living with IBD and a stoma are at an increased risk of anxiety and depression and it is likely that several factors mediate these relationships, including illness perceptions and coping strategies. Using the Common Sense Model (CSM), this study aimed to characterize the mediators of anxiety and depression in an IBD stoma cohort.

Methods: Eighty-three adults (23 males) with a stoma (25 ileostomy, 58 colostomy; 26 emergency, 57 planned, 55 permanent, 28 temporary) completed an online survey. Health status was measured with the Health Orientation Scale (HOS), coping styles assessed with the Carver Brief COPE scale, illness perceptions explored with the Brief Illness Perceptions Questionnaire (BIPQ), and anxiety and depression were measured using the Hospital Anxiety and Depression Scale (HADS).

Results: Combining the questionnaire data using structural equation modeling resulted in a final model with an excellent fit (χ(2) (11)=12.86, p=0.30, χ(2)/N=1.17, SRMR<0.05, RMSEA<0.05, GFI>0.96, CFI>0.99). Consistent with the CSM, health status directly influenced illness perceptions, which in turn, influenced coping (emotion-focused and maladaptive coping). Interestingly, months since surgery was found to influence illness perceptions and emotion-focused coping directly, but not health status. While depression was influenced by illness perceptions, emotion-focused coping and maladaptive coping, anxiety was only influenced by illness perceptions and maladaptive coping.

Conclusions: The preliminary results provide further evidence for the complex interplay between psychological processes. In terms of directions for psychological interventions, a focus on identifying and working with illness perceptions is important.

URL: https://www.ncbi.nlm.nih.gov/pubmed/?term=23541738

 

Knowles, S. R., Gass, C., & Macrea, F. (2013). Illness perceptions in IBD influence psychological status, sexual health and satisfaction, body image and relational functioning: A preliminary exploration using Structural Equation Modeling. Journal of Crohn's and Colitis. 7(9):e344-50. doi: 10.1016/j.crohns.2013.01.018.

Abstract

Background and aims: This study aimed to characterize the relationships between illness perceptions, body image and self-consciousness, sexual health (sexual problems and sexual satisfaction), anxiety and depression, and marital and family functioning in patients with IBD.

Methods: Seventy-four IBD patients (44 CD, 13 males, 61 females, mean age 38 years) completed an online questionnaire. Illness perceptions explored with the Brief Illness Perceptions Questionnaire, and anxiety and depression measured using the Hospital Anxiety and Depression Scale, Sexual Problems Scale, Sexual Satisfaction Scale, Marital Functioning Scale, Family Functioning Scale, and Body Image and Self-Consciousness During Intimacy Scale.

Results: Exploratory Structural Equation Modeling (SEM) provided a final model with an excellent fit (χ(2) (25)=27.84, p=.32, χ(2)/N=1.11, CFI>0.99, RMSEA<0.04, SRMR<0.07, GFI>0.93). Illness perceptions had a significant direct influence on depression (β=0.49, p<0.001), anxiety (β=0.55, p<0.001), and family functioning (β=-0.17, p<0.001). Several mediating pathways were also found involving sexual problems, sexual satisfaction, and body image and self-consciousness during intimacy. Being female was associated with increased sexual problems but increased sexual satisfaction.

Conclusions: The findings provide further evidence for the adverse impact of patient IBD-related illness perceptions on anxiety and depression. The findings also provide the preliminary evidence for the impact of illness perceptions and psychological comorbidity in relation to sexual health and relationship and family functioning. These aspects of psychological processing provide a framework and direction for further research into the nature of IBD and its influence on the patient and their family.

URL: https://www.ncbi.nlm.nih.gov/pubmed/?term=23453888

 

Gondalia, Shakuntla V., Mahon, Peter J., Palombo, Enzo A., Knowles Simon R. and Austin, David W. (2013). Evaluation of biogenic amines in the faeces of children with and without autism by LC-MS/MS, International Journal of Biotechnology and Biochemistry, 9(2), 245-255.

Abstract

Previous researchers have postulated that gastrointestinal bacteria may contribute to the development and maintenance of Autism Spectrum Disorders (ASD). There is evidence based on quantitative evaluation of the gastrointestinal bacterial population in ASD that this is unlikely and an alternate mechanism will be examined where the bacteria may contribute to the development of ASD via their metabolic products and the role of biogenic amines (BAs) will be investigated. In humans, BAs influence a number of physiological processes via their actions as neurotransmitters, local hormones and gastric acid secretion. Various amines have been implicated in several medical conditions such as schizophrenia and colon cancer. To date, the relationship between BAs and autism has not been explored. This study has been designed to identify differences (and/or similarities) in the level of Bas in faecal samples of autistic children (without gastrointestinal dysfunction: n = 14; with gastrointestinal dysfunction; n = 21) and their neurotypical siblings (n = 35) by LC-MS/MS. Regardless of the diagnosis, severity of ASD and gastrointestinal dysfunction there were no significant differences found between the groups. The findings suggest that BAs in the gastrointestinal tract do not play a role in the pathophysiology of gastrointestinal dysfunction associated with ASD.

URL: http://dro.deakin.edu.au/view/DU:30058758

Knowles, S.R., Monshat K., Castle, D. (2013). The Efficacy and Methodological Challenges of Psychotherapy for Adults with Inflammatory Bowel Disease: A Review. Inflammatory Bowel Diseases. 19(12), 2704-2715. Impact Factor: 4.855 DOI: 10.1097/MIB.0b013e318296ae5a

Abstract

Adults with inflammatory bowel disease (IBD) are at a greater risk of anxiety and depression and impaired quality of life (QoL) compared with healthy controls and other chronic physical illness groups. Consequently, the development and evaluation of well-defined and theoretically robust psychotherapeutic interventions for adults with IBD are desirable. To date, interventions have, for the most part, used multiple cross-theoretical approaches. Published reviews are heterogeneous in terms both of categorization of psychotherapeutic approaches and also of conclusions relating to efficacy. A recent Cochrane meta-analysis of randomized controlled trials found no evidence for the efficacy of these interventions in adults, as in a number of previous reviews, ideologically disparate interventions (e.g., psychodynamic and cognitive behavioral) were grouped together. We aimed to extend the currently available literature on psychological intervention in IBD by: evaluating the efficacy of specific strategies (i.e., stress management, psychodynamic, cognitive behavioral therapy, or hypnosis) in improving psychological symptoms and QoL, including all controlled and noncontrolled studies, and explicating the methodological problems in published trials. Sixteen studies (5 stress management, 4 psychodynamic, 5 cognitive behavioral therapy, and 2 hypnosis) were evaluated. Interventions predominantly based on stress management showed only modest benefits for IBD or mental health symptoms or QoL. Cognitive behavioral therapy studies showed generally consistent benefits in terms of anxiety and depression symptoms, but inconsistent outcomes regarding IBD symptoms. Psychodynamically informed interventions reduced depressive and anxiety symptoms, but not IBD severity. Both hypnosis studies, albeit using different methods, seemed to have a more positive impact on disease severity than mental health symptoms or QoL. Our results suggest that while further well-designed and evaluated interventions are needed, psychological input can make a positive contribution to best practice multidisciplinary treatment of adults with IBD.

URL: https://www.ncbi.nlm.nih.gov/pubmed/?term=23846488

 

Hyde, M., Knowles, S. R., & White, K. (2013) What predicts university students’ intentions to volunteer their time for community service? Australian Journal of Psychology, 65(3), 135-145. DOI: 10.1111/ajpy.12014.

Abstract

University students represent one target population with great potential to serve as volunteers. The primary focus on describing the characteristics of students who choose to volunteer, however, has resulted in limited understanding of the psychosocial factors impacting on students’ decisions to volunteer. To bridge this gap, we used an extension of a well-known theoretical framework, the theory of planned behaviour (TPB), to predict students’ intentions to volunteer for community service. Using content and thematic analysis, we explored also students’ motivations and constraints for volunteering. Students (N = 235; M age = 22.09 years) self-reported their attitude, normative influences, control perceptions, moral obligation, past behaviour, demographic characteristics, and intentions for volunteering via questionnaire. Regression analyses showed that the extended TPB explained 67% of the variance in students’ volunteering intentions. In qualitative analyses, themes primarily represented the factors contributing to low efficacy for volunteering (e.g., time constraints). Control perceptions and perceived moral obligations related to volunteering represent important future targets to encourage student volunteering for organisations providing critical services for those most in need.

URL: http://onlinelibrary.wiley.com/doi/10.1111/ajpy.12014/full

Knowles, S.R., Wilson, J., Wilkinson, A., Connell, W., Salzberg, M., Castle, D., Desmond, P., & Kamm, M.A. (2013). Psychological Well-being and Quality of Life in Crohn’s Disease Patients with a Stoma. Journal of Wound, Ostomy and Continence Nursing, 40(6):623-9. doi: 10.1097/WON.0b013e3182a9a75b.

Abstract

Purpose: The aims of this research were to explore associations among elective versus emergency surgery, type of ostomy (permanent vs temporary), illness perceptions and coping style, anxiety, depression, and health-related quality of life in persons with Crohn’s disease. A further aim was to determine the extent of current and past use of psychological care and use of psychotropic medications.
Subjects and setting: The sample comprised 31 persons (17 men and 14 women; mean age 45 years) with Crohn’s disease and an ostomy from 2 large teaching hospitals in Melbourne, Australia.

Methods: Data were collected using a descriptive, cross-sectional design. The questionnaire incorporated 3 validated instruments: the Brief Illness Perceptions Questionnaire, the Hospital Anxiety and Depression Scale, and the Stoma Quality of Life Scale.

Results: Poor illness perception correlated significantly with increased anxiety, depression, and reduced health-related quality of life (specifically, sexuality and body image, work and social functioning, stoma function, and financial concerns). Forty-eight percent of patients scored more than the cutoff for anxiety, and 42% scored more than the cutoff for depression on the Hospital Anxiety and Depression Scale. Of these, only 20% and 31%, respectively, reported currently receiving psychological care. The timing of ostomy surgery (planned vs emergency) or ostomy type (permanent vs temporary) was not significantly associated with anxiety, depression, or health-related impaired quality of life.

Conclusions: In this exploratory, cross-sectional study, patients with Crohn’s disease and a stoma had high rates of psychological comorbidity and low scores on quality of life. Adverse illness perception appeared to explain some of these findings, but most were not receiving psychological help. Psychological care is indicated for many of these patients and further research is indicated.

URL: https://www.ncbi.nlm.nih.gov/pubmed/24202226

2012

Gondalia, S., Palombo, E., Knowles, S., Cox, S. B., Meyer, D., & Austin, D. (2012). Molecular characterization of gastrointestinal microbiota in children with autism (with and without gastrointestinal dysfunction) and their neurotypical siblings. Autism Research, 5(6) (Dec 2012), pp. 419-427.

Abstract

Many children with autism spectrum disorders (ASDs) suffer from gastrointestinal problems such as diarrhoea, constipation and abdominal pain. This has stimulated investigations into possible abnormalities of intestinal microbiota in autistic patients. Therefore, we designed this study to identify differences (and/or similarities) in the microbiota of children with autism (without gastrointestinal dysfunction: n = 23; with gastrointestinal dysfunction: n = 28) and their neurotypical siblings (n = 53) who share a similar environment using bacterial tag-encoded FLX amplicon pyrosequencing. Regardless of the diagnosis and sociodemographic characteristics, overall, Firmicutes (70%), Bacteroidetes (20%) and Proteobacteria (4%) were the most dominant phyla in samples. Results did not indicate clinically meaningful differences between groups. The data do not support the hypothesis that the gastrointestinal microbiota of children with ASD plays a role in the symptomatology of ASD. Other explanations for the gastrointestinal dysfunction in this population should be considered including elevated anxiety and self-restricted diets.

URL: http://onlinelibrary.wiley.com/doi/10.1002/aur.1253/full

 

Knowles, S. R., Hyde, M. K., & White, K. M. (2012). Predictors of young people's charitable intentions to donate money: An extended theory of planned behaviour perspective. Journal of Applied Social Psychology, 42(9), 2096-2110. doi: 10.1111/j.1559-1816.2012.00932.x

Abstract

An extended theory of planned behavior (TPB) was used to predict young people’s intentions to donate money to charities in the future. Students (N = 210; 18–24 years) completed a questionnaire assessing their attitude, subjective norm, perceived behavioral control (PBC), moral obligation, past behavior, and intentions toward donating money. Regression analyses revealed that the extended TPB explained 61% of the variance in intentions to donate money. Attitude, PBC, moral norm, and past behavior predicted intentions, representing future targets for charitable-giving interventions.

URL: http://onlinelibrary.wiley.com/doi/10.1111/j.1559-1816.2012.00932.x/full

 

2011

Knowles, S. R., Wilson, J.L., Connell, W.R., Kamm. M. A. (2011). A preliminary examination of the relations between disease activity, illness perceptions, coping strategies and psychological morbidity in Crohn's disease guided by the common sense model of illness. Inflammatory Bowel Diseases, 17(12), 2551-2557.

Abstract

Background: An individual’s psychological adjustment to illness is influenced by disease severity, illness perceptions, and coping strategies. A more precise understanding of the contribution of each of these factors to a patient’s well-being may influence the kind of psychological support required by patients. This study therefore aimed to characterize the contributors to psychological well-being in patients with Crohn’s disease (CD). The design was a cross-sectional questionnaire-based study.

Methods: Ninety-six CD patients (34 males, 62 females, mean age 38 years) attending a tertiary hospital inflammatory bowel disease outpatient clinic were studied. Disease severity was evaluated according to the Crohn’s Disease Activity Index (CDAI), coping styles assessed with the Carver Brief COPE scale, illness perceptions explored with the Brief Illness Perceptions Questionnaire (BIPQ), and anxiety and depression measured using the Hospital Anxiety and Depression Scale (HADS).

Results: Combining the questionnaire data using structural equation modeling resulted in a final model with an excellent fit (χ(2) (7) = 10.42, P = 0.17, χ(2) /N = 1.49, root mean square error of approximation (RMSEA) < 0.07, comparative fit index (CFI) > 0.97, Goodness-of-fit index (GFI) > 0.97). Disease activity had a significant direct influence on illness perceptions (β = 51, P < 0.001). In turn, illness perceptions had a significant direct influence on depression and anxiety (β = 41, P < 0.001, β = 0.40, P < 0.001, respectively). Use of emotional coping strategies was associated significantly (P < 0.001) with the presence of anxiety and depression.

Conclusions: There is an interrelationship between disease activity, illness perceptions, coping strategies, and depression and anxiety. These aspects of psychological processing provide a framework and direction for the psychological support that patients with CD require.

URL: https://www.ncbi.nlm.nih.gov/pubmed/?term=21425208

2010

Gondalia, S., Palombo, E., Knowles, S., Austin, D. (2010). Gastrointestinal microbiology in Autistic Spectrum Disorder: A review. Reviews in Medical Microbiology, 21, 44-50. Impact Factor: 0.370

Abstract

Cases of autism have frequently been reported in association with gastrointestinal problems. These observations have stimulated investigations into possible abnormalities of intestinal microbiota in autistic patients. The objectives of this paper were to review the possible involvement and mechanisms of gastrointestinal microbiota in autistic spectrum disorder and explain the possible role of gastrointestinal microbiota in the condition. This review addresses the possible involvement of bacteria, viruses and fungi, and their products in autism. Direct viral damage of neurons or disruption of normal neurodevelopment by immune elements such as cytokines, nitric oxide and bacterial products, including lipopolysaccharides, toxins and metabolites, have been suggested to contribute to autistic pathology. Numerous intestinal microbial abnormalities have been reported in individuals with autism. Research to date exploring possible gastrointestinal problems and infection in autism has been limited by small and heterogeneous samples, study design flaws and conflicting results. Furthermore, interventions designed to modify the intestinal microbial population of autistic patients are few and limited in their generalisation. In order to bring clarity to this field, high-quality and targeted investigations are needed to explore the role of gastrointestinal microbiology in autism. To this end, several promising avenues for future research are suggested.

URL: http://journals.lww.com/revmedmicrobiol/Abstract/2010/07000/Gastrointestinal_microbiology_in_autistic_spectrum.2.aspx

 

Gondalia, S., Palombo, E., Knowles, S., Austin, D. (2010). Faecal microbiota of individuals with autism spectrum disorder. E-Journal of Applied Psychology, 6(2), 24-29.

Abstract

Many children with autistic spectrum disorders (ASDs) suffer from gastrointestinal problems such as diarrhoea, constipation and abdominal pain. Such symptoms may be due to a disruption of the indigenous gut microbiota promoting the overgrowth of potentially pathogenic micro-organisms. These observations have stimulated investigations into possible abnormalities of intestinal microbiota in autistic patients. The purpose of the present study was to determine if a relationship exists between ASD severity (mild – severe) and GI microbial populations. The faecal microbiota of 22 male and 6 female participants with ASDs (aged 7 ± 6 years) were analyzed by standard microbial culture methods and compared within-group (based on ASD severity) and with a standard laboratory reference range. Comparisons between children with mild ASD and those with moderate to severe ASD, as well as comparisons to a neurotypical control group previously reported, revealed that no significant differences appear to exist in the composition of the gut microbiota. Nevertheless, examination of each individual’s gut microbial composition showed 10 cases of unusual findings witch means 1out of 3 cases have unusual microbiota. Our data do not support consistent GI microbial abnormalities in ASD children, but the findings do suggest that aberrations may be found in a minority subset of ASD children. Further studies are required to determine the possible association between the microbiota and gastrointestinal dysfunctions in a subset of children with both ASD and gastro-intestinal problems.

URL: http://pandora.nla.gov.au/pan/51365/20110812-0020/ojs.lib.swin.edu.au/index.php/ejap/article/view/213.html

2008

Nelson, E. A., Palombo, E. A., & Knowles, S. R. (2008). Comparison of evaporation techniques for the preparation of salivary cortisol for analysis by liquid chromatography-electrospray tandem mass spectrometry. Clinical Biochemistry. Clinical Biochemistry, 41(16-17), 1413-1416.

Abstract

Objective: Compare evaporation techniques in the work-up procedure of saliva samples for cortisol analysis by a previously validated liquid chromatography-tandem mass spectrometry (LC-MS/MS) method.

Design and methods: Samples were evaporated using freeze drying, centrifugal concentration, and nitrogen flow and analyzed by LC-MS/MS.

Results: Cortisol concentrations detected using each technique did not significantly differ. Factors other than the recovery of cortisol were evaluated.

Conclusions: Evaporation using freeze drying/centrifugal concentration is an automated process, reducing overall processing time for analysis of numerous samples.

URL: https://www.ncbi.nlm.nih.gov/pubmed/?term=18789315

 

Goldsworthy, B., & Knowles, S. (2008). Caregiving for Parkinson’s Disease Patients: An Exploration of a Stress-Appraisal Model for Quality of Life and Burden. Journal of Gerontology: Psychological sciences, 63, 372-376.

Abstract

Extending the 2002 stress-appraisal model of Chappell and Reid, we examined the relationships between caregiver stressors (e.g., cognitive impairment and functional dependency of the recipient), appraisal (informal hours of caregiving), and protective factors (e.g., social support, self-esteem, and quality of the caregiver-recipient relationship) associated with the burden and quality of life of Parkinson’s disease caregivers. There were 136 caregivers (M = 64.59 years) who completed an online survey. Using structural equation modeling, we found that the extended stress-appraisal model of Chappell and Reid provided a good fit to the data (chi2 = 67.87, df = 55, p >.05; chi2/df = 1.23, Comparative Fit Index = 0.98, Root Mean Square Error of Approximation = 0.04). This study provides an important contribution to a growing field of research that applies theoretical models to investigate the stressors, appraisals, and protective factors that impact caregiver well-being.

URL: https://www.ncbi.nlm.nih.gov/pubmed/?term=19092040

Tucker, P., & Knowles, S. (2008). Review of studies that have used the Standard Shiftwork Index: Evidence for the underlying model of shiftwork and health. Applied Ergonomics, 39, 550-564.

Abstract

The Standard Shiftwork Index (SSI) provides shiftwork researchers with a standardised battery for assessing the impact of shiftwork on psychological and physiological well-being. We review the published SSI literature and evaluate the extent to which the results of these publications support the model underpinning the SSI. A total of 70 SSI publications were identified, of which 41 were selected. The 41 studies were published between 1993 and 2006 and had a combined total of 21,420 respondents. The analysis indicated support for parts of the SSI model, particularly in relation to the impact of shift systems design on individual well-being, as well as the role of individual factors (e.g., personality, coping style). However, evidential support for the model as a whole is incomplete. The findings of the reviewed studies are summarised and methodological limitations are discussed.

URL: https://www.ncbi.nlm.nih.gov/pubmed/?term=18348885

 

Knowles, S.R., Nelson, E.A., & Palombo, E.A. (2008). Investigating the role of perceived stress on bacterial flora activity and salivary cortisol secretion: a possible mechanism underlying susceptibility to illness. Biological Psychology, 77, 132-137.

Abstract

This study examined the impact of academic stress on salivary cortisol concentrations and lactic acid bacteria activity. Whole, unstimulated saliva samples and faecal samples were collected from 23 healthy undergraduate students (23.0+/-6.8 years; range 18-44) over two 1-week periods: during the beginning of semester (low-stress baseline condition) and during the first week of exams (high-stress condition). Students also completed a series of questionnaires measuring perceived levels of stress, gastrointestinal symptoms, and nutritional intake. Significant findings indicated that faecal lactic acid bacterial levels were lower during the high-stress condition. Paralleling this, students rated perceived levels of stress as being greater during the exam period compared to the baseline condition. The findings from this study have provided further insight into the link between stress and gastrointestinal flora activity in humans.

URL: https://www.ncbi.nlm.nih.gov/pubmed/?term=18023961

 

2007

Campbell, A., & Knowles, S. (2007). A Confirmatory Factor Analysis of the GHQ12 using a large scale Australian sample. European Journal of Psychological Assessment, 23(1), 2-8.

Abstract

The GHQ12 has become a popular screening instrument used by both clinicians and researchers. To date there have been a number of studies investigating the factor structure of the GHQ12. Most have identified a factorial structure to the instrument but there has been little consistency in the factors identified. One reason for this may be that different investigators are using different scoring methods and this could impact the structure identified. This study used structured equation modeling (LISREL 8.7) to carry out a confirmatory factor analysis, with a large sample of 8,732 university staff, on four 3-factor and one unitary model solutions using the three most common scoring methods (Classical, Corrected, and Likert). It was found that the method of scoring substantially affects model estimation and suggestions were made as to the best scoring method for future use.

URL: http://econtent.hogrefe.com/doi/abs/10.1027/1015-5759.23.1.2

2006

Moore, S. & Knowles, S. (2006). Beliefs and Knowledge about Parkinson’s Disease. E-Journal of Applied Psychology, 2(1), 15-21.

Abstract

A survey of public attitudes showed that there is significant stigma perceived to be associated with Parkinson’s disease (PD), as well as significant misconceptions about the course and outcomes of the disease. Negative attitudes to PD were associated with perceived stigma, (younger) age, knowledge of a sufferer and knowledge of the disease. Perceived stigma, negative attitudes and incorrect beliefs are likely to impinge on the psychosocial well-being of those living with the disease, particularly those with early onset. The data from this study was collected from 200 householders and suggest that more public information about positive lifestyle possibilities for those living with Parkinson’s would be of value to disease sufferers and their carers.

URL: http://pandora.nla.gov.au/pan/51365/20070816-0000/ojs.lib.swin.edu.au/index.php/ejap/article/view/32.html

Knowles, S., & Bull, D. (2006). Assessing the Relationship Between Age and Personality Variables Measured by the Standard Shiftwork Index on the Psychological and Physiological Well-being of Police Officers. Canadian Journal of Police & Security Services, 4(1), 28-34.

Abstract

The aim of this study was to assess the relationships between age and various personality variables (i.e., morningness, languidity, flexibility, neuroticism, and extroversion) on a variety of well-being scores, including: (1) physiological (i.e., chronic fatigue, cardiovascular symptoms, and digestive symptoms), (2) psychological (i.e., cognitive and somatic anxiety), and (3) total sleep disturbance. It was hypothesized that morningness, flexibility, and extroversion scores would have a significant beneficial relationship with subjective well-being. In contrast, age, languidity, and neuroticism scores would have a significant adverse relationship with subjective well-being. One hundred and twenty-nine Police Officers completed a modified version of the Standard Shiftwork Index (SSI). The results of the Pearson’s product coefficients indicated that higher morningness, flexibility, and extroversion personality scores were related to increased subjective well-being, while age, languidity, and neuroticism were correlated with reduced subjective well-being. The results of this current study provide additional empirical support for the premise that an individual’s psychological and physiological well-being is influenced by personality. In addition, the impact of the outlined personality measures may either exacerbate or attenuate the ability to adapt successfully to a shift-working lifestyle.

URL: https://www.questia.com/library/journal/1G1-147390791/assessing-the-relationship-between-age-and-personality

 

2005

Kambouropoulos, N. & Knowles, S. R. (2005). Psychological distress and responses to blocked and random presentation of emotional Stroop stimuli; an online experiment. E-Journal of Applied Psychology, 1(2), 3-8.

Abstract

There is an extensive amount of literature utilising the emotional Stroop task (EST) to investigate attentional processes underlying a range of psychological conditions. Relatively fewer studies have specifically examined the impact of different Stroop stimuli presentation methods (i.e., blocked or mixed presentation of words). The aim of this study was to directly investigate this issue using an online version of the task. After an initial practice trial, 117 Psychology students (19 Male, 98 Female) were randomly allocated to either a random or counterbalanced blocked condition. Demographic information and level of psychological distress (K10) were also collected. Results indicated that there were no significant differences between blocked and random conditions on attentional interference. Further analysis indicated that random presentation produced significantly higher levels of response latencies to emotional words in participants with high levels of psychological distress. These data add to the methodological debate surrounding the use of blocked vs. random presentation of Stroop stimuli. Implications of these results for assessing control and clinical groups using the EST are discussed.

URL: http://pandora.nla.gov.au/pan/51365/20070816-0000/ojs.lib.swin.edu.au/index.php/ejap/article/view/20.html

 

2004

Knowles, S., & Bull, D. (2004). Exploring the mediating roles of cognitive and behavioural coping strategies on the relationship age and well-being. Canadian Journal of Police & Security Services, 2(4), 229-236.

Abstract

The aim of this study was to investigate the possible mediating role of various cognitive and behavioural coping strategies on the relationship between age and psychological (i.e., cognitive and somatic anxiety) and physiological (i.e., chronic fatigue, digestive and cardiovascular symptoms) well-being. Fourteen specific individual coping strategies (four disengagement, four engagement, and six behavioural) were assessed in this study. The four disengagement and four engagement coping styles were taken from the Coping Strategies Inventory (CSI) included in the Standard Shiftwork Index (SSI), while the six behavioural coping strategies were based on recommendations published within the shiftwork literature (e.g., exercising, altering family or social life commitments to fit in with working shifts, advising friends and family about shift patterns, etc). Three open-ended questions were also included in the questionnaire allowing shiftworkers to provide further contextual detail about the specific coping strategies utilised. One hundred and eight Police Officers with at least 12 months shiftworking experience completed a modified version of the SSI and an active coping questionnaire. A series of exploratory stepwise regressions provided evidence that shiftworkers utilise a constellation of different coping strategies, and that each of these coping strategies may mediate specific aspects of the relationship between age and psychological and/or physiological well-being. Comments from shiftworkers provided further evidence for the variety of coping strategies utilised to help adapt to shiftwork.

URL: https://www.questia.com/library/journal/1G1-140303715/exploring-the-mediating-roles-of-cognitive-and-behavioural

Knowles, S., & Bull, D. (2004). Investigating the affect of stress on police officer psychological and physiological well-being. Canadian Journal of Police & Security Services, 2(2), 83-89.

Abstract

The aim of this study was to utilize a subset population initially reported in Knowles and Bull (2003) to investigate the impact of perceived stress on individual psychological and physiological well-being. Of the original 129 participants participating in the 2003 study, 64 also completed the modified version of the Standard Shift-work Index (SSI) and two other questionnaires: the Perceived Stress Scale (PSS) and the General Health Questionnaire (GHQ). It was hypothesized that an analysis of the responses to these scales would indicate that age, disengagement, and perceived stress would be adversely related to well-being. Furthermore, it was also hypothesized that perceived stress would be a more influential covariate of well-being when compared to the covariates of age and disengagement coping. Analysis of the data provided partial support for the hypotheses that age, disengagement coping, and perceived stress were adversely related to a variety of psychological and physiological symptoms. In addition, results also indicate that the covariate of perceived stress accounted for a majority of the significant findings. Overall these findings provide evidence that, while age and disengagement coping moderate well-being, levels of perceived stress may play a more influential role.

URL: https://www.questia.com/library/journal/1G1-140242542/investigating-the-affect-of-stress-on-police-officer

 

2003

Knowles, S., & Bull, D. (2003). Assessing the Impact of Shift Work and Stress on the Psychological and Physiological Wellbeing of Police Officers. Canadian Journal of Police & Security Services, 1(4), 337-342.

Abstract

The primary aim of this article is to assess the impact of a high stress shift work occupation (i.e., police work) on psychological (i.e., cognitive and somatic anxiety) and physiological (i.e., chronic fatigue, digestive and cardiovascular symptoms) wellbeing. Specifically, this study seeks to assess the impact of age on psychological and physiological wellbeing as well as to assess the mediating impact of adverse (disengagement) and beneficial (engagement) coping strategies on psychological and physiological wellbeing. One hundred and twenty-nine subjects from two Police Local Area Commands in Eastern Australia completed a modified version of the Standard Shiftwork Index (SSI). It was hypothesized that age and disengagement coping would be adversely related to psychological and physiological symptoms and that, conversely, engagement coping would be beneficially related to psychological and physiological wellbeing. Although analysis of the data supported the hypothesis that age and disengagement coping were adversely related to a variety of psychological and physiological symptoms, the results did not support the hypothesis that engagement coping was beneficially related to either psychological or physiological wellbeing. These findings are discussed within the context their implications for police officer psychological and physiological wellbeing.

URL: https://www.questia.com/library/journal/1G1-140242549/assessing-the-impact-of-shift-work-and-stress-on-the