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The Journal of Positive Psychology: Dedicated to furthering research and promoting good practice Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/rpos20

On the confluence of optimism and hope on depressive symptoms in primary care patients: Does doubling up on bonum futurun Proffer any added benefits? a

a

Edward C. Chang , Elizabeth A. Yu & Jameson K. Hirsch

b

a

Department of Psychology , University of Michigan , 530 Church Street, Ann Arbor , MI , 48103 , USA b

Department of Psychology , East Tennessee State University , Johnson City, TX , 37614 , USA Published online: 15 Jul 2013.

To cite this article: Edward C. Chang , Elizabeth A. Yu & Jameson K. Hirsch (2013) On the confluence of optimism and hope on depressive symptoms in primary care patients: Does doubling up on bonum futurun Proffer any added benefits?, The Journal of Positive Psychology: Dedicated to furthering research and promoting good practice, 8:5, 404-411, DOI: 10.1080/17439760.2013.818163 To link to this article: http://dx.doi.org/10.1080/17439760.2013.818163

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The Journal of Positive Psychology, 2013 Vol. 8, No. 5, 404–411, http://dx.doi.org/10.1080/17439760.2013.818163

On the confluence of optimism and hope on depressive symptoms in primary care patients: Does doubling up on bonum futurun Proffer any added benefits? Edward C. Changa*, Elizabeth A. Yua and Jameson K. Hirschb a

Department of Psychology, University of Michigan, 530 Church Street, Ann Arbor, MI 48103, USA; bDepartment of Psychology, East Tennessee State University, Johnson City, TX 37614, USA

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(Received 14 March 2013; final version received 17 June 2013) A model involving optimism and hope as predictors of depressive symptoms was tested in a sample of 28 male and 67 female primary care patients. Beyond the distinct influence of the two predictors on depressive symptoms, optimism and hope were also hypothesized to interact together to predict depressive symptoms. Results of a regression analysis indicated that, independent of demographic variables (viz. age, sex, race/ethnicity, marital status, and educational level), optimism and hope were significant and unique predictors of depressive symptoms in adults. Noteworthy, beyond optimism and hope, the Optimism  Hope interaction term was found to significantly augment the prediction of depressive symptoms. Some implications of the present findings are discussed. Keywords: optimism; hope; depressive symptoms; primary care

“Obiectum spei est bonum futurum arduum possibile adipisci” [The object of hope is a good future, difficult but possible to obtain] – St. Thomas Aquinas, Summa Theologiae

Western philosophers have long noted that humans are cognitive beings (res cogitans; Descartes, 1641/ 1986). We are able to define ourselves by our quintessential ability to question the truth and meaning of our own existence. But, what is the meaning of being? More than half a century ago, Heidegger (1927/1962) asked this question of fundamental ontology in his work, Being and Time. Heidegger raised to social consciousness a way of understanding human being as Dasein. As Dasein, or “being-there,” humans are not merely what they are (actuality) but, more importantly, are what they are not yet but can be in the unfolding future (potentiality). This idea has been prominently reflected in the subsequent writings of notable philosophers (Camus, 1942/ 1955; de Beauvoir, 1949/2009; Merleau-Ponty, 1945/ 1962; Sartre, 1943/1956) and psychologists (Allport, 1955; Frankl, 1946/2006; Jaspers, 1938/1971; Maslow, 1962; Rogers, 1961). Accordingly, it is the power of future possibility that represents an important determination of who and what we are, and how we exist in the *Corresponding author. Email: [email protected] Ó 2013 Taylor & Francis

world. Thus, it may not be surprising that two of the most studied cognitions found in the scientific psychological literature over the past two decades have been optimism and hope, both representing cognitions predicated on the notion that good things will happen (bonum futurum). According to Scheier and Carver (1985), optimism is defined as the disposition to expect that good things will occur in the future. As a broad personality construct, optimism is not tied to any specific context, but rather reflects a general confidence about one’s life. Accordingly, one may remain optimistic even when dealing with specific situations that may be challenging or stressful (Scheier & Carver, 1992). And, consistent with the notion that being optimistic is good (cf. Tennen & Affleck, 1987; Weinstein, 1980), and being pessimistic is bad (cf. Chang, 1996), findings from numerous studies over the past two decades have pointed to a reliable positive association between optimism and positive psychological outcomes (e.g. life satisfaction, positive affect and psychological well-being; Chang, 1998, 2009; Marshall, Wortman, Kusulas, Hervig, & Vickers, 1992), and a negative association between optimism and negative psychological outcomes (e.g. anxiety, stress and negative affect; Endrighi, Hamer, & Steptoe, 2011; Marshall et al., 1992; Siddique, LaSalle-Ricci, Glass, Arnkoff, & Díaz, 2006). Indeed, with regard to the latter, one of the most common associations found has been an

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The Journal of Positive Psychology inverse relationship between optimism and depressive symptoms (see Carver, Scheier, & Segerstrom, 2010, for a review). Similar to the pattern found in studies of optimism, hope has also been found to represent an adaptive personality variable. According to Snyder et al. (Feldman & Snyder, 2005; Snyder et al., 1991, 2005), hope represents a central cognitive set defined by a determination to reach goals and an ability to make plans to meet those goals. Findings from studies have shown that greater hope is not only positively associated with positive psychological outcomes (e.g. subjective well-being and life satisfaction; O’Sullivan, 2011; Werner, 2012), but is also negatively associated with negative psychological outcomes (e.g. anxiety and negative affect; Arnau, Rosen, Finch, Rhudy, & Fortunato, 2007; Snyder et al., 1991), including depressive symptoms (Arnau et al., 2007; Chang, 2003; Geiger & Kwon, 2010; Hirsch, Duberstein, Chapman, & Lyness, 2007). Thus, hope, like optimism, also represents an important positive future cognition associated with adjustment (Snyder, Sympson, Michael, & Cheavens, 2001). However, these constructs are not theoretically equal. As argued by Alarcon, Bowling, and Khazon (2013), the optimistic person believes that for a variety of reasons (e.g. luck, fate and personal control), his/her future will be positive, whereas the hopeful person believes in his/her ability to secure a positive future. Consistent with this view, Bryant and Cvengros (2004) found that optimism was distinctly associated with positive appraisal, whereas hope was distinctly associated with self-efficacy. Given these conceptual and empirical differences, it is not surprising that findings from a small, but growing number of studies have shown that optimism and hope have unique associations with adjustment (e.g. Gallagher & Lopez, 2009; Magaletta & Oliver, 1999; Wong & Lim, 2009). For example, in a study involving 65 adult patients who experienced a traumatic brain injury, Peleg, Barak, Harel, Rochberg, and Hoofien (2009) found that although the correlation between optimism and hope was large (r = 0.59), results from conducting a regression analysis that included both of these positive future cognitions indicated that optimism (β = 0.30) and hope (β = 0.42) were unique and significant predictors of depressive symptoms. To date, however, no study has examined whether optimism and hope are also uniquely involved in predicting depressive symptoms in a primary care patient population. This is important given that primary care patients are at great risk for clinical depression (e.g. Hooper et al., 2012; Unützer, 2002). Accordingly, to broaden and build on the handful of existing studies that have looked at the unique contributions of optimism and hope on depressive symptoms in adults, it would be useful to examine the distinct utility of these positive future cognitions in primary care patients.

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Beyond an examination of optimism and hope as distinct predictors of depressive symptoms in primary care patients, there is also some reason to believe that these positive future cognitions may interact in predicting important outcomes. Specifically, studies on defensive pessimism (e.g. see Norem, 2008, for a review; Norem & Cantor, 1986; Norem & Illingworth, 1993) indicate that some individuals who expect negative outcomes to occur (i.e. low optimism) may still be able to attain positive outcomes if they believe that taking some personal action may alter the course of their future (i.e. high hope). Accordingly, there may be some benefit in ‘doubling up’ on positive future cognitions. That is, consistent with research on defensive pessimism, it may be that being pessimistic (i.e. less optimistic) is associated with greater depressive symptoms in adults, but this may be less true for pessimists who have high hope. Alternatively, it may be that being optimistic may be associated with less depressive symptoms in adults; but, this may be more true for optimists who have high hope. For example, in a recent study, Chang, Yu, Kahle, Jeglic, and Hirsch (2013) found that Latino adults with high positive problem orientation (a form of problem-solving optimism) reported lower suicide behavior, when they had high vs. low hope. Interestingly, however, the negative link between positive problem orientation and suicide behavior was most pronounced among low hope Latinos, rather than among high hope Latinos. To date, however, no study has examined the role of optimism and hope as interactive predictors of depressive symptoms in an at-risk adult population (e.g. primary care patients). Purpose of the present study Given these concerns and possibilities, we conducted the present study to: (a) examine the relations between optimism, hope, and depressive symptoms; (b) determine if optimism and hope are unique predictors of depressive symptoms; and (c) determine if the Optimism  Hope interaction would add further incremental validity to these predictions beyond the main effects of optimism and hope. Given conceptual similarities between optimism and hope (Alarcon et al., 2013), we predicted that these variables would be positively related to each other. However, consistent with past research findings (e.g. Gallagher & Lopez, 2009; Peleg et al., 2009), we expected to find evidence for their unique role in predicting depressive symptoms. Finally, consistent with research and theory on defensive pessimism (Norem & Cantor, 1986), we expected to find evidence for a significant Optimism  Hope interaction. Specifically, we expected to find that hope will interact with optimism in predicting depressive symptoms, such that depressive

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symptoms will be lower among pessimists at high, than at low levels of hope. We also expected that depressive symptoms may be lower among optimists at high, than at low levels of hope. However, consistent with some findings indicating that the benefit of positive future cognitions may be most pronounced among those who start off with minimal positive expectations (Chang et al., 2013), we expected the negative link between hope and depressive symptoms to be most pronounced in pessimists, compared to optimists.

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Method Participants A total of 101 adults (29 males and 72 females) were recruited from a primary care clinic serving working, uninsured patients, in the Southeast USA. Ages ranged from 18 to 64 years, with a mean age of 42.18 (SD = 12.83). Most of the participants were Caucasian (93%), followed by Black (3%), Asian (1%), and ‘Other’ (2%). With regard to marital status, most of the participants indicated being ‘married, living with spouse’ (37.4%), followed by ‘single, never married’ (28.3%), ‘divorced’ (25.3%), ‘married, not living with spouse’ (6.1%), and ‘widowed’ (3.0%). On highest level of education attained, most of the participants indicated ‘high school diploma/GED’ (38.6%), followed by ‘college graduate’ (21.8%), ‘sophomore in college’ (11.9%), ‘freshman in college’ (10.9%), ‘junior in college’ 7.9%), ‘Master’s degree’ (3.0%), ‘11th grade’ 2.0%), ‘less than 9th grade’ (2.0%), ‘10th grade’ (1.0%), and ‘9th grade’ (1.0%). Measures Optimism Optimism was assessed by the revised Life Orientation Test (LOT-R; Scheier, Carver, & Bridges, 1994). The LOT-R is a 10-item measure of individual differences in generalized positive and negative outcome expectancies. Three items are positively worded (e.g. ‘In uncertain times, I usually expect the best’), and three items (reverse scored) are negatively worded (e.g. ‘I hardly ever expect things to go my way’). The remaining four items are filler items. Respondents are asked to rate items across a 5-point Likert-type scale ranging from 0 (strongly disagree) to 4 (strongly agree). Evidence for the construct validity of the LOT-R has been reported in past studies. For example, Scheier et al. (1994) found that LOT-R scores were positively related to measures of self-mastery and self-esteem, and negatively related to measures of neuroticism and anxiety. Test–retest reliability for the LOT-R has been reported to be 0.79 (28 months) in a sample of college students (Scheier et al., 1994). In the present sample,

internal consistency of the LOT-R as measured by Cronbach alpha was 0.92. In general, higher scores on the LOT-R are indicative of greater dispositional optimism, whereas lower scores are indicative of greater dispositional pessimism. Hope Hope was assessed by the Hope Scale (HS; Snyder et al., 1991). The HS is a 12-item measure of dispositional hope (e.g. ‘My past experiences have prepared me well for my future’). Four items are filler items. Respondents are asked to indicate how accurately each item described them using an 8-point Likert-type scale, ranging from 1 (definitely false) to 8 (definitely true). Evidence for the construct validity of the HS has been reported in past studies. For example, Snyder et al. (1991) found that HS scores were positively related to measures of personal control and self-esteem, but negatively related to hopelessness and depressive symptoms. Test–retest reliability for the HS has been reported to be 0.85 (3 weeks) in a sample of college students (Snyder et al., 1991). In the present sample, internal consistency of the HS as measured by Cronbach α was 0.94. In general, higher scores on the HS indicate greater hope. Depressive symptoms Depressive symptoms were assessed by the Center for Epidemiologic Studies Depression Scale (CES-D; Radloff, 1977). The CES-D is a commonly used 20-item scale that assesses for the severity of depressive symptoms in the past week. Respondents are asked to rate the extent to which they have experienced specific depressive symptoms (e.g. ‘I felt depressed’) across a 4-point Likert-type scale, ranging from 0 (rarely or none of the time) to 3 (most or all of the time). Evidence for the construct validity of the CES-D has been reported in past studies. For example, Radloff (1977) found that CES-D scores were positively related to a measure of negative affect, and negatively related to a measure of positive affect. Importantly, CES-D scores have been found to discriminate between psychiatric inpatient and general population samples (Radloff, 1997). Test–retest reliability for the CES-D has been reported to be 0.67 (4 weeks) in a sample of adults (Radloff, 1977). In the present sample, internal consistency of the CES-D as measured by Cronbach alpha was 0.93. In general, higher scores on the CES-D indicate more severe levels of depressive symptoms (i.e. increased risk for clinical depression). Procedure Approval for the study was obtained from the Institutional Review Board prior to data collection. Participants were

The Journal of Positive Psychology Table 1. Partial correlations between measures of optimism, hope, and depressive symptoms in primary care patients controlling for demographic variables. Variable 1. 2. 3.

1 LOT-R HS CES-D Range M SD

– 0.73⁄⁄⁄ 0.67⁄⁄⁄ 0–4 3.30 0.68

2 – 0.68⁄⁄⁄ 1–8 5.56 1.51

3

– 0–3 0.77 0.59

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Notes: Ns = 95–101. LOT-R = Revised Life Orientation Test; HS = Hope Scale; CES-D = Center for Epidemiological Studies-Depression Scale; Control variables are age, gender, race/ethnicity, marital status, and educational level. ⁄⁄⁄p < 0.001.

recruited at a primary care clinic using advertisements displayed throughout the clinic and were compensated $15 for completion of the study. All participants were provided with written informed consent that indicated that all data would be kept strictly confidential. Results Of the original sample of 101 adults, six participants (one male & five females) failed to complete the CES-D. However, no significant difference emerged between those who completed and did not complete the CES-D on age, sex, race/ethnicity, marital status, educational level, optimism, and hope, Wilks’ λ (7, 93) = 0.96, n.s. To increase the generalizability of our findings, we controlled for key demographic variables, namely, age, sex, race/ethnicity, marital status, and educational level in all subsequent analyses. Relations between optimism, hope, and depressive symptoms in adults Partial correlations for all study measures that control for demographic variables are presented in Table 1. In addition, range, mean, and standard deviations for the present measures based on standardized scale scores (i.e. raw scores divided by number of items on a given measure) are also presented in this table. As the table shows, LOT-R scores were found to have a large association (Cohen, 1988) with CES-D scores. Similarly, HS scores were also found to have a large association with scores on the depressive symptoms measure. Although LOT-R scores and HS scores were found to have a large and positive association with each other, it is important to note that scores on these measures had less than 46% of the variance in common. Lastly, consistent with the idea that primary care patients represent an important mental health population, the mean standardized score on the CES-D was close to the cut-off (a raw score of 16) used to identify individuals at risk for clinical depression.

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Optimism and hope as predictors of depressive symptoms in adults To examine the predictive utility of optimism (as measured by the LOT-R) and hope (as measured by the HS) in accounting for variance in depressive symptoms (as measured by the CES-D), we conducted a hierarchical regression analysis. For the prediction equation, demographic variables were entered as controls in the First Step, followed by LOT-R and HS scores as a set in the Second Step. Finally, to test for an Optimism  Hope interaction, the multiplicative term was entered in the Final Step of the equation. Prior to conducting this analysis, optimism and hope scores were centered to reduce multicollinearity in the interaction term. Results of this analysis for predicting unique variance in depressive symptoms are presented in Table 2. To determine if optimism and hope accounted for a small, medium, or large amount of the variance in depression, we used Cohen’s (1977) convention for small (f 2 = 0.02), medium (f 2 = 0.15), and large effects (f 2 = 0.35). As the table shows, after controlling for demographic variables, optimism (β = 0.33) and hope (β = 0.43) were found to be significant and unique predictors, and to account for a large (f 2 = 0.82) 45% of significant variance in depressive symptoms, F(1, 93) = 48.57, p < 0.001. Independent of demographic variables, the interaction term involving Optimism  Hope was found to account for a small (f 2 = 0.03) but significant 3% of additional variance above and beyond optimism and hope, F(1, 86) = 6.83, p < 0.05. To visually inspect the manner in which optimism and hope interacted with each other in predicting depressive symptoms, we plotted the regression of depressive symptoms on hope at low and high levels (split 1 SD below & above the mean, respectively) of optimism based on our initial regression results (see Figure 1). As the figure shows, results of plotting this interaction offer some support for the doubling-up hypothesis. Specifically, pessimists reported less depressive symptoms when they had high vs. low hope. Likewise, optimists also showed a slight decrease in depressive symptoms when they had high vs. low hope. Consistent with expectations, the beneficial value of hope appeared to be stronger for pessimists than for optimists. Discussion Given the dearth of research examining the potential impact of ‘doubling up’ on key positive future cognitions that may be involved in adult depressive symptoms, the purpose of the present study was to examine the value of an integrative model that included optimism and hope as predictors of depressive symptoms in an adult community sample of primary care patients. Consistent with past findings in studies of optimism in adults (e.g. Hart, Vella, & Mohr, 2008; Scheier et al., 1994; Tindle et al., 2012),

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Table 2. Results of hierarchical regression analyses showing amount of variance in depressive symptoms accounted for by optimism and hope in primary care patients, after controlling for demographic variables. β

Outcome Depressive symptoms Step 1: demographic variables Age Gender Race/ethnicity Marital status Education level Step 2: positive future cognitions Optimism Hope Step 3: Optimism  Hope

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Note: N = 95. ⁄p < 0.05

⁄⁄

p < 0.01.

R2

ΔR2

0.16

F

p

3.17