Psychosocial Factors

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Marital Status. Participants were asked if they were currently married, separated, divorced, widowed or single.  In visit 11 they were also asked how many years they were married, divorced, or widowed, and whether they acted as a caregiver in the home.

Living situation. Participants were asked if they lived alone, who they lived with, and type of accommodation.

Social Engagement. This questionnaire was adapted from the Berkman-Syme Social Network Index1. It asks participants to indicate number of close friends and family members, frequency of contact, and level of involvement with various social groups. Select questions were asked at different visits.

Fordyce Happiness Measures2. Participants were asked to indicate how happy or unhappy they usually felt, and to indicate, on average, the percentage of time they felt happy, unhappy, and neutral.

Stress and Coping. Participants were asked to rate their level of stress past in the past year and to indicate their perceived balance between life’s demands and their resources.

Quality of Well-Being3: A health-related quality of life index which combines preference-weighted values for symptoms and functioning for four subscales of physical activity, social activity, symptoms, and mobility.  On each subscale scores range from 0 – asymptomatic to 1 – fully impaired.  These scores are combined into a total quality of life score, which ranges from 0.0 (death) to 1.0 (optimal functioning). This scale was administered through a structured telephone interview.

Life Satisfaction. Two life satisfaction scales were administered, the 13 item Life Satisfaction Index Z (LSIZ)4 and the 5 item Satisfaction with Life Scale (SWL)5.  For the LSIZ, a response of “agree” to eight of the statements and “disagree” to the remaining five (items 3,4,5,11 and 12) indicate satisfaction. Participants received two points for each response indicating satisfaction, one point for a response of “don’t know”, and zero points for each response indicating dissatisfaction. Scores range from 0–26 with higher values indicative of greater life satisfaction. For the SWL agreement with each item indicates satisfaction. Scores range from 0 – 35 with higher values indicating greater satisfaction with life.

Hopelessness Scale.  Developed for the Kuopio Ischemic Heart Disease Risk Factor Study, this scale consists of 2 items (impossible to reach goals, feeling hopeless) with responses on a 5 point scale from absolutely agree to absolutely disagree. Items are reversed scored, and summed to create a hopelessness score ranging from 0 – 8, where higher scores represent greater feelings of hopelessness.

Type A/B Personality: The Bortner Rating Scale 7, a14-item self-administered questionnaire was used to assess Type A/B personality traits.  Individuals indicated where they fell along a line separating two extreme values of a trait. Distance from the non-A end of the line was measured and is provided for each item. Total score, summed across all 14 items to yield the Pattern A score, is also provided. The higher the score, the greater the tendency toward Type A behavior.

Optimism: The 10-item Life Orientation Test –Revised (LOT-R) provides a measure of optimism and pessimism 8. Of the 10 items, 3 measure optimism (#1, 4, and 10), 3 measure pessimism (#3,7,9) and 4 (#2,5,6,8) serve as fillers and are not scored. Respondents rate each item on a 4-point scale: 0 = strongly disagree, to 4 = strongly agree. Pessimism items are reverse-scored. Higher total scores (maximum = 24) reflect higher degree of optimism.

Personality Trait – Active. A 10-item measure of the personality trait “Activity” from the International Personality Item Pool for Activity9.  Participants rate degree to which each statement describes them, ranging from 0 = Very inaccurate to 5 = very accurate. Half the items reflect activity, the other half reflect inactivity. The latter are reverse scored and a total score (maximum of 50) reflects degree of activity.

Depressed Mood. The 21-item Beck Depression Inventory 10 assesses symptoms of depression. In visit 4, an 18 item version was used. Scores on this visit are scaled to the full-length version of the inventory, which was administered in subsequent visits. Higher scores indicate higher level of depressed mood.


  1. Berkman, L. F., & Syme, S. L. (1979). Social networks, host resistance, and mortality: A nine-year follow-up of Alameda county residents. American Journal of Epidemiology, 109, 186–204.
  2. Fordyce MW. A review of results on the happiness measures: A 60-second index of happiness and mental health. Soc Indic Res. 1988;20:355–81.
  3. Kaplan RM, Bush JW. Health-related quality of life measurement for evaluation research and policy analysis. Health Psychol 1982;1:61–80.
  4. Wood V, Wylie ML, Sheafor B.  An analysis of a short self-report measure of life satisfaction:  Correlation with rater judgements.  J Gerontology 1969;24:465-469.
  5. Diener E, Emmons RA, Larson RJ, Grifin S.  The Satisfaction with Life Scale. J Personality Assessment 1985;49:71-75.
  6. Everson S, Kaplan G, Goldberg D, et al. Hopelessness and four-year progression of carotid atherosclerosis. The Kuopio Ischemic Heart Disease Risk Factor Study. Aterioscler Thromb Vasc Biol. 1997;17:1490–1495
  7. Bortner RW, Rosenman RH. The measurement of Pattern A behavior. J Chron Dis  20,525,1967
  8. Scheier MF, Carver CS, Bridges MW.  Distinguishing optimism from neuroticism (and trait anxiety, self-mastery, and self-esteem): A re-evaluation of the Life Orientation Test. J Pers Social Psychol 1994;67:1063-1078.
  9. International Personality Item Pool for Activity.
  10. Beck, A.T., Ward, C. H., Mendelson, M., Mock, J., & Erbaugh, J. (1961) An inventory for measuring depression. Archives of General Psychiatry, 4, 561-571.