Scenario

A cancer which is present within families may be considered to be a stressful life event which may cause psychosocial morbidity and lead to other health risks. Frost et.al (2000) conducted a study into the psychosocial morbidity and health concerns accompanying individuals’ perceived increased risk of cancer. In this study, they recruited 39 patients with and without a cancer diagnosis. These 78 patients were then asked to complete questionnaires. This was both before and after these patients completed tests in the cancer clinic. Before the risk evaluation included Spielberger’s Trait Anxiety Scale, the Medical Outcome Study Questionnaire, the Bipolar Profile of Mood States (POMS-BI), and an investigator-designed open-ended questions reviewed by a panel of experts. The results from these questionnaires demonstrated that the patients that were at risk of developing cancer had been identified as having an emotional breakdown when they had sought to deal with their circumstances (Frost et.al. 2013).

Introduction

The scenario, which is to be explored in this report, relates to the study by Frost et.al. (2000) which sought to understand the psychosocial morbidity and health concerns accompanying individuals’ perceived increased risk of cancer. The questionnaires to test this included the Bipolar Profile of Mood States (POMS-BI). This sought to understand how each individual’s experience and their mood states changed on a daily basis (Frost et.al. 2013). These two factors are often highly variable from individual to individual (Lorr, 1984: Lorr, McNair & Heuchert, 1984). This is because changes in their experiences and mood states may be affected by consuming different food or drink, all social interactions, any life events, which may occur in conjunction with the effects of any drugs or prescribed medications, which the patient may be taking (Loke, Hinrichs & Ghoneim, 1985).

The POMS-BI test was developed to assess all of the possible factors, which may influence an individual mood states negatively, or positivity (Lorr, 1984: Lorr, McNair & Heuchert, 1984). These mood states may range from an individual being extremely happy to depressed, agreeable to aggressive, anxious to cool, calm and collected, clear headed to confused, assertive to unconfident and lethargic to energetic (Lorr, 1984; Lorr, McNair & Heuchert, 1984). It was believed that in clinical settings only the negative states, which have been described, were measured as individuals ignored any positive feelings. However, the PMOS-BI test allowed both positive and negative states to be measured and observed in a clinical setting.

Suitability of the items

The POMS-BI test is based on the principle that it can be used to identify both positive and negative moods states and feelings when it is used on psychiatric patients. This enables health professionals to identify the patient’s current clinical condition. Furthermore, it may be used to measure the effectiveness of treatments such as, various psychotropic drug treatments, which may be utilised for patients presenting with anxiety or depression disorders (Lorr, McNair & Fisher, 1982). Each of these items, which the POMS-BI test is able to measure, can also be used to understand the effectiveness of other treatments such as, relaxation therapy or cognitive behavioural therapy. It may also be utilised to compare a variety of personality disorders (Svrakic, Przybeck, & Cloninger, 1992) which have been outlined in DSM III.

The POMS-BI test has two sections, one, which focuses on how patients feel in their present state, and one, which determines how they have felt over the last week. The section which focuses on their present state of mind asks the patient to rate how they feel. They are given a number of options within the questionnaire and have to choose the most appropriate of these. The second part of the questionnaire asks them to rate when they have felt ‘much like this’, so it is less focused than the first part. However, again patients are asked to choose from a range of options. The options, which they choose, allow the clinician to sum the score from the scales and this then allows them to rate the patient’s positive or negative states.

Lorr & Wunderlich (1988) found in their study, that in order to measure positive effects from the questionnaire, the half scale score items needed to be twelve half scales for each. The identification of the positive effect is based on the sum total of the item scores on the six positive scales, whilst the negative effect is based on the sum of item scores on the six negative scales.

Thus, from the above, for the suitability of answering POMS-BI, we can ascertain that this test is expedient for each patient to answer them and it does not take a long time. The questionnaire is easy to understand and individuals do not have to think through their answers, they just have to be aware of their current mood state or feeling to be able to undertake the POMS-BI questionnaire (Svrakic, Przybeck, & Cloninger, 1992). This makes it suitable for a number of patients who may need to be assessed in a clinical setting.

Reliability

One example, which may be cited which demonstrates the reliability of the POMS-BI test was undertaken from a study where mood states were assessed using the POMS –BI (McNair, Lorr & Droppleman, 1971). The responses from respondents were provided on a 5-point scale anchored by 0 = “not at all” and 4 = “extremely”. The study found that the internal consistency (alpha) coefficients for the POMS subscales ranged from .84 to .95 (McNair, Lorr & Droppleman, 1971). Furthermore, the Test-retest reliability coefficients ranged from .65 to .74 (McNair, Lorr & Droppleman, 1971). This one study demonstrates that the POMS-BI test is highly reliable.

Validity

The POMS-BI tests validity has also been ascertained through a number of studies, which have been undertaken in psychotherapy, outpatient drug trials, emotion inducing studies and criterion studies. Each of these types of validity tests has proven the usefulness of POMS-BI. From the psychotherapy studies that have been undertaken to ascertain the validity of POMS-BI, Lorr et.al. (1961) found that over an eight-week period, whilst it was compared to other treatments that there was a significant improvement in the tension, depression and anger that was reported by patients. In comparison to this, another study (Haskell, Pugatch & McNair, 1969) that found that there was no significant changes in the same emotional states of tension and anger, only in depression, which Lorr et.al. (1961) had identified.

In a study of POM-BI, with outpatient drug trials Lorr & McNair (1966) successfully demonstrated that the prescribed medication had reduced the levels of tension in the control group. However, this also demonstrated that the prescribed drugs did not reduce the patient’s vigour.

Further, to this studies, which have examined the effectiveness of POMS-BI to measure emotionally induced states. In one study conducted by Startup & Davey (2001), scholars found that there was a direct link between a patient’s mood state and the level of worry that they experienced. Further to this, in another study conducted by Doyle and Parfitt (1999) a direct correlation was measured between induced mood states and the perceived need profile of patients. Both of these studies, show that PMOS-BI may be used to measure emotionally induced states effectively.

In the criterion studies, Parloff, Kelman, & Frank, J. D. (1954) surmised that the patients that were tested by using POMS and the Hopkin Symptom Distress Scale, both attained the same outcome scores in relation to the levels of tension, depression or fatigue that they were feeling. This demonstrates the validity of POMS.

Normative Data or Norms

When each of these studies has been undertaken, utilising the POMS-BI scholars has been able to establish normative data or norms. For example, in one study, was conducted to understand the influence of a weight lifting programme that lasted for ten weeks. The patient group comprised of 32 adults who were aged between 60-84. The data indicated that ‘before the intervention, the depressed participants in both groups reported less frequent energy feelings compared with age norms (i.e., the mean SD for the relevant norms is 59.9, 22.1, and these data stem from a sample of 442 U.S. men and women between the ages of 65 and 74 yr).. After the 10-wk intervention, those who exercised reported a large increase in the frequency of energy feeling of 1.3 standard deviations’ (Rayman et.al. 2006: 148). This shows that by using the POMS-BI scholars are able to understand norms and normative data by which they may measure the outcomes of their studies and compare them to others.

Practical Considerations

The practical considerations which need to be considered when planning to utilise the POMS-BI are small, as the questionnaire does not take long for patients to fill in (no more than ten minutes on average). The materials needed for them to do this are the questionnaire which is usually printed on paper and a pencil so that they can choose the response that is most relevant to them. The POMS-BI score is easily calculated by clinicians using negative and positive mood state indicators. They do not even need to have scoring templates as the scores can be easily placed into a scoring page so that they can assess the patient’s current mood state. In addition, to each of these factors the questionnaire is easy to understand, so patients and clinicians should not need to spend too much time discussing what each of them need to do. This adds to the amount of therapy time which the patient may have. The only other consideration is if the patient’s first language is not English, under the circumstances it may be necessary to take some time to explain the questionnaire to them to ensure that they fill it in correctly. However, you may also be able to get POMS_BI forms in other languages upon request. The only other consideration is that this type of form should only be used by qualified clinicians who are fully competent and understand the outputs from the questionnaire fully.

Conclusion

This report has assessed many of the different aspects of using POMS-BI to assess patient’s positive and negative mood states or feelings. From each of the sections above, it may be understood that the use of this questionnaire is easy, not time consuming and simple. From this perspective, one may say that using the POMS-BI questionnaire to measure the patient’s positive and negative mood states or feelings is practical. In addition to this, a number of clinicians and scholars have used this toll successfully over the last few decades to assess patient’s moods, and today there are many citations in the literature that may be used to attain this methods validity and reliability. This method has also been used in a wide variety of organisations from schools, universities to working environments or clinical settings. Therefore, the questionnaire may be widely used in a variety of settings to measure patients positive and negative mood states or feelings. All of this evidence attests to why it was a useful tool which could be utilised to understand the psychosocial morbidity and health concerns accompanying individuals’ perceived increased risk of cancer (Frost et.al. 2000). As Frost et.al. (2000) could use the questionnaire to understand how each individual’s experience and their mood states changed on a daily basis (Frost et.al. 2000) in relation to their experiences, the food or drink that they consumed, their social interactions or any life events which may have occurred during this time (Loke, Hinrichs & Ghoneim, 1985). Thus, the test was ideal for this scenario and it should be utilised by clinicians in the future, as individuals that are at risk of developing cancer due to their circumstances may also be at a higher risk of suffering from depression, anxiety or other psychological disorders. This test could help to diagnose their symptoms early and this could ensure that they received the appropriate treatment sooner rather than later

References

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