MODELOS DE SISTEMAS DE SALUD

There were six separate group comparisons of mean scores on the measures. The first comparison was between the present sample and normative samples. The remaining comparisons were between groups of participants, which are presented here as two sets of results: (1) demographic characteristics and (2) medical characteristics.

Comparison of Sample with Norms

A series of z-score tests were performed to determine the significance of mean score differences on the measures between the present sample and normative samples. A z-score test provides an indication as to whether the ‘distance’ a mean score deviates from a population is most likely to have occurred by chance (Heiman, 1992). The critical value (or ‘cut-off score’) used to locate significant differences in mean scores was equivalent to the significance level of .05 (critical value [z] = ± 1.64). Each z-score test was calculated separately for males and females. The results of the z-score tests including mean scores for the male and female samples (and normative samples where available) are presented in Table 11.

Table 11. Mean Score Differences Between the Present Sample and Normative Samples on the Measures for Males and Females.

MALES FEMALES

Sample Normative Sample Normative

Measures M M SD Z M M SD Z SF-36 Summary • Physical Health 42.7 50.1 9.9 -4.4* 47.7 49.5 10.4 -1.0 • Mental Health 46.2 50.8 9.6 -5.2* 45.7 49.4 10.3 -3.9* SIPI Patterns • Positive Construct. 46.5 48.5 9.1 -1.9* 46.4 50.2 9.6 -4.3*

• Guilt & Fear Failure 38.5 34.3 9.9 2.5* 35.6 33.1 10.1 2.7*

• Poor Attentional Con. † 44.4 46.9 9.8 -1.5 43.4 48.7 10.7 -5.4* Sample: SF-36: male n = 34, female n = 116; SIPI: male n = 34; female n = 119.

Normative: SF-36: male n = 8856, Female n = 9612; SIPI: male n = 449; female n = 547. † This measure is negative scored: higher scores represent lower attentional control.

* p < .05.

As can be seen in Table 11 mean scores recorded by the samples of males and females on the measures were significantly different from the norm. Specifically, the mental health of the male and female samples was below the norm in the general population. The physical health of males, but not females, was also below the norm. The samples of males and females reported fewer positive constructive daydreams, but more guilt and fear of failure daydreams than the norm for college students. The attentional control of females, but not males, was also ‘better’ then the norm.

Comparison of Male and Female Samples

A multivariate analysis of variance (MANOVA) was performed to determine if differences in mean scores on the measures between males and females were significant. There were eight dependent variables: severity of physical symptoms, physical health, mental health, frequency of daydreaming, positive constructive daydreaming, guilt and fear of failure daydreaming, poor attentional control, and quality of daydreaming. Sex (male or female) was entered as the independent variable. Age was included as a covariate as males were older in age than females. The identification of significant interactions was set at the significance level of .05.

Multivariate interaction effects were interpreted using Pillai’s Trace criterion. There were no univariate outliers (using a case-wise plot of outliers outside + 3.0 standard deviations) or multivariate outliers (using Mahalanobis Distance). Two- univariate homogeneity of variance tests (Cochrans C & Bartlett-Box F tests) were significant (p < .05) for severity of physical symptoms and physical health. A multivariate test of homogeneity (Box’s M Test) was, however, not significant (p > .05). The number of cases in each cell was greater than the number of dependent variables. Within-cell scatter-plots indicated that the relationships between dependent variables were linear, and there were no serious indications of singularity or multicollinearity (using within-cell correlations & Log [Determinant]).

Age had a significant multivariate effect on the combined dependent variables, F

(8, 131) = 4.4, p < .001. There were significant univariate effects for age on physical health, F (1, 138) = 12.8, p < .001, mental health, F (1, 138) = 4.0, p < .05, attentional

control F (1, 138) = 11.3, p = .05, frequency of daydreaming, F (1, 138) = 15.6, p <

.001, and guilt and fear of failure daydreaming, F (1, 138) = 4.7, p < .05.

There was no significant multivariate effect for sex on the combined measures of health and daydreaming, F (8, 131) = 1.1, p > .05, controlling for age. The results

of univariate tests for each dependent variable are available in Appendix B.

The measure of social desirability was not entered in the MANOVA due to a low number of respondents (n = 83). Its inclusion would have led to a marked decline in the number of valid cases accepted in the analysis. Instead a one-way analysis of variance (ANOVA) was performed to determine if there was a significant sex difference in mean scores for social desirability. Sex (male or female) was entered as the independent variable, while social desirability was the dependent variable. Age was included as a covariate. The identification of significant interactions was set at the significance level of .05.

Age did not have a significant univariate effect on scores for social desirability,

F (1, 82) = 4.1, p > .05. There was also no significant difference, F (1, 82) = 2.9, p >

.05 in mean scores for social desirability between males (M = 3.8, SD = 1.7, n = 26) and females (M = 4.4, SD = 1.7, n = 57) controlling for age.

Comparison of Age Groups

A MANOVA was performed to determine if there were significant differences in mean scores on the measures between three age groups: (1) 18 to 34 years, (2) 35 to

54 years, and (3) 55 years or more. There were eight dependent variables: severity of physical symptoms, physical health, mental health, frequency of daydreaming, positive constructive daydreaming, guilt and fear of failure daydreaming, poor attentional control, and quality of daydreaming. Age was entered as the independent variable. The MANOVA was performed separately for males and females. The identification of significant interactions was set at the significance level of .05.

Multivariate interaction effects were interpreted using Pillai’s Trace criterion. There were no univariate outliers (using a case-wise plot of outliers outside + 3.0 standard deviations) or multivariate outliers (using Mahalanobis Distance). Two- univariate homogeneity of variance tests (Cochrans C & Bartlett-Box F tests) were significant (p < .05) for male scores on severity of physical symptoms. A multivariate test of homogeneity (Box’s M Test) was, however, not significant (p > .05). The number of cases in each cell was greater than the number of dependent variables. Within-cell scatter-plots indicated that the relationships between dependent variables were linear and there were no serious indications of singularity or multicollinearity (using within-cell correlations & Log [Determinant]).

The multivariate effect of age on the combined dependent variables was significant for females, F (8, 99) = 2.32, p < .01, but not males, F (8, 24) = 1.17, p >

.05. Age of females had a significant univariate effect on scores for physical health, F

(2, 105) = 9.12, p < .001. The results for females of Scheffe Post-Hoc Tests used to locate significant differences are presented in Table 12.

Table 12. Post-Hoc Testing for Significant Age Differences on Measures of Physical Health and Mental Health for Females (n = 108).

Dependent Variables † Age (Years) M SD F P

Physical Health • 18 to 34 51.7 8.3 9.12 .00 • 35 to 54 45.6* 9.5 • 55 & more 41.2* 8.7 Mental Health • 18 to 34 42.6 11.6 2.62 .07 • 35 to 54 47.9 11.4 • 55 & more 47.1 13.4

* Mean scores for these two age groups were significantly below 18 to 34 years. † Higher scores indicate more favourable states of health.

There was a linear decline in female physical health with increasing age (Table 12). The physical health of females aged over 35 years was significantly below that of younger females aged 18 to 34 years. There was also a trend for younger females (18 to 34 years) to report lower mental health. They recorded a mean score for mental health that was much lower than that of females aged over 35 years. The results of all univariate tests with descriptive statistics for males and females are in Appendix B.

A subsequent independent t-test was performed for females with two age groups as the independent variable: 18 to 34 years and 35 years and older. Mental health was the dependent variable. The mental health of younger females aged 18 to 34 years (M = 42.12, SD = 11.55) was significantly, t (114) = -2.9, p < .05, below that of females aged above 34 years (M = 48.46, SD = 11.56).

An ANOVA was performed to determine if there were significant differences in mean scores between the three age groups on the measure of social desirability. Age was entered as the independent variable. Social desirability was the dependent variable. The ANOVA was performed separately for males and females. The identification of a significant interaction was set at the significance level of .05.

Age did not have a significant univariate effect on social desirability for males,

F (2, 23) = .8, p > .05, or females, F (2, 54) = .8, p > .05. The results of the ANOVA

with descriptive statistics for males and females are available in Appendix B. Comparison of Socio-Economic Groups

A MANOVA was performed to determine if there were significant differences in mean scores on the measures between participants low and high in socio-economic status. Scores for socio-economic status were condensed into these two groups via median split (median = 3, score range = 1 to 7). There were eight dependent variables: severity of physical symptoms, physical health, mental health, frequency of daydreaming, positive constructive daydreaming, guilt and fear of failure daydreaming, poor attentional control, and quality of daydreaming. Socio-economic status (low or high) was entered as the independent variable. The MANOVA was performed separately for males and females. Age was included as a covariate. The identification of significant interactions was set at the significance level of .05.

Multivariate interaction effects were interpreted using Pillai’s Trace criterion. There were no univariate outliers (using a case-wise plot of outliers outside + 3.0 standard deviations) or multivariate outliers (using Mahalanobis Distance). Two- univariate homogeneity of variance tests (Cochrans C & Bartlett-Box F tests) were

significant (p < .05) for severity of physical symptoms and physical health. A multivariate test of homogeneity (Box’s M Test) was, however, not significant (p > .05). The number of cases in each cell was greater than the number of dependent variables. Within-cell scatter-plots indicated that the relationships between dependent variables were linear, and there were no serious indications of singularity or multicollinearity (using within-cell correlations & Log [Determinant]).

Age had a significant multivariate effect on the combined dependent variables for males, F (8, 16) = .63, p < .05, and females, F (8, 82) = .24, p < .01. There were

significant univariate effects for male age on attentional control, F (1, 23) = 19.2, p <

.001, frequency of daydreaming, F (1, 23) = 12.1, p < .01, and quality of

daydreaming, F (1, 23) = 4.9, p < .05. There were significant univariate effects for

female age on physical health, F (1, 89) = 13.1, p < .001, attentional control, F (1, 89)

= 4.5, p < .05, and frequency of daydreaming, F (1, 89) = 5.3, p < .05.

The multivariate effect of socio-economic status on the combined dependent variables was not significant for males, F (8, 16) = .37, p > .05, or females, F (8, 82) =

.06, p > .05, controlling for age. The results of univariate tests for each dependent variable for males and females are available in Appendix B.

Comparison of Low and High Attenders

A MANOVA was performed to determine if differences in mean scores between low and high attenders on the measures of health were significant. The three measures of health were entered as dependent variables: severity of physical symptoms, physical health, and mental health. The independent variable was general practice utilisation (low or high). The MANOVA was performed separately for males and females. Age was included as a covariate. The identification of significant interactions was set at the significance level of .05.

Multivariate interaction effects were interpreted using Pillai’s Trace criterion. There were no univariate outliers (using a case-wise plot of outliers outside + 3.0 standard deviations) or multivariate outliers (using Mahalanobis Distance). Two- univariate homogeneity of variance tests (Cochrans C & Bartlett-Box F tests) were significant (p < .05) for male scores on severity of physical symptoms. However, a multivariate test of homogeneity (Box’s M Test) was not significant (p > .05). The number of cases in each cell was greater than the number of dependent variables. Within-cell scatter-plots included that interactions between dependent variables were

linear and there were no serious indications of singularity or multicollinearity (using within-cell correlations & Log [Determinant]).

Age had a significant multivariate effect on the combined dependent variables for females, F (3, 108) = 4.4, p < .001, but not males, F (3, 28) = .7, p > .05. There

were significant univariate effects for female age on physical health, F (1, 112) =

13.6, p < .001, and mental health, F (1, 112) = 7.3, p < .01, but not severity of

physical symptoms, F (1, 112) = .2, p > .05.

The multivariate effect of general practice utilisation on measures of health was significant for males, F (3, 28) = 2.8, p = .05, and females, F (3, 108) = 5.9, p = .001,

controlling for age. The results of univariate tests including descriptive statistics for males and females for each measure of health are presented in Table 13.

Table 13. Testing for Differences Between Low and High Attenders on Measures of Health for Males (n = 20) and Females (n = 113).

General Practice Utilisation †

Low High Health Status M SD M SD F p Physical Health ‡ • Male 49.3 8.6 39.4 13.2 5.44 .03 • Female 50.4 8.2 43.4 9.8 11.26 .00 Mental Health • Male 50.0 9.6 44.3 12.8 1.95 .17 • Female 46.2 11.6 44.8 12.5 1.52 .22 Severity of Symptoms • Male 1.5 .5 1.7 .4 1.96 .17 • Female 1.5 .3 1.5 .3 .26 .61

† Male n: high n = 20, low n = 13. Female n: high n = 43, low n = 70. ‡ Higher scores indicate more favourable states of physical health.

As can be seen in Table 13 high attending males and females were significantly lower in physical health than were low attenders. There were no further significant differences between the two attendance groups in health status.

Comparison of Social Desirability Groups

A MANOVA was performed to determine if there were significant differences in mean scores on the measures between participants low and high in social desirability. Scores for social desirability were condensed into these two groups via median split (median = 4, score range = 0 to 6). There were eight dependent variables: severity of physical symptoms, physical health, mental health, frequency of daydreaming, positive-constructive daydreaming, guilt and fear-of-failure daydreaming, poor attentional control, and quality of daydreaming. Social desirability (low or high) was entered as the independent variable. The MANOVA was performed separately for males and females. Age was included as a covariate. The identification of significant interactions was set at the significance level of .05.

Multivariate interaction effects were interpreted using Pillai’s Trace criterion. There were no univariate outliers (using a case-wise plot of outliers outside + 3.0 standard deviations) or multivariate outliers (using Mahalanobis Distance). Two- univariate homogeneity of variance tests (Cochrans C & Bartlett-Box F tests) were significant (p < .05) for male scores on severity of physical symptoms. However, a multivariate test of homogeneity (Box’s M Test) was not significant (p > .05). The number of cases in each cell was greater than the number of dependent variables. Within-cell scatter-plots included that interactions between dependent variables were linear and there were no serious indications of singularity or multicollinearity (using within-cell correlations & Log [Determinant]).

Age did not have a significant multivariate effect on the combined dependent variables for males, F (8, 21) = .8, p > .05, or females, F (8, 44) = 1.6, p > .05. There

was a significant multivariate effect for social desirability on the measures for females, F (8, 44) = 2.5, p < .05, but not males F (8, 21) = .6, p > .05. The results of

female univariate tests for each dependent variable are presented in Table 14. The equivalent univariate tests for males are available in Appendix B.

Table 14. Testing for Significant Differences on the Measures Between Females Low and High in Social Desirability (n = 48).

Groups of Social Desirability

Low High

Dependent Variables M SD M SD F p

• Physical Health † 48.3 9.6 41.6 10.1 5.25 .03

45.7 12.4

• Mental Health 49.5 11.4 1.17 .29

• Severity of Physical Symptoms 1.5 .3 1.5 .3 .52 .48

• Positive Constructive 46.9 9.7 45.0 9.4 .45 .51

• Guilt & Fear of Failure 36.9 7.8 31.8 10.0 3.47 .07

• Poor Attentional Control ‡ 43.8 8.2 38.0 8.6 5.53 .02

• Quality of Daydreaming 1.2 .3 1.3 .3 1.98 .17

• Frequency of Daydreaming 3.4 1.6 2.4 1.4 4.85 .03

† Higher scores indicate more favourable states of physical health.

‡ This measure is negative scored: higher scores represent lower attentional control. The results in Table 14 show that females high in social desirability reported significantly lower physical health than did females low in social desirability. They also reported significantly ‘better’ attentional control and less frequent daydreaming than did females low in social desirability. There was also a trend for females high in social desirability to report less guilt and fear of failure daydreaming.

Summary of Comparisons

The vast majority of participants (98%) provided at least one physical condition as the reason for seeing a general practitioner. Almost half of these participants (45%) reported two or more physical conditions. More than half of all participants (52%) were ‘high attenders’: they had seen a general practitioner at least once each month over a 12-month period. However, their self-reported severity of physical symptoms was not dissimilar to that of low attenders. Most participants (93%) reported symptoms of minor severity. No participant reported symptoms with ‘a great deal of severity’. There was no difference between males and females in symptom severity.

There was also no sex difference in physical health. Even so, only the physical health of males was below the norm in the general population. Male and female high attenders recorded the lowest physical health (in comparison to low attenders). The physical health of females aged over 35 years was below that of younger females aged 18 to 34 years. Most (70%) younger females (18 to 34 years) were low attenders,

while most (81%) older females (55 years or more) were high attenders. Females high in social desirability also reported lower physical health (but not lower mental health). There was no difference between males and females in mental health. The mental health of both samples was below the norm in the general population. Even so, only a minority of participants (3%) nominated mental disorders as the reason for seeing a general practitioner. The mental health of male and female high attenders was also not dissimilar to that of low attenders. However, the mental health of females aged over 35 years was higher than that of younger females 18 to 34 years of age.

The health of participants was not related to financial (and social) background. However, individual indicators of socio-economic status were associated with how often participants saw general practitioners. Most participants (85%) earning high incomes were low attenders. Most high attenders (60%) were low-income earners. Males with no more than primary education also saw general practitioners the most often (74%), whereas most males with secondary schooling were low attenders (75%).

There were no differences between males and females in frequency or patterns of daydreaming. Most males (70%) and females (55%) reported a low frequency of daydreaming. They also reported fewer positive constructive daydreams than the norm (comprising college students), but more guilt and fear of failure daydreams. The attentional control of females was also ‘better’ than the norm. Females high in social desirability also reported better attentional control and less frequent daydreaming.

RELATIONSHIPS BETWEEN MEASURES: