This study examined pregnancy risk and protective factors for developing postpartum depression from a structural family theory lens. The purpose of this study was to (1) examine previously identified pregnancy stressors to learn which stressors put women more at risk for postpartum depression and (2) to identify possible buffers for women who are at risk for developing postpartum depression. In this paper, two analyses were proposed. Analysis I, uses a hierarchal regression analysis to examine the impact of couple related stress on postpartum depression. Analysis II uses moderated multiple regression to test factors during pregnancy which may protect at-risk women from postpartum depression symptoms. Three post-hoc exploratory analyses were conducted following the originally proposed analyses. Secondary data was used in this study. The data was collected in four large urban hospitals in Utah from 2005-2007 and included 1568 women. The results of these analyses illustrate the importance of conceptualizing postpartum depression from a family systems perceptive. Specifically, this study shows that a couple’s relationship, depending on the stress level experienced in the relationship, can be both a risk and protective factor for pregnant women. / Ph. D.

Fatigue, diminution des capacités physiques, diminution de la qualité de vie … sont les conséquences directes d’un cancer et des traitements associés. Lutter contre la diminution de la qualité de vie des patients est désormais une priorité en matière de lutte contre le cancer. L’activité physique adaptée a démontré son efficacité pour des patients en cours de traitement anti-cancéreux. Cette thèse a été réalisée à l’Institut des Sciences du Mouvement. Dans le cadre d’une collaboration avec l’Institut Paoli Calmettes, l’objet de ce travail était de contribuer au développement des connaissances dans le domaine de l’activité physique adaptée en oncologie. Le programme de recherche de cette thèse était organisé en 5 études, rassemblant 262 sujets. Les principaux résultats ont montré que l’activité physique adaptée était bénéfique pour des populations très spécifiques (étude 1) ; d’autre part nous avons montré que l’activité physique pilotée à distance via de nouvelles technologies pouvait être une réelle alternative aux programmes supervisés (étude 3). Par ailleurs, une autre étude (étude 2) a mis en évidence une participation des patients très limitée à ces programmes. Nous avons montré pour la première fois dans la littérature que la perspective temporelle est une variable à prendre en compte dans la promotion de l’activité physique chez ces patients (étude 4) ainsi que la personnalité, l’âge et le lieu de prise en charge (étude 5). Cette thèse apporte donc de nouveaux éclairages tant sur le plan des connaissances scientifiques que sur des propositions thérapeutiques afin de développer et d’améliorer la prise en charge en activité physique des patients pendant un cancer. / Fatigue, decrease of physical capacity, decrease of quality of life ... are direct consequences of cancer and related treatments. Contend against the decline of patients’ quality of life is now a priority in the fight against cancer ( “Plan Cancer 2014-2019”). Adapted physical activity has proven effective for patients undergoing cancer treatment. This thesis, described as "action-research", was conducted at the Institut of Movement Sciences (CNRS UMR 7287 AMU). As part of collaboration with the Institut Paoli Calmettes, Centre de Lutte Contre le Cancer in the PACA region, the objective of this work was to contribute to knowledge development in the field of adapted physical activity in oncology. This research’s program was organized in 5 studies, collecting 262 subjects. Firstly, the main results illustrated that adapted physical activity is beneficial for very specific populations (Study 1); secondly we demonstrated that physical activity remotely managed via new technologies could be a real alternative to supervised programs (Study 3). Furthermore, an additional study (Study 2) revealed a very limited involvement of patients in these programs. For the first time in literature, we revealed that the time perspective is a variable to be considered in the promotion of physical activity for patients (Study 4) as well as personality, age and type of hospital (Study 5). This thesis sheds new light both in terms of the contribution of scientific knowledge and on therapeutic proposals in order to develop and improve supportive physical activity for patients suffering from cancer.

Ce travail de thèse trouve son origine dans une intervention menée auprès du collectif d’ergothérapeutes du centre de rééducation François Gallouedec. Il prend pour objet les dilemmes de métier de ces professionnels lorsqu’ils sont confrontés à la question du travail des patients. L’intervention s’est déployée en suivant une méthodologie développementale propre à la clinique de l’activité. Elle a permis aux ergothérapeutes de prendre pour objet d’analyse leur propre travail lors de programmes de restauration fonctionnelle. La littérature sur ces programmes confirme le choix de s’intéresser aux ergothérapeutes comme principaux destinataires des questions professionnelles des patients. Cependant, les recherches dans le domaine tendent à éluder la question du travail des professionnels de santé et à résumer celui des patients au simple retour à l’emploi.C’est justement pourquoi il nous a semblé intéressant de renverser la question en nous intéressant au travail de ceux qui s’intéressent au travail. Nous avons émis l’hypothèse que ce point difficile confrontait les ergothérapeutes du centre François Gallouedec à des dilemmes de métier notamment lors de la réalisation d’un « atelier geste professionnel ». Les résultats de cette recherche montrent toute l’importance de s’intéresser au travail des professionnels de santé, ce qui est fait mais aussi ce qui n’est pas fait ou ce qu’on aurait voulu faire, pour le développement des modèles de prise en charge des patients. Le réel du travail des rééducateurs peut ainsi devenir une ressource dans la mise en place de programmes de rééducation qui souhaitent s’intéresser à la question du travail du patient. / This thesis work originated in an intervention conducted with the collective of occupational therapists of the rehabilitation center François Gallouedec. It focuses on the job dilemmas of these professionals when confronted with the issue of patient’s work.The intervention was deployed following a developmental methodology specific to the clinic of the activity. It allowed occupational therapists to take their own work as an object of analysis during functional restoration programs. The literature on these programs confirms the choice to focus on occupational therapists as the primary addressee for patients' professional issues. However, research in the field tends to evade the question of the work of health professionals and to summarize that of patients simply returning to employment. This is why we felt it necessary to focus on the work of those who are interested in work. We hypothesized that this difficult point confronted the occupational therapists of the François Gallouedec center with job dilemmas, particularly during the realization of a "professional gesture workshop". The results of this research show the importance of taking an interest in the work of health professionals, which is done but also what is not done or what we would have liked to do, for the development of models of patient care. The real work of there educators can thus become a resource in the implementation of rehabilitation programs that wish to be interested in the question of the work of the patient.

Research is beginning to find a positive and significant relationship between marriage and health. Even though the current literature shows that separation and divorce have strong negative consequences for the mental and physical health of both spouses (Dush & Amato, 2005), the answer to why and how this occurs has yet to be solved. A comprehensive perspective that could greatly benefit the analysis of this connection is the use of social neuroscientific methods in a biopsychosocial model. By including biological factors, social elements, and psychological variables in analyzing marriages, researchers would be able to further understand both the intra- and interpersonal elements of a relationship and their subsequent influence on marital stability. Thus, the purpose of this dissertation was to use social neuroscientific techniques to provide a comprehensive biological, psychological, and social assessments of couples, and compare that comprehension with marital satisfaction. This was accomplished by performing three studies focused on each section of the model: heart and brain reactions for biological, familial influence for social, and personal definition of love for psychological. The sample used for the first study involved 20 married couples that were recruited through flyers on the University’s campus and through announcements on a website (i.e., Craigslist). The participants came into the Family Interaction Resource Lab located on campus and were instructed to engage in a conflict interaction while being connected to a device used to measure heart and brain waves. The sample used for studies two and three included 635 participants that were recruited through mailouts, emails, and recruitment on a website (i.e., Facebook). These participants completed an online questionnaire using Qualtrics software and were all currently married. The insights provided by the results helped to (1) advance current knowledge surrounding interpersonal relationships, (2) elucidate on marital conflict for therapists and educators working with couples, (3) expand upon a rarely used research procedure for analyzing relationships, and (4) build upon the extant literature across numerous disciplines.

Background: Clinical and physiotherapy professional guidelines advocate enquiry into, and documentation of the impact of musculoskeletal pain on a range of psychosocial and functional aspects of life. However, there is no clinical tool to assist this process. The Impact of Symptoms Questionnaire (IoSQ) is patient-completed and was developed to meet the needs of outpatient physiotherapists. It explores the impact of health conditions on patients’ beliefs/concerns and their ability to undertake work/caring responsibilities and activities of daily living; and to enjoy their usual hobbies or activities. It also enquires into the impact on mood and relationships. It comprises a “Yes” or “No” response for each of the five domains with the option of providing written comments. There are also four numerical rating scales. A discharge version determines if patients’ needs and expectations have been addressed. However, the acceptability and usefulness of the IoSQ has not been explored in a department naive to its development. Project purpose Two studies were undertaken, to explore: the role of the IoSQ for enhancing documentation of psychosocial and functional assessment; and the perceptions of staff and patients regarding the acceptability and clinical value of the IoSQ Research questions Enquiry into the primary research question, “Is the introduction of the Impact of Symptoms Questionnaire to a physiotherapy outpatient department acceptable and clinically useful for patients and staff?” was undertaken through secondary questions which explored: patients’ experiences of psychosocial and functional assessment before and after the introduction of the IoSQ; the role of the IoSQ for the provision of documentation; evidence for staff and patients engaging with the IoSQ; and staff and patients’ experiences of using the IoSQ. Project design and methods: A pragmatic mixed model project was undertaken in a department comprising predominantly post-surgical orthopaedic patients. Study 1 explored current practice; study 2 explored the impact of introducing the IoSQ, with minimal training as to its role or use. Methods for both studies comprised sequential audits of patients’ notes, and surveys and focus groups for patients and staff. Results: The audits (study 1, n=60; study 2, n=55) highlighted that documentation by physiotherapists for assessing the impact across all five domains remained low at about 20%, with 40% of the notes in both studies not providing evidence of enquiry into any of the domains. Only one set of notes provided physiotherapist evidence that a domain was still affected at discharge. Study 2 showed that patients consistently completed the IoSQ with 62.6% of the domains being affected at assessment and 19% of the domains being unresolved at discharge, affecting 64.1% of the patients. Survey feedback (study 1, n=19/60; study 2, n=33/55) identified that patients felt it was important to assess the broader impact of a health problem and staff and patients indicated that the IoSQ was relevant to the presenting conditions and was easy to use. This was further explored in the three focus groups (patients, n=3 studies 1 and 2; physiotherapists n=8, study 2) where frustration with validated outcome questionnaires in current use was expressed. However, patients felt they took responsibility for raising issues, even when the IoSQ was provided. Patients and staff felt that if physiotherapists were able to engage with the IoSQ better, it could help to provide structure and prompts to identify patients’ questions or concerns about their condition and the functional impact. The potential for patients to describe the impact in their own words was particularly valued as well as its potential, to improve rapport and more effectively match expectations It was also demonstrated that the IoSQ can enhance documentation of the impact of health problem - from the patient’s perspective. Conclusion: Patients engaged well with the IoSQ and it has potential to be a useful tool to facilitate identification and discussion of the broader psychological, social and functional impact of a health problem. However, staff would need additional training to facilitate discussion with the completed forms and patients, and further research would be required to determine its impact on patient outcomes.

<p>Uvod: Mikrodiskektomija je jedan od savremenih hirur&scaron;kih metoda u lečenju osoba sa lumbalnim sindromom, čiji je uzrok hernijacija intervertebralnog diska. Na postoperativni oporavak, ishod rehabilitacije i funkcionalno stanje, veliki uticaj imaju i biopsihosocijalni faktori. Cilj: Glavni cilj istraživanja je bio procena uticaja biopsihosocijalnih faktora na ishod lečenja i funkcionalni status bolesnika sa lumbalnim sindromom nakon mikrodiskektomije i sprovedenog rehabilitacionog tretmana. Materijal i metode: Sprovedena je prospektivna studija na 200 pacijenata (96 mu&scaron;karaca i 104 žene), različitih profesija, prosečne životne dobi 50.20 &plusmn; 10.26 godina (raspon 29&ndash;69 godina). U istraživanje su uključeni pacijenti nakon operativnog lečenja hernijacije diska, putem mikrodiskektomije, preme&scaron;teni sa Klinike za neurohirurgiju na Kliniku za medicinsku rehabilitaciju, Kliničkog centra Vojvodine u Novom Sadu. Stratifikacija ispitanika je izvr&scaron;ena prema njihovim biolo&scaron;ko-demografskim, socio-ekonomskim, psiholo&scaron;kim i funkcionalnim obeležjima, uz kori&scaron;ćenje podataka iz anamneze, kliničkog pregleda, raspoložive medicinske dokumentacije i odgovarajućih upitnika i testova. Kori&scaron;ćeni su sledeći upitnici: za procenu bola-vizuelna analogna skala (VAS), upitnik o bolu (Pain Detect Test), za procenu psiholo&scaron;kih karakteristika Spilbergerovi testovi za trenutnu i op&scaron;tu anksioznost (Spielberger Anxiety Inventory-State and Trait Test), Bekova skala depresije (BDI), upitnik za procenu prisustva straha od fizičke aktivnosti i posla i njihovog izbegavanja (The Fear-Avoidance Beliefs Questionnaire - Physical activity and Work), a za procenu funkcionalnog statusa Osvestrijev upitnik o onesposobljenosti (ODI) i Kvebek skala onesposobljenosti osoba sa lumbalnim sindromom. Fleksibilnost i indeks pokretljivosti lumbalnog segmenta kičme su procenjivani pomoću &Scaron;oberovog i Tomajerovog testa. Navedena ispitivanja su obavljena postoperativno pre početka sprovođenja rehabilitacionog tretmana (0. mesec), potom posle mesec dana i zatim 3 i 6 meseci posle mikrodiskektomije. Rezultati: Na doživljavanje bola i na funkcionalnu sposobnost imali su signifikantnog uticaja sledeći navedeni činioci. Pol: subjektivno doživljavanje bola je bilo jače kod žena nego kod mu&scaron;karaca, ali je stepen funkcionalne onesposobljenosti (prema ODI i Kvebek skali) bio signifikantno veći (p&lt;0.01) kod mu&scaron;karaca. Životna dob: Stepen oporavka pacijenata nakon mikrodiskektomije je tokom vremena u pojedinim starosnim grupama bio promenljiv, ali je u celini bio lo&scaron;iji kod starijih osoba. Navika pu&scaron;enja: intenzitet bola (VAS) i stepen funkcionalne onesposobljenosti (prema ODI i Kvebek skali ) su bili veći kod pu&scaron;ača nego kod nepu&scaron;ača (p&lt;0.01). Mehaničko opterećenje kičme: manji stepen oporavka su imali ispitanici čije zanimanje je povezano sa većim dinamičkim i statičkim opterećenjem kičmenog stuba. Socijalni faktori: redovno zaposlenje i novčana primanja su povezani sa boljim funkcionalnim oporavkom. Psiholo&scaron;ki status i stepen optimizma: anksioznost i strahovi od fizičke aktivnosti i posla, strah od gubitka posla, depresija, negativni stavovi i pesimizam su signifikantno če&scaron;će prisutni kod ispitanika koji su imali manji stepen funkcionalnog oporavka tokom praćenog perioda. Zaključci: Na doživljavanje bola i na funkcionalnu sposobnost i oporavak pacijenata nakon mikrodiskektomije imali su signifikantnog uticaja sledeći biopsihosocijalni faktori: pol, životna dob, navika pu&scaron;enja, mehaničko opterećenje kičme, socijalno-ekonomski faktori, psiholo&scaron;ki status i stepen optimizma pacijenta. Primenom odgovarajućih upitnika i registrovanjem ovih faktora, može se kreirati model za predviđanje stepena funkcionalnog oporavka i za primenu dopunskih terapijskih postupaka posle načinjene mikrodiskektomije.</p> / <p>Introduction: Microdiscectomy is one of the modern surgical methods for the treatment of people with low back pain, caused by a herniated intervertebral disc. On postoperative recovery, rehabilitation outcome and functional status, among others, great influence have also biopsychosocial factors. Goal: The main goal of the research was to assess which biopsychosocial factors have a significant impact on treatment outcome and functional status of patients with low back pain after lumbar microdiscectomy and the subsequent physical therapy. Material and methods: The research was conducted as a prospective study on 200 patients (96 men and 104 women), of various professions and mean age 50.20 &plusmn; 26.10 years (range 29-69 years). The study involved patients after surgical treatment of disc herniation by microdiscectomy, who were transferred from the Clinic for neurosurgery to the Clinic for medical rehabilitation, in Clinical center of Vojvodina, Novi Sad, in order to perform physical therapy and rehabilitation. Stratification of patients was performed according to their biological, demographic, socio-economic, psychological and functional characteristics, using data from the health history, clinical examination, the available medical records and appropriate questionnaires and tests. Among the questionnaires were those that are used for assessment of pain, psychological and psychosocial characteristics and functional status of patients with low back pain, including a visual analogue scale, Pain Detect Test, Spielberger Anxiety Inventory-State and Trait, Beck Depression Inventory, The Fear-Avoidance Beliefs Questionnaire (Physical activity and Work), Oswestry Low Back Pain Disability Questionnaire (ODI) and Quebec Back Pain Disability Scale. The flexibility of the lumbar segment of the spine and its movement index were assessed by Schober&#39;s and Thomayer&#39;s tests. All of these above mentioned assessments were carried out just before the start of the rehabilitation treatment (month 0), at the beginning of physical therapy (month 0), one month later and then 3 and 6 months after microdiscectomy. Results: On the pain and functional ability / disability the significant influences had following listed factors. Gender: subjective perception of pain was stronger among women than among men, but the degree of functional disability (ODI and Quebec Scale) was significant higher in the group of men (p&lt;0.01). Age: The degree of recovery among patients after microdiscectomy over time in different age groups was varying, but in general was worse in the group of older people. Smoking habits: pain intensity and degree of functional disability were higher among smokers than nonsmokers (p&lt;0.01). Mechanical loading of the spine: lower degree of recovery had subjects whose job is associated with a higher dynamic and static loading of the spine. Social factors: regular employment and cash income are associated with better functional recovery. Psychological status and the degree of optimism: anxiety and fear of physical activity and work as well as the possibility of job loss, depression, negative attitudes and pessimism, were significantly more often present in the group of patients who had a lower degree of functional recovery during the studied period. Conclusions: On the experience of pain, on functional ability and recovery of patients after microdisectomy, significant influences have the following biopsychosocial factors: gender, age, smoking habits, the mechanical loading of the spine, socio-economic factors, psychological status and the degree of optimism of the patient. Using the appropriate questionnaires and registering mentioned factors, it is possible to create a model for predicting the degree of functional recovery and for the application of additional therapeutic procedures after microdisectomy.</p>

In Minnesota’s workers’ compensation system, injured employees at risk for sustaining permanent disability may be eligible for receipt of vocational rehabilitation (VR) services if they are determined to be capable of benefitting from such services. VR services can be a valuable resource to injured employees who need assistance minimizing their work disability and maximizing their residual wage-earning capacity. However, for VR services to be effective at a system level, it is necessary to precisely and accurately identify an injured employee’s rehabilitation potential. Failure to do so is likely to result in the misallocation of a scarce and costly resource. Given recent trends in Minnesota’s workers’ compensation system (e.g., higher VR service costs and lower RTW rates among injured employees with indemnity claims), this study was conducted with the purpose of developing and validating an objective, evidence-based method of predicting the RTW status as of claim closure of injured Minnesota employees who sustained permanent impairment and received VR services. To accomplish this purpose, a closed-claim, retrospective design was implemented. Data for this cross-sectional study was obtained from the Minnesota administrative claims database. There were 15,372 claims that met all eligibility criteria. With guidance from the biopsychosocial disablement models developed by Nagi and the World Health Organization, 15 discrete predictor variables that represented medical, individual, and workplace factors were selected for study inclusion. Descriptive and predictive analyses were used to assess the relationship between this study’s RTW outcome and its set of RTW predictors. Using logistic regression, an optimal RTW model was first developed and then internally validated with a split-dataset approach. The optimal RTW model included four main effects (attorney involvement; severity of permanent impairment; age; job tenure) and three first-order interaction effects (pre-injury average weekly wage X pre-injury industry; attorney involvement X severity of permanent impairment; attorney involvement X job tenure). Though not retained in the optimal RTW model, part of body affected and education also had notable bivariate relationships with the outcome. The optimal RTW model’s performance regarding goodness-of-fit and clinical usefulness suggests it may be of value to those assessing rehabilitation potential within Minnesota’s workers’ compensation system.

Poor diet quality is a source of morbidity and mortality within the United States. Previous researchers have examined psychosocial influences on diet; however, the relationship between life chaos, a psychosocial measure, and diet quality was not known. The purpose of this cross-sectional survey study was to use the Life Chaos Scale and the Healthy Eating Index-2010 to collect data on life chaos and diet quality, consistent with the biopsychosocial model of health, from a sample of 103 U.S. adults. Regression analysis was used to construct a predictive model. According to the study results, life chaos was not a significant predictor of diet quality (p = .699), although household income, when added to the model, was a predictor of diet quality (p = .011). Although there was no relationship between life chaos and diet quality, life chaos could be found universally throughout household income levels. Additionally, diet quality had a negative correlation with household income. Life chaos was not a significant predictor of diet quality, while confirming the role of income in diet quality. As inequalities of health and nutrition continue to be better understood through studies such as this, social change efforts can be targeted in an evidence-based way to bring the health benefits of a high quality diet to more Americans starting with greater outreach to low-income individuals.

The present study was designed to assess the risk factors associated with carpal tunnel syndrome (CTS). Toward this end, a wide range of putative occupational, biological , and psychosocial correlates of CTS was investigated using a case-control methodology. Cases were 87 patients from an orthopedic clinic with clinical symptoms and electrodiagnostic testing results suggestive of CTS. Controls were 74 gender-matched patients from the same orthopedic clinic, without clinical symptoms of CTS and normal electrodiagnostic testing results. Participants completed a self-report questionnaire that included eight potential occupational correlates (i.e., repetition, force, vibration, typing, lifting heavy loads, and standing on feet), 10 potential personological correlates (i.e., obesity, advocational exercise levels, diabetes, thyroid problems, arthritis, gynecological surgery, and menstrual complications), and 11 potential psychosocial correlates (i.e., depression, anxiety, somatization, health locus of control job satisfaction, and physical and mental health indices). Results of multiple logistic regression analyses revealed that occupational repetition , vigorous exercise, physical activities with wrist strain, physical health, and job satisfaction were significant predictors of CTS. In addition, obesity was a borderline significant predictor of CTS. Plausible explanations for the current findings, along with implications, are discussed .

The current research examined the proposition that individuals who were securely attached had a fundamentally different reaction and experience of chronic pain to the experience of individuals with an insecure attachment style. A biopsychosocial model of chronic pain was created that included the variables of attachment style, pain, depression, anxiety, somatisation, quality of life, function, disability, neuroticism, age and gender. Three cross-sectional quantitative studies and one qualitative study were conducted. Participants were (a) patients from a multidisciplinary pain centre in a major public hospital, and (b) members of the general population with chronic pain who were recruited from both urban and rural settings, across various community support groups. The total sample was 470. Instruments for the quantitative studies included the Revised Adult Attachment Scale (Collins & Read, 1990), the McGill Pain Questionnaire (Melzack, 1975), the Pain Patient Profile (Tollinson & Langley, 1992), the Quality of Life Inventory (Frisch, 1994), the International Association for the Study of Pain Assessment Protocol (International Association for the Study of Pain, 1986), the Migraine Disability Scale (Stewart, Lipton, Kolodner, Liebermann, & Sawyer, 1999), and the short form of the Eysenck Neuroticism Scale (Eysenck, Eysenck, & Barret, 1985). The clinical and non-clinical participants with a diagnosis of chronic pain syndrome were partitioned as securely or insecurely attached. In the clinical sample, the proportion of securely attached individuals was less than one quarter of the group, while in the non-clinical sample the proportion of individuals in the securely attached group was 50%. For Study 1, (200 individuals from the clinical sample), the groups were partitioned using the classification criteria of Collins and Read (1990). Securely attached participants = 27%, insecurely attached 73%. An analysis of effect of attachment style on overall pain showed that the Securely Attached group reported less overall pain than the Insecurely Attached group. For Study 2, (using the total clinical sample), the sample comprised 27.3% securely attached and 72.7% insecurely attached participants. The Securely Attached group reported less overall Pain, less Negative Affect and Somatisation than the Insecurely Attached group, and higher levels of Quality of Life. Somatisation provided a significant unique contribution of variance to predicting overall Pain, providing some support for the biopsychosocial model, and Negative Affect (Depression and Anxiety combined) made a significant unique contribution to Quality of Life, explaining 26% of the variance. Gender was unrelated to any variable. For Study 3, the sample consisted of rural and urban participants, and the rural group was significantly older than the urban group. No other differences were found. The groups were combined to form the non-clinical group. The group was evenly divided (50%) between securely and insecurely attached groups. Gender was unrelated to any variable. For the non-clinical group, using the variables investigated in Study 2, there was no difference on overall pain scores, but negative affect and somatisation were higher and quality of life lower in the insecure group than in the secure group. No differences were found on Pain Intensity but Pain Pattern differed between the groups. Three new variables were added to the model - Neuroticism, Function and Disability. Disability and Function were significantly different between the attachment style groups. Age was significantly related to lower pain scores, less loss of function, less disability and higher quality of life. Pain scores were most related to somatisation, with age and quality of life contributing significant variance. Neuroticism added further to this explanation. Negative Affect made the most contribution to the variance explained in quality of life, and neuroticism and function made no significant contribution. Neuroticism and Attachment Style contributed significant amounts of variance to Function. To compare the Secure and Insecure Attachment groups in the Clinical and Non-clinical samples, a matched groups study, N = 190, was conducted. Clinical and non-clinical participants were matched for Age, Gender and Attachment Style. No differences were reported on overall pain between the attachment groups, but differences existed on negative affect, somatisation and quality of life. For sample type, the clinical group reported higher overall pain scores, less negative affect and less somatisation, but no differences were found on quality of life, compared to the non-clinical group. Study 4 was a qualitative study that used structured interviews of 24 clinical and non-clinical participants matched for age, gender, attachment style and etiology. The securely attached group reported having extensive, positive social support, high community involvement and appropriate reliance on medical and allied health care and medications. The insecurely attached group reported more problems with physical pain and psychological distress, less social support, less function and more perceived disability. The insecurely attached group reported more use of medical, allied and alternative health resources. Older securely attached individuals reported the lowest overall pain scores and the highest quality of life. These results support the hypotheses that a secure attachment style contributes to more positive outcomes for individuals with chronic pain syndrome and were consistent with a model of chronic pain that includes biological, psychological and social variables.