This paper reports on the initial efforts to validate a brief self‐report inventory, the Systems of Belief Inventory(SBI‐15R), for use in quality of life (QOL) and psychosocial research studying adjustment to illness. The SBI‐15R was designed to measure religious and spiritual beliefs and practices, and the social support derived from a community sharing those beliefs. The authors proposed this scale to address the need for greater exploration of spiritual and religious beliefs in QOL, stress and coping research. Phase I: Item generation. The research team identified four domains comprised of 35 items that make up spiritual and religious beliefs and practices. The instrument was piloted in a structured interview format on 12 hospitalized patients with varying sites of cancer. Phase II: Formation of SBI‐54. After these initial efforts, the research team increased the number of items to 54 and adopted a self‐report format. To assess patients' reactions to the questionnaire, the new version was piloted on 50 outpatients with malignant melanoma. Phase III: Initial validation. To begin establishing validation, 301 healthy individuals with no history of cancer or serious illness in the prior year were asked to complete the SBI‐54 and several other instruments. A principal components analysis with varimax rotation of the SBI‐54 identified two factors, in contrast to the four which were hypothesized, one measuring spiritual beliefs and practices, the other measuring social support related to the respondent'rsquo;s religious community. Phase IV: Item reduction of the SBI‐54. A shortened version of the SBI‐54 with 15 items, five from the items identifying factor I and ten from those identifying factor II, was developed to lessen patient burden. The new SBI‐15 correlated highly with the SBI‐54, and demonstrated convergent, divergent, and discriminant validity. Revision of SBI‐15. The investigators rephrased one statement in order to broaden the applicability of the SBI‐15 to patients other than those with a diagnosis of cancer, and to healthy individuals. Discussion. The SBI‐15R met tests of internal consistency, test‐retest reliability, and convergent, divergent, and discriminant validity in both physically healthy and physically ill individuals. The SBI‐15R may have value in measuring religious and spiritual beliefs as a potentially mediating variable in coping with life‐threatening illness, and in the measurement of QOL. © 1998 John Wiley & Sons, Ltd.

In planning for studies relating psychological factors and/or stress (PF&/oS) to cancer, one should be aware of epidemiological findings that might contribute to or even account wholly for any found relationships. Most studies have not examined the known biological causes of cancer, nor have they described a rationale for relationships sought. The two broad mechanisms leading to cancer, carcinogens and lowered resistance to it, include physical and chemical causes, viruses and chronic infection, medication, genetic predisposition, hormonal stimuli, and aging. Interfering variables may bias or dilute a real relationship. Validity and reliability of instruments measuring PF&/oS are so variable as to warrant considerable care in their use. The latent periods of different cancers are measured in years, not months, with consequent potent impact on possible inferences drawn from prebiopsy and short prospective studies. In these and in retrospective studies, cancer can have strong and biasing effects on apparently straightforward PF&/oS measurements, as can iatrogenic effects. Some theoretical issues are discussed. The known prospective studies are discussed and reasons are given for the view that they are less convincing then many seem to think. A sketch of a model relating PF&/oS to cancer appearance is outlined, with some theoretical implications, and issues in research design are addressed.

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Twenty healthy volunteers (half male) recalled and relived maximally disturbing (NEG) and maximally pleasurable (POS) emotional experiences. Forty minutes of silence, then neutral conversation, preceded and followed 40 minutes of emotion elicitation (NEG and POS randomly rotated). They were under video, cardiovascular, and immunological monitoring. Subjects reported appropriate emotions and showed significant cardiovascular activation during the NEG condition. Speech alone had an independent cardiovascular activating effect. Emotion, particularly NEG, led to further activation. NEG emotion promoted significant declines in mitogenic lymphocyte reactivity, followed by return to pre-emotion levels. A similar though less extreme decline was seen in the POS condition. There was a weak trend for elevated natural killer cell activity under the NEG condition, possibly due in part to changed trafficking patterns. Correlational findings confirmed these group effects. The decline in mitogenic reactivity during POS emotion appeared to be due to subtle degrees of tension and excitement triggered by the experimental experience regardless of the exact emotions recalled. Results suggest that immunologic processes are sensitive to influence by arousal of emotion.