Self-Efficacy Beliefs Are Associated with Visual Height Intolerance: A Cross-Sectional Survey

<div><p>Background</p><p>Responses to height may range from indifference to minor distress to severe symptoms of fear of heights (acrophobia); visual height intolerance (vHI) denotes the whole spectrum of symptoms. Although there are options to manage vHI, only a small part of persons affected by vHI are willing to seek professional help or confront their problem. Purpose of this study was to determine if persons with vHI, specifically those who show avoidant behavior towards heights (avoiders), score lower in their general self-efficacy (GSE) than those who confront vHI (confronters).</p><p>Method</p><p>Cross-sectional survey in 607 individuals living in the urban region of Munich, Germany, using a mailed questionnaire on presence or absence of vHI, confronting or avoiding behaviour, and GSE.</p><p>Results</p><p>Of all participants (mean age 53.9, 50.3% female), 407 reported life-time presence of vHI. Participants with vHI had a mean GSE score of 31.8 (SD 4.3) points (participants without vHI: 32.5, SD 4.3, p  = 0.008 for difference). Among individuals with vHI, 23% reported confronting behavior. Confronters were significantly younger (p<.0001, 50.2 vs. 55.7 years), more likely to be female (p  = 0.0039, 64.3% female), and had a higher GSE score (p  = 0.0049, 32.5 vs. 31.1). Associations remained significant after multiple adjustment.</p><p>Conclusions</p><p>Our study provides evidence for the association of GSE and vHI. These findings may have consequences for strategies of alleviation and therapy of vHI.</p></div

DAG derived from literature and expert knowledge - Nodes represent variables and arrows represent causal associations.

<p>Darkly colored nodes label exposure (general self-efficacy, GSE) and outcome (visual height intolerance, vHI). The dashed arrow indicates the postulated association between exposure and outcome. Numbers represent available sources of literature describing the associations. References for these associations are given in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0116220#pone.0116220.s001" target="_blank">S1 Appendix</a>.</p

Sociodemographic characteristics.

<p>¹ SF-12.</p><p>vHI+ =  participants with visual height intolerance.</p><p>vHI− =  participants without visual height intolerance.</p><p>Sociodemographic characteristics.</p

Spearman–rank order correlations between HBI components and main symptoms of major depression.

<p>Spearman–rank order correlations between HBI components and main symptoms of major depression.</p

MDI item means across UA, mild BO, moderate BO, severe BO and MD.

<p><b>UA</b> = physicians unaffected by burnout symptoms and major depression. <b>BO</b> = physicians suffering from burnout symptoms without suffering from major depression. Mild <b>BO</b> is characterized by an HBI_sum in the third quartile (a score between 145–178), individuals with moderate <b>BO</b> have an HBI_sum between the third quartile and ninth decile (a score between 179–200), and severe <b>BO</b> is characterized by an HBI_sum in the highest decile (a score of ≥ 201). <b>MD</b> = physicians suffering from major depression without suffering from burnout symptoms. T-tests revealed significant increases in all MDI item means across <b>UA</b>, mild <b>BO</b>, moderate <b>BO</b>, severe <b>BO</b> and <b>MD</b> (see <b><a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0149913#pone.0149913.s002" target="_blank">S1 Table</a></b>).</p

Confirmatory Factor Analysis of the HBI components.

<p>Confirmatory Factor Analysis of the HBI components.</p

Odds Ratio for burnout (HBI_sum≥ 145), predicted by the components of the HBI.

<p>Odds Ratio for burnout (HBI_sum≥ 145), predicted by the components of the HBI.</p

Linear Regression: Explained variance of HBI_sum by different combinations of HBI components.

<p>Linear Regression: Explained variance of HBI_sum by different combinations of HBI components.</p

HBI components means, separated by burnout grade.

<p>HBI components means, separated by burnout grade.</p

Demographic and work-related information for participants compared to all Austrian physicians.

<p>Demographic and work-related information for participants compared to all Austrian physicians.</p