Biomedical subjects

R H Moos

Publications and source records attributed to R H Moos.

At least 109 records · Page 6Linked to original sources

PubMed1993

The contexts of adolescents' chronic life stressors.

Proposed and tested a model of the determinants of adolescents' chronic life stressors, consisting of sociodemographic, personal, and contextual stress and coping factors, using baseline and 1-year follow-up data from 259 adolescents who varied in their psychological and physical health. Concurrent regression analyses at Time 1 and at Time 2, and longitudinal regressions that controlled for the levels of chronic stressors 1 year earlier, showed that sociodemographic, personal, and contextual factors each made a significant contribution to predicting adolescents' ongoing stressors with their mother, father, siblings friends and classmates and teachers at school. Personal factors of an emotional temperament and low perceived self-worth, and contextual factors of more negative life events and fewer social resources, were related to more chronic stressors. Suggestions for further development of the model are discussed.

Adaptation, Psychological↗

PubMed1993

The process of treatment selection among previously untreated help-seeking problem drinkers.

A sample of 515 untreated problem drinkers was followed up for 1 year after contacting alcohol information and referral or detoxification services. At the 1-year follow-up, participants were placed into one of four treatment status groups: no treatment (24%), Alcoholics Anonymous only (18%), outpatient (25%), and inpatient or residential (32%). Participants with fewer financial resources, more serious drinking problems, and poorer functioning at baseline were more likely to enter inpatient or residential programs than outpatient treatment. Persons who selected AA only for treatment were of lower socioeconomic status than outpatients, and were functioning better than those who opted for treatment in inpatient or residential settings. In general, individuals who entered treatment received a considerable amount of treatment. Poorer baseline functioning was related to attending more AA meetings or outpatient sessions, and to staying longer in inpatient or residential treatment. The results are discussed in the context of a conceptual model of selection into alcoholism treatment.

Adult↗

PubMed1993

Gender differences in the individual characteristics and life contexts of late-middle-aged and older problem drinkers.

This study focuses on gender differences in the individual characteristics and life contexts of late-life problem drinkers. Late-middle-aged women with drinking problems (n = 183) consumed less alcohol, had fewer drinking problems, and reported more recent onset of drinking problems than did their male counterparts (n = 476). They also used more psychoactive medications, were more depressed, and were less likely to seek alcohol treatment. Consistent with a gender role perspective on alcohol abuse, problem-drinking women had more family-related and fewer financial stressors than did problem-drinking men. Contrary to expectation, however, problem-drinking women reported more support from children, extended family members, and friends than did problem-drinking men. Moreover, women who continued to have drinking problems over a 1-year interval reported some unexpected short-term benefits at follow-up, including reduced spouse stressors. Women who had remitted at follow-up experienced less spouse support, and more family-related stressors and depression than did remitted men. They also lost support from extended family members over the 1-year interval. The results suggest a need for screening and treatment efforts tailored more closely to the life circumstances of women with late-life drinking problems.

Aged↗

PubMed1993

Quality of care and outcomes of chronic mentally ill patients in hospitals and nursing homes.

OBJECTIVE: Quality of care in three types of facilities in which chronic mentally ill patients reside was examined to determine how it was related to patient functioning and to determine how patients' dependency on others for self-care moderated relationships between quality of care and patient functioning. METHODS: Discriminant function analyses and multiple regression analyses were used to examine 12-month follow-up data from a Department of Veterans Affairs (VA) study of 294 chronic mentally ill patients in 52 community nursing homes, nine VA nursing home care units, and 43 VA hospital psychiatric units. RESULTS: The three types of facilities were best differentiated by staff and resident characteristics and facility policies. Residents of community nursing homes were more impaired, and staff were less well trained, than in the VA facilities. The community nursing homes had less restrictive policies. Patients who lived in facilities that gave them more control over their daily lives and that had larger proportions of high-functioning patients reported more life satisfaction and vigor. Patients in facilities with more social and recreational activities reported less life satisfaction. The extent to which facility features were beneficial or harmful was related to patients' self-care dependency. Supportive physical features and living-assistance services tended to aid impaired residents, whereas more experienced staff and policies that promoted control by residents tended to aid independent residents. CONCLUSIONS: Program managers may need to tailor facility environments to patients' level of functioning to maximize beneficial effects.

Activities of Daily Living↗

PubMed1993

Patterns of diagnosis and treatment among late-middle-aged and older substance abuse patients.

This study examines the diagnoses and treatment received by a cohort (N = 22,678) of late-middle-aged and older substance abuse patients. More than 23% of substance abuse inpatients admitted to Department of Veterans Affairs (VA) Medical Centers in fiscal year 1987 were 55 years of age or older. Most of these patients had multiple health problems. More than 90% had an alcohol-related diagnosis; almost 30% were diagnosed with a psychiatric disorder; and more than 80% had a medical disorder. Compared with their younger counterparts, older substance abuse patients were less likely to receive specialized inpatient or outpatient treatment specifically directed toward their substance abuse or psychiatric problems. In general, older substance abuse patients received services oriented more toward medical management than toward rehabilitative substance abuse or psychiatric care. These findings imply a need to develop treatment programs tailored to the characteristics and substance abuse problems of older patients, and to encourage more use of specialized outpatient aftercare services by these individuals.

Adolescent↗

PubMed1992

New directions in substance abuse services: programmatic innovations in the Veterans Administration.

The purpose of this paper to describe the Department of Veterans Affairs' (VA) recent expansion and enhancement of its substance abuse treatment services. Several treatment innovations are considered from both clinical and administrative perspectives. These services include extended care programs for multiply impaired patients, programs for substance abuse patients with comorbid psychiatry conditions and services designed to improve continuity of care and community re-entry. Emergent themes include a broadening of services to meet the needs of a changing substance abuse population and an emphasis on providing more cost-efficient treatment.

Comorbidity↗

PubMed1992

Adaptation to juvenile rheumatic disease: a controlled evaluation of functional disability with a one-year follow-up.

Compared the adaptation of 165 patients with juvenile rheumatic disease (JRD) to that of their healthy siblings. Patients were divided into those with mild functional disability and those with moderate/severe disability. Adaptation in several domains was assessed by parents and children on two occasions 1 year apart. The adjustment difficulties of the JRD children were limited primarily to social functioning but appeared also in the psychological and family problems domains. Compared to "mild" patients, "moderate/severe" patients had more adjustment difficulties; in some areas, mild patients functioned as well as their healthy siblings. Some Time 1 differences were replicated at Time 2. The results help to delineate (a) the specific domains in which children with chronic disease have adjustment difficulties and (b) the factors that put children at risk for developing adjustment problems.

Activities of Daily Living↗

PubMed1992

Functioning among mothers and fathers of children with juvenile rheumatic disease: a longitudinal study.

Examined the adaptation of mothers and fathers of children with juvenile rheumatic disease on two occasions, 1 year apart, using 159 married couples at Time 1, and 111 of these couples at Time 2. A stress and coping model was tested in which parental functioning is determined by ongoing life stressors (patient and spouse dysfunction), family resources, and parents' illness-related coping. Mothers reported more depression than fathers did. However, poorer concurrent functioning among both mothers and fathers was explained partly by patients having more functional disability, pain, and psychosocial problems. In addition, spouse's dysfunction and the parent's use of avoidance coping were related to poorer parental adaptation, both concurrently and 1 year later. The implications of the findings for developing stress and coping models of parental adaptation to having a chronically ill child, and for intervention strategies with parents, patients, and families, are discussed.

Adaptation, Psychological↗

PubMed1992

The long-term course of treated alcoholism: II. Predictors and correlates of 10-year functioning and mortality.

This study examines factors related to mortality and 10-year posttreatment functioning for a sample of alcoholic patients who return to their families after an index residential treatment episode. Of the 113 patients followed 2 years after treatment, 20 had died by the time of the 10-year follow-up. Mortality risk was greater among patients who, prior to treatment, consumed more alcohol and were unemployed. Mortality was more strongly associated with medical conditions, liver problems, medication use and lack of confidants assessed 2 years posttreatment. The course for the surviving patients between the 2-year and 10-year follow-ups was one of improvement in terms of alcohol consumption, relative stability in terms of physical symptoms and depression, and an aging-related decline in social activities and employment. Life context and coping factors assessed 2 years after treatment were predictive of long-term outcome. Persons in less stressful life situations, in more cohesive and organized families, and who more frequently used active cognitive coping responses at the 2-year follow-up tended to function better at the 10-year follow-up. Overall, the findings support the value of embedding long-term follow-up studies in a theory of the disorder that is the target of the intervention.

Activities of Daily Living↗

PubMed1991

The Drinking Problems Index: a measure to assess alcohol-related problems among older adults.

Research on problem drinking among older adults has been hampered by the lack of specialized instruments to assess drinking problems. In this paper, we examine the psychometric properties of a 17-item measure specifically designed to assess drinking problems in this population. The Drinking Problems Index (DPI) exhibits excellent psychometric properties, with an internal consistency reliability estimate of .94, a cross-temporal correlation over a 1-year interval of .66, and cross-sectional correlations with alcohol consumption at two points a year apart of .37 and .42. In addition, the construct validity of the DPI is supported by significant concurrent correlations indicating that persons who have more drinking-related problems experience more depression, have less self-confidence, and participate in fewer social activities. Consistent with the high internal consistency reliability estimate, a factor analysis confirmed that the measure is largely unifactorial. Overall, the findings suggest that the DPI is a reliable and valid instrument for assessing problems associated with drinking in surveys of older persons.

Activities of Daily Living↗

PubMed1991

Life stressors, personal and social resources, and depression: a 4-year structural model.

By extending earlier stress-resistance research with a 1-year time lag, findings with 254 adults show that adaptive personality characteristics and positive family support operate prospectively over 4 years in predicting reduced depression, even when prior depression is controlled. By strengthening knowledge about the determinants and mediational role of coping, the results demonstrate in a 2-group LISREL analysis that the pattern of predictive relations differs under high and low stressors. Under high stressors, personal and social resources relate to future psychological health indirectly, through more adaptive coping strategies. Under low stressors, these resources relate directly to psychological health. The results support the idea that such resources play a causal role in maintaining psychological health, and they suggest the potential for a general, adaptively oriented framework applicable to adjustment under both high and low stressors.

Adaptation, Psychological↗

PubMed1991

A typology of social climates in group residential facilities for older people.

A typology of the social climates of group residential facilities for older people was developed by a cluster analysis of seven social climate attributes obtained on a national sample of 235 nursing homes, residential care facilities, and congregate apartments. The analysis yielded six distinct types of social climate: Supportive, Self-Directed; Supportive, Well-Organized; Open Conflict; Suppressed Conflict; Emergent-Positive; and Unresponsive. Facility and resident characteristics were related to social climate type. In addition, the type of social climate was related to resident adaptation. Supportive, Self-Directed and Supportive, Well-Organized facilities had residents who rated higher in well-being and levels of self-initiated activities and who used fewer health services. A configural approach to describing social climates and their determinants and effects may help to develop more humanistic residential facilities and to better match individual residents to appropriate housing placements.

Adaptation, Psychological↗

PubMed1991

Functioning, life context, and help-seeking among late-onset problem drinkers: comparisons with nonproblem and early-onset problem drinkers.

We compared the functioning and life contexts of late-middle-aged adults classified as late-onset problem drinkers (n = 229), early-onset problem drinkers (n = 475), and nonproblem drinkers (n = 609). Compared with nonproblem drinkers, late-onset problem drinkers consumed more alcohol and functioned more poorly; they also reported more negative life events and chronic stressors, fewer social resources, and more use of avoidance coping. However, late-onset problem drinkers consumed less alcohol, had fewer drinking problems, functioned better, and had more benign life contexts than did early-onset problem drinkers. We found no evidence of an association between age-related loss events and the onset of late-life drinking problems. Very few problem drinkers sought help specifically for their alcohol abuse, but about 25% did seek treatment from mental health practitioners. Problem drinkers who were functioning more poorly and who reported more life stressors and fewer social resources were more likely to seek help.

Adaptation, Psychological↗

PubMed1991

The long-term course of treated alcoholism: I. Mortality, relapse and remission rates and comparisons with community controls.

This study examines the course of alcoholism for a sample of patients who were followed 2 years and 10 years later after an index residential treatment episode. The alcoholic patients were 9.5 times as likely to die as matched community controls over the 8-year interval between the two follow-ups, a ratio considerably higher than that found in previous studies. Of the 83 surviving and successfully followed patients, 57% were classified as remitted at the 10-year follow-up. Of the patients classified as remitted at the 2-year follow-up and recontacted 8 years later, 77% had the same outcome status at the long-term follow-up, 67% of the initially relapsed patients retained that status at the 10-year follow-up. The 10-year remitted patients generally were functioning as well as matched, nonproblem-drinking community controls, whereas the relapsed patients exhibited dysfunction in a number of areas. Retrospective data on drinking patterns during each of the 6 years prior to the 10-year follow-up indicated a slight increase over time in the proportion of patients reporting abstinence or nonproblem drinking, with a concomitant decrease in the proportion indicating heavy or binge drinking. Overall, our data show a substantially elevated mortality risk among these alcoholic patients. For those patients who survive, however, the average course is one of modest improvement.

Adult↗

PubMed1991

Short-term processes of remission and nonremission among late-life problem drinkers.

This prospective study compares alcohol use, functioning, life stressors, social resources, and help-seeking among three groups of older adults: remitted problem drinkers, nonremitted problem drinkers, and nonproblem drinkers. At initial assessment, to-be-remitted problem drinkers had several advantages compared with individuals who would continue to have drinking problems. Specifically, they consumed less alcohol, reported fewer drinking problems, had friends who approved less of drinking, and were more likely to seek help from mental health practitioners. Problem drinkers who remitted improved somewhat over time, but they did not attain the level of functioning or type of life contexts shown by nonproblem drinkers. Time of onset of drinking problems influenced the short-term process of remission: Compared with early-onset individuals, late-onset problem drinkers were more likely to remit over the 1-year interval. The predictors of short-term remission suggested that late-onset problem drinkers may be more reactive to physical health stressors and to social influences than are individuals with more long-standing problems with alcohol.

Adaptation, Psychological↗

PubMed1990

Life stressors, resistance factors, and improved psychological functioning: an extension of the stress resistance paradigm.

This study applied a set of factors previously identified as being linked with stress resistance to the prediction of both stable and improved psychological functioning over a 1-year interval with more than 400 community-resident adults. Stable psychological functioning under high stressors is predicted at the beginning of the year by personal and social resources that are linked to functioning through their influence on increased approach coping during the year. In contrast, improved psychological functioning under low stressors is predicted directly by initial resources. As predicted by crisis theory, improved functioning under high stressors is related to an increase in resources during the year. The findings are discussed in the context of an extension of the stress-resistance paradigm beyond illness prevention toward a general, adaptively oriented health framework.

Adaptation, Psychological↗

PubMed1990

Approach and avoidance coping responses among older problem and nonproblem drinkers.

The Coping Responses Inventory (CRI) was used to study coping among older problem and nonproblem drinkers. The CRI organizes coping efforts according to their focus (approach or avoidance) and method (cognitive or behavioral). Compared with nonproblem drinkers, older problem drinkers were more likely to use cognitive and behavioral avoidance responses to manage life stressors. Problem drinkers who experienced more negative life events and more severe stressors used both more approach and more avoidance coping. Those who had more financial and social resources relied more on approach and less on avoidance coping. Problem drinkers who relied more on avoidance coping tended to have more drinking problems and to report more depression and physical symptoms and less self-confidence. Positive reappraisal was associated with less depression and more self-confidence.

Adaptation, Psychological↗

PubMed1990

Life stressors, social resources, and late-life problem drinking.

Life stressors and social resources among late-middle-aged problem and nonproblem drinkers were studied. Problem drinkers (n = 501) reported more negative life events, chronic stressors, and social resource deficits than did nonproblem drinkers (n = 609). In a comparison of problem drinkers, men reported more ongoing stressors involving finances and friends, and fewer resources from children, extended-family members, and friends than did women. Women who are problem drinkers reported more negative life events, more ongoing difficulties with spouses and extended-family members, and fewer resources from spouses. Among both the problem and nonproblem drinkers, more stressors were associated with fewer social resources, but only within certain life domains. Late-middle-aged adults' chronic stressors and social resources helped explain their drinking behavior, depression, and self-confidence even after sex, marital status, and negative life events were considered.

Age Factors↗