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Biomedical subjects

S Folkman

Publications and source records attributed to S Folkman.

At least 37 records · Page 2Linked to original sources
PubMed1996

Postbereavement depressive mood and its prebereavement predictors in HIV+ and HIV- gay men.

Prebereavement predictors of the course of postbereavement depressive mood were examined in 110 gay men who were their partner's caregiver until the partner's death of AIDS. In all, 37 HIV+ and 73 HIV- bereaved caregiving partners were assessed bimonthly throughout a 10-month period beginning 3 months before and ending 7 months after the partner's death. Throughout the 10 months, mean Centers for Epidemiology Scale-Depression (CES-D) scores on depressive mood were above the cutoff for being at risk for major depression. CES-D scores decreased for 63% bereaved caregivers over the 7 postbereavement months, and 37% showed little change from high CES-D scores or increasing CES-D scores. High prebereavement CES-D scores and finding positive meaning in caregiving predicted diminishing depressive mood; HIV+ serostatus, longer relationships, hassles, and use of distancing and self-blame to cope predicted unrelieved depressive mood.

Acquired Immunodeficiency Syndrome↗
PubMed1994

Socioeconomic status and health. The challenge of the gradient.

Socioeconomic status (SES) is consistently associated with health outcomes, yet little is known about the psychosocial and behavioral mechanisms that might explain this association. Researchers usually control for SES rather than examine it. When it is studied, only effects of lower, poverty-level SES are generally examined. However, there is evidence of a graded association with health at all levels of SES, an observation that requires new thought about domains through which SES may exert its health effects. Variables are highlighted that show a graded relationship with both SES and health to provide examples of possible pathways between SES and health end points. Examples are also given of new analytic approaches that can better illuminate the complexities of the SES-health gradient.

Health Behavior↗
PubMed1994

Caregiver burden in HIV-positive and HIV-negative partners of men with AIDS.

This study examines factors associated with caregiver burden in 82 HIV-positive (HIV+) and 162 HIV-negative (HIV-) partners of men with AIDS. We expected HIV+ caregivers to report more burden than HIV- caregivers because of the toll of their disease on their resources. HIV+ caregivers did report more burden and, compared with the HIV- caregivers, they were more religious or spiritual, had less income, and coped by using more positive reappraisal and cognitive escape-avoidance and by seeking social support. Comparisons of HIV+ caregivers with 61 HIV+ partners of healthy men indicated that most differences between HIV+ and HIV- caregivers were associated with HIV seropositivity rather than caregiving. However, of the variables associated with HIV seropositivity, only religiosity or spirituality contributed independently to burden in HIV+ caregivers, suggesting a relatively weak link between HIV seropositivity and caregiver burden. The model explained 62% of the variance in burden in HIV+ caregivers and 36% of the variance in HIV- caregivers.

Acquired Immunodeficiency Syndrome↗
PubMed1994

Psychological impact of HIV disease and implications for intervention.

The stress associated with HIV infection and the psychological impact of that stress have been documented. The complex issues that HIV-positive individuals encounter in managing their disease were described. The existing research on behavioral interventions designed to provide strategies to assist HIV-positive individuals cope with their disease was reviewed, and one particularly cognitive-behavioral intervention (Coping Effectiveness Training) was outlined. Given the evidence of the psychological distress that can accompany HIV disease and the consequences that accrue from this distress in terms of delayed access to care, nonadherence to treatment regimens, and quality of life, recommendations were made for health professionals interested in intervening to assist those who are living with the complex challenges of HIV disease.

Acquired Immunodeficiency Syndrome↗
PubMed1994

Stress and coping in caregiving partners of men with AIDS.

HIV disease presents profound challenges to primary caregivers including adjusting to the care recipient's disease progression, having increasing responsibilities for decision making as the disease progresses, responding to unexpected improvement, having to deal with a virtually uncontrollable disease, and managing role conflict and fatigue. Caregivers who are themselves infected with HIV face additional challenges. Caregiving partners of men with AIDS have high levels of dysphoric mood but, at the same time, they report levels of positive morale that are comparable to community norms. Caregivers sustain positive morale by deriving meaning from their caregiving. Health professionals are in a good position to support caregivers and, thereby, help their patients.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Stress, control, coping, and depressive mood in human immunodeficiency virus-positive and -negative gay men in San Francisco.

This study examined the relationship between stress, appraised control, and coping and depressive mood in 425 human immunodeficiency virus-positive and -negative gay men in San Francisco. Depressive mood was assessed by self-report in 1988 and 1989. Participants were also surveyed in 1989 on the stress in their lives, their appraised control over the stress, and the ways they coped. Depressive mood in 1988 and symptoms of human immunodeficiency virus disease in 1989 accounted for 50% of the variance in 1989 depressive mood; stress, appraised control, and coping accounted for an additional 10% of the variance in depressive mood in 1989. Path analysis indicated: stress appraised as controllable was associated with involvement coping, which in turn was associated with diminished depressive mood; stress associated with detachment was associated with increased depressive mood; and stress was also directly associated with increased depressive mood.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Immunologic changes occurring at kindergarten entry predict respiratory illnesses after the Loma Prieta earthquake.

Previous studies in adult populations have demonstrated alterations in immune function after psychologically stressful events, and pediatric research has shown significant associations between stress and various childhood morbidities. However, no previous work has examined stress-related immune changes in children and subsequent illness experience. Twenty children were enrolled in a study on immunologic changes after kindergarten entry and their prospective relationship to respiratory illness (RI) experience. Midway through a 12-week RI data collection period, the October 17, 1989 Loma Prieta earthquake occurred. The timing of this event created a natural experiment enabling us to study possible associations between immunologic changes at kindergarten entry, the intensity of earthquake-related stress for children and parents, and changes in RI incidence over the 6 weeks after the earthquake. Immunologic changes were measured using helper (CD4+)-suppressor (CD8+) cell ratios, lymphocyte responses to pokeweed mitogen, and type-specific antibody responses to Pneumovax, in blood sampled 1 week before and 1 week after school entry. RI incidence was assessed using home health diaries and telephone interviews completed every 2 weeks. RIs per child varied from none to six. Six children showed an increase in RI incidence after the earthquake; five experienced a decline. Changes in helper-suppressor cell ratios and pokeweed mitogen response predicted changes in RI incidence in the postearthquake period (r = .43, .46; p < .05). Children showing upregulation of immune parameters at school entry sustained a significant increase in RI incidence after the earthquake.(ABSTRACT TRUNCATED AT 250 WORDS)

Antibody Formation↗
PubMed1993

How house officers cope with their mistakes.

We examined how house officers coped with serious medical mistakes to gain insight into how medical educators should handle these situations. An anonymous questionnaire was mailed to 254 house officers in internal medicine asking them to describe their most important mistake and their response to it; 45% (N = 114) reported a mistake and completed the questionnaire. House officers experienced considerable emotional distress in response to their mistakes and used a variety of strategies to cope. In multivariate analysis, those who coped by accepting responsibility were more likely to make constructive changes in practice, but to experience more emotional distress. House officers who coped by escape-avoidance were more likely to report defensive changes in practice. For house officers who have made a mistake, we suggest that medical educators provide specific advice about preventing a recurrence of the mistake, provide emotional support, and help them understand that distress is an expected concomitant of learning from the experience.

Adaptation, Psychological↗
PubMed1992

Stress, coping, and high-risk sexual behavior.

We examined the relation between stress, coping, and a high-risk sexual behavior (unprotected anal intercourse) in 398 nonmonogamous gay and bisexual men from the AIDS Behavioral Research Project in San Francisco. Unprotected anal intercourse during the previous month, the amount of stress experienced during the previous month in each of 10 domains, six types of coping (self-controlling coping, escape-avoidance, distancing, planful problem-solving, seeking social support, and positive reappraisal), and spiritual beliefs and spiritual activities were assessed through self-report. There was no relation between stress and unprotected anal intercourse. However, there was a relation between coping and unprotected anal intercourse. Subjects who reported unprotected anal intercourse used sex more of the time to help cope with stressful situations than did subjects who did not report unprotected anal intercourse. Unprotected anal intercourse was negatively associated with seeking social support and spiritual activities and positively associated with self-controlling coping, which involves keeping one's feelings to oneself, and positive reappraisal. The findings suggest that social aspects of coping may be a key to understanding differences between those who engage in high-risk sexual behavior and those who do not.

Adaptation, Psychological↗
PubMed1991

Do house officers learn from their mistakes?

Mistakes are inevitable in medicine. To learn how medical mistakes relate to subsequent changes in practice, we surveyed 254 internal medicine house officers. One hundred fourteen house officers (45%) completed an anonymous questionnaire describing their most significant mistake and their response to it. Mistakes included errors in diagnosis (33%), prescribing (29%), evaluation (21%), and communication (5%) and procedural complications (11%). Patients had serious adverse outcomes in 90% of the cases, including death in 31% of cases. Only 54% of house officers discussed the mistake with their attending physicians, and only 24% told the patients or families. House officers who accepted responsibility for the mistake and discussed it were more likely to report constructive changes in practice. Residents were less likely to make constructive changes if they attributed the mistake to job overload. They were more likely to report defensive changes if they felt the institution was judgmental. Decreasing the work load and closer supervision may help prevent mistakes. To promote learning, faculty should encourage house officers to accept responsibility and to discuss their mistakes.

Analysis of Variance↗
PubMed1991

War-related stress. Addressing the stress of war and other traumatic events.

A task force on war-related stress was convened to develop strategies for prevention and treatment of psychological, psychosocial, and psychosomatic disorders associated with the Persian Gulf War and other extreme stressors facing communities in general. The task force focused on the return home, reunion, and reintegration of service personnel with their families and work. Although the Persian Gulf War was won with relative ease, negative psychological sequelae may develop in some individuals because of the stress of war, family disruption, financial difficulty, and changes in family routines. Typical stress reactions and modes of coping that are usually unsuccessful or destructive were outlined, and suggestions were made for monitoring these. In addition, guidelines for successful coping were developed. Special attention was given to children's reactions and needs. Recommendations were made for outreach and intervention on the policy, systems (e.g., schools, businesses, governmental agencies), family, and individual levels.

Adaptation, Psychological↗
PubMed1989

Psychoactive drugs, alcohol, and stress and coping processes in older adults.

Data are presented on a) the relationship between psychoactive substance use and personal characteristics, b) the relationship between psychoactive substance use and appraisal of and coping with stressful situations, and c) the use of psychoactive substances specifically to cope with stress among older people. Data were provided by 141 65-to-74-year-old retired Caucasians who were assessed repeatedly over 6 months. Compared to national samples, subjects were relatively heavy users of alcohol and average users of psychoactive drugs. Use of alcohol increased with income, and drug use was associated with several psychosocial characteristics as well as with psychological and somatic health. Psychoactive substance use did not relate to the ways subjects appraised and coped with stressful encounters. Further, only a small number of subjects used drugs or alcohol specifically to help them cope in these encounters. The findings about psychoactive drug users are compared with other findings about misusers of drugs, and the risks associated with each type of drug use are discussed.

Adaptation, Psychological↗
PubMed1988

The relationship between coping and emotion: implications for theory and research.

Historically, coping has been viewed as a response to emotion. Our purpose here is to evaluate this idea and offer a broader view based on cognitive and relational principles concerning the emotion process. We will explore the ways emotion and coping influence each other in what must ultimately be seen as a dynamic, mutually reciprocal relationship.

Adaptation, Psychological↗
PubMed1988

The impact of daily stress on health and mood: psychological and social resources as mediators.

This study examined daily stress processes among 75 married couples across 20 assessments during a 6-month period. The somatic and psychological effects of common everyday hassles were investigated. Overall, there was a significant relationship between daily stress and the occurrence of both concurrent and subsequent health problems such as flu, sore throat, headaches, and backaches. The relationship of daily stress to mood disturbance was more complex. The negative effects of stress on mood were limited to a single day, with the following day characterized by mood scores that were better than usual. Furthermore, striking individual differences were found in the extent to which daily stress was associated with health and mood across time. Participants with unsupportive social relationships and low self-esteem were more likely to experience an increase in psychological and somatic problems both on and following stressful days than were participants high in self-esteem and social support. These data suggest that persons with low psychosocial resources are vulnerable to illness and mood disturbance when their stress levels increase, even if they generally have little stress in their lives.

Adult↗
PubMed1988

Centrality and individual differences in the meaning of daily hassles.

In this study we introduce the concept of centrality in an attempt to assess individual differences in the meaning underlying daily hassles. Central hassles are defined as those which reflect important ongoing themes or problems in the person's life. The characteristics of central hassles, and their role in psychological and somatic health, were assessed in a sample of 150 community-residing men and women. The results indicate that central hassles vary in content from person to person and touch more on problems with personal needs and deficits in coping skills compared to noncentral hassles. The dimension of centrality was found to play a significant role in the prediction of psychological symptoms. Although the empirical case for the importance of centrality in the stress-illness relationship is inconclusive due to problems of confounding and a cross-sectional rather than longitudinal design, the ideas presented appear promising and provide a basis for further research on psychological vulnerability to stress.

Adult↗