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The Type A belief system: relationships to hostility, social support, and life stress.

Certain core beliefs may underlie the Type A behavior pattern, predisposing individuals to health problems and impaired interpersonal relationships. Previous studies have revealed that the Type A Cognitive Questionnaire (TACQ), a self-report measure reflecting these beliefs, is indeed related to emotional distress. The current study assessed the TACQ's relationship to aspects of the interpersonal environment, including perceived social support and stressful events. It also investigated the TACQ's relationship to subtypes of hostility (ie, cynicism and paranoid alienation). Subjects were 111 college undergraduate volunteers. As hypothesized, the TACQ was significantly related to poor quality of social support and to greater perceived life stress. The TACQ appeared more strongly related to cynicism than to paranoid alienation. Findings were generally more pronounced for males. The discussion suggests that Type A beliefs may predispose individuals to health problems through impaired interactions with their interpersonal environment.

Achievement↗

Stressful events, pessimism, natural killer cell cytotoxicity, and cytotoxic/suppressor T cells in HIV+ black women at risk for cervical cancer.

OBJECTIVE: This study examines whether stressful negative life events and pessimism were associated with lower natural killer cell cytotoxicity (NKCC) and T cytotoxic/suppressor cell (CD8+CD3+) percentage in black women co-infected with human immunodeficiency virus Type 1 (HIV-1) and human papillomavirus (HPV), a viral initiator of cervical cancer. METHOD: Psychosocial interviews, immunological evaluations, and cervical swabs for HPV detection and subtyping were conducted on 36 HIV+ African-American, Haitian, and Caribbean women. RESULTS: Greater pessimism was related to lower NKCC and cytotoxic/suppressor cells after controlling for presence/absence of HPV Types 16 or 18, behavioral/lifestyle factors, and subjective impact of negative life events. CONCLUSIONS: A pessimistic attitude may be associated with immune decrements, and possibly poorer control over HPV infection and increased risk for future promotion of cervical dysplasia to invasive cervical cancer in HIV+ minority women co-infected with HPV.

AIDS-Related Opportunistic Infections↗

[New perspectives in life-event history analysis].

"In the last decade, life-event history analysis, also called failure time data analysis or survival analysis, has been widely adopted by demographers. This methodology in demography allows [us] to overcome major hurdles especially when analyzing longitudinal survey data. This paper describes the new perspectives opened to research in that field, and is illustrated by new results and examples of research projects. The authors concentrate on four issues: the analysis of incorrect and imperfect data, the analysis based on more complex data and lastly the study of interaction between phenomena." (SUMMARY IN ENG AND SPA)

Demography↗

Effects of psychological stress on human semen quality.

We investigated the relationship between psychological stress and sperm concentration, motility, and morphometry in a prospective study of 157 volunteers who were enrolled in a prepaid health plan. We measured psychological job stress and life-event stress by telephone interview. Sperm-kinematic and nuclear-morphometric variables were measured using computer-assisted image analyses. Sperm concentration, percent motility, and semen volume were determined by objective visual methods. We performed multiple linear regression for each semen variable to examine its relationship to stress, controlling for potential confounders. Stress at work and total number of life events were not related to differences in semen quality. However, the recent death of a close family member was associated with a reduction in straight-line velocity (P = 0.002) and percent of progressively motile sperm (P = 0.02); it was also marginally associated with an increase in the fraction of sperm with larger and more tapered nuclei. These findings suggest that the fecundity of men experiencing the stress of a family member's death might be temporarily diminished.

Adult↗

Identification of predictor variables of a postpartum emotional reaction.

Clinical observations and research suggest that postpartum emotional reactions (PEREA) are a widespread phenomenon. Prenatal identification of women who are at risk is essential if health professionals are to intervene and prevent long-term problems for the mother and her family. Health status, previous psychiatric history, locus of control, psychosocial assets, and life change events, as well as maternal adaptation to pregnancy and motherhood were examined in this study as possible predictor variables of a postpartum emotional reaction. Twenty-seven expectant women were assessed once prenatally and twice in the postpartum period. The data revealed that 59% of the participants, both primiparas and multiparas, experienced an increase in negative affect at some stage of the pregnancy and/or within 4 to 6 weeks postpartum. There were no significant differences between those who developed a PEREA and those who did not on the following variables: planned versus unplanned pregnancy, desired versus undesired pregnancy, attendance at prenatal class, and feeding plans. There was a significant association (p less than .01) between breastfeeding and the occurrence of a PEREA at 4 to 6 weeks postpartum among the primiparas. The study demonstrated that there was no single cause but several factors that, if present in combination, were predictive of an emotional reaction postpartum. Locus of control and existing emotional reactions, especially prenatal depression, were the most important predictor variables. The individual's ability to adapt to day-to-day life was influenced by the presence or absence of a combination of factors. These included preexisting emotional reactions, perceived locus of control, health status, and/or stress.(ABSTRACT TRUNCATED AT 250 WORDS)

Adaptation, Psychological↗

Context moderates illness-induced lifestyle disruptions across life domains: a test of the illness intrusiveness theoretical framework in six common cancers.

The illness intrusiveness theoretical framework maintains that illness-induced lifestyle disruptions compromise quality of life in chronic life-threatening conditions and that this effect is moderated by social, psychological, and contextual factors. Considerable evidence indicates that lifestyle disruptions compromise quality of life in cancer and other diseases and that the effects differ across life domains. The hypothesis that contextual factors (e.g. age, education, income, stressful life events) moderate these effects has not been tested extensively. We investigated whether age, income, education, and/or recent stressful life events modify the experience of illness intrusiveness across three central life domains (Relationships and Personal Development, Intimacy, and Instrumental life) in six common cancers. A sample of 656 cancer outpatients with one of six common cancers (breast, prostate, lymphoma, lung, head and neck, and gastrointestinal, all n's>100) completed the Illness Intrusiveness Ratings Scale while awaiting follow-up appointments with an oncologist. Results indicated statistically significant (all p's<0.05) interactions involving each of the hypothesized moderator variables and the Life Domain factor. In each case, greatest divergence was evident when illness intrusiveness involved instrumental life domains (e.g. work, finances, health, and active recreation). The findings substantiate the illness intrusiveness theoretical framework and support its relevance for people with cancer. The psychosocial impact of chronic life-threatening disease differs across life domains and depends on the context in which it is experienced.

Chronic Disease↗

Life events, sense of coherence and health: gender differences on the kibbutz.

The effects of recently experienced life events (RLE) and of a personal coping resource--the sense of coherence (SOC)--on the health of men and women were investigated among members of two small and cohesive communities--two kibbutzim in Israel (n = 230). Results of analyses lend support to previous findings about the negative effects of life events on health, and to Antonovsky's theory about the positive influence of SOC on health. Separate analyses for men and women, however, show that while RLEs negatively affect women's health, SOC has no significant counterbalancing effect on their health. Among men, an opposite pattern is found; their health is not affected by RLE, but is significantly affected by their SOC. Our findings lead to the conclusion that men and women are differentially affected by stressors and make different use of their coping resources. These findings should be taken into consideration in further research on stress, coping and health.

Adaptation, Psychological↗

Impact of family demands and family strengths and capabilities on family well-being and adaptation after critical injury.

BACKGROUND: Increases in demands on patients' family members that are not reduced by family strengths may contribute to decreases in family adaptation and complicate patients' recovery after trauma. The purpose of this study was to examine family demands (prior stressors and severity of patients' injuries) and family strengths and capabilities (hardiness, resources, coping, and problem-solving communication) associated with outcomes of family well-being and adaptation. METHODS: A multivariate, descriptive design based on the Resiliency Model of Family Stress was used. A convenience sample of family members (N = 51) of adult patients participated within the first 2 days of critical injury. Family demands were measured with the Family Inventory of Life Events and Changes and the Acute Physiology, Age, and Chronic Health Evaluation III. Family strengths were measured with the Family Hardiness Index, Family Inventory of Resources for Management, Family Crisis Oriented Personal Evaluation Scale, and Family Problem Solving Communication Index. Family adaptation outcomes were measured with the Family Well Being Index and Family Adaptation Scale. RESULTS: Increases in family demands were significantly related to decreases in family strengths and family adaptation. Family demands scores accounted for 40% of the variance in family well-being scores. The only significant family strength variable influencing family adaptation was problem-solving communication. CONCLUSIONS: Increases in family demands seem to be an important indicator of the amount of assistance a family may need. Interventions that help mobilize family strengths, such as problem-solving communication, may be effective in promoting the adaptation of families of critically injured patients.

APACHE↗

Coronary heart disease and coronary risk factor prevalence in rural Rajasthan.

To determine the prevalence of coronary risk factors and coronary heart disease (CHD) in rural Rajasthan, 1150 randomly selected individuals in a cluster of villages in central Rajasthan have been studied. These included 805 men and 345 women. The prevalence of various coronary risk factors in the whole group were: Smoking 488 (42.4%); Diabetes (history): 5(0.4%); Alcohol intake: 146 (12.7%); Sedentary lifestyle: 797 (69.3%); Stressful life events: 48 (4.2%); Hypertension (BP > or = 140/90) 152 (13.2%); obesity (BMI > or = 27 Kg/M2): 194 (10.9%); and Truncal obesity (waist:hip > or = 0.93): 20.8%. The overall prevalence of CHD was 46.1/1000. Patients with CHD had a higher prevalence of male sex (67.9 vs 51.5%); educated persons (30.2 vs 28.8%); businessmen (13.2 vs 10.2%); smoking (47.2 vs 40.5%); sedentary lifestyle (75.5 vs 62.3%); stressful life events (7.5 vs 4.8%); and hypertension (26.4 vs 14.8%). On the other hand, persons without CHD had higher prevalence of alcohol intake (10.8 vs 7.5%); regular prayers (23.1 vs 22.6%); physically active lifestyle (37.7 vs 24.5%); obesity (13.6 vs 6.9%), and truncal obesity (21.0 vs 20.0%). The following risk factors emerged significant on statistical analysis (Odds ratio, 95% confidence intervals): male sex (1.99, 1.04 to 3.7); hypertension (2.04, 1.01 to 4.09); male smokers (1.80, 1.28 to 4.09); and sedentary lifestyle (1.86, 1.01 to 3.59). This study shows a low prevalence of CHD in rural population which is however more than previously reported studies from India.

Adult↗

Dilemmas of talking about lifestyle changes among couples coping with a cardiac event.

Persons who have experienced a myocardial infarction (MI) and/or coronary artery bypass graft (CABG) surgery may benefit from a low-fat diet, regular exercise, smoking cessation, and stress management. Yet many patients do not make these changes. A spouse or partner's attempts at support may facilitate or interfere with patient behavior change. The present study explores dilemmas that may arise when couples talk about lifestyle changes following one person's MI or CABG. In interviews carried out in Urbana-Champaign, Illinois, and surrounding communities with 25 patients and 16 partners we found communicating support for lifestyle change may be interpreted as undesired control or criticism. The caring conveyed by talking may be viewed positively but can also threaten patient autonomy and entrap partners in unwanted expectations and obligations. Finally, lifestyle change conversations may reflect empowered patients collaborating with partners to take control of health but can also serve as potent reminders of loss. These multiple, potentially conflicting meanings give an account for why talking with a partner does not always facilitate patient lifestyle change. Understanding these dilemmas also suggests practical implications for helping patients and partners.

Adaptation, Psychological↗

Biological underpinnings of health alterations in women with PTSD: a sex disparity.

Women develop posttraumatic stress disorder (PTSD) at twice the rate of men, even though fewer women than men experience traumatic events over their lifetimes. Current studies of individuals with PTSD provide evidence of alterations in the neuroendocrine system that involve levels and activity of cortisol and DHEA and changes in immune function that predispose these individuals toward an innate (Th1) immune response. Yet few studies have addressed the possible role of these biologic alterations in women's increased vulnerability to developing PTSD. In addition, current studies are limited in their ability to link biologic alterations to the observed fourfold increase in medical conditions in women with PTSD as compared to women without PTSD. And finally, few studies have addressed the biologic impact of co-occurring major depressive disorder (MDD) in individuals with PTSD. This critical review provides an update on neuroendocrine and immune perturbations associated with PTSD with and without co-occurring MDD to suggest links to health and possible mechanisms underlying the observed sex disparity in the development of PTSD.

Adaptation, Physiological↗

Can we disentangle life course processes of accumulation, critical period and social mobility? An analysis of disadvantaged socio-economic positions and myocardial infarction in the Stockholm Heart Epidemiology Program.

The accumulation hypothesis would propose that the longer the duration of exposure to disadvantaged socio-economic position, the greater the risk of myocardial infarction. However there may be a danger of confounding between accumulation and possibly more complex combinations of critical periods of exposure and social mobility. The objective of this paper is to investigate the possibility of distinguishing between these alternatives. We used a population based case-control study (Stockholm Heart Epidemiology Programme) of all incident first events of myocardial infarction among men and women, living in the Stockholm region 1992-94. The analyses were restricted to men 53-70 years, 511 cases and 716 controls. From a full occupational history each subject was categorized as manual worker or non-manual at three stages of the life course, childhood (from parent's occupation), at the ages 25-29 and 51-55, resulting in 8 possible socio-economic trajectories. We found a graded response to the accumulation of disadvantaged socio-economic positions over the life course. However, we also found evidence for effects of critical periods and of social mobility. A conceptual analysis showed that there are, for theoretical reasons, only a limited number of trajectories available, too small to form distinct empirical categories of each hypothesis. The empirical task of disentangling the life course hypotheses of critical period, social mobility and accumulation is therefore comparable to the problem of separating age, period, and cohort effects. Accordingly, the interpretation must depend on prior knowledge of more specific causal mechanisms.

Aged↗

Quantifying and predicting recovery after heart surgery.

The validity of the biopsychosocial approach to the study of health and illness is reaffirmed by the prospective findings of the Recovery Study. This is a multidisciplinary examination, conducted in four teaching hospitals, of the predictors of symptoms of cardiac illness in 463 patients 6 months after coronary artery bypass or cardiac valve surgery. We found that the following preoperative measures predict freedom from cardiac symptoms 6 months after surgery: low levels of all of the following: angina pain, shortness of breath, fatigue and sleep problems, lifetime cigarette usage, and preoperative hospitalization for cardiac treatment; low levels of anxiety, depression, and hostility, and few life change events; high levels of all of the following: self-esteem, well-being, vigor; prevalence of activities and hobbies, social participation, and social support. The six variables in bold print contributed independently in a multiple regression equation that accounted for 21% of the variance of the symptoms score and was associated with an estimated 45% difference in success of recovery. The statistical strength and general nature of many of the predictors indicate that the predictors may also be important in recovery from other health crises. Psychosocial and biomedical factors correlate across time (predictively), as well as cross-sectionally, indicating that psychological, social, and biological mechanisms may be parts of a single general multifaceted process influencing recovery of health. A clinical trial could determine if psychological, social, or behavioral interventions will hasten and improve recovery from physical illness or trauma.

Activities of Daily Living↗

Stress reduction in child-abusing families: global and specific measures.

This study compared in-home treatment to traditional county services for their ability to reduce stress in child-abusing families. 47 families who were at risk for having at least one child removed from the home for child abuse were referred to Families First for an intensive 6-wk., in-home therapy program. A comparison group of 29 families who were also at risk for having at least one child removed for abuse received traditional county services but no in-home therapy. Stress scores used were derived from a factor analysis of the Family Inventory of Life Events and Changes (FILE) that had identified 10 stress factors. The stress data were analyzed by a series of 2 x 2 analyses of variance, group and time being the independent variables and the stress factors the dependent variables. Total stress was significantly reduced over time for both groups, and several specific stress factors were also significantly reduced over time. In secondary analyses, 2 x 3 (group by time) analyses identified interactions for total stress and three of the individual stress factors. In-home treatment was effective in reducing stress, but traditional services were also effective. Some possible explanations were discussed. A major finding was that, by including analyses using the specific stress factors (rather than just the Total Stress score), a much richer understanding of the role stress plays in abusive families is provided. It was concluded that, although global stress may be reduced by different methods, some specific types of stress are more likely to be reduced than others.

Adaptation, Psychological↗

Maternal stress and preterm birth.

This study examined a comprehensive array of psychosocial factors, including life events, social support, depression, pregnancy-related anxiety, perceived discrimination, and neighborhood safety in relation to preterm birth (<37 weeks) in a prospective cohort study of 1,962 pregnant women in central North Carolina between 1996 and 2000, in which 12% delivered preterm. There was an increased risk of preterm birth among women with high counts of pregnancy-related anxiety (risk ratio (RR) = 2.1, 95% confidence interval (CI): 1.5, 3.0), with life events to which the respondent assigned a negative impact weight (RR = 1.8, 95% CI: 1.2, 2.7), and with a perception of racial discrimination (RR = 1.4, 95% CI: 1.0, 2.0). Different levels of social support or depression were not associated with preterm birth. Preterm birth initiated by labor or ruptured membranes was associated with pregnancy-related anxiety among women assigning a high level of negative impact weights (RR = 3.0, 95% CI: 1.7, 5.3). The association between high levels of pregnancy-related anxiety and preterm birth was reduced when restricted to women without medical comorbidities, but the association was not eliminated. The prospective collection of multiple psychosocial measures on a large population of women indicates that a subset of these factors is associated with preterm birth.

Adolescent↗

Relationship between stress and relapse in multiple sclerosis: Part II. Direct and indirect relationships.

OBJECTIVE: The aim of this two-year prospective study was to determine which factors were: (i) directly related and/or (ii) indirectly related to multiple sclerosis (MS) relapse. These factors included life-event stressors, disease, demographic, psychosocial and lifestyle factors. BACKGROUND: Relatively little attention has been paid to the role of non-clinical relapse predictors (other than stressful life-events) in MS, or factors that indirectly impact on the stress-relapse relationship. METHODS: A total of 101 consecutive participants with MS were recruited from two MS clinics in Sydney, Australia. Stressful life-events, depression, anxiety and fatigue were assessed at study-entry and at three-monthly intervals for two years. Disease, demographic, psychosocial and lifestyle factors were assessed at baseline. Patient-reported relapses were recorded and corroborated by neurologists or evaluated against accepted relapse criteria. RESULTS: MS relapse was predicted by acute stressor frequency counts, coping responses that utilized social support, and being born in Australia, but not by chronic stressors, disease, demographic, psychosocial or lifestyle factors. No factors were found to indirectly impact on the stress relapse relationship. CONCLUSIONS: The number rather than severity of stressors was most important in relation to MS relapse risk, along with coping responses that utilized social support, suggesting that MS patients should avoid situations that are likely to generate multiple stressors or which provide few avenues for social support.

Adult↗

Patient and family adjustment to kidney transplantation with and without an interim period of dialysis.

This exploratory study was designed to examine the process of patient and family adjustment to kidney transplantation and to compare differences between those who had and those who did not have dialysis pretransplant. To capitalize on benefits of longitudinal and cross-sectional designs, a mixed-method approach described by Aaronson and Kingry (1988) was used. Participants were recruited from two major transplant centers in Western Canada. Twenty patients with ESRD and their partners were studied longitudinally at three points: during the period before the kidney transplant assessment phase and then at 3 and 6 months posttransplant. Forty-seven ESRD patients and their partners comprised the cross-sectional sample. Participants comprising the cross-sectional sample provided responses from at least one of the three time points. Patients and/or their partners completed a series of questionnaires focusing on family functioning (Family Inventory of Life Events and Change [FILE], Feetham Family Functioning Survey [FFFS]); support and resources (Family Inventory of Resources for Management [FIRM]); as well as uncertainty (Uncertainty Stress Scale [USS]); sickness impact (Sickness Impact Profile [SIP]); and sense of coherence (Sense of Coherence Scale [SOC]). The findings indicated that patients and their partners were under considerable stress as they underwent kidney transplantation. Illness and family care strains as well as financial strains were significant. The participants expressed low to moderate uncertainty that decreased over time from the pretransplant to the posttransplant period. Patients on dialysis prior to transplant were more physically and psychologically affected than patients pre-empted to transplant. Those who were pre-empted to transplant reported minimal impact pretransplant but considerable improvement in their psychological and physical state posttransplant. In conclusion, transplantation without prior dialysis resulted in less physical and psychological impact for patients and their spouses. These findings point to a need for interdisciplinary education and support programs at both the pretransplant and posttransplant phase to help patients and their partners adjust to living with a kidney transplant. Given the beneficial effects of pre-emptive transplantation, emphasis must be placed on increasing the organ donor pool so that more pre-emptive transplants can be conducted.

Adaptation, Psychological↗

A community study on the relationship between stress, coping, affective dispositions and periodontal attachment loss.

BACKGROUND: Psychological factors may increase the risk for periodontal diseases. Contemporary conceptualization of the stress process supports the evaluation of stress at three levels: stressors, moderating and mediating factors, and stress reactions. OBJECTIVE: This study was undertaken to investigate the relationship of periodontal disease in terms of clinical attachment level (CAL) to psychosocial stress, making reference to the major components of stress process. METHODS: A cross-sectional study of 1000 subjects aged 25-64 years in Hong Kong was conducted. Subjects were asked to complete a set of questionnaires measuring stressors including changes, significant life event and daily strains, stress reactions including physiological and affective responses, and coping and affective dispositions. CAL was assessed. RESULTS: Individuals with high mean CAL values had higher scores on the job and financial strain scales than periodontally healthy individuals (P < 0.05), after adjusting for age, gender, cigarette smoking and systemic disease. Depression, anxiety trait, depression trait, problem-focused coping, and emotion-focused coping were also related to CAL. Logistic regression analysis indicated that all these factors were significant risk indicators for periodontal attachment loss, except problem-focused coping, which reduced the odds of CAL. Individuals who were high emotion-focused copers, low problem-focused copers, trait anxious, or trait depressive had a higher odds of more severe CAL. CONCLUSION: Chronic job and financial strains, depression, inadequate coping, and maladaptive trait dispositions are significant risk indicators for periodontal attachment loss. Adequate coping and adaptive trait dispositions, evidenced as high problem-focused coping and low anxiety/depression trait, may reduce the stress-associated odds.

Adaptation, Psychological↗