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PubMed2004

Illness-specific and general perceptions of social relationships in adjustment to rheumatoid arthritis: the role of interpersonal expectations.

BACKGROUND: Adjustment to rheumatoid arthritis (RA) may be made more difficult when patients are unable to meet the expectations of family and friends about how well they are coping. PURPOSE: This study investigated the influence of illness-specific interpersonal expectations and general indices of social interactions on depressive symptoms among 39 women with RA (M age = 46.9 years; M disease duration = 11.2 years). METHODS: Female patients with RA and their spouses were recruited from an outpatient rheumatology clinic at an urban university hospital. Participants completed questionnaires at home and returned them to the research staff in prepaid, stamped envelopes. RESULTS: Results showed a significant correlation between spousal expectations and patients' perceived inability to meet them. Further, hierarchical regression analyses indicated that even when controlling for disease severity and traditional measures of social interactions (e.g., social support, perceived criticism, and general quality of the dyadic relationship), patient's perceived inability to meet spousal expectations contributed unique variance in depressive symptoms. CONCLUSIONS: These results suggest that adjustment to RA is not due entirely to the general features of social relationships, but additionally reflect specific aspects of the chronic illness milieu where spousal expectations and the patient's perceived inability to meet them are also related to adjustment.

Arthritis, Rheumatoid↗
PubMed1997

Military family adaptation to United Nations Operations in Somalia.

In this first known investigation of family responses to the absence of the active duty sponsor deployed to Somalia, 16 adults and 12 children repeatedly completed self-report measures of psychopathology and parenting attitudes. Stay-home parents registered more distress than their deployed spouses. Levels of parental intimacy varied significantly over time, reaching its lowest point near the end of the mission. Future humanitarian mission deployment support programs may need to more effectively address issues of parenting and spousal stress if future research confirms our findings.

Adaptation, Psychological↗
PubMed2000

The relationship between social support and major depression: cross-sectional, longitudinal, and genetic perspectives.

Although social support (SS) is associated with risk for major depression (MD), we are uncertain of the extent to which a) low SS increases risk for MD, b) MD lowers SS, or c) both variables reflect a common genetic liability. Using two waves of interview data on female twin pairs from a population-based registry, we examine the cross-sectional and longitudinal association of eight dimensions of perceived SS and MD. Risk for MD in the last year was inversely associated with supportive spouse and relative relationships, and directly associated with problems in these relationships (e.g., too many demands, criticism, tension, and disagreements). Significant cross-time associations were seen only for spousal variables. The history of MD in one twin significantly predicted low relative and spouse support, and relative and friend problems, in her co-twin (MZ > DZ pairs). The relationship between SS and MD in women is complex and due to at least the three separate mechanisms outlined above that operate to varying degrees in different dimensions of SS.

Adolescent↗
PubMed2006

Evaluating spousal abuse as a potential risk factor for Alzheimer's disease: rationale, needs and challenges.

BACKGROUND: Repetitive head trauma is an identified risk factor for Alzheimer's disease (AD). The violence in wife assault is repetitive and targets the head. This association provides a rationale for studying the relationship between spousal abuse and AD. DESIGN: To preliminarily evaluate the possibility of an increased susceptibility for AD in women subjected to spousal abuse and to identify challenges associated with such a study, we performed a pilot case-control study involving women with AD and compared the incidence of spousal abuse against two control groups. Forty consecutive women with AD referred to a Memory Disorders Clinic were enrolled. Individuals were evaluated at three visits (0, 3, 9 months) and were followed for an additional 12 months to ensure that no other diagnosis emerged. Two control groups were likewise assessed. RESULTS: 17.5% (7/40) of the women (average age 71 years) with AD reported spousal abuse with head trauma. In control group 1, 5.0% (2/40) and in control group 2, 7.5% (3/40) of the women reported spousal abuse with head trauma. CONCLUSIONS: The development of AD may be a potential long-term consequence of wife assault. Our study suggests spousal abuse as a possible risk factor for AD, and supports the need for larger studies. However, there are practical challenges associated with the successful execution of such a study.

Aged↗
PubMed1987

Predictors of psychological reactions during the early stages of widowhood.

In conclusion, this preliminary study of 2-month outcome to spousal bereavement found (1) most widows and widowers had social supports and lack of such supports was not related to outcome; (2) a clinical depressive syndrome was common, and a history of past depressions was associated with poor outcome; (3) more subjects increased alcohol consumption and cigarette use after their loss than decreased their use, but a past history of problems with alcohol was not related to outcome; (4) female, younger, and poorer survivors had the worst outcomes; (5) more disturbed marital relationships correlated highly with poor outcomes; (6) when the deceased spouse died without warning and without a prolonged illness, the survivor was more apt to have a difficult adjustment; and (7) the continued presence of active grief was associated with increased levels of anxiety, somatization, interpersonal sensitivity, and depression. Finally, the results of the study show that self-rated overall adjustment is highly correlated with other, standardized psychometric scale scores as well as with grief-specific affects. Assessing global adjustment may, therefore, be a simple, time-efficient, yet meaningful area of inquiry in clinical situations. This is the first in a series of studies on this widowed population. Future reports will focus on other dimensions of widowhood, changes over long-term follow-up, and the validity and reliability of the Widowhood Questionnaire.

Adult↗
PubMed2002

Active consideration: conceptualizing patient-provided support for spouse caregivers in the context of prostate cancer.

In this study, the authors examine the under-investigated topic of patient-provided support for spouse caregivers. Thirty-four men with prostate cancer and their female partners were interviewed separately three times: before the man's radical prostatectomy, 8 to 10 weeks postsurgery, and 1 year postsurgery. The core category of active consideration encompassed 4 dimensions: easing spousal burden, keeping us up, maintaining connection, and considering spouse. Patient-provided support entails two overlapping tasks: minimizing the practical and emotional impact of the illness and tending to the caregiver's social-emotional needs. A theory expounding on the double bind of being both a patient and an agent in light of masculine socialization practices is articulated and brought to bear on the phenomenon of patient-provided support.

Adaptation, Psychological↗
PubMed1999

Spousal negative responses to cancer patients: the role of social restriction, spouse mood, and relationship satisfaction.

This cross-sectional study examined perceptions of spousal negative behaviors in 219 cancer patients. A mediational model was proposed to explain why a spouse might respond negatively to an ill partner because of greater restriction on activities as functional impairment increases. A moderating effect of the spouse's marital satisfaction assessed 3 months before other study measures was also proposed. Results provided support for the proposed model. The relationship between increasing patient functional impairment and spousal negative behaviors was medicated by greater restriction in spouse activities, as well as spousal negative mood. A marginally significant moderating effect for marital satisfaction was found. Although these results must be replicated with a prospective study, the findings begin to shed light on why spouses might respond in negative ways to an ill partner.

Adult↗
PubMedDate not supplied

Long-term associations of helpful and harmful spousal behaviors with smoking cessation.

It has repeatedly been demonstrated that increased levels of social support are positively associated with a smoker's likelihood of achieving abstinence. It remains unclear, however, what specific support behaviors influence smoking cessation. This study explores the effects of supportive and undermining behaviors experienced by subjects (N = 624) in the context of a romantic/marital relationship on a number of smoking cessation outcomes. The associations of social support behaviors with one-, two-, and three-year abstinence and recycling and making quit attempts at 6, 12, 24, and 34 months were examined. Frequencies of both supportive and undermining behaviors predicted the dependent variables under study. Subjects whose spouses demonstrated fewer undermining behaviors were more likely to be successful continuous abstainers, whereas participants' recycling and making quit attempts seemed to be best predicted by a greater frequency of supportive behaviors. Initial success at cessation might be associated with increased supportive behaviors by a spouse, whereas lower rates of undermining behaviors might be associated with long-term maintenance. Long-term tailored feedback to spouses of smokers wanting to quit might be helpful.

Adult↗
PubMed2002

Genetic segregation analysis of recurrent, early-onset major depression: evidence for single major locus transmission.

Coordinated efforts are now underway to identify susceptibility genes for unipolar major depressive disorder (MDD) and related disorders. These studies have focused on recurrent, early-onset MDD (RE-MDD), thought to be the most familial form of this disorder. The goal of this study was to conduct a complex segregation analysis of recurrent MDD and other major mood disorders aggregating in families identified by probands with RE-MDD. Eighty-one families were identified through probands over the age of 18 who met criteria for recurrent (> or =2 episodes), early-onset (< or =25 years), nonpsychotic, unipolar MDD (RE-MDD) and included 407 first-degree relatives and 835 extended relatives. Psychiatric diagnoses for probands and their family members who provided blood samples were formulated from structured personal interviews, structured family history assessments, and available medical records. The remaining family members who participated and those who were deceased were evaluated through the family history method augmented by available medical records. Best-estimate diagnoses were made during a consensus conference according to established diagnostic criteria. Segregation analyses were performed using the REGD routine in S.A.G.E. release 4.0. The segregation analysis of recurrent MDD supported a sex-independent Mendelian codominant model. Analysis of major mood disorders supported a sex-independent Mendelian dominant model. Interestingly, inclusion of spousal residual correlations provided better fitting models for recurrent MDD but not the broader phenotype of major mood disorders. Unlike unipolar MDD, the lifetime prevalence of bipolar I disorder in this sample of families did not exceed the reported population prevalence [Zubenko et al., 2001]. Our results suggest that a major locus contributes to the expression of recurrent MDD and possibly other major mood disorders within families identified by probands with RE-MDD. Due to the limitations of the segregation analysis model, our results cannot address whether the same major locus is segregating across families in our sample or whether multiple major loci are involved (genetic heterogeneity). The absence of aggregation of bipolar I disorder in these families strongly suggests that while the genetic determinants of unipolar and bipolar disorders may overlap, they are not identical. Our findings illustrate the advantage of employing families identified by probands with RE-MDD in studies designed to detect susceptibility loci for unipolar MDD and related disorders.

Adolescent↗
PubMed1995

Well-being of caregivers of spouses with Parkinson's disease.

This study examined the relationship among stages of Parkinson's disease (PD), elderly care receivers' physical and social functioning, and spousal caregivers' physical, social, psychological, and economic well-being. The nonrandom, convenience study sample comprised 30 spousal caregivers of elderly individuals diagnosed with PD; all attended group support sessions. Findings indicated a statistically significant linear relationship between stages of PD and care receivers' functional ability and between care receivers' functional and social ability and caregivers' hours of caregiving. Caregivers' health was associated with diminished physical functioning of care receivers. Caregivers' age, years of marriage, and educational level were associated with their social, psychological, and financial well-being. The main implication for nursing practice is that elderly family caregivers must be included in mutually developed care plans; they are at high risk for diminished well-being because of the time and energy involved in providing needed care.

Aged↗
PubMed2004

Stress and coping among orthopaedic surgery residents and faculty.

BACKGROUND: Evaluations of physicians and residents have revealed concerning levels of psychosocial dysfunction. The purposes of this study were to determine the quality of life of orthopaedic residents and faculty and to identify the risk factors for decompensation. METHODS: Twenty-one orthopaedic residents and twenty-five full-time orthopaedic faculty completed a 102-question voluntary, anonymous survey. The survey consisted of three validated instruments, i.e., the Maslach Burnout Inventory, the General Health Questionnaire-12, and the Revised Dyadic Adjustment Scale; and three novel question sets addressing background and demographic information, stress reaction and management, and the balance between work and home life. Descriptive statistics, pairwise correlations, simple t tests, and Pearson and nonparametric Spearman correlations were calculated. The simple correlation coefficient was used to assess bivariate relationships. RESULTS: The mean overall quality-of-life score, on a scale of 0 to 4 points, was 2.5 points for residents compared with 3.6 points for faculty members. Residents reported considerable burnout, showing a high level of emotional exhaustion and depersonalization and an average level of personal achievement, whereas faculty reported minimal burnout, showing a low level of emotional exhaustion (p < 0.0003), an average level of depersonalization (p < 0.0001), and a high level of personal achievement (p < 0.0001). Only two of twenty-five faculty members (compared with seven of twenty-one residents) scored over 4 points on the General Health Questionnaire-12, indicating significant symptomatology (p < 0.01). The majority of subjects reported that a partner or spouse showed nondistressed levels of marital adjustment and satisfaction. All residents and nine of the twenty-five faculty members had mentors but judged the resource to be minimally beneficial. Resident burnout and psychiatric morbidity correlated with weekly work hours; conflict between the commitments of work and home life; discord with faculty, nursing staff, and senior residents; debt load; and work-related stress. Protective factors included being a parent, spending time with a spouse, having a physician father, and deriving satisfaction from discussing concerns with colleagues, friends, and family. CONCLUSIONS: In pursuit of our goal of determining the quality of life of orthopaedic residents and faculty, we identified a large disparity between the two groups. The resident group reported much greater levels of dysfunction particularly with regard to burnout and psychiatric morbidity. Furthermore, with regard to our second goal; our data revealed a number of risk factors for resident decompensation, most notably, increased workload, high debt levels, and discord with superiors. In addition, our research revealed that the current support interventions by the residency program, including mentoring and facilitation of spousal adjustment, are viewed as being of little help.

Adaptation, Psychological↗
PubMed2003

The relational context of social support: Relationship satisfaction moderates the relations between enacted support and distress.

In two studies of kidney transplant patients and their significant others, the authors examined whether the relations between enacted social support and patient distress were moderated by patients' satisfaction with their relationship with the support provider (i.e., their significant other). In Study 1 (n = 121 couples), unsupportive spousal behaviors were associated with more distress only among patients who were less satisfied with their marital relationship. In Study 2 (n = 112 couples), the relations between unsupportive behaviors and distress again varied as a function of the patient's relationship satisfaction, although the particular pattern of the interaction depended on the specific unsupportive behaviors offered to the patient. In both studies, relationship dissatisfaction was associated with higher levels of patient distress. Supportive behaviors were not related to distress and did not interact with relationship satisfaction. Implications for future research on social support in marriage are discussed.

Communication↗
PubMed2004

The transition to widowhood and the social regulation of health: consequences for health and health risk behavior.

OBJECTIVES: This study estimates the effects of the transition to widowhood on changes in the social regulation of health and examines the consequences of this association for health and health risk behavior following spousal death. METHODS: Analysis of longitudinal data from the Changing Lives of Older Couples Study tests the following hypotheses: (a) Widowed individuals experience greater declines in health regulation over time than their married counterparts and (b) the extent to which widowhood undermines health and increases health risk behavior depends on whether it is accompanied by a decline in health regulation. RESULTS: Compared with their continually married counterparts, those who experience the transition to widowhood report a significant decline in the frequency of health reminders and health assistance received from others. The decline in the frequency of health regulation has important consequences for health behavior and health outcomes. Widowhood undermines health and increases health risk behaviors only when it is accompanied by a decline in health regulation. Widowed individuals who experience increases in health regulation show improvements in health and declines in health risk behavior. DISCUSSION: Interventions targeted at improving the health habits of widowed individuals by mobilizing health-related support systems may be effective at minimizing the negative health consequences of spousal loss.

Aged↗
PubMed2000

The psychological and physical health of hospice caregivers.

This study explores the psychological distress of caring for a dying family member and examines the differences in depression, anxiety, health, social and occupational functioning, and social support among hospice caregivers and community controls. It compares psychological functioning of spousal and adult child hospice caregivers. Caregivers of terminally ill hospice patients were assessed prior to death as a part of a longitudinal bereavement study. Caregivers reported experiencing higher levels of depression, anxiety, anger, and health problems than controls. Hospice caregiving was associated with deterioration in physical health and in social and occupational functioning. The comparisons between adult children and spouse caregivers revealed that levels of psychological and physical morbidity were very similar for the two generations of caregivers. An awareness of distress symptoms among hospice caregivers could lead to timely proactive clinical intervention that may prevent bereavement complications.

Adult↗
PubMed2000

Effects of caregiving, gender, and race on the health, mutuality, and social supports of older couples.

OBJECTIVES: The purpose of this article is to report caregiving, gender, and race effects on the physical health, social supports, and mutuality of older couples. METHODS: The study involves cross-sectional results from a longitudinal study of 234 older couples, 118 in caregiving situations and 116 comparison couples. Spouses were interviewed in their homes. RESULTS: Spousal older caregivers are in poorer physical health than noncaregivers but have no greater numbers of social supports to help them in the caregiving role. Also, African Americans are in poorer physical health than Caucasians; yet, as caregivers, they have no greater numbers of social supports than Caucasian caregivers. Although females have more social supports than males, female caregivers have more negative feelings about their husbands than male caregivers have about their wives. DISCUSSION: Males and African Americans are in potentially more severe caregiving situations than their female and Caucasian counterparts. Results of this study are compared to Wallsten (1999), which found that African Americans and males had more favorable psychological indicators of stress. The two studies complement each other but open the question of response bias as a factor.

Black or African American↗
PubMed1995

A prospective longitudinal investigation of spousal bereavement examining Parkes and Weiss' Bereavement Risk Index.

The purpose of this study was (a) to describe spousal bereavement both prospectively and longitudinally and (b) to examine the validity of the Bereavement Risk Index (BRI) published by Parkes and Weiss (1). Psychological distress was measured in 46 subjects across five time intervals beginning prior to a spousal death from lung cancer and ending 25 months after the death using the Brief Symptom Inventory (BSI) (2). The hypothesis that the BRI discriminates between bereaved spouses at high and low risk for psychological distress was supported by measurements taken within two months of the patient's diagnosis (prior to death), at 6 weeks following the death, and at 6 and 13 months thereafter. These findings support the need for early identification of individuals at high risk for negative bereavement outcomes even prior to the spousal death.

Adolescent↗
PubMed2004

Social support as experienced by Chinese and Israeli husbands of women with breast cancer: a comparative study.

The purpose of this research was to compare the experience of social support of Israeli and Chinese husbands of women with breast cancer. Social support was examined from three different sources: wives, friends and family, and the healthcare team. This study is part of a larger descriptive comparative study investigating the husbands' adjustment to their wives' diagnosis of cancer. A convenience sample of 50 husbands from each cultural framework was selected. Support from family and friends and the healthcare team was measured by items from the Social Support Questionnaire (SSQ), the Psychosocial Adjustment to Illness Scales (PAIS) and questions developed by the authors. Israeli husbands reported significantly higher levels of support in all three areas. Chinese husbands were significantly more interested in joining a support group. The results of this study show that culture has an impact on spousal responses to their wives' illness. In developing appropriate breast cancer nursing, nurses need to practice sensitivity and awareness of the cultural differences in order to provide culturally sensitive family oriented nursing care. This study is an ongoing effort of collaboration between nursing professionals from the far east and the middle east.

Adaptation, Psychological↗
PubMed2001

Caregiving tasks among family caregivers of patients with lung cancer.

PURPOSE/OBJECTIVES: To describe family caregivers' perceptions of time spent and difficulty experienced with performing specific caregiving tasks for patients with lung cancer. To compare adult child and spousal caregivers in relation to time and difficulty of tasks. DESIGN: A secondary analysis of data from a study using a cross-sectional, descriptive, comparison design. SETTING: A university outpatient oncology center, two veterans administration outpatient clinics, and a private outpatient oncology practice. SAMPLE: 78 family caregivers of patients with lung cancer (62 spouses and 16 adult children). METHODS: Data that previously had been collected using a structured interview guide were analyzed using descriptive statistics, comparison of item means, and multivariate analysis of variance. MAIN RESEARCH VARIABLES: Time and difficulty with caregiving tasks. FINDINGS: The most time-consuming tasks for adult children and spouses were providing emotional support, transportation, and monitoring symptoms. The most difficult duties were emotional support, behavioral management, monitoring symptoms, and household tasks. Time and difficulty of tasks did not differ significantly between adult child and spousal caregivers. CONCLUSIONS: Some caregivers may require guidance in providing transportation, emotional support, behavioral management, and symptom management. IMPLICATIONS FOR NURSING PRACTICE: Oncology nurses can make a significant impact in assisting family members in providing care by addressing the provision of transportation, emotional support, behavioral management, and symptom management.

Adult↗