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PubMed2004

Mate similarity for substance dependence and antisocial personality disorder symptoms among parents of patients and controls.

UNLABELLED: Substance dependence (SD) and antisocial personality disorder (ASPD) are highly comorbid and aggregate in families. Mating assortment may be an important process contributing to this familial aggregation. HYPOTHESIS: Symptom counts of substance dependence, antisocial personality disorder, and retrospectively assessed conduct disorder (CD) will be correlated significantly among parents of youth in treatment for substance use and conduct problems and, separately, among parents of community controls. METHODS: We examined SD, ASPD, and CD among 151 pairs of parents of adolescents in treatment for substance use and conduct problems, and in 206 pairs of parents of control subjects. RESULTS: For average dependence symptoms (ADS) (the sum of across-drug substance dependence symptoms divided by the number of substance categories meeting minimum threshold use) mother-father correlations were 0.40 for patients and 0.28 for controls. Mother--father correlations for ASPD symptom count were 0.33 for patients and 0.26 for controls and for CD symptom count were 0.31 for patients (all P < 0.01) and 0.10 for controls (P = 0.14). CONCLUSIONS: Spousal correlations for ADS and ASPD, suggest substantial non-random mating. Results support gender differences in homogamy for SD. Behavior genetic studies of these disorders need to account for assortment to avoid biases in estimates of genetic and environmental effects.

Adult↗
PubMed1998

Spousal illness burden is associated with delayed use of hospice care in terminally ill patients.

Patients' families are important in hospice not only because they themselves might benefit from it, but also because they influence whether and how hospice is used to begin with. We hypothesized that, among the married, people with less capable spouses (in this case, those who are less healthy) should be less able to use home hospice care and should enroll in hospice later in the course of their illness, closer to death. We tested this hypothesis by evaluating the impact of spousal health on the timing of patients' use of hospice in a select group of 517 couples, a total of 1034 patients, for whom we have health data for both partners from Medicare claims records. We evaluated cohort survival using the Kaplan-Meier method and Cox regression, and we measured illness burden using the Charlson comorbidity score. Among the probands, 45.6% had a primary cancer diagnosis, 44.5% were female, 7.5% were nonwhite, their mean age was 80.0 years (+/-7.6 SD), and their mean Charlson score was 3.1 +/- 3.0. The probands' median survival after hospice enrollment was 55 days. Spouses were similarly composed demographically, but were less likely to have a cancer primary diagnosis (35.4% had cancer) and were slightly younger than the probands; their mean Charlson score was 2.9 +/- 2.9. Each additional point in the Charlson score of the spouse, controlling for measured characteristics of the proband, is associated with a 5.1% increase in the risk of death after enrollment. That is, after controlling for the characteristics of hospice patients themselves, those with sicker spouses are enrolled later. Compared with patients with the healthiest spouses, those with moderately sick and very sick spouses had considerably later enrollment into hospice, with the median survival decreasing from 111 to 49 to 22 days across the groups. Our data suggest that there may be a separate role of spousal health in affecting the time of hospice enrollment, and that patients' social support may affect not just their health status to begin with, but also their use of health care in general.

Journal Article↗
PubMed2005

Barriers to the implementation of programs for the prevention of mother-to-child transmission of HIV: a cross-sectional survey in rural and urban Uganda.

BACKGROUND: Implementation of programs for the prevention of mother-to-child transmission (PMTCT) of HIV faces a variety of barriers and challenges. The assessment of these challenges has generally been conducted in large urban health facilities. As programs expand into rural areas, the potential barriers that may be encountered there also need to be assessed. This study examines potential barriers that might affect the acceptability of interventions for PMTCT in rural and urban settings. RESULTS: Four hundred and four women at a large urban hospital and three rural clinics that had recently started implementing PMTCT were interviewed. Level of knowledge of MTCT and preference for rapid HIV testing were equally high in both areas, but rural women had a higher tendency to think that they should consult their husbands before testing, with borderline statistical significance (72% vs. 64% p = 0.09). Health facility-based deliveries were significantly lower among mothers in rural areas compared to those in the urban setting. Overall, significant predictors of willingness to test for HIV were post-primary education (OR = 3.1 95% CI 1.2, 7.7) and knowledge about rapid HIV tests (OR = 1.8, 95% CI 1.01, 3.4). The strongest predictor of willingness to accept an HIV test was the woman's perception that her husband would approve of her testing for HIV. Women who thought their husbands would approve were almost six times more likely to report a willingness to be tested compared to those who thought their husbands would not approve (OR = 5.6, 95% CI 2.8, 11.2). CONCLUSION: Lessons learned in large urban hospitals can be generalized to rural facilities, but the lower proportion of facility-based deliveries in rural areas needs to be addressed. Same-day results are likely to ensure high uptake of HIV testing services but male spousal involvement should be considered, particularly for rural areas. Universal Primary Education will support the success of PMTCT programs.

Journal Article↗
PubMed2001

Family carers and the adult head-injured: a critical review of carers' needs.

PRIMARY OBJECTIVE: To appraise recent literature on the topic of perceived needs of family carers of head-injured adult relatives. MEDLINE (1966-2000), EMBASE PSYCHIATRY (1987-1999), CINAHL (1982-January 2000) and PSYCHLIT (1967-1999) databases were searched. MAIN OUTCOMES AND RESULTS: A total of 13 papers were reviewed, of which six employed standardized research methods. The remainder used researcher developed questionnaires. Needs described by carers as important were predominantly related to information. Most unmet needs were linked to the provision of emotional support. There were significant differences in the perceived needs and their fulfilment between parental and spousal carers. In addition, unfulfilled needs could be predicted by behavioural problems in patients. CONCLUSIONS: The design and variation in methodology of most studies reviewed limits the generalization of reported data. Further research is required to fully identify both common and individual needs of family carers of the head-injured.

Adult↗
PubMed2001

The unique contribution of key existential factors to the prediction of psychological well-being of older adults following spousal loss.

PURPOSE: This study examined the unique contribution of key existential factors to the prediction of psychological well-being of older adults following spousal loss. DESIGN AND METHOD: A number of measures to assess psychological well-being, sociodemographic standing, social resources, and religious and spiritual resources were administered to a volunteer sample of widows and widowers to test the hypothesis that existential factors such as personal meaning, religiosity, and spirituality are more potent predictors of psychological well-being than are previously hypothesized variables of sociodemographic, social support, and physical factors. RESULTS: A hierarchical regression analysis of the data supported the hypothesis that existential factors are major contributors to psychological well-being of older adults following spousal loss. Findings showed that widowers, compared to widows, scored lower on the measure of psychological well-being. IMPLICATIONS: Implications of the findings are discussed for practitioners working with bereaved spouses; suggestions for further research concerning bereavement and psychological well-being are made.

Adaptation, Psychological↗
PubMed1999

Lung cancer and environmental tobacco smoke: occupational risk to nonsmokers.

The principal epidemiologic evidence that environmental tobacco smoke (ETS) increases the risk of lung cancer in (lifelong) nonsmokers is from studies of nonsmoking women married to smokers. This article estimates exposure-response curves for 14 studies (1, 249+ cases, 7 countries) with data on lung cancer categorized by the number of cigarettes/day smoked by the husband. The pooled results from the five U.S. studies alone are extrapolated to ETS levels in the workplace using measures of serum cotinine and nicotine samples from personal monitors as markers of exposure to ETS. It is predicted that the increase in lung cancer risk for nonsmoking women from average ETS exposure at work (among those exposed at work) is on the order of 25% (95% confidence interval (CI) = 8, 41) relative to background risk (i.e., with no ETS exposure from any source). This compares to an estimate of 39% (95% CI = 5, 65) for nonsmoking women whose husbands smoke at the adult male smoker's average of 25 cigarettes/day. At the 95th percentiles of exposure, the estimate from spousal smoking is 85% (95% CI = 32, 156), compared to 91% (95% CI = 34, 167) from workplace ETS exposure. Subject to the validity of the assumptions required in this approach, the outcome supports the conclusion that there is a significant excess risk from occupational exposure to ETS. The excess risk from ETS at work is typically lower than that from spousal smoking, but may be higher at the 95th percentiles of exposure.

Adult↗
PubMed2004

Health impact on caregivers of providing informal care to a cognitively impaired older adult: rural versus urban settings.

INTRODUCTION: Rural caregivers, compared to urban caregivers, may experience a heavier burden, which could result in poorer health status for these caregivers. Furthermore, caregiving demands may prevent rural caregivers from engaging in healthy behaviours. We investigated potential differences between rural and urban caregivers in the health impact on these caregivers of caring for cognitively impaired individuals. METHODS: Two convenience samples of caregivers of older adults with cognitive impairment were obtained from Northern Ontario. The rural sample (n = 20) was taken from a community of < 15,000 inhabitants, the urban sample (n = 17) from a community of 125,000. We obtained demographical information for caregivers and care recipients, and information regarding the level of independence in activities of daily living and frequency of behaviour problems of care recipients, the type and quantity of supports available and used by caregivers, global health indices and a measure of healthy behaviours from caregivers. RESULTS: A greater proportion of rural caregivers was non-spousal and employed. Care recipients' characteristics from the 2 groups were similar, except for higher frequencies of behaviour problems among the rural sample. Rural caregivers had access to fewer formal supports but did not report greater burden, poorer health status, or fewer healthy behaviours than urban caregivers. However, for rural caregivers, higher reports of burden were associated with fewer healthy behaviours (r = 0.79, p = 0.001); we found no such association for urban caregivers (r = 0.04, p = 0.861). CONCLUSION: Rural caregivers may have special needs regarding the management of behaviour problems in care recipients and in the promotion of healthy behaviours for themselves. Primary health care providers have an important role in ensuring that these needs are met.

Activities of Daily Living↗
PubMed2006

Social constraints and spousal communication in lung cancer.

The Social Cognitive Processing Model suggests that talking with others facilitates cognitive and emotional processing of experiences such as cancer if the social context in which these discussions take place is supportive and positive. Despite this, patients and spouses may inadvertently constrain each other's attempts to process and cope with the disease. To our knowledge, no previous studies have directly examined the effect of lung cancer on the spousal relationship. We began to examine this effect by identifying the social constraints experienced by couples coping with lung cancer through semi-structured interviews with 13 patients and 12 spouses. Using Grounded Theory methodology, our analyses showed that these couples experienced a wide variety of social constraints, including denial, avoidance, and conflict that can hinder open spousal communication. Specifically, patients and spouses reported trouble discussing continued tobacco use, cancer-related symptoms, prognosis, and the emotional effects of lung cancer on the spouse. Despite these constraints, participants who reported talking with their partners about their relationships reported fewer constraints and better communication about cancer. These findings highlight the importance of a relationship perspective in the study of lung cancer and provide information about how talking together about the spousal relationship may enable couples to minimize social constraints and enhance cognitive and emotional processing of the disease.

Adaptation, Psychological↗
PubMed1995

Do you need to shop around? Age at marriage, spousal alternatives, and marital dissolution.

"This article attempts to shed light on the oft-observed relationship between age at marriage and marital dissolution by first deriving a hypothesis from marital search theory that relates both variables to the supply of spousal alternatives in the local marriage market. This hypothesis states that, relative to people who marry later in life, persons who marry at comparatively young ages will be especially susceptible to divorce when confronted with abundant alternatives to their current spouse. Marital history data from the National Longitudinal Survey of Youth were then merged with aggregated data from the Public Use Microdata Samples of the 1980 U.S. census to test this hypothesis." The author finds that "discrete-time event history analyses offer no support for this hypothesis. Although the risk of marital dissolution is highest where either husbands or wives chance numerous spousal alternatives, the impact of age at marriage on divorce is significantly weaker in marriage markets containing abundant remarriage opportunities. Some of the effect of age at marriage on marital dissolution is attributable to the detrimental impact of early marriage on educational attainment."

Americas↗
PubMed2005

Reconsidering evolved sex differences in jealousy: comment on Harris (2003).

In a recent article, Harris (2003) concluded that the data do not support the existence of evolved sex differences in jealousy. Harris' review correctly identifies fatal flaws in three lines of evidence (spousal abuse, homicide, morbid jealousy), but her criticism of two other lines of evidence (self-report responses, psychophysiological measures) is based, in part, on a mischaracterization of the evolutionary psychological theory and a misunderstanding of the empirical implications of the theory. When interpreted according to the correct criterion (i.e., an interaction between sex and infidelity type), self-report studies (both forced-choice and non-forced choice) offer strong support for the existence of sex differences in jealousy. Psychophysiological data also offer some support, although these data are weakened by validity-related concerns. In addition, some refutational evidence cited by Harris (responses to real infidelity, responses under cognitive load) actually does not refute the theory. An integrative model that describes how jealousy might result from the interaction of sociocultural variables and evolved sex differences and suggestions for future research directions are discussed.

Arousal↗
PubMed2004

Uterine cervical cancer: a holistic approach to mental health and it's socio-psychological implications.

This correlation study investigated outpatients with early stage uterine cervical cancer. The subjects' mental health and its' relationship with demographic characteristics, clinical characteristics, and quality of life were examined. One hundred and seventy six patients from three major hospitals in the Fukuoka area were surveyed with a structured questionnaire. The status of mental health measured by CES-D (Center for Epidemiologic Studies Depression Scale) indicated an average score of 13+/-8 (mean+/-SD). No clinical parameters were found to have significant correlation to CES-D. However, increased pain (p< 0.001) and the absence of a husband or a partner (p < 0 .01) had greater CES-D score which indicated worse mental health outcome. The QOL (Quality of Life) scale developed for this study consists of the four domains: "Feel satisfied with life" (r = -.526, p < 0. 01), "Find life worth living" (r= -.485, p < 0.01), "Feel no hindrance in daily life" (r= -.319, p<0.01), and "Feel no anxiety with illness" (r= -. 578, p < 0.01) all which have statistically significant correlations with CES-D scores respectively. Upon examination using the multi-regression model, a strong relationship between CES-D scores and "Feel no anxiety with illness" (r= -.331, p<0.001) was evident. This showed to be the strongest indicator affecting the depression outcome, followed by "Strong pain" (r= .231, p<0.01). Clinical parameters, such as performance status, clinical stage, and medical treatment did not show any correlation to CES-D scores. The research suggests that the mental health of outpatients with uterine cervical cancer was influenced by pain and quality of life, rather than the clinical parameters. The presence of a husband or a partner played the role as social support to reduce the level of depression. In order to provide complete care of patients, pain management, anxiety management, and spousal involvement are crucial to patients' mental health, especially in the ongoing care of uterine cervical cancer.

Anxiety↗
PubMed1999

Gender roles, marital intimacy, and nomination of spouse as primary caregiver.

Using data from a sample of married men and women undergoing treatment for cancer, we tested two potential hypotheses for the unequal representation of husbands and wives as spousal caregivers, including societal gender role norms and emotional closeness in the marital relationship. Multivariate analyses support both hypotheses; wives are only one third as likely as husbands to select their spouses as caregivers, and spouses who name their mates as confidants are three times more likely than those who do not to also name them as caregivers. We conclude that although gender role norms are key to caregiver selection, the intimacy inherent in the caregiving role renders an emotionally close marriage an important criterion to the selection of spouse as caregiver.

Adult↗
PubMed1998

Impotence and perceived partner support.

Because impotence has both physiologic and psychologic components, it seems that impotent patients might benefit from a holistic approach to treatment that includes a medical regimen for physiologic factors as well as treatment for social and psychologic factors. The spousal relationship is one social and/or psychological factor. Often, a male experiences his sexual dysfunction as profoundly stressful while the partner finds it annoying or disturbing, but not threatening to the overall bond between them (Rust, Golombok, & Collier, 1988). This study was conducted to explore patient perception of the spousal (partner) relationship during admission to an erectile dysfunction clinic.

Adult↗
PubMed2000

Affect and behavioral involvement in spousal complaints and compliments.

The authors explored affect and behavioral involvement (gaze, talk time, and speaking turns) in spousal complaints and compliments, relating these constructs to current and longitudinal relational well-being. Participants were 65 married couples. Concurrent relational well-being was higher when partners negotiated (a) complaints with less negative affect, more gaze, less wife talk time, and more husband talk time and (b) compliments with less negative affect and more husband gaze. Husbands' satisfaction decreased over time when they experienced more negative affect while complimenting. Both spouses' satisfaction decreased over time when either partner, especially wives, took more speaking turns complaining. Partial support for the sentiment-override effect is discussed, but findings went beyond the effect to demonstrate contingent affect when responding to spousal behaviors.

Adult↗
PubMed2001

Mortality following conjugal bereavement, Belgium 1991-96: the unexpected effect of education.

This paper examines excess mortality following spousal bereavement by time since bereavement, sex, age, and education. The main hypothesis challenged is that higher education buffers the harmful effects of spousal loss. Using a log-rate model, death-rate ratios (widowed/married) are estimated for 49,849 and 126,746 Belgian widowers and widows and an equal number of non-bereaved controls matched to the bereaved on their socio-demographic characteristics. The hypothesis that the more educated suffer less excess mortality is not supported. Although higher educational levels are associated with lower mortality in general, they do not alleviate the effects of bereavement. On the contrary, in the period immediately following spousal loss, the more highly educated seem to have more, rather than less, excess mortality. Three possible arguments are suggested to account for this: education-related differences in the partner-relationship, structural differences in the availability of appropriate social support, and cultural differences in potential support networks.

Belgium↗
PubMed2002

Who expects to continue working after age 62? The retirement plans of couples.

OBJECTIVES: This study examines the individual, spousal, and household characteristics associated with the retirement expectations of husbands and wives. METHODS: Using data from the 1992 Health and Retirement Study, subjective probabilities of working full-time after reaching age 62 and age 65 are used to measure retirement expectations. The retirement expectations of husbands and wives are modeled simultaneously using a joint-generalized least-squares approach. RESULTS: Within a marriage, retirement expectations are shaped by individual, spousal, and household characteristics. We observe some gender differences in cross-spousal influence with wives' retirement expectations being more influenced by husbands' resources and constraints than vice versa. Nonetheless, individual and household factors associated with retirement expectations are widely shared by husbands and wives. DISCUSSION: Husbands and wives both respond to individual and joint constraints and opportunities when planning for retirement. Findings support that there is considerable overlap in retirement planning of husbands and wives during early parts of the retirement decision-making process. However, inequity in cross-spousal influences is a defining characteristic of retirement decision making. Implications for both policy makers and practitioners are briefly discussed.

Aged↗
PubMed1994

Inconsistency between workplace and spousal studies of environmental tobacco smoke and lung cancer.

In a risk assessment released at the end of 1992, the U.S. Environmental Protection Agency (EPA) concluded that environmental tobacco smoke (ETS) is a known human lung carcinogen. The Agency reached that conclusion primarily on the basis of epidemiologic studies of self-reported never-smoking women, in which the exposure index was marriage to a smoker. However, the use of the spousal smoking exposure surrogate introduces many potential confounding factors. Such confounding and bias due to denial of active smoking are likely explanations for weak and inconsistent reported ETS-lung cancer associations. This contention is supported by the results of 14 worldwide studies of lung cancer and ETS exposure in the workplace, which in combination indicated no risk elevation. Workplace ETS-lung cancer studies are not subject to the bias and confounding introduced by the spousal smoking exposure surrogate. The EPA ignored the workplace studies in its risk assessment and extrapolated the results of spousal smoking studies to workplace and other sources of ETS exposure. In its estimate of ETS-attributable lung cancer deaths in the United States, the EPA ascribed over 70% of the deaths to nonspousal ETS exposure, primarily workplace exposure. Considered in their entirety, the ETS-lung cancer epidemiologic data do not support a causal inference or provide a scientific basis for government regulation of smoking in the workplace.

Bias↗
PubMed2003

Attitudes and practices of doctors toward domestic violence victims in South Africa.

Our study intended to ascertain doctors' attitudes and practices toward domestic violence in a sample of 402 doctors randomly chosen for a mail survey from a list of registered medical practitioners in South Africa. We found that the mean number of patients treated for domestic violence per month was 11.4 (SD = 13.4); for White doctors 15.8, African Black 6.2, and for Asian doctors 5.3. The high frequency of domestic violence detected in this sample seems to reflect national surveys on domestic violence. Most doctors believed that they should play a role in prevention and treatment, and their attitudes toward victims of domestic violence were generally sympathetic and supportive. Male doctors and long-serving practitioners tended to have more conservative views of the causes and attitudes of spousal assault and of the doctors' role in prevention. Only 9.7% of the doctors had received any training on domestic violence. Further research is needed to establish the prevalence of domestic violence in women presenting to medical practitioners and to investigate how the problem currently is being addressed.

Adult↗