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PubMed2001

Infidelity, initiation, and the emotional climate of divorce: are there implications for mental health?

A large literature has examined the role of "secondary" stressors, such as problems with finances, social support, residential mobility, and children, in producing the well-documented association between divorce and a variety of psychopathological conditions. Much less attention, however, has been paid to variation in the "primary" disruption experience. We address this omission using data from the National Survey of Families and Households to investigate the interrelationships among depression, initiator status, and spousal infidelity. While we find little evidence of direct effects of initiator status or spousal infidelity on post-divorce depression, the importance of these characteristics emerges when they are considered in an interactive context. Specifically, while divorce initiation is associated with reduced depression among individuals with unfaithful spouses, initiation is associated with increased depression in the absence of spousal infidelity. Taken together, our findings suggest that characteristics of the divorce experience may interact in complex ways to produce variation in mental health outcomes.

Divorce↗
PubMed2006

The impact of gender regarding psychological well-being and general life situation among spouses of stroke patients during the first year after the patients' stroke event: a longitudinal study.

BACKGROUND: The informal caregivers perceive lack of choice to take on the role of caregiving, receiving little or no preparation for the caregiving role at home. The typical informal caregiver is female, either a spouse or adult child of the care recipient, and seldom shares the responsibilities of caregiving with other family members. The spouses worry about the ill relative, but also about what consequences the disease might have for their own life. The worries seem to vary with gender and disease. There are, to our knowledge, few previous longitudinal studies that have focused on gender differences among spouses of stroke patients. OBJECTIVES: To explore gender differences among spouses in perceived psychological well-being and general life situation, during the first year after the patients' stroke event. DESIGN: Longitudinal study with three assessments regarding psychological well-being and general life situation during 1 year. SETTINGS: The study took place at a stroke ward, Stockholm, Sweden. PARTICIPANTS: Consecutively 80 female and 20 male spouses of stroke patients admitted to a stroke unit participated. METHODS: Data were analysed using analyses of variance. RESULTS: Female spouses have a negative impact on psychological well-being, while male spouses have a lower occurrence of emotional contacts in their social network. Consistently, the female spouses reported lower quality of life and well-being than the male spouses. CONCLUSIONS: This study generates the hypotheses that there are gender differences among spousal caregivers of stroke patients; female spouses are more negatively affected in their life situation due to the patients' stroke event than the male spouses. It is important to take the individual differences under consideration when designing a nursing intervention, to meet the different needs and demands of male and female caregivers. The interventions should focus on individual support, so that the caregivers can adapt to their new role and be comfortable and effective as informal caregivers.

Female↗
PubMed2004

[Researches on health and welfare promotion based on an approach of social medicine].

This article was derived from my memorial talk given when receiving the prize of the Japanese Society for Hygiene at their academic congress. The reader could review my research on health and welfare promotion made by introducing new conceptual health policy based on the approach of social medicine. Through my experience in different research work, the importance of social factors in the etiology of health during childhood, adulthood and old age was discussed. In addition, it was revealed that social factors not only influence the population's health status but also constitute the context within which organized efforts can be made to promote health. For the elderly, the annual health check, stroke patient registration, and insurance for care and spousal bereavement; for adults, the Karoshi and occupational health; and for children, air pollution-atopy predisposition and lifestyles were highlighted as social medicine-related issues. The research on mostly longitudinal population studies showed that health status, including the life expectancy and the prevalence of disability and chronic disorders, are related to one's marital status, social support, psychosocial working conditions and environmental factors as well as to lifestyles such as physical activity and hours of work and sleep at entry. More attention should be directed to independent factors' effects on health, separate from those of adverse health habits and bio-medical situations, under the health and welfare promotion strategy.

Aged↗
PubMed2006

Basic health, women's health, and mental health among internally displaced persons in Nyala Province, South Darfur, Sudan.

OBJECTIVES: We assessed basic health, women's health, and mental health among Sudanese internally displaced persons in South Darfur. METHODS: In January 2005, we surveyed 6 registered internally displaced persons camps in Nyala District. Using systematic random sampling, we surveyed 1293 households, interviewing 1 adult female per household (N=1274); respondents' households totaled 8643 members. We inquired about respondents' mental health, opinions on women's rights, and the health status of household members. RESULTS: A majority of respondents had access to rations, shelter, and water. Sixty-eight percent (861 of 1266) used no birth control, and 53% (614 of 1147) reported at least 1 unattended birth. Thirty percent (374 of 1238) shared spousal decisions on timing and spacing of children, and 49% (503 of 1027) reported the right to refuse sex. Eighty-four percent (1043 of 1240) were circumcised. The prevalence of major depression was 31% (390 of 1253). Women also expressed limited rights regarding marriage, movement, and access to health care. Eighty-eight percent (991 of 1121) supported equal educational opportunities for women. CONCLUSIONS: Humanitarian aid has relieved a significant burden of this displaced population's basic needs. However, mental and women's health needs remain largely unmet. The findings indicate a limitation of sexual and reproductive rights that may negatively affect health.

Adolescent↗
PubMed1999

Spousal resemblance and risk of 7-year increases in obesity and central adiposity in the Canadian population.

OBJECTIVE: Spousal similarities in 7-year changes in obesity and obesity-related phenotypes were examined in a subsample of 376 pairs of spouses from a sample of 1487 participants in the 1988 Campbell's Survey follow-up of the 1981 Canada Fitness Survey. MEASURES: Indicators of body fatness included the body mass index (BMI), the sum of five skinfolds (SF5), and waist circumference (WAIST), whereas those for relative adipose tissue (AT) distribution included the ratio of two trunk to three extremity skinfolds, adjusted for SF5 (TERadj), and WAIST adjusted for BMI (WAISTadj). RESULTS: Spouse correlations were 0.17, 0.17, and 0.17 for the BMI (p<0.05) and 0.20, 0.20, and 0.21 for SF5 (p<0.05) for the initial measurement, follow-up, and 7-year change, respectively. Spouse correlations for WAIST were somewhat lower: 0.16 (p<0.05), 0.11 (p<0.05), and 0.11 (p<0.05) for the initial measurement, follow-up, and 7-year change, respectively, whereas those for TERadj and WAISTadj were low and not significant. Spouses of probands who had increases in adiposity and central AT distribution had elevated risks of also increasing in these parameters. Spousal risks (risk ratios) were 1.48 (95% CI = 1.08-2.03), 1.49 (95% CI = 1.10-2.02), and 1.68 (95% CI = 1.28-2.21) for increases in BMI, SF5, and WAIST, respectively, whereas the risks for increases in central adiposity were 1.22 (95% CI = 0.86-1-73), and 1.05 (95% CI = 0.72-1.53) for TERadj, and WAISTadj, respectively. DISCUSSION: The results indicate significant spousal resemblance and risk for increases in fatness in the general Canadian population, whereas both the spousal resemblance and risks for increases in AT distribution, adjusted for level of fatness, are non-significant. The results suggest that shared environmental factors may be important determinants of spousal similarities in changes in total body fatness over time; however, cohabitation in the short term may not lead to increases in spousal resemblance.

Adipose Tissue↗
PubMed1990

Changes in reproductive function among remarried women: the effects of spousal characteristics.

"This paper examines the relationship between change in childbearing function from a woman's first to second marriage and the degree of similarity between her first and second husbands in age, education, and religion. Using data from the [U.S.] 1982 National Survey of Family Growth, the specific hypothesis tested is: where plans are similar, the second husband tends to resemble the first to a greater extent than where childbearing functions differ. Separate tests relating to age, education, and religion provide only limited support for this hypothesis. However, when the various tests are considered collectively as a system, the weight of the evidence provides general support for the hypotheses. The implications of these findings for understanding trends in marriage are discussed."

Americas↗
PubMed1989

Incest. Its causes and repercussions.

Throughout history, societies have circumscribed certain forms of intimacy in the family setting. Transgression has been punished by force of ecclesiastical rules and government statutes. However, no single definition of incest is widely accepted, as the degree of kinship in which marriage is allowed and the age of consent vary. Fueled in part by the current emphasis on child abuse prevention, the reporting of incest is increasing. The perpetrator in the majority of reported cases is a male adult, and most often the victim is a young girl. Other dyads do occur and are probably under-estimated in frequency. Disturbed family relationships generate a shift in individual responsibilities and expectations that can lead to incest. A lack of spousal sexual activity is a common preceding factor. The sequelae of this breach of family integrity are significant. Frequently, the family itself is destroyed; the destruction often begins before incest occurs. The victim faces a future characterized by emotional turmoil, diminished self-esteem, impaired interpersonal relationships, and impulsive acting-out behavior. Family and individual therapy, participation in support groups, and referral for chemical dependency treatment are essential if future problems in the lives of everyone involved are to be avoided.

Child↗
PubMed2000

Uncertainty and expectations: taking care of a cardiac surgery patient at home.

Family members of postsurgical patients are, by necessity, taking on the caregiving role sooner without any specified resources to help them. The input of these caregivers is essential so nurses can understand their concerns, needs, and struggles and develop strategies to support the caregivers in their caregiving role. This study was designed to increase nursing knowledge regarding the experiences of being a caregiver of a cardiac surgery patient during the immediate postdischarge period. The qualitative research method of Interpretative Description, first described by Thorne, Kirkham, and MacDonald-Emes in 1997 guided the study. In-depth interviews were held with eight spousal caregivers. Findings revealed that the experience was molded by caregivers' past participation as a caregiver, as well as caregivers' and care recipients' outlook on life, their interpersonal relationship, and their expectations. Caregivers engaged in the process of caregiving that involved being vigilant and monitoring the care recipient's recovery, implementing strategies to assist the recovery process, and taking on a role to provide care and seek help as required. The encounter with caregiving affected all realms of caregivers' lives, and they experienced feelings of stress, vulnerability, and having to put their lives on hold; these feelings were often compounded by uncertainty.

Aged↗
PubMed1996

Genetic segregation analyses of serum IgG2 levels.

Summary : The aim of this study was to determine whether there was evidence for a genetic component in the immune response as measured by IgG2 levels. The study was motivated by our studies of early-onset periodontitis (EOP), a group of disorders characterized by rapid destruction of the supporting tissues of the teeth in otherwise healthy individuals. EOP has two subforms, localized juvenile periodontitis (LJP) and a generalized form (G-EOP). IgG2 levels are elevated in LJP but not G-EOP individuals; and African-American IgG2 levels are higher than Caucasian levels regardless of EOP status. IgG2 levels were determined in 123 EOP families and in 508 unrelated non-EOP control individuals. Segregation analysis under the regressive model approach of Bonney was used to analyze IgG2 levels for evidence of major locus segregation. After adjusting for LJP status, race, sex, and age, the best fitting model was an autosomal codominant major locus model (accounting for approximately 62% of the variance in IgG2), plus residual parent/offspring and spousal correlations. Smoking and GM23 are also known to affect IgG2 levels. If additional adjustments are made for smoking and GM23, the best-fitting model is still a codominant major locus but with no significant residual correlations.

Black People↗
PubMed1998

A comparison of spousal anticipatory grief and conventional grief.

The purpose of the present investigation was to compare the degree of similarity between the grief experienced by spouses of terminally-ill patients prior to (anticipatory grief) and following the death (conventional grief). Responses of this sample were also compared with those of two control groups: spouses of chronically-ill patients and spouses of relatively healthy individuals from the community. The impact of such factors as the quality of the marital relationship, perceived ability to cope, concurrent stressors, previous losses, perceived social support, and perception of spouse's pain and suffering on anticipatory and conventional grief was also systematically explored. Results indicated that these two phenomena are statistically similar with regard to the majority of subscales on the Grief Experience Inventory. Furthermore, when compared with conventional grief, anticipatory grief was unexpectedly associated with higher intensities of anger, loss of emotional control, and atypical grief responses.

Aged↗
PubMed1989

Respiratory symptoms and lung function in relation to passive smoking: a comparative study of American and French women.

Results are reported from a parallel analysis of the association of passive smoking with respiratory symptoms and lung function (FEV1, FVC and FEV1/FVC) in 2220 US and 3855 French women from the general population examined over the same time period using similar methods. Age, city, educational level, occupational exposure and height (for lung function) were taken into account. In the US survey, being a never smoker married to a current or former smoker was significantly associated only with wheezing compared to being a true never smoker. A borderline significant association between passive smoking and dyspnoea was observed among women older than 40 in the French survey. No association was observed with cough or phlegm production. Passive smoking was significantly related to lower FVC and FEV1 values among French women 40 years or more, even among those without a history of wheeze or asthma. However, even among US women older than 40 years of age, there was no significant association between passive smoking and level of lung function. Better housing conditions, higher divorce rates, more frequent exposure to passive smoking in childhood, and different selection factors for active smoking in the US compared to France might explain the lack of association of current spousal smoking habits with lower lung function in American women.

Adult↗
PubMed1995

Correlates of the caregiving process in multiple sclerosis.

This study sought to identify predictors of general health, mood, family, and life satisfaction for spousal caregivers of persons with multiple sclerosis. Cross-sectional data were obtained through structured interviews with 34 husbands and 27 wives of the disabled individuals. Results of the hierarchical regression analyses indicated that objective burden, subjective burden, and perceived uncertainty about the illness situation accounted for the largest proportion of variance in caregivers' general health, mood, family and life satisfaction. Perceived social support explained an additional small, but significant proportion in caregivers' general health, mood, and family satisfaction. Contrary to expectation, family coping did not significantly explain any variance in caregiver outcome measures.

Adaptation, Psychological↗
PubMed2006

Women's position within the household as a determinant of maternal health care use in Nepal.

CONTEXT: Although gender inequality is often cited as a barrier to improving maternal health in Nepal, little attention has been directed at understanding how sociocultural factors may influence the use of health care. In particular, how a woman's position within her household may affect the receipt of health care deserves further investigation. METHODS: Data on ever-married women aged 15-49 from the 2001 Nepal Demographic and Health Survey were analyzed to explore three dimensions of women's position within their household-decision making, employment and influence over earnings, and spousal discussion of family planning. Logistic regression models assessed the relationship of these variables to receipt of skilled antenatal and delivery care. RESULTS: Few women reported participation in household decision making, and even fewer had any control over their own earnings. However, more than half reported discussing family planning with their husbands, and there were significant differences among subgroups in these indicators of women's position. Though associations were not consistent across all indicators, spousal discussion of family planning was linked to an increased likelihood of receiving skilled antenatal and delivery care (odds ratios, 1.4 and 1.3, respectively). Women's secondary education was also strongly associated with the greater use of health care (5.1-5.6). CONCLUSIONS: Gender inequality constrains women's access to skilled health care in Nepal. Interventions to improve communication and strengthen women's influence deserve continued support. The strong association of women's education with health care use highlights the need for efforts to increase girls' schooling and alter perceptions of the value of skilled maternal health care.

Adolescent↗
PubMed2006

Physical violence by husbands: magnitude, disclosure and help-seeking behavior of women in Bangladesh.

This paper explores the magnitude of physical violence by husbands, the disclosure of it and the help-seeking behavior of abused women in urban and rural Bangladesh. The data come from a larger study on domestic violence against women conducted in Bangladesh during 2000-2004. All ever-married women covered by the population-based survey component (n=2702) conducted in 2001 were included in the current analysis. We also draw on in-depth interviews with 28 women who were physically abused by their husbands. Results show a high prevalence of lifetime physical spousal violence against women: 40% in urban and 42% in rural areas. Most of the abused women (66%) were silent about their experience. The main reasons behind this silence were high acceptance of violence, stigma and fear of greater harm. Sixty percent of urban and 51% of rural abused women never received any help from others. Only 2% ever sought help from institutional sources, from where support was not forthcoming. Women approached these sources only when they could not endure anymore or the violence became life threatening or children were at risk. The findings show that although providing appropriate services is absolutely necessary, it is also important to foster the use of such services and to help women overcome the barriers for accessing these services.

Adaptation, Psychological↗
PubMed1997

Spousal coping during the surgical wait.

The purpose of this study was to identify the coping strategies used by a patient's spouse and the perceived effectiveness of these coping strategies while waiting during a loved one's surgery. Forty spouses, male and female (age 25 to 65 years), waiting during a patient's surgery completed a demographic questionnaire and the Jalowiec Coping Scale. Mean scores of the styles and individual strategies were calculated and ranked in descending order. The optimistic coping strategy of "tried to think positively" was used most often by the subjects. The supportant coping strategy of "prayed or put trust in God" was ranked as the most effective strategy. The nurse who instructs the patient regarding their surgery should also prepare the spouse for the surgical wait. Recommending coping strategies to spouses may be a component of stress inoculation.

Adaptation, Psychological↗
PubMed1999

Medicaid eligibility workers discuss Medicaid estate planning for nursing home care.

This study was part of a multiphase project examining the perceptions of elder law attorneys, certified financial planners, and Medicaid eligibility workers regarding Medicaid estate planning (MEP) for nursing home care. Focus group methodology (5 groups, N = 32 participants) was used to explore the perspectives and experiences of Medicaid eligibility workers, who are responsible for interpreting, administering, and enforcing federal and state regulations. Findings describe factors influencing MEP, enforcement of regulations, and potential policy responses to MEP. Participants identified numerous impediments to effective implementation of current regulations. Recommendations for improved policy include redefinition of spousal assessment policies, other valuable consideration determinations, and penalty period formulas.

Aged↗
PubMed1993

The role of paternal variables in divorced and married families: predictability of adolescent adjustment.

The predictability of adolescent adjustment, based on teacher reports, in divorced and married families was examined in relationship to four variables: paternal mood, spouse-ex-spouse relationship, father-adolescent relationship, and parental visitation. Analyses indicated that the father-adolescent relationship was predictive of adolescent functioning in divorced families, and the spousal relationship and paternal mood were similarly predictive in married families.

Adaptation, Psychological↗
PubMed2000

A study of the spousal role of Egyptian women in clerical jobs.

More women are seeking outside employment worldwide. However, the spousal role with all that it entails remains a significant core for women, particularly in developing countries. How women experience this role when they are also employed in low-income jobs has not been uncovered adequately. One hundred and ninety Egyptian women who are employed in clerical jobs were asked about the satisfaction and the stress they experience in their spousal role. The study's participants described the centrality of their spousal role in their life and discussed how fulfilling the needs and the expectations of their husbands were most significant for them. Their role in creating harmony in the family and the extent to which they were able to succeed in achieving this goal also were cited as the most significant aspects of their spousal relationship. Another satisfying part of their marital life was having children. On the other hand, their husbands' demanding behavior, the way the husbands express their demands, the husbands' abuse, and the participants' constant feeling of el masooliah, or their "sense of overload from responsibilities," were some of the stresses described by the participants. They also perceived a gap in the values that they and their husbands hold. This gap was most constraining to some of the participants. The participants coped by enduring the stress. This begs the question of what societal values keep women in less than satisfying relationships. The findings are discussed within a framework of societal norms and values expectations that reinforce women's commitment and endurance of spousal stress.

Adaptation, Psychological↗