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PubMed2002

Effect of support programme to reduce stress in spouses whose partners 'fall off' clinical pathways post cardiac surgery.

Cardiac surgery is flourishing in today's health care industry and looks to prosper well into the future. More than ever, improved technology, surgical skill and the worldwide trend of increasing longevity means that surgical intervention is offered to patients rarely seen in cardiac units in previous years. Patients are now much older, with multiple co-morbidity including repeat cardiac surgery. In line with advances in cardiac surgery, critical pathways to map the expected recovery route for the patient have been introduced. These maps are used extensively as guides for treatment and care. It is not only health professionals who use the pathways; patients and their relatives also refer to them as indicators of a 'normal' post-operative route. As a result, the critical pathway provides an avenue for expectations of predicted progress through to discharge. These predictors appear to give spouses hope, access to earliest possible visitation and confidence in a positive outcome. Nevertheless, it has recently become increasingly clear that for partners of patients who fail to proceed as expected, who apparently 'fall off' the predicted road to recovery, the critical pathway is problematic. Partners of such patients tend to demonstrate greatly heightened anxiety and nurses often have to deal with them at the point of crisis. In the cardio-thoracic unit at which this study was undertaken, the significant number of spouses who ended up in crisis drew attention to the need for additional support to be built into the post open-heart surgery critical recovery pathway. This study sought therefore to examine how nurses might assist spouses to adapt in the event of a complicated recovery following bypass surgery. A convenience sample of 39 spouses of cardiac surgical patients admitted to the cardio-thoracic recovery unit was obtained to assess stress responses at a critical post-operative data point, 5 days post-surgery. A symptoms of stress inventory was used to measure 94 items of physiological stress in 10 specific subscale categories. As a result of this study, it was found that incorporating a spousal support programme into the critical pathway of open-heart surgical patients significantly reduced stress suffered by spouses of patients who deviated from pre-determined recovery goals. The findings suggest that nurses need to understand the implications of the critical pathway and provide families with information concerning issues associated with complicated recovery. An unexpected finding of the study pointed to an apparent difference in the stress experienced by male spouses to that of female spouses. Recommendations from this study are to further explore the qualitative component of the stress felt by spouses and the negative association of stress with morbidity and mortality for women and patients without spouses. Nurses need to consider developing and implementing a stress management programme for spouses, establishing spousal support groups and exploring the possibility of incorporating spousal support strategies into the critical pathways of patients across hospital settings.

Adult↗
PubMedDate not supplied

Depression and self-reported physical health in patients with coronary disease: mediating and moderating factors.

OBJECTIVES: The purpose of this study was to define how the relation between depression and self-reported physical health in patients with coronary disease is modified by other patient-centered factors. METHODS: We conducted a prospective cohort study of 111 patients (members of a health maintenance organization) with angiographically documented coronary disease, examining factors (physical symptoms, psychological states and traits, and spousal support) modifying the relation between depression and patient-reported physical health 5 years later using multiple hierarchical regression models. RESULTS: Five regression models (all including demographic and disease severity covariates) were constructed to predict physical health from depression only (R2 = 0.22); depression plus angina and fatigue (R2 = 0.53); depression plus positive affect and novelty seeking and their interaction (R2 = 0.48); depression plus spousal support (R2 = 0.27); and depression, angina, fatigue, positive affect, and novelty seeking (overall model) (R2 = 0.65). Depression remained significant in each model, but the proportion of variance it predicted was diminished in the presence of the other variables (bivariate r = 0.39, partial r = 0.37-0.13). CONCLUSIONS: The effect of depression on self-reported physical health is significantly mediated by physical symptoms (angina and fatigue), personality states and traits (positive affect and novelty seeking), and spousal support. Positive affect and novelty seeking had more marked effects on physical health in the presence of more depression. Thus, a broad range of factors beyond the severity of coronary disease itself affect the perceived physical health of patients with coronary heart disease.

Affect↗
PubMed2005

Burnout in academic chairs of otolaryngology: head and neck surgery.

BACKGROUND: Burnout can be characterized by a low degree of personal accomplishment and a high degree of emotional exhaustion and depersonalization using the Maslach Burnout Inventory-Human Services Survey (MBI-HSS). With increasing demands and constraints placed on academic department chairs, the risk of developing burnout may be increasing. The prevalence of burnout in chairs of academic departments of otolaryngology and the factors associated with it have not been previously described. OBJECTIVES/HYPOTHESIS: The purpose of this study was to determine the prevalence of burnout in otolaryngology chairs and to identify the factors that are associated with burnout development. Understanding these elements can lead to improved prevention, recognition, and treatment of professional burnout. STUDY DESIGN: A cross-sectional questionnaire-based study of 120 academic chairs of otolaryngology in the United States was performed. METHODS: A confidential questionnaire was mailed to U.S. otolaryngology chairs. The questionnaire consisted of six parts assessing the following elements: 1) demographic information, 2) professional stressors, 3) personal and professional life satisfaction, 4) a self efficacy survey, 5) a spousal support survey, and 6) the MBI-HSS. Statistical analyses were performed using Pearson correlation and analysis of variance, and burnout data were compared with previously reported data from other department chairs and physicians. RESULTS: Questionnaires were returned from 107 department chairs for a response rate of 89%. Chairs were on average 56 years of age, serving as chair for a mean of 11 years. Average work week was 68 hours and did not vary significantly with increasing duration as chair. Sixty-six percent of time was spent delivering patient care, 8% in research, and 26% performing administrative duties. MBI-HSS scores demonstrate 3% of chairs experiencing high burnout, 81% of chairs with moderate burnout, and 16% of chairs with low burnout. On average, chairs have low depersonalization scores, low-moderate emotional exhaustion scores, and low-moderate personal accomplishment scores. High emotional exhaustion or depersonalization was correlated with low self-efficacy, low spousal support, disputes with the dean, department budget deficits, working nights and weekends, Medicare audits, loss of key faculty, and being a malpractice defendant. High personal accomplishment was correlated with increased time spent performing administrative duties. When compared with other physician specialties, otolaryngology chairs demonstrate less sense of emotional exhaustion and depersonalization but also slightly less sense of personal accomplishment. Duration as chair, age, and hours worked per week were not associated with increased burnout. CONCLUSIONS: Most otolaryngology chairs experience moderate levels of burnout. The biggest risk factors for burnout include low self-efficacy, low spousal support, disputes with the medical school dean, department budget deficits, and nights/weekends worked. These findings may help department chairs identify and prevent burnout and may help in developing programs to minimize burnout in our field's academic leaders.

Academies and Institutes↗
PubMed1993

Pain-relevant support as a buffer from depression among chronic pain patients low in instrumental activity.

OBJECTIVE: This study examined the hypothesis that among chronic pain patients lacking participation in activities, perceived pain-relevant spousal support would act to compensate for a low level of social reinforcement and provide a buffer against depression. DESIGN: Hierarchical regression analyses were conducted to examine the relative and cumulative effects of support and activity, and their interactions, in the prediction of depression severity. SETTING: The study setting was a training and research oriented Veterans Administration Medical Center. PATIENTS: Participants were 105 married, male chronic pain patients evaluated for a comprehensive pain management program. MAIN OUTCOME MEASURE: Depression severity was measured by the Beck Depression Inventory. RESULTS: Three categories of activity, and perceived interference of pain accounted for significant proportions of the variance in depression severity scores beyond that accounted for by age and pain severity. Support was not predictive of depression. Interactions between interference and support, and between two of the specific activities and support added significantly to the prediction of depression. CONCLUSIONS: Results are consistent with a buffering model of social support in which perceived spousal support among chronic pain patients appears to moderate the potentially deleterious effects of a low level of activity.

Chronic Disease↗
PubMed2000

Marital satisfaction in patients with cancer: does support from intimate partners benefit those who need it the most?

This cross-sectional study assessed 3 ways of providing spousal support. Active engagement means involving the patient in discussions and using constructive problem-solving methods; protective buffering means hiding one's concerns; and overprotection refers to underestimation of the patient's capabilities, resulting in unnecessary help and excessive praise for accomplishments. Ratings of received spousal support by 68 patients with cancer revealed findings similar to those of partners' ratings of provided support. The positive association between active engagement and the patient's marital satisfaction was stronger for patients with a rather poor psychological and physical condition than for those with a rather good condition. Furthermore, protective buffering and overprotection were negatively associated with marital satisfaction only when patients experienced relatively high levels of psychological distress or physical limitations.

Adaptation, Psychological↗
PubMed1994

Social network, social support and heavy drinking in elderly men--a population study of men born in 1914, Malmö, Sweden.

We analysed whether there were associations among different aspects of social network and social support, on one hand, and heavy drinking and alcohol problems on the other. The study sample (n = 621) comprised a random half of all male residents born in 1914 in Malmö, Sweden. Five hundred (80.5%) participated. Heavy drinking was defined as an alcohol consumption above 250 g alcohol per week and alcohol problems were assessed by a modified Michigan Alcoholism Screening test. Eight conceptually differential aspects of social networks and social support were measured. Four of five social network indices (social anchorage, social participation, contact frequency, spousal support) were associated with heavy drinking (OR 1.9-2.5) and two social network indices (social anchorage, spousal support) were associated with alcohol problems (OR 2.1-2.3). The results in this study are independent of social class, but based on a cross-sectional study, so we do not know if heavy drinking has caused social isolation or the contrary. If these results can be verified in a prospective study, a strengthening of the social network of the individual could perhaps lead to more moderate alcohol habits and better health, a finding of potential importance in the field of health promotion.

Aged↗
PubMed1995

Individual coping style and psychological attitudes during pregnancy and predict depression levels during pregnancy and during postpartum.

Fifty primigravidae were investigated from 30 weeks of gestation until 6 months after delivery to assess the predictive value of individual coping style, conception time and specific psychological changes during pregnancy for the depression levels assessed during the third trimester of pregnancy and 5 days, 6 weeks and 6 months after delivery. The individual coping style is an effective predictor of depression levels during the third trimester of pregnancy and 6 months after delivery, but not for the depression levels 5 days and 6 weeks after delivery. A path analysis revealed that high depressive coping and low social support-seeking predict a longer conception time, which all predict a more important lack of spousal support during pregnancy. Higher depressive coping, a longer conception time and a more important lack of spousal support during pregnancy all predict high depression levels 6 months after delivery. The present findings thus suggest helpful predictors for the psychological adaptation during the transition to parenthood.

Adaptation, Psychological↗
PubMed2000

[Jichi Medical School Social Support Scale (JMS-SSS) revision and tests for validity and reliability].

OBJECTIVE: To develop a perceived social support scale for the Japanese. METHODS: Participants consisted of a total of 2,150 residents who responded to a perceived social support scale questionnaire in four communities involved in the Jichi Medical School Cohort Study at the study baseline in 1992-1994 (Analysis I) and 380 residents of Akaike town who responded to a questionnaire survey with the revised scale in 1999 (Analysis II). The first analysis was performed to confirm cross validity of the perceived social support scale measuring the availability of functional support from the spouse, family, and friends. The factor structures estimated for each district were compared with each other. The second analysis was set to revise the scale, modified in terms of a 4-point scoring format. The correlation between each item and a social desirability scale score, Cronbach alpha, and correlation coefficients between the revised scale scores and the original scale scores were calculated. RESULTS: Cross validity was confirmed based on the similarity of the factor structures of the responses obtained from the four different communities. Four selected indices supported the constancy of the factor structures across the communities. For the revised scale, two items were removed from the original scale-items measuring spousal support because of their statistically significant correlations with the social desirability scale score. The first principal component accounted for 57.0% of variance for spousal support, 68.2% for family support, and 67.0% for friends support and uni-dimensionality of the scales was confirmed. Alpha coefficients of the scales were .89, .95, and .94, respectively. Social support levels were stable over a mean period of 6.2 years. CONCLUSIONS: On an empirical basis, we have been able to develop a perceived social support scale. Homogeneous data from three different sources were obtained which were free from social desirability response bias and thus applicable for Japanese adults.

Adult↗
PubMed2006

Older spouses' perceptions of partners' chronic arthritis pain: implications for spousal responses, support provision, and caregiving experiences.

This study of older patients with osteoarthritis and their spouses examined concordance between patients' and spouses' reports of patients' pain severity and the association of concordance with support and caregiving outcomes. Patients and spouses independently viewed videotapes of the patient performing simulated household tasks and provided ratings of patients' pain. Spousal overestimation of patients' pain was the most common type of nonconcordance. Spouses who were accurate in their perceptions of their partner's level of pain during a log-carrying task responded less negatively and provided emotional support that was more satisfying to patients. In addition, spouses who were accurate in their perceptions of their partner's pain during the log-carrying task reported less stress from providing support and assistance. Future research that uses such observational methods may be highly useful for understanding the effects of chronic illness on older couples.

Activities of Daily Living↗
PubMedDate not supplied

Prevalence and psychosocial correlates of disordered eating among Chinese pregnant women in Hong Kong.

Three-hundred-and-fifty-nine Chinese pregnant women were surveyed to determine prevalence and psychosocial correlates of eating disturbance in pregnancy. About 9.8% of participants reported disordered eating symptoms. Prevalence of these symptoms was related to general factors of drive for thinness, body image dissatisfaction, and traditional gender role attitudes. These general factors were, in turn, associated with factors specific to pregnant women. In particular, drive for thinness was related to poor spousal support; body image dissatisfaction was related to poor maternal-fetal attachment; and traditional gender role attitudes were related to strong maternal-fetal attachment and spousal support. Limitations and implications of these findings are discussed.

Journal Article↗
PubMed2003

Adult attachment, the transition to parenthood, and depressive symptoms.

Testing a model suggested by J. Bowlby (1988), this study investigated how a personal vulnerability (attachment ambivalence) interacts with perceptions of deficient spousal support before and during a major life stressor (the transition to parenthood) to predict pre-to-postnatal increases in depressive symptoms. Highly ambivalent women who entered parenthood perceiving either less support or greater anger from their husbands experienced pre-to-postnatal increases in depressive symptoms at 6 months postpartum. The associations between these 2 prenatal interaction terms and pre-to-postnatal increases in depressive symptoms were mediated by perceptions of declining spousal support across the transition period. Moreover, for highly ambivalent women, the association between prenatal and postnatal depression scores was mediated by perceptions of the amount of support available from their husbands.

Adult↗
PubMed1995

Twelve month adherence of adults who joined a fitness program with a spouse vs without a spouse.

OBJECTIVE: The purpose was to determine adherence of apparently healthy adults who joined an exercise program with a spouse (Married Pairs) vs. without a spouse (Married Singles). It was hypothesized that Married Pairs would have significantly higher adherence than Married Singles; and that self motivation would be associated with adherence. EXPERIMENTAL DESIGN: Twelve month adherence of Married Pairs and Married Singles were compared to self motivation in a retrospective design. SETTING: Subjects in this study did not volunteer for a scientific investigation, instead they were spontaneous participants in a university fitness program. PARTICIPANTS: Married Pairs were 16 couples and Married Singles were 16 married men and 14 married women. INTERVENTIONS: This study observed the 12 month spontaneous participation in a fitness program. The only intervention was the self motivation questionnaire. MEASURES: Adherence was defined as monthly attendance, compliance to the exercise prescription, dropout, and reason(s) for dropout. Self motivation was also measured. RESULTS: For Married Pairs, monthly attendance was significantly higher (54.2% +/- 10.3 vs 40.3% +/- 14.3) and dropout (6.3% vs 43.0%) was significantly lower than for Married Singles. Compliance to the exercise prescription was good for all of the groups except for the Married Single Men. Fifty percent of the dropouts left because of family responsibilities/lack of spousal support; 25% dropped-out to continue exercising on their own. Self motivation did not differ between Married Pairs and Married Singles. Monthly attendance of spouses in the Married Pairs demonstrated a significant correlation. CONCLUSIONS: Married Pairs had significantly higher attendance and lower dropout than Married Singles which appeared to be primarily influenced by spousal support rather than by self motivation.

Adult↗
PubMed1994

Remission of late-life drinking problems: a 4-year follow-up.

This 4-year follow-up study compared stably remitted late-life problem drinkers to nonremitted problem drinkers and nonproblem drinkers. At time 1, to-be-remitted drinkers reported less alcohol consumption and fewer drinking problems, more depression and less self-confidence, less spousal support and approval of drinking from friends, and more help-seeking than did to-be-nonremitted drinkers. Remitted drinkers showed improvement in functioning and life context at the 4-year follow-up, but compared with nonproblem drinkers some deficits persisted. Stable remission and abstinence among late-onset drinkers were closely tied to receiving less spousal support and approval from friends for drinking at time 1, whereas help-seeking was a strong predictor of stable remission and abstinence among early-onset problem drinkers. For both late- and early-onset drinkers, abstinence was predicted by initially having more drinking problems, depression, and health stressors.

Adaptation, Psychological↗
PubMed1993

[Risk of low birth weight in the Plaza de la Habana region].

The objective of this study was to confirm the risk factors (RF) for low birth-weight (LBW) and suggest new risk factors, which were analyzed separately and together, in order to define a program to be coordinated by family doctors to reduce the frequency of this problem. For this purpose, a retrospective cross-sectional survey was carried out with 57 cases (mothers who had had LBW babies) and 58 controls (mothers who had not had LBW babies). In addition, data were obtained from the prenatal records of mothers who received care at family doctors' offices and at the clinica in the Plaza de la Habana Area. Estimates were made of the relative risk and the percentage attributable risk of 107 hypothetical RF for LBW from a clinical-epidemiological and social standpoint. One-way analysis of variance, the chi-square test, multiple linear regression, and logistic regression were used to analyze the results, which suggested the following RF for LBW: family dysfunction, family crisis, lack of spousal support, extended family, failure to attend prenatal group sessions for pregnant women, and failure to receive education on how to prevent LBW. The multifactorial risk profile was the following: risk of [corrected] intrauterine growth retardation, family dysfunction, threat of preterm delivery, coffee-drinking, attendance at fewer than 11 prenatal checkups, and failure to attend prenatal group sessions for pregnant women. The variables excluded from the model were: low weight-for-height, lack of spousal support, smoking more than 10 cigarettes a day, and family history of LBW. The findings confirmed 10 of the suspected risk factors for LBW in Cuba and nine of those described in the international literature. Maternal age, spontaneous abortion, and alcohol consumption were not confirmed. Six RF for LBW preventable by the family doctor through his/her actions at the family and community level are identified, as is a multifactorial profile of six RF for LBW. On the basis of these results, proposals are made in regard to programming priorities and the implementation of strategies aimed at preventing LBW, and it is recommended that the study be continued with a larger sample.

Adolescent↗
PubMed2001

Depression and marital dissatisfaction in patients with end-stage renal disease and in their spouses.

Little research has been performed assessing patients with end-stage renal disease (ESRD) as parts of marital dyads or within family structures. Recent findings suggest patient interactions within such systems are associated with patient outcomes. To evaluate the relationship between level of patient depression and spouse psychosocial status, 55 couples in which one partner was undergoing chronic hemodialysis therapy for ESRD were interviewed. Two variables that alone and in interaction with one another were expected to relate to the spouse's level of depression and marital satisfaction were investigated: patient depression level and spouse's perceived social support. Depression was assessed using the Beck Depression Inventory (BDI). Spouses' levels of depressive affect correlated directly with patient BDI scores. A significant two-way interaction for spousal depression (patient depression and spousal support) supported viewing spouses' adjustment as a function of the interaction between spouse and patient factors. Additionally, a main effect of perceived spousal social support on spousal marital satisfaction indicated that spouses reporting high levels of social support had the least marital strain. The severity of the patient's illness did not correlate with any of the predictor variables or measures of spousal adjustment, but spouses reported significantly lower functional status for patients than did nephrologists. Spouse and patient levels of depression are related, although causal relationships cannot be determined by these studies. Moreover, spouse perception of marital satisfaction is related to depression scores. These findings suggest the patient with ESRD functions in a psychosocial dyad. Spouse psychosocial status could impact on the level of patient depression, and the spouse might be amenable to interventions that could improve patient outcome.

Adult↗
PubMed2005

Changes in Marijuana Use Over the Transition Into Marriage.

Reductions in substance use tend to coincide with marriage, as both may occur during emerging adulthood. During the transition to marriage, it is possible that one's spouse may be the influence that causes the reduction in substance use. Data on participants (N = 471 couples) for this report are taken from a longitudinal study of early marriage. The objective of the current analysis is to determine if having a spouse who uses marijuana is associated with a greater likelihood of one's own use. Additionally, we are interested in spousal influence and cessation. The findings support spousal influence. Husbands are more likely to start using marijuana if their wives use marijuana, but the reverse is not true. Husbands also are more likely to stop using if their spouses do not use. During the transition into marriage, the drug use of one spouse does affect the other. However, this influence appears to be unidirectional, with wives influencing their husbands more often.

Journal Article↗
PubMed1988

Decree No. 2458 of 1988 authorizing civil marriage separations before a notary, 28 November 1988.

This Decree authorizes separations in civil marriages in Colombia to be effected before a notary in cases of mutual consent. In such cases, the public instrument is to make provision for children and spousal support. An agreement of the spouses regarding their reciprocal obligations and their common children can be modified by common agreement before a notary or revised through judicial proceedings in accordance with the law.

Americas↗
PubMed1999

Interpersonal and psychological correlates of marital dissatisfaction in late life: a review.

Developmental studies suggest that marital quality improves in old age (e.g., Guilford & Bengtson, 1979). However, many of the studies are replete with sampling biases that probably led to an overinflated positive report of marital satisfaction in older adults. Our review evaluated contemporary studies that have investigated interpersonal and psychological factors associated with dissatisfaction in long-term marriages. Recent investigations indicate that older marriages benefit from lower levels of conflict and greater sources of mutual pleasure following child-rearing cessation. Studies of social support in long-term marriages suggest that perceptions of spousal support are more strongly related to marital satisfaction and general well-being for older women than for men. A few investigations have found a significant relationship between depression and marital discord in older adult samples, and the causal flow between these two variables appears to be unidirectional in that depression has a detrimental impact on late-life marital quality. Indeed, depression has been found to mediate the link between many age-related stressors (e.g., ill health, retirement) and declines in marital adjustment. However, our preliminary analysis of marital adjustment within a depressed, older adult, outpatient sample of married individuals did not confirm statistically that marital discord is associated with depressive symptomatology. This, in part, was attributed to the very narrow range of older adults sampled (i.e., clinic patients suffering from depression). However, the majority of depressives characterized their marriages as discordant. The implications for these findings are discussed and future directions are offered.

Adult↗