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PubMed1978

Suicide pact in a depressed elderly couple: case report.

An elderly depressed couple with multiple physical problems decided that death was preferable to their present lifestyle, and made a suicide pact. At the last minute the wife felt unable to go through with it and the couple entered a psychiartic hosptial. During their 3-week stay they were treated appropriately with amitriptyline and psychotherapy. Since discharge they have been followed closely for two years. Some psycho- and socio-dynamic and therapeutic aspects are discussed.

Adjustment Disorders↗
PubMed2005

Prevalence and risk factors of sexual dysfunction among younger married men in a rural area in China.

OBJECTIVES: To investigate the prevalence and factors associated with sexual dysfunction (SD) among younger married men living in rural China. METHODS: An anonymous questionnaire was self-administered by the husbands of 298 randomly selected married women aged 20 to 39 years. RESULTS: Of all 298 respondents, 84 (28.8%) had at least one of the seven studied SDs. The prevalence of an individual SD ranged from 3.7% (physical pain) to 19.5% (premature ejaculation); 41.9% were dissatisfied with their sexual life. Age, education level, age at marriage, and income were, in general, not statistically significant in predicting SD. Adjusting for age, education level, and age at marriage, the following were significantly associated with different categories of SD: smoking, SD of the wife, perceived health status, mental health and vitality quality of life (QOL), sharing a bedroom with nonspouse family members, masturbation, and the perceived importance of sexual life. Income, the perceived importance of sexual life and adequate sexual knowledge, mental health QOL, inability to achieve climax, and erectile problems were independently associated with sexual satisfaction. CONCLUSIONS: SD among younger married men in rural China was significantly associated with mental health QOL and vitality QOL. Other factors, such as perceived physical health, room sharing, and spousal SD, were also involved. Most respondents perceived their sexual knowledge to be inadequate, which was also associated with sexual satisfaction. Because various factors were significant in predicting SD, multiple approaches are required in promoting sexual health in this study population.

Adult↗
PubMed1994

Selected lifestyle practices in urban African American women--relationships to pregnancy outcome, dietary intakes and anthropometric measurements.

The relationships of selected lifestyle factors (cigarette smoking, consumption of alcoholic beverages, recreational drug use, and exercise during pregnancy), all self-reported, to pregnancy outcomes, dietary intake during pregnancy, and maternal anthropometric measurements, were investigated in a group of urban African American pregnant women. The 234 subjects were aged 16-35 years and were free of diabetes and abnormal hemoglobins. The lifestyle data were collected by trained interviewers during the subjects' prenatal clinic visits, and the dietary data by monthly, quantitative 24-hour food recalls conducted during these same visits. Maternal anthropometric measurements were obtained from the subjects' hospital records, and pregnancy outcome data during physical examinations of the newborn infants. Both cigarette smoking and drug use were associated with significantly lower mean birth weight, length, and head circumference, while exercise was associated with a significantly higher mean birth weight, and head circumference (P < 0.05). Drug use during pregnancy was associated with a significantly higher intake of vitamin C, and a significantly lower intake of iron; while women reporting drug use before pregnancy had significantly higher mean intakes of food energy, protein, total and saturated fat, and zinc. Prepregnancy weight, percent ideal prepregnancy body weight, prepregnancy body mass index, and delivery weight were significantly lower among those reporting drug use before pregnancy. Multiple regression analyses indicated that smoking explained a relatively small proportion of the variance in infant birth weight compared with delivery weight and percent of ideal prepregnancy body weight.

Adolescent↗
PubMedDate not supplied

Psychosocial sequelae of closed head injury: effects on the marital relationship.

Head injury frequently produces physical and psychological sequelae involving cognitive, behavioural, and personality disturbances which are chronic and perhaps even permanent. Clinically, it is apparent that the marital relationships of head injury patients face initial disruption as well as ongoing challenges in dealing with the physical, neuropsychological, and emotional changes post-injury. However, there is little empirical data to substantiate these observations. In this study, the marital relationships of 55 male head injury patients were assessed, based on the spouse's self-report obtained through interview and questionnaires. The sample was divided into three groups according to the severity of the injury: mild (N = 10), moderate (N = 25) and severe (N = 20). Based on a one-way multivariate analysis of variance, dyadic consensus, affectional expression, and overall dyadic adjustment were significantly lower for wives in the severe group than the moderate group. Affectional expression was also lower in the severe group than the mild group. Stepwise multiple regression analysis determined that 47% of the variance of overall dyadic adjustment could be accounted for by three variables (multiple R = 0.69, p less than 0.001). Dyadic adjustment was greater when wives reported a lower level of financial strain, perceived their spouse to have a relatively low level of general psychopathology or maladjustment, and when the injury was relatively mild based on GCS scores. The implications for intervention in rehabilitation at the marital level are highlighted.

Activities of Daily Living↗
PubMed2006

Young people of minority ethnic origin in England and early parenthood: views from young parents and service providers.

The paper explores the phenomenon of early parenthood in minority ethnic communities in England. The data were collected using focus group interviews, in-depth semi-structured interviews and a telephone survey. The sample consisted of 139 participants (41 service providers, 10 grandmothers, 88 young parents). The findings map out the complexity and diversity of experience of early parenthood amongst young people of minority ethnic origin, not least the multiple attachments many experience in relation to their social groups, religious affiliations and the traditional patterns of parenting within their immediate and extended family. Both the young parents and professionals in this study constructed early parenthood in more positive terms than is currently portrayed in the contemporary policy. The findings are analysed and discussed in relation to ethnic identity, social inclusion and exclusion. We explore participants' attempts to counter negative 'deficit' models of early parenthood with reference to perspectives on youth, parenthood and contemporary strategic policy. In conclusion, we suggest an unambiguous focus on the reduction of pregnancy is not a credible message when teenage pregnancy is a social norm for a particular ethnic or cultural group. For young parents of Muslim faith in particular, teenage parenting within marriage is not necessarily considered a 'problem' or seen as a distinctive event. Most participants did not view early parenthood as a barrier to re-establishing career and educational aspirations. A wide diversity of experience amongst young parents is evidenced in the communities studied; this needs to be reflected more comprehensively both in UK policy and in support services.

Adolescent↗
PubMed2004

Job strain and minor psychiatric morbidity among hospital nurses in southern Taiwan.

Nursing is recognized as a stressful occupation and has indicated a probable high prevalence of distress. The purpose of this study was to identify the degree of job strain and to investigate the association between job strain and the minor psychiatric disorder in hospital nurses. A total of 907 registered nurses were recruited for this study via stratified random sampling from hospitals in Kaohsiung, Taiwan. Each participant was requested to answer a structured questionnaire anonymously and a 98.1% response rate was achieved. The Job Strain Questionnaire was used to measure job strain. The minor psychiatric disorder was measured by the Chinese Health Questionnaire, and a cut-off score of 4 or more was used to identify which subjects had minor psychiatric disorder. Results indicated that 24.5% of the nurses were in the high strain group and that those who were unmarried, had a lack of social support, and those with shift work were the most susceptible to high job strain. A total of 443 (48.8%) respondents were identified as having minor psychiatric disorder. Multiple logistic regression revealed that high job strain, poor social support, and poor self-perceived health were the significant factors for nurses to have minor psychiatric disorder. These findings suggested that the best way to decrease the prevalence of psychological distress of nurses might focus on organizational attempts to reduce work stress and to develop effective health promotion programs and give more assistance to nurses who have a managerial role.

Adult↗
PubMedDate not supplied

Child adaptational development in contexts of interparental conflict over time.

This multi-method study sought to identify parameters of developmental change and stability of child reaction patterns to interparental conflict in the context of family relations in a sample of 223 6-year-old children and their parents followed over the course of one year. Consistent with the sensitization hypothesis, interparental withdrawal and hostility each consistently and uniquely predicted child distress reactions to conflict even after analytically controlling for parental warmth. Associations were found across multiple domains of child responding (i.e., overt negative affect, subjective negative affect, internal representations) and both concurrent and prospective, autoregressive analyses. Results of the autoregressive path analyses indicated moderate stability in each of the domains of conflict reactivity over the 1-year longitudinal period.

Adaptation, Psychological↗
PubMed1996

Life values, resuscitation preferences, and the applicability of living wills in an older population.

OBJECTIVES: To determine whether life values are related to resuscitation preferences and living will completion in an older population and to assess beliefs about the applicability of living wills. DESIGN: Individual structured interviews. SETTING: An independent retirement community. PARTICIPANTS: One hundred thirty-two subjects older than 63 years of age. MEASUREMENTS: Resuscitation preferences were elicited in five hypothetical scenarios. Subjects with living wills were asked whether their living will would play a role in the scenarios. Subjects rated the importance of 13 life value statements. RESULTS: The percentage of subjects desiring CPR in each scenario was as follows: current condition (66%); acute illness (33%); terminal disease (8%); functional impairment (8%); and dementia (7%). The percentage of those with a living will who thought their living wills would play a role in the scenarios was as follows: acute illness (84%); terminal disease (93%); functional impairment with intact cognition (66%); and dementia (91%). Factor analysis of the life value statements revealed five meaningful factors: quality of life; capacity/autonomy; family relations; physical comfort; and treatment philosophy. Multiple correlations were found between four of five life value factors and hypothetical resuscitation preferences or the presence of a living will. CONCLUSION: Subjects misinterpreted the applicability of living wills in nonterminal illness scenarios. A relationship between life values and resuscitation preferences was noted, which emphasizes the importance of eliciting and including life values when discussing advance directives.

Aged↗
PubMed1977

Multiple overt incest as family defense against loss.

A case report of father-daughter incest is presented that illustrates the way in which overt incest can function as a multi-determined familial defense against separation and loss. The case is further distinguished by: (a) multiple incest and (b) family therapy--an approach infrequently described in the literature on this problem. The authors have adopted the psychodynamic view that incest expresses the collective psychopathology of all the family members as well as their common adaptational capacities. Specifically, we have attempted to demonstrate that separation anxiety was a shared dread in this family and that incest defended against this painful prospect.

Adolescent↗
PubMed1993

Family treatment of spouses and children of patients with multiple personality disorder.

Although there is a large body of literature on the individual treatment of patients with multiple personality disorder (MPD), there are few accounts of the treatment of the spouses and children of these patients. After reviewing some of the existing literature, the authors present case examples of family work with patients, spouses, and children on two inpatient units and in the partial hospitalization program at Menninger. Techniques for the beginning, middle, and later phases of family treatment are illustrated.

Adult↗
PubMed1981

Sudden unexpected death in women: biologic and psychosocial origins.

The relationship of the risk of sudden death from arteriosclerotic heart disease to biologic and psychosocial factors was studied retrospectively in Allegheny County, Pennsylvania, in 80 white women who died from arteriosclerotic heart disease during March, 1977-October, 1978, and in 80 age-matched neighborhood controls. All cases of sudden death in white women aged 25-64 years who died outside the hospital within 24 hours of onset of symptoms were ascertained. The overall autopsy rate was 63%. Detailed post-mortem examinations were conducted on 42 of 80 sudden cardiac cases. Cases were more often heavy smokers and had fewer children than the control population. Fifteen out of 80 women who died suddenly of heart disease and three controls had a definite history of psychiatric disease. Cases had more often experienced the death of a significant other within six months prior to their demise. Multiple regression analysis showed that cigarette smoking, psychiatric history and death of a significant other contributed significantly to differences between women who died suddenly and control women. Thirteen women died suddenly under the age of 45 years. Six of the 13 deaths were due to arteriosclerotic heart disease. These six women were all smokers, and four were currently taking oral contraceptives or estrogen replacements.

Adult↗
PubMed1986

Stress in social and family relationships during the medical residency.

A study of stress during residency training involved data analysis of questionnaires completed by 108 residents and fellows in internal medicine. Over 40 percent of the respondents experienced important problems with their spouse or partner. Of these, 72 percent believed that these problems were due to the residency, and 61 percent reported that their spouse or partner agreed with this assessment. Only 21 percent of the residents with relationship problems felt that their hospital work was being affected negatively. A multiple regression analysis showed that 10 variables accounted for 50 percent of the variance in predicting relationship stress. The results suggest that scheduling and structural changes in residencies are necessary in order to reduce stress among residents. Perhaps equally important is the finding that stress can be buffered by family relationships and social contact. The authors conclude that social support systems need to be fostered during the residency.

Adult↗
PubMed1987

The Cape Town Teenage Clinic.

Over a 6-month period 265 white females aged under 24 years attending the Teenage Clinic of the Western Cape Region of the Family Planning Association were interviewed at their first visit; 81% were sexually active. The age of menarche and the parents' marital status were important parameters of socio-sexual behaviour. The earlier the menarche, the higher the prevalence of coitus at a younger age, and the shorter the interval between menarche and the first coitus. Young age at first coitus, in turn, was associated with a higher prevalence of multiple sexual partners and smoking, and a longer period of unprotected intercourse before attending the clinic than among those who first attempted intercourse at a later age. Of those who had first experienced coitus at under 17 years, 37% came from single-parent families, compared with 12% of those in whom coitus was delayed until over 19 years of age. The important health and educational implications are discussed.

Adolescent↗
PubMed1987

Inbreeding and prereproductive mortality in the Old Order Amish. II. Genealogic epidemiology of prereproductive mortality.

The effects of offspring and parental inbreeding on prereproductive mortality (death before age 20 years) in the historical population of the Lancaster County, Pennsylvania, Old Order Amish were investigated using the Amish genealogic registry, which contains information on 42,465 births dating to the time of the pioneer migrants in the 1700s. Inbreeding coefficients for offspring and parents were computed using the path method of tracing common ancestors in the multigenerational pedigrees. In this population, prereproductive mortality declined from about 15% in the late 1800s to about 5% after 1930. Offspring inbreeding was found to be an independent predictor of prereproductive mortality after multivariate adjustment for demographic risk factors for mortality. Moreover, the higher the coefficient, the higher the relative risk of prereproductive death, and the higher the risk of multiple deaths in the same sibship. There was no evidence of declining inbreeding effects over 10 generations of continuous inbreeding, nor of any significant parental inbreeding effects. Because of the high levels of inbreeding, it could be shown that inbreeding accounts for about 40% of all prereproductive deaths in the present population. Genetic load analysis showed an average of about 1.7 lethal equivalents and a mostly mutational load.

Adult↗
PubMedDate not supplied

Psychological responses to the use of the fetal monitor during labor.

Fetal monitoring, a major advance in obstetrical care, transforms the labor room into an intensive care setting. The psychological effects of this new technology were investigated by means of structured interviews with 25 postpartum women. The multiplicity of psychological responses obtained are described. The relationship of demographic, obstetrical, and psychosocial variables to women's overall positive or negative reaction to the monitor was investigated. Personality characteristics and life experiences with pregnancy and childbirth were factors that shaped the manner in which the monitor was experienced. The effect of fetal monitoring on maternal anxiety is discussed. The impact of mechanization on the total experience of childbirth is noted.

Anxiety↗
PubMed1994

Social support and postpartum depression.

Discrepancies between prenatal social support expectations and subsequent perceptions of support actually received were examined in relation to postpartum depression. Low-risk primiparous women (N = 105) were surveyed 1 month before and 1 month after delivery. Almost half of the women prenatally and one third postpartially had depression scores which would lead them to be classified as possibly depressed (CES-D scores of 16 or greater). In multiple regression, two social support discrepancy measures, prenatal depression and postpartal closeness to husband, correlated with postpartal depression and accounted for nearly 40% of its variance. The generalizability of the findings should be further explored, but the findings suggest the need for attention to prenatal expectations of postpartum support as a way to influence the incidence of postpartum depression. In addition, continued efforts to identify causes of postpartum closeness with the spouse are needed.

Adult↗
PubMed1986

Reproductive potential in the older woman.

There is a definite increase in the number of women bearing children in the 30- and 40-year-old age groups. The total number of women who are 35 to 40 years of age in the United States is projected to increase 42% and the percent births to this age group is projected to increase 37%. This is apparently because of a trend to postpone childbearing and first birth due to women's career priorities, advanced education, control over fertility, financial concerns, late and second marriages, and infertility. Associated with this is an increase in visits to the infertility specialist for older women who have an intrinsic decrease in fecundity with advancing age. Although, on the average, a woman will not experience menopause until about 50 years of age, her effective childbearing period may stop almost a decade earlier. A woman in her late 30s and, especially, early 40s is at some disadvantage in terms of conception delay, ability to carry a chromosomally normal fetus until term, and risk of trisomic conception. Certain endocrinologic parameters have been identified for the woman entering the transition to menopause. Biologic aging of the hypothalamic-pituitary-ovarian axis is intertwined with changes in the endocrine milieu of the perimenopause and preperimenopause. Despite a clear association of decreased fecundity in older women due to multiple biologic and social influences, so long as the individual has regular cycles and essentially normal endocrine parameters, she should be a candidate for an expedited infertility workup and ovulation induction, if not more aggressive treatment. Her obstetric profile is much improved, except for an increase in congenital anomalies and chromosomal defects. Chorionic villus biopsy study or amniocentesis is advised in all cases, regardless of therapy.

Abortion, Spontaneous↗
PubMed1998

Long-term physical, psychological and social consequences of severe injuries.

This 6 year follow-up study was designed to evaluate the long-term physical, psychological and social outcomes of severely injured patients (Injury Severity Score of greater than or equal to 16). Patients were treated at the University Hospital Groningen, the Netherlands, between January 1989 and December 1989. Outcomes were assessed using a postal questionnaire. After injury, the 55 respondents had predominantly complaints of the extremities, the spine and the head. Psychological complaints were present in 84 per cent of patients and mainly concerned fatigue, slowness and memory impairments. Despite these physical and psychological complaints, 74 per cent of patients were able to return to work and the memory succeeded in complying with job requirements. Injuries of the extremities and the spine were risk factors for failing to return to work. Social consequences were also reflected in broken marriages (6/22) and changes of leisure activities (45 per cent). On the basis of the impairments and disabilities revealed, we conclude that further improvement of the long-term outcomes of severely injured patients may be achieved by advancements in the treatment of injuries to the head, spine or extremities, comprehensive psychological support and vocational rehabilitation.

Adolescent↗