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PubMed1978

Psychosocial factors in juvenile rheumatoid arthritis.

A detailed survey of 88 children with juvenile rheumatoid arthritis (JRA) was made in an attempt to elucidate characteristics that may participate in the etiologic mechanism. Data from a random pediatric population from the same geographic area were also included for comparisons. The most striking findings were psychosocial factors. Children whose parents were unmarried as a result of divorce, separation, or death comprised 28.4% of the JRA population, compared to 10.6% of the comparison group. In addition, adoption occurred three times more often in the JRA population. Fifty-one percent of these events (divorce, separation, death, or adoption) occurred near the date of onset of the disease.

Adolescent↗
PubMed2002

A case illustration of resistance from a gestalt-experiential perspective.

The case of Victoria illustrates psychotherapy with a woman faced with a difficult and unexpected divorce. The authors present a summary of typical struggles faced by Victoria through three phases of therapy. The therapy focused initially on coping with the divorce, then moved to work on her career dissatisfaction, and finally to her efforts to develop a new relationship. The case presentation illustrates resistance as it manifested itself in both a behavioral manner and as in-session resistance to awareness of internal states. The behavioral mode of resistance is manifested by her inability to follow through on decisions made in therapy sessions and by her interruptions of ongoing therapy. A transcript of a typical in-session exchange illustrates the resistance to awareness. The authors also describe interventions intended to work with the resistance.

Adult↗
PubMed2002

Childhood antecedents of adult sense of belonging.

Sense of belonging has been proposed to be a basic human need, and deficits in sense of belonging have been linked to problems in social and psychological functioning. Yet, there is little evidence about what early life experiences contribute to sense of belonging. The purpose of this study was to examine potential childhood antecedents of adult sense of belonging. The sample consisted of 362 community college students ranging in age from 18 to 72 years, with a mean age of 26 years. Measures included the Sense of Belonging Instrument, the Parental Bonding Instrument, and the Childhood Adversity and Adolescent Deviance Instrument. Multiple regression analysis was used to correlate childhood antecedents with adult sense of belonging. The final reduced model included 12 variables, which accounted for 25% of the variance in sense of belonging. Significant positive antecedents with a relationship with sense of belonging were perceived caring by both mother and father while growing up, participation in high school athletic activity, and parental divorce. Significant negative variables with a relationship with sense of belonging included perceived overprotection of father, high school pregnancy, family financial problems while growing up, incest, and homosexuality. Knowledge of these factors should influence interventions with families regarding child-rearing and parenting practices, mediating the effects of crises during childhood such as divorce and teen pregnancy, and the interpersonal growth needs of teenagers.

Adolescent↗
PubMed1980

Some uses of client and census records in community mental health planning.

A conceptual framework is presented which outlines uses of client and community data for mental health planning. Client records from a mental health center and 1970 census data were analyzed three ways to illustrate some of these uses: (a) a geographic analysis which compared service utilization rates with the social characteristics of census tracts; (b) a demographic analysis which compared the social characteristics of clients with those of the catchment area population; and (c) an analysis of clients who dropped out of treatment and who left therapy unimproved. The results revealed that (a) census areas characterized by high proportions of disenfranchised groups (e.g., divorced, low status, Spanish heritage) showed high service utilization rates; (b) higher proportions of divorced, high school educated, and unemployed residents utilized services than expected by population estimates; and (c) dropouts from therapy could be discriminated based on demographic differences in marital status, income level, employment status, educational level, ethnicity, and previous mental health treatment.

Community Mental Health Services↗
PubMed1988

Treatment outcome of secondary orgasmic dysfunction: a two- to six-year follow-up.

Sixty-six women reporting secondary orgasmic dysfunction and their partners, who received one of five group treatment formats, were sent questionnaires 2-6 years later. Thirty-eight of the women and 38 of the male partners responded to the follow-up questionnaires. Women who were not divorced and who did not receive additional treatment after group treatment (n = 28) showed consistent increases across time in their ability to experience orgasm during intercourse, improving from a mean coital orgasmic frequency of 9.5% before treatment to 36.9% at long-term follow-up. Sexual harmony and coital frequency showed similar increases following treatment but had returned to near baseline levels 2-6 years later. Divorced women and women who received additional treatment (n = 10) demonstrated greater declines in sexual harmony over the follow-up period than did their untreated counterparts. The subjects reported generally favorable reactions to treatment and stressed the importance of a treatment focus on communication and relationship skills. Regression analyses suggested the predictive importance of variables associated with the male partner's functioning. The implications of the results for clinical practice and for future research are discussed.

Adult↗
PubMed1995

A twin study of the association of post-traumatic stress disorder and combat exposure with long-term socioeconomic status in Vietnam veterans.

This study examines the association between post-traumatic stress disorder (PTSD) and combat exposure with the socioeconomic status of 2210 male monozygotic veteran twin pairs in 1987. In the unadjusted analysis on individuals, modest correlations indicated that those with PTSD were more likely to have been divorced, and less likely to be currently employed or to achieve high status in income, education or occupation. In the crude analysis of veterans not suffering from PTSD, there were small positive correlations between combat level experienced and the likelihood of ever being married, ever being divorced, and the number of years employed at the current job. However, when we examined identical twins discordant for PTSD, and adjusted for pre-military and military service factors, only unemployment remained significant. Likewise, in combat-discordant twins, no significant effects on the socioeconomic indicators were seen. We conclude that PTSD and combat experience in Southeast Asia have not had a major impact on the socioeconomic status of veterans.

Adaptation, Psychological↗
PubMed2006

Prevalence of psychoactive drug use among medical students in Rio de Janeiro.

BACKGROUND: Drug use and abuse may hamper learning capabilities and the development of technical skills in medical students and, therefore, the quality of care offered to patients. The aim of this investigation was to estimate the prevalence of psychoactive drug use among medical students of public universities in Rio de Janeiro, Brazil, and to identify characteristics associated with substance use. METHOD: This was a cross-sectional investigation designed to include all medical students of four universities. The final sample included 1,054 students. Patterns of licit and illicit drug use (at least once in lifetime drug use, drug use in the last 30 days (LTD) and CAGE) before and during medical school were assessed by a multiple-choice, self-administered anonymous questionnaire. RESULTS: Alcohol abuse was more prevalent among male students from higher income families. Alcohol LTD use was more prevalent among male students with college-educated parents. Tobacco, cannabis and inhalant lifetime use was more prevalent among males and tranquillizer use among females. Tobacco, cannabis and tranquillizer lifetime use was more prevalent among students with divorced or dead parents. Inhalant lifetime use was more prevalent among students from higher income families. Students who had college-educated, divorced or dead parents or evidenced tobacco, cocaine or inhalant lifetime use were more prevalent among cannabis users. Male students from higher income families had higher prevalence of cocaine lifetime use. CONCLUSION: Substance use in this group of medical students is not widespread compared to rates reported for developed countries. Preventive efforts should focus on alcohol and cannabis use by medical students.

Adolescent↗
PubMed2000

Factors associated with problem behaviors in Turkish immigrant children in The Netherlands.

BACKGROUND: The objective of this study was to examine the relationship between child, parent, family/support, and stress variables and problem behaviors in Turkish immigrant children in the Netherlands. METHODS: Parents of 833 children were interviewed and administered a Turkish version of the Child Behavior Checklist for ages 4 through 18 and a Turkish immigrant assessment questionnaire. RESULTS: Increased integration (i.e., children belonging to a second generation of immigrants, older children) generally reduced the risk for problem behaviors, while frequent arguments, divorce, psychological problems, and convictions/incarcerations increased the risk for problem behaviors. CONCLUSIONS: Results indicate that problem behaviors are associated with the high level of separation faced by Turkish immigrant families and that more integration leads to lower levels of problem behavior. Additionally, migration history alone does not contribute to problem behavior. Factors in the family (e.g., quarrels, divorce, conviction) associated with problem behaviors in Turkish immigrants are similar to those found in Dutch and American populations. Future studies could examine predictors of problem behaviors in other culturally separated immigrant groups in the Netherlands, and in Turkish immigrant groups in other countries.

Adolescent↗
PubMed2000

The gender gap in depression reconsidered: the influence of marital and employment status on the female/male ratio of treated incidence rates.

BACKGROUND: The consistently observed predominance of female over male rates in depression - in treated as well as in untreated populations - has never been satisfactorily explained. Among the many possible biological and psychosocial explanations, marital and employment status have not been extensively studied and virtually nothing is known about the combined effect of these variables on sex differences in depression. A main reason for this lack of knowledge is the limited number of cases available in epidemiological studies. METHODS: The present paper examines the combined effects of marital and employment status on sex differences in depression rates by analysing in-patient admission rates of all depressed patients aged 18-67 admitted for the first ever time to the Department of Psychiatry of the University of Vienna from a strictly defined catchment area over a period of 42 months. Stepwise Poisson regression analyses were carried out in order to identify the relative contribution of these variables to the variance of first ever in-patient admission rates for depression. RESULTS: A total of 2599 depressed patients fulfilled the inclusion criteria. When analysed separately, sex, marital status and employment status were shown to have distinct influences, with the "not married" carrying a two-fold higher risk than the married (2:1), and female sex (1.7:1) as well as not being employed (1.7:1) showing similar but smaller effects. In the detailed combined analysis, marriage was significantly less advantageous for women than for men, while sex differences disappeared completely in the widowed group. Also, there was no sex difference in the employed divorced; in the employed widowed there was even a slight preponderance in men. The highest rates were found in not employed divorced women, the lowest in employed married men. CONCLUSION: While in-patient admissions are certainly selective in relation to epidemiological data, the large sample made it possible to perform combined analyses of sex, marital status and employment status. It was shown that the statement of a female preponderance in depression, which was found for the total sample, is a gross oversimplification. If marital and employment status are considered simultaneously, the sex differences disappear in some subgroups and in some are even reversed. We suggest that the combined influence of marital and employment status should be studied in epidemiological studies as well before conclusions about the influence of sex on depression rates are drawn.

Adolescent↗
PubMed2006

Childhood family correlates of heterosexual and homosexual marriages: a national cohort study of two million Danes.

Children who experience parental divorce are less likely to marry heterosexually than those growing up in intact families; however, little is known about other childhood factors affecting marital choices. We studied childhood correlates of first marriages (heterosexual since 1970, homosexual since 1989) in a national cohort of 2 million 18-49 year-old Danes. In multivariate analyses, persons born in the capital area were significantly less likely to marry heterosexually, but more likely to marry homosexually, than their rural-born peers. Heterosexual marriage was significantly linked to having young parents, small age differences between parents, stable parental relationships, large sibships, and late birth order. For men, homosexual marriage was associated with having older mothers, divorced parents, absent fathers, and being the youngest child. For women, maternal death during adolescence and being the only or youngest child or the only girl in the family increased the likelihood of homosexual marriage. Our study provides population-based, prospective evidence that childhood family experiences are important determinants of heterosexual and homosexual marriage decisions in adulthood.

Child↗
PubMedDate not supplied

Secular trends in lifetime onset of MDD stratified by selected sociodemographic risk factors.

We used multivariate proportional hazards (Cox) models to investigate the effects of cohort of birth on age of first onset of major depression measured independently at two occasions, about six years apart, in the first degree relatives of probands with major affective illnesses. We estimated the cohort trends in strata defined by sociodemographic and other measures, to see if the cohort trends are the same across strata. Graphical summaries of the trends reveal a generally consistent pattern of increasing rates and earlier age of onset with successive birth cohorts, across all strata examined. The relatives with a divorced parent had a somewhat delayed secular increase, suggesting either a ceiling effect or an interaction of the two risk factors (recent cohort of birth and divorced parents) such that the combined effect is less than the sum of the individual effects. Otherwise, the cohort effect is persistent and ubiquitous in this sample.

Adult↗
PubMed1983

Life events and elevated blood pressure in young men.

The study group was recruited from a population of 18-yr-old men who were subjected to blood pressure screening. Subjects with blood pressure elevation from this group were compared with two samples from the same population, one normotensive and one hypotensive, with regard to self-reported life events. A detailed interview regarding life events during the total life span revealed no significant differences in total mean number of events between the groups. However, there were significant differences with regard to reports of positive life events. More positive events were reported during the later years in the hypotensive group. An analysis of particular events related to separation from family revealed no instances of reported divorce in the families of the hypertensive subjects in contrast to two divorces in the normotensive and four in the hypotensive families. The hypertensive group was divided into two subgroups, those who during an interview session showed consistent vasoconstriction--with more sustained and severe blood pressure elevation--and those who did not--with a less stable blood pressure elevation. These subgroups differed as to mean number of life events and life events perceived as negative. As a parallel to the findings in the main groups, the subgroup with more sustained blood pressure elevation had the smallest number of reported events. The psychosocial differences between the subgroups within the hypertensive group found in the present study is a further indication to the existence of different psychosomatic mechanisms operating.

Adolescent↗
PubMed1991

Demographics and cigarette smoking among women.

BACKGROUND: A population-based sample of 893 white women ages 25 to 59 years from five San Francisco, California, Bay Area counties were queried about their demographic characteristics, height, reported weight at age 25, cigarette smoking history, and oral contraceptive and sunscreen use. METHODS: Multiple logistic regression techniques were used to analyze the data. Forty-three percent of the women in the sample had never smoked more than 100 cigarettes, while 27% were current and 30% were former smokers. Separated or divorced women were more likely to have ever smoked. RESULTS: Women who were less educated, single, separated, or divorced or had smoked between 10 and 30 cigarettes per day were less likely to quit smoking. Women with less education and a longer history of smoking smoked more cigarettes per day. Women who had never smoked were more likely to use sunscreen and to report their weight as slightly less at age 25 than were smokers.

Adult↗
PubMed1984

Life events and depression. Part 1. Effect of sex, age and civil status.

This is the first of three articles dealing with some basic aspects of the relationship between life events and depression, and is also one part of a larger study in which the possible impact of stressful events has been studied from a multifactorial point of view. Two-hundred and four patients suffering from a depressive disorder, consecutively admitted to the Department of Psychiatry of the Umeå University have participated in a study of life events carried out by means of a specially constructed life events inventory that was used as a guideline for a semistructured interview. The results of this part of the study show that there are no pronounced differences in the occurrence, or appraisal of life events between male and female patients. The more vulnerable, older patients have experienced significantly fewer life events, even of the fateful type, prior to the onset of depression. No difference was found between patients who were married or lived together with a partner and patients who were unmarried, separated, divorced or widowed except in the categories of events (e.g. 'conflict' events) which might have been the very reason for a separation or a divorce. The results are discussed in relation to other findings in the literature.

Adult↗
PubMed1984

Life events or life processes as determinants of mental strain? A 5-year follow-up study.

In a study among Finnish metal industry employees (n = 748) mental strain was measured at the beginning and at the end of a 5-year follow-up. Life event data for the follow-up period were gathered retrospectively through a questionnaire and a later interview. Mental strain was substantially higher among blue-collar than white-collar workers. In contrast, no differences in the occurrence or in the rating of life events was observed between these groups. Self-rated undesirable events were associated with high levels and desirable events with low levels of mental strain. Similar associations were observed in three objectively defined live events, viz. divorce, promotion in the job and change in housing conditions. Life events were, however, also related with the mental strain measured prior to the life events. Both the self-rated and objectively defined desirable events had usually a favourable impact on mental well-being, whereas undesirable events in most cases slightly increased mental strain. The differences in mental strain between occupational status groups seem to be caused by differences in the life processes rather than life events. Furthermore, many life events, e.g. divorce, are actually only discrete moments in long-lasting processes, which have an impact on mental well-being. And last, desirable life events can be seen rather as a preventive than a risk factor of mental strain.

Adult↗
PubMed1993

Vasectomy as a reason for donor insemination.

Among 200 couples referred for counselling with a view to donor insemination (DI) were 21 whose request arose from an earlier vasectomy. This had been judged irreversible, apart from one case where the man had been sterilised for genetic reasons and therefore had not sought reversal. An overall incidence of 10.5% indicates that vasectomy may lead to fertility problems in the event of remarriage, which has become more common with an increasing divorce rate. All 21 husbands but only 3 wives had been previously married; 3 former wives had died, otherwise all previous marriages had ended in divorce. Most husbands were considerably older than their second wives, especially as compared with the majority of men in the larger series who were still in a first marriage. Their relative maturity may have helped them to respond more sensitively to their wives' maternal needs when they already had children of their own. During a follow-up interval of up to 8 years, 2 couples had separated after a brief relationship but 9 of the other 12 contacted had become parents by DI. The 3 remaining couples included a wife who at the latest report was 5 months pregnant, and 2 who were still pursuing treatment. Despite the low failure rate in this small series we should bear in mind that DI is not an ideal solution to the problem of male infertility, nor always even acceptable.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Perception and social consequences of tuberculosis: a focus group study of tuberculosis patients in Sialkot, Pakistan.

Treatment defaulting is one of the major causes of the failure of TB control programs. In Bethania Hospital, Sialkot, defaulting rates are high: 72% for the standard 12 months course and 56% for the 8 months course. Attrition is especially important in the first weeks of treatment: < 70% of the patients start the 10th week of treatment. A focus group discussion study has been carried out to gain a better understanding of the impact of social stigmatization, treatment cost and pregnancy on defaulting. The study population consisted of 3 male and 3 female groups each with 8 hospitalized TB patients. The study shows that TB is perceived as a very dangerous, infectious and incurable disease. This perception has many social consequences: stigmatization and social isolation of TB patients and their families: diminished marriage prospects for young TB patients, and even for their family members: TB in one of the partners may lead to divorce. Due to fear patients often deny the diagnosis and reject the treatment. While both male and female TB patients face many social and economical problems, female patients are more affected. Divorce and broken engagements seem to occur more often in female patients. Females are usually economically dependent on their husbands and family in law, and need their cooperation to avail of treatment. The belief that pregnancy enhances the risk for relapse decreases their marriage prospects. Pregnancy is also a reason for stopping TB treatment as both are considered as incompatible. The findings of this study reveal the urgent need for a health education campaign to convince the general population that tuberculosis is curable. All health care providers should act as destigmatizers.

Adolescent↗
PubMed1982

Learned helplessness and responses to nerve blocks in chronic low back pain patients.

In a double-blind study, 67 chronic low back pain patients received 4 lumbar sympathetic nerve blocks, two given with bupivacaine and two given with saline. It was hypothesized that patients showing evidence of 'learned helplessness,' as measured by dependence on habit-forming medications for the pain, low activity levels, and elevated MMPI scores on Hypochondriasis, Depression and Hysteria would show the least reduction in subjective pain intensity following injections with both bupivacaine and saline. It also was hypothesized that placebo responses would be greatest in patients who had a high educational level, were divorced, and had no pending disability claims. Responses 30 min following nerve blocks failed to correlate with these variables. However, decreases in subjective pain intensity 24 h following both types of nerve blocks were greater in patients who showed low levels of pain behavior, who were divorced, and who had no pending disability claims. Decreased pain 24 h following saline injections was significantly related to low scores on the Lie, Defensiveness, Hypochondriasis, and Hysteria scales of the MMPI and to reduced subjective pain intensity following a 6 week comprehensive outpatient pain rehabilitation program. It was concluded that chronic pain patients who are fixed in their focus on pain, high in pain-related behaviors, and low in responsibilities are less likely to respond favorably to nerve blocks and that medical treatment for them needs to be paired with therapies designed to reduce their helplessness.

Activities of Daily Living↗