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PubMed1993

Environmental factors related to the outcome of panic disorder. A seven-year follow-up study.

The purpose of this study was to examine factors related to the outcome of naturalistically treated panic disorder. In order to achieve this we followed up 69 patients 7 years after they had presented at a psychiatric clinic. At follow-up, the patients were generally doing well despite persisting symptoms. Patients who were more severely ill at the time of initial assessment had a worse outcome. These patients had more severe panic and agoraphobic symptoms, had illnesses of longer duration, and more often had histories of major depression. Among the developmental variables examined, separation from a parent by death or divorce was strongly related to poor outcome. Other factors associated with poor outcome included high interpersonal sensitivity, low social class, and unmarried marital status. The findings show that, for this chronic illness, measures of severity and chronicity predict more severe and persisting symptoms. They also indicate that outcome is importantly related to the social environment in which the illness develops and with which it interacts.

Adult↗

PubMed1995

Psychache in context:states'spending for public welfare and their suicide rates.

This analysis draws together the concept of psychache that describes the psychological pain associated with suicide and Durkheim's social integration theory in analyzing the relationship between states' spending for public welfare and their suicide rates over a 30-year period, from 1960, 1970, 1980, 1985, and 1990. Given that the threshold for enduring psychological pain varies from person to person, the questions were: Does suicide also vary with social context and has this changed over time? The answer to both questions was yes. Whereas the prevalence of divorce in combination with low population density and high rates of population change provided the context for interstate differences in suicide rates over the entire observational period and accounted for their increased variability in 1970 and 1980, this was not the case in 1985 or 1990. In both 1985 and 1990, the two variables that were important in this regard were states' spending for public welfare and race. In 1990, not only were suicide rates higher in states that spent less for public welfare than in states that spent more, but states' spending for public welfare was the only variable that accounted for the widening of differences in states' suicide rates. Given the strong prevailing skepticism that government can help solve people's problems and widespread antagonism toward government social spending, these findings carry an important message.

Costs and Cost Analysis↗

PubMed2001

Combat trauma: trauma with highest risk of delayed onset and unresolved posttraumatic stress disorder symptoms, unemployment, and abuse among men.

Little is known about the risk and course of posttraumatic stress disorder (PTSD), and other forms of dysfunction, associated with combat trauma relative to other traumas. Modified versions of the DSM-III-R PTSD module from the Diagnostic Interview Schedule and Composite International Diagnostic Interview were administered to a representative national sample of 5,877 persons 15-54 years old in the part 2 subsample of the National Comorbidity Survey. Of the weighted subsample, 1,703 men reported a traumatic event. The risk of PTSD and other forms of dysfunction were compared for men who nominated combat as their worst trauma versus men nominating other traumas as worst, controlling for confounding influences. Men reporting combat as their worst trauma were more likely to have lifetime PTSD, delayed PTSD symptom onset, and unresolved PTSD symptoms, and to be unemployed, fired, divorced, and physically abusive to their spouses than men reporting other traumas as their worst experience.

Adolescent↗

PubMedDate not supplied

Marital discord and immunity in males.

While limited data suggest significant gender differences in mental and physical health risks following marital disruption, men have not been studied as intensively as women. In this study, self-report data and blood samples were obtained from 32 separated or divorced men and 32 sociodemographically matched married men. Separated/divorced men were more distressed and lonelier, and reported significantly more recent illness than did married men; the former also had significantly poorer values on two functional indices of immunity (antibody titers to two herpesviruses), while not differing significantly on quantitative indices (percentages of helper and suppressor cells and their ratio). Among married men, poorer marital quality was associated with greater distress and a poorer response on one functional immunological measure, antibody to Epstein-Barr virus (EBV), as well as lower helper/suppressor ratios. Among separated/divorced subjects, those who had separated within the past year and who had initiated the separation were less distressed, reported better health, and had a better performance on one functional immunological assay (EBV antibody titers) than did noninitiators. These data are discussed in the context of research on longer-term adaptation to marital disruption.

Adult↗

PubMedDate not supplied

Physiologic markers of chronic stress in premenopausal, middle-aged women.

OBJECTIVE: The purpose of this study was to identify physiological markers of chronic stress in middle-aged women that can be assessed simply and are thus feasible for introduction into large-scale, epidemiologic studies of aging. METHODS: Subjects were 40 nonsmoking, premenopausal women between the ages of 42 and 52 years, 20 of whom were chronically stressed because of undergoing a divorce or separation and 20 of whom were nonstressed because of being in stable marriages. Stressed and nonstressed women were matched for age, ethnicity, and education. Hypotheses focused on morning and evening salivary cortisol, overnight urinary catecholamines, cortisol, and testosterone, and platelet catecholamines. RESULTS: Relative to the nonstressed control subjects, the stressed women had elevated evening (9 PM) salivary cortisols, a finding that was observed on both days (mixed effects model: effect = 0.44; se = 0.14, p =.003). Support for the importance of the HPA axis was provided by the observation that the stressed women had less suppression of salivary cortisol in response to low-dose dexamethasone. Contrary to our hypothesis that stressed women would have lower overnight urinary testosterone, they had higher testosterone on day 2 (stressed = 0.76 ng/mg, nonstressed = 0.55 ng/mg; p =.04). Post hoc repeated measures analysis revealed a significant group effect over all time periods of observation (F = 5.48, p =.03, df = 1,18). Stressed women had a nonsignificant trend toward elevated platelet catecholamines. No association was found for overnight urinary catecholamines or cortisol. CONCLUSIONS: Promising markers of marital upheaval in middle-aged women are evening salivary cortisol and urinary testosterone from a first morning void. Replication of these findings with the same and different chronic stressors and with women of older ages is needed. The low cost and minimal burden of these potential markers makes it feasible to introduce them into large-scale epidemiologic studies of health in aging women.

Adult↗

PubMed2005

Women in couples antenatal HIV counseling and testing are not more likely to report adverse social events.

BACKGROUND: Couple counseling has been promoted as a strategy to improve uptake of interventions to prevent mother-to-child HIV transmission (pMTCT) and to minimize adverse social outcomes associated with disclosure of HIV status. OBJECTIVES: We tested whether women counseled antenatally as part of a couple were more likely to accept HIV testing and nevirapine in a pMTCT program, and whether they would be less likely to experience later adverse social events than women counseled alone. METHODS: A pMTCT program that included active community education and outreach to encourage couple counseling and testing was implemented in two antenatal clinics in Lusaka, Zambia. A subset of HIV-positive women was asked to report their experience of adverse social events 6 months after delivery. Couple-counseled women were compared with individual-counseled women stratified by whether or not they had disclosed their HIV status to their partners. RESULTS: Nine percent (868) of 9409 women counseled antenatally were counseled with their husband. Couple-counseled women were more likely to accept HIV testing (96%) than women counseled alone (79%); however uptake of nevirapine was not improved. Six months after delivery, 28% of 324 HIV-positive women reported at least one adverse social event (including physical violence, verbal abuse, divorce or separation). There were no significant differences in reported adverse social events between couple- and individual-counseled women. CONCLUSIONS: Couple counseling did not increase the risk of adverse social events associated with HIV disclosure. Support services and interventions to improve social situations for people living with HIV need to be further evaluated.

Adult↗

PubMed1997

Kinship resources for the elderly.

As population ageing strains social insurance systems, cohorts whose own fertility was low will be reaching elderly status, leaving close biological kin in short supply. However, there is a countervailing trend, inasmuch as burgeoning divorce, remarriage and family blending have expanded the numbers and varieties of step-kin and other non-standard kinship ties. Methods of computer microsimulation in conjunction with richer sample surveys can help us to foresee the contours of kin numbers and kinship relations in the future. Prime areas include the likely frequency of kin-deprived elderly, the overlap with economic deprivation and the interaction between kin frequency and intensity of contact. Step-ties may be weaker but nonetheless critical in raising the probability of at least one compatible member with whom one can choose to maintain contact and rely on. Kinship networks extended through half- and step-links, by stretching across racial and economic lines, may promote social cohesion.

Aged↗

PubMed1997

Genes and human behavior: the emerging paradigm.

The physical properties of human beings and other organisms as well as their social behavioral traits are manifestations of both genetic inheritance and environment. Recent behavioral research has indicated that certain characteristics or behaviors--such as schizophrenia, divorce, and homosexuality--are highly heritable and are not governed exclusively by social environment. A balanced view of human behavior includes the effects of social learning as well as of genetically determined behavior. A new paradigm promotes enhanced understanding and acceptance of human diversity, be it cultural, racial, or sexual, and has the potential to unite scientists and theologians by creating common grounds of understanding.

Alcoholism↗

PubMed2001

Dimensionality of psychosocial responses to marital disruption.

The purpose of the study was to assess whether psychosocial responses to marital disruption were best arranged along one single dimension ranging from maximum positive to maximum negative responses, or whether positive and negative responses constituted two separate and distinct dimensions. Participants were 658 recently divorced individuals. A confirmatory factor analysis revealed that a two-factor model provided a better fit to the data than a one-factor model. Moreover, a number of external variables differentiated between positive and negative responses, indicating that such responses reflect two separate domains. Thus, the findings support the notion that psychosocial responses after marital disruption comprise a bidimensional rather than a unidimensional pattern. The findings are discussed within the general framework of positive-negative asymmetry and the idea that positive and negative evaluations belong to different psychological system.

Adaptation, Psychological↗

PubMed2005

Impact of inherited epidermolysis bullosa on parental interpersonal relationships, marital status and family size.

BACKGROUND: The presence in a family of a child or children with epidermolysis bullosa (EB) may have profound psychological implications for other family members. OBJECTIVES: To assess the impact of the presence of EB in one or more children on the personal relationships between their parents. METHODS: Standardized questionnaires were used. RESULTS: In general, the presence of a child severely affected with EB had profound effects on many aspects of marriage. This included a lack of interest in participating in activities as couples [junctional EB (JEB), 45%; recessive dystrophic EB (RDEB), 25%], a lack of energy to invest in such pursuits (JEB, 82%; RDEB, 50%), limitations in opportunities for sharing nonintimate physical activities (reported by most parents having children with some type of generalized EB), and negatively altered parental sex life (JEB, 55%; RDEB, 39%). This is consistent with the fact that 10%, 64%, 25% and 36% of parents of an affected child with EB simplex (EBS), JEB, dominant dystrophic EB (DDEB) and RDEB, respectively, characterized their relationships as couples as revolving almost exclusively around the day-to-day care of their affected children. The severity of disease in an affected child clearly influenced parental decisions about having more children: 24% and 64% of parents of children with JEB and RDEB, respectively, chose not to have additional children, compared with 26% and 54% of parents with children having EBS or DDEB. This choice was most often pursued via tubal ligation; less often, alternative means of surgical sterilization were chosen. Divorce was common among parents of children with EB (range: 17% in EBS to 31% in JEB) and, with the exception of parents of children with EBS, was usually directly attributed by one or both parents to the profound impact that this disease had exerted on their marriage. CONCLUSIONS: Physicians caring for children with EB need to give more consideration to the many psychological factors that may contribute to their patients' well being. They may need to assist these children's parents in seeking support and counselling to prevent destruction of the family unit.

Adolescent↗

PubMed1997

Parental separation: effects on children; implications for services.

It is commonly assumed that the children of separated or divorced parents are disadvantaged financially and in terms of social development. A small-scale study was designed involving 14 volunteer parents who were separated from their spouses/partners and their 28 children, ranging in age from 5 to 12 years. Structured interviews examined the families' attitudes and feelings about the separation, the mental health of the parents, the emotional and behavioural reactions of the children, and the families' use of services. The results suggested that over 60% of the girls showed internalizing, and over 60% of the boys displayed externalizing behavioural difficulties. About 40% of the children suffered psychosomatic disorders. Nearly 75% of the parents suffered depression before and after separation. Depression, itself, may act to exacerbate children's emotional and behavioural difficulties. Although all the parents had received medication for their depression, few of the children had received any help for their difficulties. The urgent need for services to help such children is discussed.

Child↗

PubMed1981

A follow-up study among 285 men with azoospermia and severe oligozoospermia.

The present investigation deals with the answer to a simple questionnaire from 147 men with azoospermia and 138 men with severe oligozoospermia (sperm counts less than 10 million/ml), earlier admitted to our clinic as male partners in barren couples. Twenty men in the azoospermia group and 52 men in the oligozoospermia group had received different types of infertility treatment. The conception rates reported were 1.6% and 10% in the azoospermia group, and 19.8% and 17.3% in the oligozoospermia group for the untreated and treated subgroups respectively. Only 21% of the men were interested in adoption, whereas 61% answered that they were favourably inclined towards performance of heterologous insemination of their wives. No significant increase in the conception rate was observed in the couples who had achieved adoption. The marriages appeared to be remarkably stable, only 3.5% of the men were divorced or separated from their wives. These results emphasize the necessity of including control groups in treatment trials of male infertility and would also suggest that female partners in these couples should be treated more actively.

Adoption↗

PubMed1988

The relation between third graders' after-school care and social, academic, and emotional functioning.

Outcome differences associated with types of after-school care were explored among 150 white, predominantly middle-class third graders from a suburban school system. Children returned home to their mothers, attended day-care centers, stayed with sitters, or returned home alone or with siblings. No differences were found between latchkey and mother-care children in terms of their classroom sociometric nominations, academic grades, standardized test scores, conduct grades, self-reports of self-competence, or parent and teacher ratings of the children. Significant differences were found for children who attended day-care centers after school. These children received more negative peer nominations, made lower academic grades, and had lower standardized test scores than either mother-care or latchkey children. The children who stayed with sitters after school received more negative peer nominations than the latchkey and mother-care children but, in other areas, resembled these groups. These outcome differences were apparent in both divorced and intact families. Factors contributing to these differences are examined.

Achievement↗

PubMed2006

Psychological adaptation after marital disruption: the effects of optimism and perceived control.

The present study explored the extent to which the two personality factors--perceived control and dispositional optimism--are related to psychological adaptation after marital disruption. A sample of 658 recently divorced individuals participated in the study by filling in an anonymous questionnaire. Bivariate findings revealed that perceived control and optimism were strongly related to psychological adaptation. However, when both predictors were included in a multiple regression analysis, optimism had a much larger effect than perceived control. The findings clearly indicate that personality factors account for a substantial proportion of the variance in adaptation to marital disruption.

Adaptation, Psychological↗

PubMed2004

Association between adolescent chronic daily headache and childhood adversity: a community-based study.

The relationship of chronic daily headache (CDH) and childhood adversity is still controversial. We therefore conducted a survey for CDH (> or =15 days/month, average > or = 2 h/day) among all students in three public schools in Taiwan. The Global Family Environment Scale (GFES), which yields a score according to childhood adverse events in the family, was used to compare childhood adversity between cases of CDH and their age- and sex-matched controls. In total, 4645 students were surveyed and 58 with CDH were identified. Significantly lower GFES scores, indicative of worse childhood adversities, were evident in the CDH group (76.7 +/- 19.2), compared with the control group (86.0 +/- 8.9, P = 0.001). Physical abuse (10% vs. 0, P = 0.012) and parental divorce (17% vs. 3%, odds ratio = 5.8, P = 0.015) were more frequent in the CDH group. The results indicate that childhood adversities may contribute to greater risk of the development of CDH in young adolescents.

Adolescent↗

PubMed1990

Life changes and protective capacities in enuretic and non-enuretic children.

Life changes and protective factors of 156 enuretic and 170 non-enuretic 7-yr-old children were analysed using the multi-item Life Change Unit method and psychological examination. Of the single life events, divorce or separation were seen to increase the risk of enuresis. The weighted life change scores were significantly higher for the enuretics than for the controls at age levels of 3, 5 and 6 yrs. Secondary night-wetting was precipitated by increased life stress, but this was not the case with secondary day-wetting. Repression showed a predominance in enuretics. A strong ego was found to serve as a protective factor against enuresis under changing life conditions.

Adaptation, Psychological↗

PubMed1991

The transition to adolescence: the role of gender and stress in problem behavior and competence.

The differential change of boys and girls across pre-adolescence, early adolescence, and middle adolescence was examined. The participants were 259 children, their mothers, and their social studies teachers. The children completed a measure of internalizing problems and adults completed measures of the child's externalizing and internalizing problems and competence. Relative to girls, boys had more problems and less competence at pre-adolescence and/or less problems and more competence by mid-adolescence. A stressor, parental divorce, did not exacerbate the gender by developmental age period interaction. The differential vulnerability of boys and girls at different developmental periods is considered.

Achievement↗

PubMed1989

Epidemiology and trends in hospital discharges for pelvic inflammatory disease in England, 1975 to 1985.

Hospital Inpatient Enquiry data were analysed to determine trends in hospital discharges for pelvic inflammatory disease in England from 1975 to 1985. Cases where the disease was thought to be related to another condition, e.g. appendicitis, were excluded from the analysis. Discharge rates for both acute and chronic disease increased over the review period and there was a 28% increase in the discharge rate for total disease. Women in their 20s were most likely to be involved and this group showed the greatest increase in the discharge rate, both for acute and chronic disease. In the 20-24-year age group the rate of discharge for acute disease rose by 50%, from 125.6/100,000 in 1975 to 189.0/100,000 in 1985. Patients with a diagnosis of chronic pelvic inflammatory disease tended to be older than those with acute disease. Women who were divorced were more at risk of both acute and chronic forms of the disease than single or married women. Increase in the use of surgery to confirm the diagnosis occurred only for those with chronic disease. About a quarter of patients with acute disease had the diagnosis confirmed surgically, and this proportion did not change in the period studied, although laparoscopy increased as laparotomy decreased.

Acute Disease↗