Mental health among older adults in Japan: do sources of social support and negative interaction make a difference?

This study addresses the question of whether social support and interpersonal strain from different sources (i.e., spouse, children, and other relatives and friends) have differential impact on mental health. Data for this research came from a national probability sample of 2200 persons aged 60 and over in Japan. Structural equation models were evaluated within the context of two types of social networks: (a) persons who had a spouse and children (n=1299), and (b) those with children only (n=677). Between these two networks, the links among social support, negative relations, and mental health were contrasted. The effects of various sources of social support and negative interactions on mental health vary depending on the specific dimension of mental health as well as the nature of social networks. Among older Japanese who are married with children, social support from spouse has a greater association with positive well-being than social support from children and others. However, cognitive functioning is uncorrelated with all sources of positive and negative social exchanges. In contrast, among those without a spouse, only greater support from children is significantly correlated with higher positive well-being, less distress, and less cognitive impairment.     

Social support and psychological well-being in breast cancer patients

many aspects of the role of social support in psychological adaptation to illness have been investigated using different definitions of the construct. The present study focused on the role of instrumental social support and one aspect of emotional social support, namely supportive communication. In addition, the differential role of support provided in these areas by the spouse and significant others (SO) was examined. Subjects were 76 post-mastectomy breast cancer patients treated at a University Hospital in Istanbul. Patients were administered Spielberger's State-Trait Anxiety Inventory and the Beck Depression Inventory, and were interviewed using a structured interview developed by the authors. Results showed that supportive communication with the spouse, positive reaction of the spouse to mastectomy, marital satisfaction and open discussion of emotions concerning cancer were positively associated with psychological well-being. Instrumental support from the spouse or SO was not related to depression or anxiety.     

Changes in reciprocal support provision and need-based support from partners of patients undergoing radical prostatectomy

We examined need-related and reciprocal provision of support in couples facing radical prostatectomy and its sequelae, including patients’ urinary incontinence. Partners’ reciprocal support provision to patients was assumed to drop from prior to until after patients’ surgeries and increase again in the following months, while need-related indicators were assumed to remain unique correlates throughout. In this study of German prostatectomy patients and their partners, N = 141 couples provided data on 4 measurement occasions from presurgery to 1-year postsurgery. Need-based predictors of partners’ support provision were patients’ mobilized support, such as efforts to obtain advice or comfort, and degree of postsurgery incontinence. Strength of association between partner-received and provided supports served as an indicator of reciprocal support provision. Data suggested that partners’ reciprocal support provision dropped significantly postsurgery and then increased again in the following months. This was true for emotional as well as instrumental reciprocal support provision. Findings also indicated that one need-based predictor of partners’ support provision, patients’ mobilization of support from their partners, remained a unique correlate of partners’ support provision to patients. Reciprocal support provision in couples may vary during the adaptation to illness-related functional impairment and coexist with need-oriented support provision.     

安徽省某血源性艾滋病高发乡艾滋病人/感染者社会支持现况研究

目的：了解当地艾滋病病人/HIV感染者的社会支持现况,为安徽省农村社区艾滋病病人/感染者社会支持模式的建立提供依据.方法：整群抽取某血源性AIDS高发乡10个行政村的219名艾滋病病人/感染者.用自制的农村社区艾滋病病人/感染者社会支持模式调查表对目标人群进行调查.结果：93.2%（204/219）的艾滋病病人/感染者与家人生活在一起,67.6%（121/179）的人认为夫妻关系和以前一样,从配偶处获得支持和照顾的比例为79.3%（142/179）,因而家庭仍是艾滋病病人/HIV感染者获得支持的主要来源.调查对象中93.6%（205/219）的有卖血史,剩下的14名艾滋病病人/感染者没有卖血史,但其配偶均是艾滋病病人/感染者,提示性传播可能是二代传播HIV的主要途径.结论：艾滋病病人/感染者迫切的需要整个社会的支持和帮助,建立适合农村社区的社会支持模式是非常必要的.     

The contribution of social-environmental factors to the emotional adjustment of Israeli religious Jewish women coping with infertility

The community is often considered a resource for coping with health-related stress but has potential for negative effects when coping with fertility problems. In this study, we examined the associations between the social–environmental variables (seeking the support of the community, perception of pressure from the community, and perception of spouse support as a possible moderator of this pressure) and emotional adjustment to fertility problems among religious Jewish women in Israel, a highly pronatalist society. Data were collected from January to August 2011. Structural equation modeling using data from 186 women indicated that perception of pressure from the community was associated with poorer emotional adjustment. This association was not moderated by perceived spouse support, but spouse support was associated with better adjustment. Seeking the support of the community was found to be composed of two dimensions: Seeking Ties and Belonging to the Community, which was associated with poorer adjustment, and Seeking Approval and Recognition from the Community, which was associated with better adjustment. These results point to the complexity of dealing with health-related stress when it comes to important community values. Understanding this complexity can help professionals conduct culturally sensitive evaluation and treatment that will contribute to women’s emotional adjustment to fertility problems.     

照料失能配偶对老年女性抑郁程度的影响--基于CHARLS数据的实证分析

目的:研究照料失能配偶对老年女性抑郁程度的影响。方法:利用“中国健康与养老追踪调查”2015年全国数据,通过工具变量回归进行分析。结果:相比于没有照料配偶的女性,参与配偶照料的女性抑郁得分更高(P<0.01)。结论:提供长期照料会增加老年女性的抑郁程度。制定老年长期照料政策时应关注女性照料者的心理健康。     

Marital quality predicts hospital stay following coronary artery bypass surgery for women but not men

This study examined how two indices of spouse support, one relatively general and chronic (perceived overall marital quality), and one relatively situation-specific and acute (spouse support while in the hospital), separately and in interaction with patient gender, predict postoperative length of stays following major (coronary bypass) surgery. In a sample of 226 male and 70 female patients drawn from three hospitals in the San Diego area, California, the results indicated that marital quality, in combination with patient gender, predicted postoperative lengths of stay, such that relatively poor marital relationships elevated risk for longer stays for female but not male patients. Lengths of stay for female patients with higher quality marital relationships were similar to those of male patients (regardless of marital quality). These results were not attributable to any assessed preoperative differences in patient health and were independent of perceptions of spouse support received while in the hospital, which did not independently predict patients' lengths of stay.     

An exploration of spousal separation and adaptation to long-term disability: six elderly couples engaged in a horticultural programme

The main objective of the present study was to explore the impact of separation on couples where one spouse lives in a skilled nursing facility and the other spouse lives alone in the community. Six couples participated in a 10-week gardening group. Semi-structured interviews were conducted at the beginning of the study and observations were made and discussions engaged through the 10-week horticultural programme. Thematic analysis of interviews and discussions revealed reduced social participation of community-dwelling spouses in an effort to maintain their marital role. In one or more cases the non-institutionalized spouse adapted to separation by developing social roles and relationships within the skilled nursing facility and continuing as a caregiver to their spouse. Occupational therapists are encouraged to include spouses in programmes to nurture healthy spousal roles. Further research is needed to explore how elderly couples may support each other through purposeful occupation while one spouse is in a long-term care facility.     

Effect of spouse support and health beliefs on medication adherence

This study addressed the issue of social support for patients' adherence to medical regimens. Social support of wives was assessed by structured interview of 150 male participants in the Coronary Primary Prevention Trial, their wives, and medical staff. In addition, wives were interviewed about their beliefs related to their husbands' health and participation in the trial. Unobtrusive packet counts were used as the measure of adherence. The participants were classified as having high spouse support if wife support scores were in the top one third of the distribution and as having low spouse support if scores were in the bottom one third as measured from inquiry of the participant, the spouse, and the staff. The adherence of men having low support averaged 70 percent, significantly lower than the high-support group, which averaged 96 percent. The correlations between spouses' health beliefs and their level of support were significant for three of four health belief variables. In particular, highly adhering men had wives who believed more strongly in the benefits of the Coronary Primary Prevention Trial.     

Spouse and Adult-Child Dementia Caregivers in Chinese American Families: Who Are More Stressed Out?

ObjectivesThough many studies have explored differences between spouses and adult children in dementia care, empirical evidence is lacking on racial- and ethnic-minority populations. To fill this research gap, this study examined care tasks, caregiver burden, and depressive symptoms of Chinese spouse and adult-child caregivers in dementia care. Guided by the stress process model, this study asked 3 questions: Do spouse and adult-child caregivers take up different care tasks and experience different levels of caregiver burden and depressive symptoms? Does gender moderate the differences between spouse and adult-child caregivers? Whether care tasks and burden mediate the association between being a spouse/adult-child caregiver and depressive symptoms?Setting and ParticipantsData were collected from a questionnaire-based survey of Chinese Americans who provided care for their family members with dementia in New York City. The analytical sample included 126 Chinese spouse or adult-child caregivers.MethodsCare tasks was indicated by intensity of 8 types of care tasks. Caregiver burden and depressive symptoms were measured by Zarit's Burden Interview and the 10-item Center for Epidemiologic Studies Depression Scale. Linear regression, interaction term (spouse/adult-child caregiver by gender), and path analysis were conducted to address the 3 questions.ResultsThe results of linear regression show no significant difference in care tasks between the 2 groups, but spouse caregivers had significantly higher levels of caregiver burden and depressive symptoms than adult children. Wives had higher levels of caregiver burden and depressive symptoms than husbands, daughters, and sons. Caregiver burden mediated the association between being a spouse caregiver and higher depressive symptoms, whereas care tasks did not shape such association.Conclusions and ImplicationsThis study highlighted the emotional stress of Chinese American older adults in providing care for their spouses. The findings indicate the necessity of developing culturally meaningful activities to support Chinese American spouse caregivers.     

Structural characteristics of social networks and their relationship with social support in the elderly: who provides support

The analyses presented here examine relationships between structural characteristics of social networks and two types of support (instrumental and emotional support) in a sample of community-dwelling individuals aged 65 and older. For each type of support, two dimensions are examined (1) the availability of such support and (2) the perceived adequacy of that support. Regression models, adjusting for age, sex, race and income show that structural characteristics such as total network size, number of face-to-face contacts and number of proximal ties are associated with greater availability of both instrumental and emotional support. The perceived adequacy of both types of support is most strongly related to the number of monthly face-to-face contacts. Comparisons of specific types of ties show that neither ones' spouse nor ones' children are primary sources of support. Rather the presence of a confidant is strongly associated with both dimensions of instrumental and emotional support; the presence of a spouse is not. And, while ties with children are most strongly related to aspects of instrumental support, ties with close friends and relatives are more strongly related to aspects of emotional support. Analyses of possible interactions show that for those without a spouse, confidants assume greater importance in providing emotional support. For those without children, ties with close friends and relatives assume a larger role relative to the perceived adequacy of both emotional and instrumental support.     

The health effects of emigration on those who remain at home

BACKGROUND: The health effects of emigration on relatives staying behind has received little attention in the recent literature. Our aim was to assess the association of spouse and offspring emigration with acute coronary syndrome (ACS) in Albania, a country which is undergoing a particularly rapid socio-economic transition accompanied by intensive emigration. METHODS: A population-based case-control study, conducted in Tirana, Albania, in 2003-06, included 467 non-fatal consecutive ACS patients (370 men, 97 women; 88% response) and 737 population-representative controls (469 men, 268 women; 69% response) aged 35-74 years. Information on emigration of family members and financial support, socio-demographic characteristics and conventional coronary risk factors was obtained by a structured questionnaire and examination. Associations of emigrational variables with ACS were assessed by logistic regression. RESULTS: Forty five percent of female and 25% of male patients, and 17 and 15% of controls, respectively, reported emigration of a close family member. These were younger and of lower education, income and social status than controls without emigrants. Forty nine percent of patient emigrants vs 76% of control emigrants remitted funds. Excess risk of ACS was confined to individuals whose emigrant relatives did not remit monies home [multivariable-adjusted odds ratio (OR) = 10.8, 95% confidence interval (CI) = 2.6-44.8 in women, and OR = 2.0, 95% CI = 0.9-4.3 in men; P for sex-interaction = 0.03] and was attributable largely to spouse emigration. CONCLUSIONS: Our findings, which require confirmation, suggest that emigration of close family, but especially of spouses, coupled with non-remittance of financial support is associated with marked health effects in the spouse or parent left behind, and that women are more vulnerable than men.     

Spouse/partner violence education as a predictor of screening practices among physicians

INTRODUCTION: Spouse/partner violence is a major public health problem that affects 3 to 6 million women per year. Many studies show that the majority of health care practitioners do not detect or respond to cases of spouse/partner violence in their practice. Research suggests that there are potential barriers to reporting or detecting this problem. A barrier often cited is lack of proper education or training regarding spouse/partner violence. The objective of this study was to determine if physicians who received spouse/partner violence education at various stages of their careers were more likely to screen patients for spouse/partner violence. METHODS: A survey was developed and administered to family physicians and obstetricians/gynecologists in Virginia. The data were analyzed to determine screening practice and spouse/partner violence education among respondents. Four different educational opportunities were analyzed to determine potential determinants of screening. RESULTS: All respondents who had spouse/partner violence education were more likely to screen every patient than those who were lacking this education. Receiving lectures during residency training was found to be a significant predictor of screening every patient for spouse/partner violence among respondents. DISCUSSION: Screening every patient for exposure to spouse/partner violence is the ideal situation. This study indicates that education about spouse/partner violence has a significant impact on screening tendencies if provided during a physician's residency program.     

Effectiveness of spouse involvement in cognitive behavioral therapy for binge eating disorder

OBJECTIVE: This study examined whether involving the spouse in group cognitive behavioral therapy (CBT) for binge eating disorder (BED) enhances treatment outcome relative to standard group CBT. METHOD: Ninety-four overweight women with BED were randomly assigned to either (1) standard group CBT, (2) group CBT with spouse involvement, or (3) a wait-list control group. Eating and general psychopathology assessments were completed at baseline, after treatment, and at 6-month follow-up. RESULTS: Although both CBT groups fared significantly better than the wait-list control group on measures of binge eating, weight, eating psychopathology, and general psychopathology, CBT with spouse involvement did not result in any additional benefit over and above standard CBT. DISCUSSION: These results are in contrast to the success of spouse involvement in the treatment of several other physical and psychological disorders. Possible reasons for this disparity, and suggestions for improving spouse involvement in BED treatment, are discussed.     

军队住院老年人社会支持提供与利用对营养的影响

目的了解社会支持提供与利用对军队住院老年人营养的影响。方法应用社会支持评定量表、简易营养评价精法对住院老年人（年龄≥60岁）318例进行单因素相关和多因素逐步回归分析。结果社会支持与年龄呈负相关,营养与年龄不相关,但与病情相关（P〈0.01）。军队住院老年人的主、客观支持提供中,配偶、儿女居前2位。影响营养的社会支持各组的多因素分析,病情进入了各组的回归方程,营养与客观支持呈负相关,与支持利用呈正相关,安慰关心来源、儿女、亲戚均进入了相应的回归方程,但均与营养呈负相关,活动参与、烦恼倾诉进入社会支持利用度的回归方程,与营养呈正相关（P〈0.05）。结论配偶是军队住院老年人最大的社会支持。     

孕妇产前抑郁影响因素研究

目的:用Logistic回归模型分析孕中期妇女(妊娠12～28周)抑郁的影响因素。方法:对870例孕妇进行爱丁堡抑郁量表(Edinburgh Postnatal Depression Scale,EPDS)调查,并进行孕妇基本信息(生理状态、经济水平、工作状态、文化水平、病史、家庭支持状况)采集,用单因素分析、Logistic回归分析孕中期妇女抑郁的影响因素,并进行模型拟合与评估。结果:280例(32.2%)孕妇可能存在产前抑郁情绪(EPDS评分≥13分),单因素分析和Logistic回归分析显示家庭支持情况,尤其是配偶父母的支持直接影响孕妇抑郁状况(P<0.05);工作状态、文化程度、生理状态、经济水平和病史对抑郁的影响无统计学意义(P>0.01)。结论:家庭支持是孕妇抑郁的影响因素。     

Trends in informal care in Great Britain during the 1990s

The population of adult carers in Great Britain declined during the 1990s while the proportion of those heavily involved in providing informal care increased. The intensification of care-giving was associated with an increasing number of caring relationships that typically make heavy demands on the carer: spouse care and caring for a child or parent. The provision of informal care by friends and neighbours diminished resulting in an overall decline in care-giving between households. However, parents were increasingly looked after in their own homes by non-resident daughters. More women than men withdrew from the less intensive care-giving between households while more men than women took on the role of a spouse carer. By the end of the decade, as many men as women provided informal care for a spouse or partner. If the trends identified here continue beyond the study period, increasing resources will be required to identify heavily involved carers, assess their needs, and support them in their caring activities. The findings are based on secondary analysis of the British Household Panel Survey covering the years 1991-1998. As well as charting trends in the prevalence of informal care, changes in the locus of care, the number of care recipients, their relationship to their carer and the amount of time devoted to caring activities are described and interpreted.     

Spousal similarities in fruit and vegetable consumption

PURPOSE: To explore similar patterns of fruit and vegetable consumption between health center employees and their spouses. DESIGN: Cross-sectional mailed survey assessing frequency of fruit and vegetable consumption, as well as demographics and knowledge, attitudes, access, and social support related to fruit and vegetable consumption. SETTING: Six Massachusetts health centers. SUBJECTS: Two hundred eleven health center employee/spouse pairs (422 individuals). MEASURES: The kappa statistic measured agreement in fruit and vegetable consumption between employees and spouses. The Spearman rho coefficient measured correlations for individual responses. Multiple Linear Regression Models examined variables that explained fruit and vegetable consumption level differences. RESULTS: Response rate was 59%. Mean fruit and vegetable daily intake was 4.68 and 4.30 servings for employees and spouses, respectively. Over 75% of employee and spouse estimates measuring fruit and vegetable consumption-related information, on average, were within one survey response category of each other. Knowledge, attitudes, and access indices were significantly correlated with fruit and vegetable consumption for both employees and spouses. The social support index was significantly correlated with fruit and vegetable consumption only for the spouses. Differences in knowledge, attitudes, and access indices between employees and spouses helped to explain different fruit and vegetable consumption levels. Nonresponse, selection, recall, and seasonal reporting biases may limit the findings' generalizability. CONCLUSIONS: The effectiveness of worksite nutrition interventions may be improved by involving family/household members.     

Spouse intention to encourage cardiac patient participation in exercise

Abstract The aim of this study was to identify factors that influenced the intention of spouses to encourage cardiac patients to attend exercise classes. A sample of 134 spouses completed questionnaires investigating variables specified in the theory of reasoned action (Fishbein and Ajzen). Multiple regression was used with intention to encourage exercise participation as the outcome. Independent variables included: attitude toward helping, subjective social norm regarding helping, perceived efficacy of providing help, approval of patient exercising, and perceived outcomes (costs and benefits) of patient participation. Subjective social norm and approval were the only significant predictors of intention to encourage participation (R(2) = 0.41, p<0.0001). This suggests that interventions to improve spouse support for cardiac patient exercise be directed at the spouse social role rather than attitudes toward helping.