Psychosocial functioning in Barth syndrome: Assessment of individual and parental adjustment

Barth syndrome is a rare, x-linked genetic disorder. Few studies have examined psychosocial functioning in this population. The current study examined the psychosocial adjustment in individuals with Barth syndrome, as well as their parents. A secondary aim was to examine demographic as well as psychological correlates and predictors of poorer adjustment in order to identify relevant areas for intervention. Individuals with Barth syndrome completed measures of psychosocial functioning, health-related quality of life, and attitudes toward their illness. Parents completed measures relating to their child’s psychosocial functioning and reported on their own psychological functioning and coping. Results indicated that the majority of individuals and parents reported normative levels of psychological functioning. Younger age was associated with poorer health-related quality of life in some domains. Increased levels of internalizing symptoms were associated with poorer psychosocial functioning in individuals with Barth syndrome. Having a child with externalizing symptoms was associated with increased emotional symptoms for parents, as were certain maladaptive coping strategies. Clinical implications are discussed.     

Use of coping strategies and breast cancer survival: results from the Black/White Cancer Survival Study

This analysis was designed to evaluate the association between coping strategies and breast cancer survival among Black and White women in a large population-based study. A total of 442 Black and 405 White US women diagnosed with invasive breast cancer during 1985-1986 and actively followed for survival through 1994 were administered a modified Folkman and Lazarus Ways of Coping questionnaire. Coping strategies were characterized via factor analyses of the responses. Hazard ratios associated with coping strategies were estimated using Cox proportional hazards models, with adjustment for age, race, tumor stage, study location, tumor hormone responsiveness, comorbidity, health insurance status, smoking, relative body weight, and alcohol consumption. Emotion-focused coping strategies were significantly associated with survival. Expression of emotion was associated with better survival (hazard ratio = 0.6; 95% confidence interval: 0.4, 0.9). When it was considered jointly with the presence or absence of perceived emotional support, women reporting low levels of both emotional expression and perceived emotional support experienced poorer survival than women reporting high levels of both (hazard ratio = 2.5; 95% confidence interval: 1.7, 3.7). Similar risk relations were evident for Blacks and Whites and for patients with early and late stage disease. These results suggest that the opportunity for emotional expression may help improve survival among patients with invasive breast cancer.     

Couples' patterns of adjustment to colon cancer

The objectives for this longitudinal study were to: (a) compare colon cancer patients' and their spouses' appraisal of illness, resources, concurrent stress, and adjustment during the first year following surgery; (b) examine the influence of gender (male vs female) and role (patient vs spouse caregiver) on study variables; (c) assess the degree of correlation between patients' and spouses' adjustments; and (d) identify factors that affect adjustment to the illness. Fifty-six couples were interviewed at one week post diagnosis, and at 60 days and one year post surgery. Based on a cognitive-appraisal model of stress, the Smilkstein Stress Scale was used to measure concurrent stress; the Family APGAR, Social Support Questionnaire, and Dyadic Adjustment Scale were used to measure social resources; the Beck Hopelessness Scale and Mishel Uncertainty in Illness Scales were used to measure appraisal of illness; and the Brief Symptom Inventory and Psychosocial Adjustment to Illness Scale were used to measure psychosocial adjustment. Repeated Measures Analysis of Variance indicated that spouses reported significantly more emotional distress and less social support than patients. Gender differences were found, with women reporting more distress, more role problems, and less marital satisfaction, regardless of whether they were patient or spouse. Both patients and spouses reported decreases in their family functioning and social support, but also decreases in emotional distress over time. Moderately high autocorrelations and modest intercorrelations were found among and between patients' and spouses' adjustment scores over time. The strongest predictors of patients' role adjustment problems were hopelessness and spouses' role problems. The strongest predictors of spouses' role problems were spouses' own baseline role problems and level of marital satisfaction. Interventions need to start early in the course of illness, be family-focused, and identify the couples at risk of poorer adjustment to colon cancer.     

Longitudinal analyses of the relationship between unsupportive social interactions and psychological adjustment among women with fertility problems

This study examined the association of unsupportive social interactions and psychological adjustment among 123 women with fertility problems, and tested whether threat appraisals and avoidance coping mediate this association. Cross-sectional analyses suggested that infertility-specific unsupportive responses received from other people were associated positively with adjustment problems. Avoidance coping and threat appraisals mediated this association between unsupportive social interactions and adjustment. Longitudinal analyses with 67 of these women revealed that after controlling for Time 1 adjustment, Time 1 unsupportive social interactions were associated positively with depressive symptoms and overall psychological distress only for women who remained infertile at Time 2, compared with women who were pregnant or had given birth. Associations between Time 1 unsupportive social interactions and self-esteem at Time 2 were similar for both groups of women.     

Hostility and anomie: links to preterm delivery subtypes and ambulatory blood pressure at mid-pregnancy

Underlying maternal vascular disease has been implicated as one of several pathways contributing to preterm delivery (PTD) and psychosocial factors such as hostility, anomie, effortful coping, and mastery may be associated with PTD by affecting maternal vascular health. Using data from the Pregnancy Outcomes and Community Health (POUCH) study, we included 2018 non-Hispanic White and 743 African American women from 52 clinics in five Michigan, USA communities. Women were interviewed at 15-27 weeks' gestation and followed to delivery. We found that relations between psychosocial factors and PTD subtypes (i.e. medically indicated, premature rupture of membranes, spontaneous labor) varied by race/ethnicity and socio-economic position (Medicaid insurance status). Among African American women not insured by Medicaid, anomie levels in mid-pregnancy were positively associated with medically indicated PTD after adjusting for maternal age and education. Among all women not insured by Medicaid, hostility levels were positively associated with spontaneous PTD after adjusting for maternal race/ethnicity, age, and education. Failure to detect links between psychosocial factors and PTD risk in poorer women may be due to their excess risk in multiple PTD pathways and/or a more complex web of contributing risk factors. In a subset of 395 women monitored for blood pressure, anomie scores were positively associated with systolic blood pressure and heart rate and hostility scores were positively associated with systolic and diastolic blood pressure, heart rate and mean arterial pressure in models that included time, awake/asleep, race/ethnicity, and age as covariates. Further adjustment for body mass index and smoking attenuated the anomie-vascular relations but had little effect on the hostility-vascular relations. Overall this study of pregnant women provides some physiologic evidence to support findings linking levels of anomie and hostility with risk of PTD.     

Perceived stress,coping, and adjustment in adolescents

PurposeTo investigate age and gender effects on perceived interpersonal stress, coping with interpersonal stressors, and psychological adjustment among early and middle adolescents. Furthermore, the associations of perceived stress and coping with adjustment were examined.MethodsThe sample included 286 Austrian adolescents aged 10 to 14 years who attended the fifth to seventh grade. Self-report data on perceived stress, coping, as well as emotional and behavioral problems, were assessed.ResultsFifth graders scored lower on maladaptive coping strategies and externalizing problems and reported more adaptive coping strategies than sixth and seventh graders. Compared with boys, girls evaluated a higher amount of perceived interpersonal stress and used more social support. Additionally, girls scored higher on maladaptive coping strategies and emotional distress and scored lower on distraction than boys. Problem-focused and emotion-focused coping were negatively related to emotional and behavioral problems, whereas perceived stress and maladaptive coping was positively associated with adjustment problems. These relations were stronger in female than in male adolescents.ConclusionsEvaluating multidimensional coping patterns is supported. Particularly, implementation of primary preventive programs during late childhood is suggested.     

Gender and community views of stigma and tuberculosis in rural Maharashtra, India

Stigma associated with tuberculosis (TB) is often regarded as a barrier to health seeking and a cause of social suffering. Stigma studies are typically patient-centred, and less is known about the views of communities where patients reside. This study examined community perceptions of TB-related stigma. A total of 160 respondents (80 men and 80 women) without TB in the general population of Western Maharashtra, India, were interviewed using Explanatory Model Interview Catalogue interviews with same-sex and cross-sex vignettes depicting a person with typical features of TB. The study clarified features of TB-related stigma. Concealment of disease was explained as fear of losing social status, marital problems and hurtful behaviour by the community. For the female vignette, heredity was perceived as a cause for stigmatising behaviour. Marital problems were anticipated more for the male vignette. Anticipation of spouse support, however, was more definite for men and conditional for women, indicating the vulnerability of women. Community views acknowledged that both men and women with TB share a psychological burden of unfulfilled social responsibilities. The distinction between public health risks of infection and unjustified social isolation (stigma) was ambiguous. Such a distinction is important for effective community-based interventions for early diagnosis of TB and successful treatment.     

The impact of denial on health-related quality of life in patients with HIV

Background/purpose

The purpose of this study was to examine the influence of denial coping on quality of life (QOL) over time among individuals living with HIV, as denial has been understudied as a coping strategy within the literature on HIV/AIDS.

Methods

In a sample of 65 adult men and women, we used multilevel linear modeling to test trajectories of change in physical and mental health-related QOL across baseline, 3, 6, and 12?months, including denial as a predictor and gender as a moderator.

Results

The use of denial coping was associated with lower physical and mental health-related QOL at baseline. Denial coping predicted an increase in QOL over time, though QOL remained low in those who practiced denial coping. Men??s baseline mental health-related QOL was more negatively affected by denial coping than women??s. Women tended to increase in QOL more slowly over time compared to men.

Conclusion

Reliance on denial as a coping strategy is associated with poorer physical and mental health-related QOL in an HIV-positive population, though participants who engaged in denial also displayed more rapid improvement in their QOL over time. Men and women displayed different rates of improvement in QOL, indicating a need for gender-based treatment approaches. Future research should examine the complex role of denial on change in QOL.     

An interpretative phenomenological analysis of African Caribbean women's experiences and management of emotional distress

African Caribbean women are under-represented within mental health services in the United Kingdom, despite sociocontextual vulnerabilities which may increase emotional distress. This qualitative study aimed to explore individual explanatory models of experiences of distress, coping and help-seeking choices, with a view to improving cultural relevance of services. Participants were recruited following their self-referral to self-help community wellbeing workshops. Interpretative phenomenological analysis was carried out following semi-structured interviews with seven African Caribbean women in central London, who reported previously experiencing emotional distress. The study was conducted during 2009. Five super-ordinate themes emerged from the data: explanations of distress, experiences of distress, managing distress, social and cultural influences and seeking help. Each super-ordinate theme consisted of several subthemes which described participants' experiences. Gender roles and a cultural legacy of being strong and hiding distress emerged as influential in participants' beliefs about managing personal difficulties. However, this was balanced with an acknowledgement that intergenerational differences highlighted an increasing acceptance amongst the community of talking about issues and seeking professional support. The findings offered support for the notion that understandings and responses to personal distress are subject to broad-ranging and interwoven influences. This complexity may be conceptualised as an 'exploratory map' where individuals make links between their current and newly encountered knowledge and experience to guide their personal route to coping and help-seeking. The study provides support for tailoring services to individual needs using a flexible approach which empowers individuals from black and minority ethnic groups by valuing explanatory models of distress alternative to the westernised medical model. Furthermore, findings emphasise the importance of readily available and accessible information about statutory and non-statutory community resources which use language relevant to the communities they are aimed at engaging.     

The role of rural communities in the recruitment and retention of women physicians

ABSTRACT

Rural communities in the United States have a shortage of primary care physicians. Women physicians are more likely than male physicians to choose primary care specialties but less likely to locate in rural areas. With an increasing proportion of women physicians, it is important to understand community characteristics that encourage their recruitment and retention. This qualitative study explored community characteristics that influenced successful rural practice. We conducted telephone interviews with 25 women family physicians in rural practice in the United States in 2012. Interviews continued until saturation of themes was reached. Data were analyzed using immersion and crystallization. Community themes associated with successful rural practice included: fit with the community; spouse/partner fit with the community; relationships with individuals; and relationships with the community. Family ties, training experience within the community, social networks, and investment in the community were positive factors, while political/cultural differences were negative. Community integration arose from compatibility between the physicians’ goals and community characteristics, opportunities for a spouse/partner, friendships, and a feeling of community purpose. This information can be used by rural communities to recruit and retain physicians, and by physicians, medical students, and those who advise them to promote successful rural practice.     

Men's adjustment to their partners' breast cancer: a dyadic coping perspective

The continuing increase in cancer rates among women in the United States is forcing more men to experience the impact of breast cancer on their relationships. Using 71 male partners of newly diagnosed breast cancer patients, this study assessed how dyadic coping strategies affected men's adjustment to their partners' illness. While their partners were undergoing treatment, participants completed standardized instruments that measured emotional well-being, illness intrusiveness, and dyadic coping styles. Regression analysis revealed significant associations between coping styles and illness intrusiveness. In addition, depression predisposed men to poorer adjustment and affected their coping patterns. The findings emphasize that social workers must work with patients and partners to develop positive couple coping strategies. Practice implications for social workers are addressed.     

Gender and community views of stigma and tuberculosis in rural Maharashtra,India

Abstract

Stigma associated with tuberculosis (TB) is often regarded as a barrier to health seeking and a cause of social suffering. Stigma studies are typically patient-centred, and less is known about the views of communities where patients reside. This study examined community perceptions of TB-related stigma. A total of 160 respondents (80 men and 80 women) without TB in the general population of Western Maharashtra, India, were interviewed using Explanatory Model Interview Catalogue interviews with same-sex and cross-sex vignettes depicting a person with typical features of TB. The study clarified features of TB-related stigma. Concealment of disease was explained as fear of losing social status, marital problems and hurtful behaviour by the community. For the female vignette, heredity was perceived as a cause for stigmatising behaviour. Marital problems were anticipated more for the male vignette. Anticipation of spouse support, however, was more definite for men and conditional for women, indicating the vulnerability of women. Community views acknowledged that both men and women with TB share a psychological burden of unfulfilled social responsibilities. The distinction between public health risks of infection and unjustified social isolation (stigma) was ambiguous. Such a distinction is important for effective community-based interventions for early diagnosis of TB and successful treatment.     

Social support reduces the impact of partner violence on health: application of structural equation models

BACKGROUND: Intimate partner violence (IPV) is associated with poorer health, yet pathways through which IPV affects either mental or physical health are not well characterized. METHODS: Structural equation modeling was used to test a model in which physical-IPV and battering were considered as separate independent variables. The sample included 191 women currently experiencing either physical IPV or battering. Emotional support provided to women experiencing IPV was hypothesized to mediate the impact of IPV on current mental and physical health (dependent variables). RESULTS: Higher scores on emotional support were associated with better physical (beta = -0.23, P < 0.01) and mental health (beta = -0.27, P < 0.001). Physical IPV was directly associated with poorer mental health (beta = 0.023, P < 0.01) and indirectly associated with poorer physical health (beta = 0.18, P < 0.001) and mental health (beta = -0.04, P < 0.05), primarily through battering. Higher battering scores were directly associated with less emotional support (beta = -0.33, P < 0.001) and indirectly associated with poorer physical (beta = 0.12, P < 0.01) and mental health (beta = 0.09, P < 0.01), primarily through emotional support. Model diagnostics indicated a good fit (chi(2) = 20.44, P = 0.37, GFI = 0.98, CFI = 0.99, RMSEA = 0.02). CONCLUSIONS: Higher levels of emotional support may modify the effect of IPV on health. Interventions to increase social and emotional support to abused women may reduce mental and physical health consequences.     

Social support,accommodation to stress and adjustment to breast cancer

A woman's emotional adjustment to breast cancer is the focus of this study. The social support the woman experiences is predicted to affect the adjustment process by improving her ability to cope. Current clinical research indicates that background factors, such as marital status, age, SES and life change, also affect adjustment; these variables are incorporated into the model as controls. Using multiple regression analysis (N = 130), the control variables are entered simultaneously with the indicators of social support to assess the independent effect of social support on adjustment. The relationship between social support, coping, and adjustment, as measured by psychological distress, self concept, and sense of power, is then examined. Two indicators of social support, perception of family cohesiveness and the amount of social contact have direct effects on coping and indirect effects on all three measures of adjustment, indicating that coping mediates the relationship between social support and adjustment. Contrary to predictions, being employed and of higher social status have significant effects on adjustment when it is measured by either self concept or sense of power.     

Stress and coping in the explanation of psychological adjustment among chronically ill adults

This study evaluates the utility of a stress and coping paradigm for explaining individual differences in psychological adjustment to chronic illness. Using data from the first wave of a longitudinal study of 170 middle-aged and elderly adults faced with one of four chronic illnesses (hypertension, diabetes mellitus, cancer and rheumatoid arthritis), this paper examines the relationship between the stresses of chronic illness and coping, and the ability of coping to explain psychological adjustment. Results show coping strategy use tends to be minimally explained by medical diagnosis. Cognitive strategies, including information seeking, are related to positive affect while emotional strategies, particularly those involving avoidance, blame and emotional ventilation, are related to negative affect, lowered self-esteem and poorer adjustment to illness. While the findings suggest that a stress and coping model may be valuable in understanding adjustment among the chronically ill, the general modesty of coping effects and the failure of the stress buffering hypothesis to explain adjustment indicates a need for new research approaches and some modification of current theories of coping.     

BMI and health-related quality of life in adults 65 years and older

OBJECTIVE: To examine relationships of BMI with health-related quality of life in adults 65 years and older. RESEARCH METHODS AND PROCEDURES: In 1996, a health survey was mailed to all surviving participants > or = 65 years old from the Chicago Heart Association Detection Project in Industry Study (1967 to 1973). The response rate was 60%, and the sample included 3981 male and 3099 female respondents. BMI (kilograms per meter squared) was classified into four groups: underweight (<18.5), normal weight (18.5 to 24.9), overweight (25.0 to 29.9), and obese (> or = 30.0). Main outcome measures were Health Status Questionnaire-12 scores (ranging from 0 to 100) assessing eight domains: health perception, physical functioning, role limitations-physical, bodily pain, energy/fatigue, social functioning, role limitations-mental, and mental health. The higher the score, the better the outcome. RESULTS: With adjustment for age, race, education, smoking, and alcohol intake, obesity was associated with lower health perception and poorer physical and social functioning (women only) but not impaired mental health. Overweight was associated with impaired physical well-being among women only. Both underweight men and women reported impairment in physical, social, and mental well-being. For example, multivariable-adjusted health perception domain scores for women were 50.8 (underweight), 62.7 (normal weight), 60.5 (overweight), and 52.1 (obese), respectively. Associations weakened but remained significant with further adjustment for comorbidities. DISCUSSION: Compared with normal-weight people, both underweight and obese older adults reported impaired quality of life, particularly worse physical functioning and physical well-being. These results reinforce the importance of normal body weight in older age.     

Experiences and understandings of social and emotional distress in the postnatal period among Bangladeshi women living in Tower Hamlets

OBJECTIVE: The purpose of this study was to explore first-generation Bangladeshi women's understandings and experiences of postnatal distress, and to describe coping strategies during the postnatal period. METHODS: This was a qualitative study using focus groups. Subjects were drawn from three existing community groups in Tower Hamlets, a multiethnic, socially deprived borough in east London. Thematic content analysis was used to explore and present the data. RESULTS: Many women received little practical or emotional support once home from hospital with a new baby, because of the lack of extended family networks; this contrasts with the 40 day rest period common in Bangladesh. These women understood emotional distress as separate from physical symptoms or illness, and recognized that one may influence or cause the other. Distinctive language was used to describe these thoughts and feelings. The roles of health visitors, midwives and GPs were understood solely in terms of physical care. Accordingly, they did not access professionals for emotional or psychological problems. Lack of language support services contributed to the women not seeking help. CONCLUSIONS: Information about services, and professional roles in the postnatal period should be extended to include key family members such as husbands and mothers-in-law. Dialogue with Bangladeshi women may ensure that women understand the extended roles of GPs, health visitors and midwives in providing help for emotional distress, alongside their role in physical health care. More language support and advocacy is needed if women are to access the full range of health services.     

A model of mother-child coping and adjustment to HIV

An increasing proportion of newly diagnosed AIDS cases is being reported among African American urban women. Recent research regarding the psychosocial and behavioral impact of a mother's HIV status on her uninfected children as well as a growing body of clinical evidence suggest that these children are extremely vulnerable and at risk for problems in psychosocial adjustment. The present paper reports the results of research designed to examine the pathways by which a mother's HIV-positive status affects the psychosocial adjustment of her uninfected school-age child. The principal predictor variables of the model are family sociodemographic characteristics, social support available to mother and child, HIV-related symptom distress in the mother, coping strategies of both mother and child, emotional distress of the mother, and quality of the parent-child relationship. The dependent variable is the psychosocial adjustment of the child. Data were collected on 147 mother-child dyads using standardized questionnaires and personal interviews. Eighty-six percent of the mothers were African American and over 96% were on public assistance. Structural equation modeling was used to test the proposed model of mother-child coping and adjustment. After adding three paths, the model had a good fit to the data (comparative fit index=0.94; root mean square estimate of error=0.06). Five model constructs accounted for 36% of the variance in child adjustment. The constructs in order of importance were maternal HIV-associated stressors, maternal emotional distress, child social support, child coping, and quality of parent-child relationship.     

The Combined Influence of Psychosocial Factors on Illness Behavior Among Women

Distinctions in illness behavior for women, such as use of health services, may result from gender-specific biological risks for disease but could also be explained by the relationships among social, psychological, and behavioral factors. The purpose of this study was to determine if illness behavior in women might be related to associations among social support satisfaction, perceived health status, coping skills, and perceived stress. Data were collected November–December 2005 from 205 female college students through self-report using questionnaires. Structural equation modeling was used to test relationships among psychosocial factors. The final model revealed associations between psychosocial factors and illness behavior for women along two paths. First, high perceived stress and poor perceived health status were associated with more reported illness behavior. Second, greater use of total coping skills, greater social support satisfaction, and good perceived health status were associated with less reported illness behavior. Consideration of multiple health-related factors may provide a more complete picture of how psychosocial factors are related to illness behavior for women. Specifically, interactions among stress, coping, social support, and perceived health status may be important to women’s health. Our results suggest that interventions should focus on skill-building and strategies to improve self-perception of health.     

Psychosocial problems and coping patterns of HIV seropositive wives of men with HIV/AIDS

The sociocultural milieu provides HIV positive women with fewer resources and more role responsibilities. The present research aimed at studying the psychosocial problems encountered in living, post HIV infection, and the coping patterns adopted by HIV seropositive wives of men with HIV/AIDS. In the background of an exploratory research design, thirty (n = 30) HIV positive women, attending Counseling Clinics in Bangalore (South India), selected through purposive sampling, were assessed using an interview schedule and a standardized coping scale. Majority of the respondents were the primary caregivers for their infected spouse and/or children. Content analysis of the problems revealed increased financial difficulties; problems in child care and support; compromised help-seeking due to stigma; problems in sexual interactions and communication in their marital relationship; role strain in caregiving; gender discriminatory and inadequate care; and increased concerns about parenting efficacy, post HIV infection. Escape avoidance was the most preferred coping strategy adopted by them. Situating the illness in a socio-familial context is indicated, and implications for social work and mental health practice follow from the findings.