The sense of control as a moderator of social class differences in health and well-being.

The authors examined social class differences in 2 aspects of the sense of control (mastery and perceived constraints) in 3 national probability samples of men and women ages 25–75 years (N??=?1,014; N??=?1,195; N??=?3,485). Participants with lower income had lower perceived mastery and higher perceived constraints, as well as poorer health. Results of hierarchical multiple regression analyses showed that for all income groups, higher perceived mastery and lower perceived constraints were related to better health, greater life satisfaction, and lower depressive symptoms. However, control beliefs played a moderating role; participants in the lowest income group with a high sense of control showed levels of health and well-being comparable with the higher income groups. The results provided some evidence that psychosocial variables such as sense of control may be useful in understanding social class differences in health. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Making sense of posttraumatic stress disorder: Illness perceptions among traumatic injury survivors.

More than 1.5 million persons in the United States sustain traumatic physical injuries each year. A significant proportion of traumatic injury survivors develop serious mental health problems, such as posttraumatic stress disorder (PTSD), yet few obtain professional mental health care. According to the commonsense model of self-regulation (Leventhal, Diefenbach, & Leventhal, 1992), illness-related perceptions can influence coping responses, including the use of professional treatment. Using the commonsense model as a guiding framework, we conducted semistructured interviews with nontreatment-seeking trauma injury survivors with PTSD (N = 23). Illness perceptions regarding the following key conceptual dimensions were examined: PTSD symptoms (identity), experienced or perceived consequences of PTSD symptoms, and beliefs about the causes, controllability, and course of PTSD symptoms. Results revealed that no respondents identified their symptoms as indicative of PTSD. Common illness perceptions included believing that symptoms would be short-lived, that symptoms were reflective of poor physical health or were a natural reaction to life in a violent community, and that symptoms were functionally adaptive. Respondents also reported exerting some limited control over symptoms by relying on religious forms of coping. None of the respondents perceived professional treatment as being able to completely control symptoms. Findings indicated that respondents' conceptualizations of PTSD symptoms might have inhibited the recognition of symptoms as a serious mental health condition that warrants professional treatment. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Ovarian vein syndrome

SETTING: A voluntary community health worker programme, in the Western Cape, South Africa, utilizing volunteers to administer directly observed therapy to tuberculosis (TB) patients. OBJECTIVE: This study describes the perceptions of health team members regarding the voluntary community health worker project. DESIGN: A qualitative, participatory research study utilizing focus groups. RESULTS: TB was perceived by the health team to be a stigmatized disease causing some patients to be reluctant to be associated with the TB control programme. Despite the project's dedicated approach to case-holding, volunteers expressed the need to develop skills in providing more comprehensive care. The volunteers appear to administer a more personalized service to TB patients and can bridge the gap between TB patients and the health agency. CONCLUSION: Sustained evaluation and support seem to be a vital tool in integrating a volunteer project into a health team approach. Its effectiveness appears to depend to a large degree on the people involved.     

Guidelines for nonspecific bronchial provocation tests

This study evaluated the effects of a predialysis patient education programme on functioning and well-being in 28 uraemic patients. The programme consisted of four group sessions with the following themes: renal disease and dietary restriction, active renal replacement therapy, physical exercise, and the impact of chronic renal failure on economy, family and social life. Three to 9 months after having started dialysis the patients were evaluated regarding symptoms, perceived health (Health Index), functional (SIP) and emotional (STAI) status. Twenty-eight patients already on dialysis treatment informed according to conventional routines constituted the comparison group. There were no significant differences between the groups regarding age, sex, educational or social background, duration of kidney disease, choice of dialysis treatment, cause of renal disease and laboratory tests except for s-urea. The patients who participated in the education programme scored significantly better mood, less mobility problems (HI), less functional disabilities (SIP) and lower levels of anxiety (STAI) compared to the comparison group. There were no significant differences between the two groups regarding symptoms and overall health. The differences between the groups prevailed during the first 6 months on dialysis treatment, after which the differences disappeared. In the comparison group age correlated significantly to anxiety and overall SIP, which was not the case in the experimental group. In conclusion, the experimental group that participated in a predialysis patient education programme, showed better functional and emotional well-being than the non-educated comparison group. The positive effects of participating in an education programme prevailed during the first 6 months of dialysis treatment. Moreover, the younger patients seemed especially to benefit from participation in a predialysis patient education programme. It is suggested that patient education should be ongoing for patients with end-stage renal failure initiated during the predialysis stage and continued after maintenance dialysis has been established.     

Objective and subjective socioeconomic status and susceptibility to the common cold.

Objective: We ask whether subjective socioeconomic status (SES) predicts who develops a common cold when exposed to a cold virus. Design: 193 healthy men and women ages 21-55 years were assessed for subjective (perceived rank) and objective SES, cognitive, affective and social dispositions, and health practices. Subsequently, they were exposed by nasal drops to a rhinovirus or influenza virus and monitored in quarantine for objective signs of illness and self-reported symptoms. Main Outcome Measures: Infection, signs and symptoms of the common cold, and clinical illness (infection and significant objective signs of illness). Results: Increased subjective SES was associated with decreased risk for developing a cold for both viruses. This association was independent of objective SES and of cognitive, affective and social disposition that might provide alternative spurious (third factor) explanations for the association. Poorer sleep among those with lesser subjective SES may partly mediate the association between subjective SES and colds. Conclusions: Increased Subjective SES is associated with less susceptibility to upper respiratory infection, and this association is independent of objective SES, suggesting the importance of perceived relative rank to health. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Maintaining perceptions of control: Finding perceived control in low-control circumstances.

Three questions about the role of perceived control in coping with a major life stressor were addressed in a sample of 71 cancer patients. As expected, those with greater perceptions of control were less depressed, even when physical functioning, marital satisfaction, and negative affectivity were controlled for. Consistent with a compensatory model of control, it was more important for patients to believe that they could control daily emotional reactions and physical symptoms than the course of the disease. Patients who endorsed irrational beliefs had lower overall perceptions of control. The results indicated that even patients who were physically or psychosocially worse off were better adjusted if they had higher perceptions of control. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The chronic illness quality of life (CIQOL) model: Explaining life satisfaction in people living with HIV disease.

The chronic illness quality of life (CIQOL) model theorizes that life satisfaction in persons living with a chronic illness such as HIV disease is a function of illness-related discrimination, barriers to health care and social services, physical well-being, social support, and coping. The CIQOL model was evaluated using data from 275 persons living with HIV disease. Women reported less life satisfaction and confronted more barriers to health care and social services than men, and White participants reported higher perceptions of AIDS-related discrimination than non-White participants. The CIQOL model provided an excellent fit to study data (root-mean-square error of approximation = .03) and accounted for almost a third of the variance in life satisfaction scores. Barriers to health care and social services played a particularly prominent role in the model. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Patient adherence to cancer control regimens: Scale development and initial validation.

Describes the development of a 38-item self-report Adherence Determinants Questionnaire (ADQ) to assess 7 elements of patients' adherence to medical treatment and prevention: (1) perceptions of interpersonal care, (2) beliefs about susceptibility to disease, (3) beliefs about severity of disease, (4) assessments of perceived utility of adhering (efficacy and benefits vs costs of adhering), (5) perceptions of subjective social norms for adhering, (6) intentions to adhere, and (7) perceptions of supports available for and absence of barriers to adherence. Past adherence and health value were also assessed. In 4 diverse field settings, intentions to adhere were most highly correlated with the perceived utility of adhering. Adherence (self-reported and objectively measured) was related most strongly to the presence of supports for and the absence of barriers to adherence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of Pain on Functioning and Well-Being in Older Adults With Osteoarthritis of the Knee.

The effects of pain on functioning and well-being were examined in 367 older adults with osteoarthritis (OA) of the knee. The relationship of OA-related pain to depressive symptoms and perceived health was hypothesized to be direct as well as mediated by physical and social functioning. Results showed that OA-related pain was related to poorer physical and social functioning, had a direct effect on depressive symptoms, and direct and indirect effects on perceived health. Lower social functioning was related to more depressive symptoms, and both lower social and physical functioning predicted worse perceived health. Thus, distinguishing between physical and social functioning when examining the costs of OA-related pain is useful. Moreover, existing pain-psychological well-being models can be generalized to perceived health. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Perceived problems for self and others: self-protection by social downgrading throughout adulthood

In this study the authors investigated social downgrading as reflected in the difference between perceptions about the self and about "most people my age." A large cross-national probability sample of adults at different age levels throughout adulthood provided ratings of perceived problems expected for the self and for "most other people my age" with regard to 12 domains of life (e.g., health, marriage, and job). Results showed that with regard to all domains, younger, middle-aged, and older adults believed other people's problems to be more serious than their own problems in these domains. Social downgrading was particularly pronounced for those domains for which a given participant experienced problems himself or herself. This self-protection tendency under threat was particularly pronounced in the older adults. The function and adaptive values for social downgrading across adulthood and old age are discussed.     

Culture as common sense: Perceived consensus versus personal beliefs as mechanisms of cultural influence.

The authors propose that culture affects people through their perceptions of what is consensually believed. Whereas past research has examined whether cultural differences in social judgment are mediated by differences in individuals’ personal values and beliefs, this article investigates whether they are mediated by differences in individuals’ perceptions of the views of people around them. The authors propose that individuals who perceive that traditional views are culturally consensual (e.g., Chinese participants who believe that most of their fellows hold collectivistic values) will themselves behave and think in culturally typical ways. Four studies of previously well-established cultural differences found that cultural differences were mediated by participants’ perceived consensus as much as by participants’ personal views. This held true for cultural differences in the bases of compliance (Study 1), attributional foci (Study 2), and counterfactual thinking styles (Study 3). To tease apart the effect of consensus perception from other possibly associated individual differences, in Study 4, the authors experimentally manipulated which of 2 cultures was salient to bicultural participants and found that judgments were guided by participants’ perception of the consensual view of the salient culture. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Facets of support related to well-being: Quantitative social isolation and perceived family support in a sample of elderly women.

The purpose of this study was to examine the independent and interactive relationships of measures of network embeddedness and perceived social support with mental and physical health measures from responses of a sample of 271 community-dwelling elderly women. Quantitative social isolation was measured as the co-occurrence of low network embeddedness with family and with friends. There was a threshold effect such that quantitatively isolated participants had poorer psychological well-being and functional health than did nonisolated participants. This effect was independent of perceived support levels. The pattern was different for perceived social support. Elderly women with low perceived family support had poorer psychological well-being regardless of perceived support from friends or network embeddedness. Implications are discussed for several unanswered questions in the social support literature, including possible interventions for the quantitatively isolated and for those with low levels of perceived support. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Somatic symptoms, social support, and treatment seeking among sexual assault victims.

In an effort to clarify the relationship between the experience of sexual assault and physical health, rape victims and a matched comparison group were repeatedly assessed for somatic symptoms, psychological distress, health care use, and self-rated health perceptions during the year immediately after the assault. Women who experienced sexual assault reported more somatic complaints, poorer perceptions of physical health, greater psychological distress, and increased use of medical services. However, victims did not show a significantly higher use of mental health services and continued to seek medical attention at the end of the year after the assault, when health perceptions and somatic symptoms were no longer significantly elevated. The use of mental health services and social support as moderating variables are examined, and implications for the medical and psychological treatment of sexual assault victims are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapeutic strategies for patients with tuberculosis

OBJECTIVES: To determine the effectiveness of strategies used to promote adherence to anti-tuberculosis treatment. SEARCH STRATEGY: MEDLINE 1966-1996 (August), Cochrane Collaboration Trials Registers (October 1996), LILACS 1982-1996 (September); reference lists in articles on adherence, contact with experts in the fields of TB and adherence research. SELECTION CRITERIA: Randomised or pseudo-randomised controlled trials of interventions to promote compliance with curative or preventive chemotherapy for TB, with at least one measure of adherence. DATA COLLECTION AND ANALYSIS: Data on study methods, participants, interventions and outcomes were collected for each study and methodological quality was assessed. Estimates of effect were assessed for categorical outcomes using the Peto odds ratio, with 95% confidence intervals. MAIN RESULTS: Strategies found to be of benefit were reminder cards sent to defaulters, assistance of patients by lay health workers, monetary incentives offered to patients, and increased supervision of TB clinic staff. It is not possible to determine from current trials whether health education by itself leads to better adherence to treatment. Even though directly-observed therapy (DOT) is widely advocated as the most cost-effective means of ensuring completion of TB treatment, no completed trials could be found which confirm or refute this view. CONCLUSIONS: RCT evidence exists that certain strategies improve adherence to anti-tuberculous therapy, and these should be adopted into clinical practice depending on their appropriateness to practice circumstances. Further innovations should be tested to find solutions that will be useful in low income countries. Randomised trials evaluating the independent effects of directly-observed therapy (DOT) are awaited.     

Presence of activated B-1 cells in chronic inflamed gingival tissue

The oncology nurse's role in breast cancer management is enhanced by knowledge of the patient's perceptions of risks. This case study elucidates the process by which perceived risks of breast cancer are embedded in sequences of biographic experiences including childhood sexual abuse, childhood injuries, and an abusive marriage. The case study shows that risk perceptions and subsequent delayed breast cancer detection is related to (a) a belief that breast cancer results from "bad luck, or fate"; (b) lack of cancer-related symptoms; (c) belief that a higher power determines ill health; (d) reluctance to turn to others for help while in an abusive marriage; (e) family history of cancer invulnerability since generations of family members died of diabetes, heart disease, and pregnancy-related illnesses; and (f) fear of gynecologic exams resulting from childhood sexual abuse. Furthermore, nonapplicability of traditional breast cancer risk factors such as heredity, age older than 30 years at first full-term pregnancy, early menarche, and late menopause prohibit an accurate assessment of self-risk. This case study suggests that breast cancer risk perception often differs from that of biomedical factors, and that an understanding of risk judgments is essential for appropriate therapeutic responses.     

Loneliness as a specific risk factor for depressive symptoms: Cross-sectional and longitudinal analyses.

The extent to which loneliness is a unique risk factor for depressive symptoms was determined in 2 population-based studies of middle-aged to older adults, and the possible causal influences between loneliness and depressive symptoms were examined longitudinally in the 2nd study. In Study 1, a nationally representative sample of persons aged 54 and older completed a telephone interview as part of a study of health and aging. Higher levels of loneliness were associated with more depressive symptoms, net of the effects of age, gender, ethnicity, education, income, marital status, social support, and perceived stress. In Study 2, detailed measures of loneliness, social support, perceived stress, hostility, and demographic characteristics were collected over a 3-year period from a population-based sample of adults ages 50-67 years from Cook County, Illinois. Loneliness was again associated with more depressive symptoms, net of demographic covariates, marital status, social support, hostility, and perceived stress. Latent variable growth models revealed reciprocal influences over time between loneliness and depressive symptomatology. These data suggest that loneliness and depressive symptomatology can act in a synergistic effect to diminish well-being in middle-aged and older adults. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Insecure attachment moderates women's adjustment to inflammatory bowel disease severity.

Objective: Insecure attachment was explored as a moderator of the relationship between disease severity and psychosocial variables in a study of adjustment in women with inflammatory bowel disease (IBD). Method: Participants were 218 women recruited through notices placed in the community, in gastroenterologists' offices, and through online postings to support groups and message boards specifically for people with Crohn's disease, colitis, or IBD in general. Participants completed a mail-in or online survey assessing severity and frequency of symptoms, attachment style (separated into anxious and avoidant subscales), perceived social support, negative affect, and efficacy of coping with IBD. Results: Anxious and avoidant attachment styles were correlated positively with disease severity and negative affect and negatively with perceived social support and coping efficacy. Hierarchical regressions indicated that disease severity was most strongly associated with negative affect for high avoidant attachment, as compared with moderate and low avoidant attachment. Disease activity was inversely related to perceived social support and coping efficacy for high and moderate, but not low, anxious attachment. Conclusion: Our study indicates that attachment moderates associations between disease severity in women with different kinds of IBD and psychological indicators of adjustment. Limitations and relationship to previous research on attachment and health are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Stigma and barriers to care in soldiers postcombat.

The present study examined the effects of leadership and unit cohesion on mental health stigma and perceived barriers to care. A sample of 680 soldiers from combat support units were surveyed 3 months after their return from combat operations in Iraq. The survey included scales on psychological symptoms and perceptions of leader behaviors and unit cohesion, as well as items assessing stigma and barriers to care. The sample was used to test the independent and interactive effects of leadership and unit cohesion on soldiers’ perceptions of stigma and barriers to care. Analyses yielded significant interaction effects between leadership and cohesion in predicting stigma and barriers to care, while controlling for the effects of mental health symptoms. Soldiers who rated their leaders more highly and who reported higher unit cohesion also reported lower scores on both stigma and perceived barriers to care. Thus, positive leadership and unit cohesion can reduce perceptions of stigma and barriers to care, even after accounting for the relationship between mental health symptoms and these outcomes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)