Investigations of the ongoing stressful situations among those with chronic illness

This paper examines methods of adaptation among those faced with stress from chronic health problems. Studies of disabled older adults and those with muscular-skeletal disorders are described with special emphasis on the role of everyday life events, and the threats to well-being imposed by chronic stressors. Attention is paid not only to psychological distress as outcome of a failure to adapt, but also to indices of psychological well-being which provide evidence of the benefits for those who cope successfully with chronic illness. The paper examines evidence for the proposition that everyday stressors can influence physiological processes linked to disease course. The implications of these findings for social interventions are discussed from community and health psychology perspectives.     

En las Manos de Dios [in God's Hands]: Religious and Other Forms of Coping Among Latinos With Arthritis.

This study tested a theoretical model concerning religious, passive, and active coping; pain; and psychological adjustment among a sample of 200 Latinos with arthritis. Respondents reported using high levels of religious coping. A path analysis indicated that religious coping was correlated with active but not with passive coping. Religious coping was directly related to psychological well-being. Passive coping was associated with greater pain and worse adjustment. The effects of active coping on pain, depression, and psychological well-being were entirely indirect, mediated by acceptance of illness and self-efficacy. These findings warrant more research on the mechanisms that mediate the relationship between coping and health. This study contributes to a growing literature on religious coping among people with chronic illness, as well as contributing to a historically under-studied ethnic group. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of disability and bereavement on the mental health and recovery of older adults.

We investigated the role of two major stressors, recent disability and conjugal bereavement, in older adults' self-reports of mental health and recovery from stress. A sample of 246 older adults between the ages of 60–80 was interviewed monthly for 3 months by trained elderly interviewers; Month-10 interview data were also analyzed. Control subjects, who were not experiencing the stressors, were carefully selected from a sample of adults matched on age, sex, and socioeconomic status. Dependent variables were psychological distress and psychological well-being, each with component subscales. The disabled group evidenced significantly lower positive well-being and significantly greater distress than did the other groups. Bereaved subjects demonstrated high levels of depression compared with the disabled subjects, but showed less anxiety. Bereaved subjects showed recovery on several indicators of mental health, but disabled subjects continued to show considerable psychological upset in comparison with the other groups. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychosocial impact of illness intrusiveness moderated by self-concept and age in end-stage renal disease.

This study assesses whether a person's self-concept as a "chronic kidney patient" differentially moderates the psychosocial impact of illness intrusiveness—illness-induced lifestyle disruptions—across the life span. Renal transplant (n?=?52) and maintenance dialysis patients (n?=?49) completed the Illness Intrusiveness Ratings Scale, a semantic-differential self-concept measure, and structured interviews measuring psychosocial well-being and emotional distress. Across ages, distress rose with increasing illness intrusiveness when self-concept was similar, but not dissimilar, to the chronic kidney patient stereotype. The relation between illness intrusiveness and psychosocial well-being differed significantly between younger and older respondents depending on whether they construed themselves as similar versus dissimilar to the chronic kidney patient. Although self-definition moderates the psychosocial impact of chronic disease, this varies across the life span and across affect states. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Neuroticism, coping strategies, and negative well-being among caregivers.

Neuroticism was incorporated into a model for predicting the well-being of family caregivers. Using data from 596 women with an adult child with a chronic disability, the model hypothesizes direct effects of neuroticism on a caregiver's perceptions of the stressor, on her wishful-escapism and problem-focused coping, and on psychological well-being. Results indicate that neuroticism exerts direct and indirect effects on negative well-being. Results also indicate that stressors have direct effects on both wishful-escapism coping and problem-focused coping. Burden had direct effects on negative psychological well-being. Diagnosis influences the model by having direct effects on stressors and wishful-escapism coping but not on problem-focused coping or burden. Inclusion of individual level variables, such as neuroticism, results in a substantial amount of explained variance in negative well-being. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Finances and Well-Being: A Dynamic Equilibrium Model of Resources.

This study of 513 Dutch farmers tested a dynamic equilibrium model of resources (an extension of the conservation of resources theory; S. E. Hobfoll, 1989, 1998, 2001). With structural equation modeling, the advantages of a 3-wave longitudinal design were comprehensively used, such as addressing bidirectional causal effects and within-individual vs. between-individual change. This allowed for a careful analysis of the management function of resources in the stress process. Results showed that well-being had stronger within-person stability than finances. Increased levels of financial problems temporarily increased psychological distress but not self-reported illness. Conversely, farmers with higher stable baselines of psychological distress also had higher baselines of self-reported illness and experienced more negative changes in their financial situation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Impact of chronic and acute stressors on daily reports of mood.

Compared the relative impact of major life events, chronic stressors, and minor daily stressors on daily reports of mood. Analyses are based on daily diary data combined with interview data derived from a longitudinal study of 96 women (mean age 33.1 yrs) sampled from the population of persons using the services of a neighborhood health center. Ss kept daily diaries for 28 days following initial personal interviews. The Affect Balance Scale was used as a baseline measure of psychological well-being. The most important direct determinants of mood were found to be concurrent daily stressors and physical symptoms, and previous levels of psychological well-being. Life events and chronic stressors had indirect effects on mood through these other variables. Results confirm and extend previous studies on the determinants of short-term changes in mood. The advantages and disadvantages of the temporal aggregation of time-series data are discussed. (44 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychosocial working conditions and well-being among immigrant and German low-wage workers.

Despite a steady increase of immigrant workers in Germany in the past decades, occupational health research has only peripherally addressed psychosocial working conditions and immigrant worker well-being. This study has two aims: (1) to investigate differences in psychosocial stressors and resources between immigrant and German low-wage workers, and (2) to examine group differences in their association with well-being using a structural equation modeling multiple group analysis approach. Eighty-nine immigrant and 146 German postmen of a German mail service company were surveyed. Results reveal more stressors in the social work environment for the immigrant workers than for their German coworkers but similar levels of task-related stressors in both groups. Stressors are more strongly associated with psychological distress among the German workers. In terms of resources, job control serves as a resource only among German workers, whereas supervisor and coworker support are more important for immigrant workers. These differences suggest that cultural factors, previous work experiences, and expectations influence the worker's experience of psychosocial working conditions and have a direct impact on worker health. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Interpersonal workplace stressors and well-being: A multi-wave study of employees with and without arthritis.

The within-person influence of interpersonal stressors on affective well-being and physical well-being was investigated for 109 women with and without arthritis. Participants were interviewed on a weekly basis for 12 consecutive weeks, and the prospective data were analyzed by using hierarchical linear modeling. Overall, interpersonal workplace stressors independently predicted both well-being outcomes. Interpersonal stressors outside the workplace were related to negative affect but not to arthritis symptoms. Compared with healthy controls, arthritis patients' ratings of negative affect were equally reactive to workplace stressors. Neuroticism did not moderate stressor reactivity for either dependent variable but did predict mean levels of negative affect. The data support the hypothesis that the psychosocial environment of the workplace contributes unique effects on well-being. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Distress and boredom among orchestra musicians: The two faces of stress.

Survey data gathered from 63 professional musicians in a small symphony orchestra in the eastern United States were used to examine the effects of work-generated stressors on their psychological health and well-being. Lack of artistic integrity, task difficulty, and social tension were found to be the 3 most potent stressors that evoked 2 types of stress reactions: distress reflecting role overload and boredom stress reflecting role underload. Lack of artistic integrity and social tension contributed to heightened distress. Lack of artistic integrity was also associated with increased boredom stress, whereas task difficulty had the opposite effect. Musicians' job involvement and the instrument group in which they played moderated the relationship of selected stressors with the 3 outcome variables. Limitations of the study and directions for future research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Siblings of adults with mild intellectual deficits or mental illness: Differential life course outcomes.

The present study contrasted the later life sibling relationships, patterns of family formation, and psychological distress and well-being of siblings of adults with disabilities to a nondisabled normative group. The authors identified 268 siblings of adults with mild intellectual deficits (ID) and 83 siblings of adults with mental illness (MI) from the Wisconsin Longitudinal Study (R. M. Hauser & W. H. Sewell, 1985; R. M. Hauser, J. Sheridan, & J. R. Warren, 1998), a prospective longitudinal study that followed participants from age 18 years to age 64 years. Compared with the norm (n = 791), siblings of adults with mild ID had more contact with family members and were more likely to live in the same state as the sibling with the disability but reported less affective closeness. Siblings of adults with MI reported more psychological distress, less psychological well-being, and less adaptive personality characteristics compared with the norm, particularly for siblings of men with MI. There were no differences between groups in the patterns of marriage and childbearing. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Race and vulnerability to stress: An examination of differential vulnerability.

Examined the possibility of race differences in vulnerability to stress through the use of self-report data obtained in 1974–1975 standardized interviews with 658 Whites and 171 Blacks in Florida. Structural models linking SES, age, and life-change events to psychological distress were fit to interview data; interviews were focused on an evaluation of vulnerability. Life-change/distress paths were slightly larger among Blacks than among Whites, though not significantly so. The possible adaptive or coping resources provided by supportive social ties and by fatalistic responses to chronic stress are suggested as topics for further research with regard to psychological well-being among disadvantaged groups. (46 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Welfare and psychological distress: a longitudinal study of African American urban mothers

This paper examines the psychological impact of receiving welfare. The prospective longitudinal data are from a cohort of African American mothers (N = 833). Four explanations structured the analyses: social selection; chronic burdens; a failure hypothesis; and earlier life conditions of welfare recipients. Psychological distress was assessed by women's reports of depressed and anxious moods. Women were categorized into one of four welfare conditions by receipt of welfare when their children were first-graders and 10 years later. Concurrent and longitudinal relationships existed between the women's welfare status and reports of psychological distress. Welfare recipients had more chronic burdens--including perceived ill health--which helped to explain these relationships. Measures of failure did not "explain' the greater psychological distress. Women who grew up receiving welfare were more likely to report psychological distress and lower self-esteem later in life. The women's education influenced welfare and physical and psychological well-being.     

Relationships of self-esteem and efficacy to psychological distress in mothers of children with chronic physical illnesses.

This study examined relationships of children's illness-related functional limitations and 2 maternal psychological resources, self-esteem and efficacy, to symptoms of psychological distress in 365 urban mothers of 5- to 9-year-old children with diverse chronic illnesses. Multiple regression controlling for sociodemographic variables indicated that presence of functional limitations in the child and lower resources each were associated with higher maternal scores on a psychological symptom scale. Self-esteem had a main effect on maternal distress; however, a significant Efficacy?×?Functional Status interaction term suggested that mothers experienced greater distress when their children had illness-related functional limitations and maternal efficacy was low. Interventions aimed at enhancing maternal psychological resources may reduce the likelihood of distress in mothers of children with chronic illness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The biopsychosocial approach to chronic pain: Scientific advances and future directions.

The prevalence and cost of chronic pain is a major physical and mental health care problem in the United States today. As a result, there has been a recent explosion of research on chronic pain, with significant advances in better understanding its etiology, assessment, and treatment. The purpose of the present article is to provide a review of the most noteworthy developments in the field. The biopsychosocial model is now widely accepted as the most heuristic approach to chronic pain. With this model in mind, a review of the basic neuroscience processes of pain (the bio part of biopsychosocial), as well as the psychosocial factors, is presented. This spans research on how psychological and social factors can interact with brain processes to influence health and illness as well as on the development of new technologies, such as brain imaging, that provide new insights into brain-pain mechanisms. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The association of parent behaviors, chronic pain, and psychological problems with venipuncture distress in infants: The Generation R study.

Objective: To examine the association of parent behavior with infant distress during a potentially painful medical procedure. A second aim was to investigate the association of parent chronic pain and psychological problems with parent behavior and infant distress during the procedure. Design: Population-based cohort study with both cross-sectional and prospective measurements. Main Outcome Measures: Video recordings of 275 parents and their 14-month-old infant undergoing venipuncture were coded with an observational instrument to yield measures of infant distress behaviors and parent behaviors, such as reassuring, showing empathy, praising, and distracting. Parent chronic pain and psychological problems were assessed through questionnaires. Results: Infants cried 58% of procedure duration. Parent reassuring occurred 34% of procedure duration, and parent distracting occurred 37% of procedure duration. Infant distress was positively related to parent reassuring and negatively related to parent praising. Parent chronic pain was related to increased parent distracting but not to parent reassuring. Parent psychological problems were not associated with parent behavior and infant distress. Conclusion: Parent behavior rather than psychological traits is related to increased venipuncture distress in young infants. This finding suggests that the focus should be on interventions based on behavior modification. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social-cognitive processes as moderators of a couple-focused group intervention for women with early stage breast cancer.

Objective: The purpose was to examine whether social-cognitive variables would moderate the efficacy of a couple-focused group intervention (CG) for women diagnosed with early stage breast cancer. Design: Participants (N = 238) were randomly assigned to 6 sessions of a couple-focused group versus usual care. Intent to treat growth curve modeling analyses indicated that emotional expression and emotional processing moderated CG effects on depression. Main Outcome Measures: The primary outcome measures for this study were psychological distress and psychological well-being. Results: Treatment attrition analyses separating out participants assigned to but not attending CG indicated that emotional expression, emotional processing, and protective buffering moderated the effects of CG among those who attended CG with the most consistent effects noted for emotional processing on indicators of distress and well-being. Conclusion: The CG intervention may be more effective for patients who begin the group experience using emotional approach coping strategies to deal with cancer. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Racial discrimination and the stress process.

The unique and combined effects of chronic and daily racial discrimination on psychological distress were examined in a sample of 174 African American doctoral students and graduates. Using a daily process design, 5 models of the stress process were tested. Multilevel random coefficient modeling analyses revealed that chronic exposure to racial discrimination predicted greater daily discrimination and psychological distress. Further, results show that differences in daily discrimination and negative events accounted for meaningful variation in daily distress responses. Finally, findings indicate that daily discrimination and negative events mediated the relationship between chronic discrimination and psychological distress. The study provides support for the need to measure chronic strains as distinctive from daily stressors in the lives of African Americans. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Establishing a research agenda for investigating alternative medical interventions for chronic pain

This article describes the University of Maryland School of Medicine's Center for Complementary Medicine Research approach to developing an agenda for investigating alternative medical treatments for chronic pain syndromes. This agenda includes conducting extensive literature searches and analyses to form a knowledge base for making clinical decisions on which chronic pain syndromes are in greatest need of better therapies, as well as which alternative medical therapies offer the greatest therapeutic promise for these specific chronic pain syndromes. To date, the Center has identified back pain, arthritis, and fibromyalgia as the chronic pain syndromes that contribute the greatest clinical and economic burden to overall chronic pain statistics. Not coincidentally, patients with these diagnoses are the greatest users of alternative therapies. The Center has identified acupuncture, homeopathy, manual/manipulative therapies, and mind-body therapies as the alternative medical therapies offering the greatest clinical potential for these three general chronic pain diagnoses. Preliminary data from the Center's ongoing clinical trials programs are presented.