Applying the Transactional Stress and Coping Model to Sickle Cell Disorder and Insulin-Dependent Diabetes Mellitus: Identifying Psychosocial Variables Related to Adjustment and Intervention

This review paper examines the literature on psychosocial factors associated with adjustment to sickle cell disease and insulin-dependent diabetes mellitus in children through the framework of the transactional stress and coping (TSC) model. The transactional stress and coping model views adaptation to a childhood chronic illness as mediated by several psychosocial factors. This review examines the utility of the model in explaining adjustment in two different childhood diseases, identifies needed research and intervention targets, as well as highlights potential changes to the model. The major conclusions of this review suggest that, in addition to child-specific factors, family functioning is an area that interventions should address in sickle cell disease and insulin-dependent diabetes mellitus.     

Marital role strain,illness intrusiveness,and their impact on marital and individual adjustment in end-stage renal disease

Abstract

A marital role theory approach was used to investigate individual psychosocial well-being and marital adjustment in 89 end-stage renal disease (ESRD) patients and their spouses. Four different patient groups were selected according to a continuum of clinical milestones in the treatment of ESRD, including pre-dialysis (n=17), incenter dialysis (n=18), home dialysis (n=19), and posttransplant patients (n=17). A nephrology clinic control group (n=18) was also included. Standardized instruments were employed to investigate marital role strain (Marital Role Questionnaire, KDS-15), marital adjustment (Locke-Wallace Marital Adjustment Test), subjective well-being (Affect Balance Scale, Rosenberg Self-Esteem Inventory), and psychopathology (Symptom Checklist 90-R). Hierarchical multiple regression analyses provided strong and consistent support for the major hypotheses relating elevated marital role strain to compromised marital adjustment and individual well-being. Further analyses demonstrated that increased perceived intrusiveness of ESRD was significantly related to greater marital role strain, poorer marital adjustment, and decreased individual well-being. This is consistent with the idea that perceived intrusiveness may be an important mediator of marital role strain and of coping with chronic illness. “Objective” intrusiveness, defined in terms of patient group, was not significantly related to marital or individual well-being. These findings support a dyadic approach to the psychosocial study of chronic illness.     

Optimism and coping as determinants of psychosocial adjustment to rheumatoid arthritis

Psychosocial adjustment in 66 patients with chronic rheumatoid arthritis, with a mean duration of 12 years with the disease, were evaluated in a prospective design, with 62% of the sample followed up 16 months later. It was predicted that dispositional optimism would predict adjustment over time and that perceived support and perceived control would be related to psychosocial adjustment at the time of concurrent measurement. At Time 1, psychosocial adjustment was associated with greater optimism and perceived support and less disability. Optimism at Time 1 was the only significant predictor of changes in adjustment at Time 2 controlling for Time 1 adjustment and Time 2 disability. It was found that optimism temporally precedes increases in psychosocial adjustment. In terms of coping strategies, wishful thinking was related to poorer social adjustment, whereas problem-focused coping was marginally related to positive adjustment. Neither coping strategy predicted adjustment across time. Optimism at Time 1 did predict problem-focused coping at Time 2. Perceived social support regarding a specific circumstance at a given point in time enables one to persist in solving a task. Interventions to enhance the quality of life of individuals coping with progressive deteriorative disease must look at the influence of their behavior and attitude on those who provide care for them.     

Diabetes mellitus as a model of psychosomatic and somatopsychic interrelationships

The article reviews research on the problem of interrelationship between different physical and psychosocial factors in type 1 diabetes mellitus (DM1). The authors consider methodological principles of health-related quality of life (HRQoL) assessment in DM1 patients and stress the need for an integrated biopsychosocial approach to the management of the disease. DM1 is a chronic metabolic disease with an absolute requirement for insulin replacement therapy. The stress-inducing nature of DM1 is associated with its unexpected and dramatic manifestation in juvenile years, life-threatening nature of severe hypo-/hyperglycaemias and long-term complications, with the burden of diabetes self-management, threat of work disability, employment and career problems etc. These features of DM1 increase the likelihood of the development of anxiety and depressive disorders, which, in turn, may negatively influence the course of diabetes and in particular, diabetes self-care. This necessitates early diagnosis of emotional and behavioral disturbances in DM1 using self-report instruments as well as clinical assessment. Evidence suggests that active problem-focused coping behavior and adequate social support promote adherence to diabetes regimes and may act as a buffer against negative effects of the disease on HRQoL in DM1 patients. The core element in the HRQoL structure is personal disease picture (as opposed by objective clinical picture)--the cognitive-affective-behavioral complex reflecting the patient's personal perception of the disease. Examination of the personal disease picture and attitude towards the ailment in DM1 patients may help to improve understanding of the mechanisms of poor adjustment. Problems in disease adjustment can be detected also by diabetes-specific HRQoL assessment. The measures of HRQoL can be applied as screening instruments useful in increasing the effectiveness of patient-provider interactions and diabetes care.     

Psychosocial characteristics of pregnant and nulliparous adolescents

A case control study was carried out with 19 pregnant and 20 nulliparous fifteen- and sixteen-year-old black teenage women patients at an adolescent clinic. Both groups were measured on twenty-one variables, which included personal and family history information as well as scores on twelve scales of adolescent psychosocial adjustment. A stepwise discriminant analysis was carried out comparing both groups. The first analysis using only psychosocial adjustment variables did not significantly discriminate between the two groups. The second analysis used family history and psychosocial adjustment variables and had a multiple correlation of .65, with p = .008. The discriminant function generated was able to correctly classify 89.5% of the pregnant group and 80% of the nulliparous group. The pregnant group had lower maternal educational level, later sex education, more brothers, better family adjustment, but poorer vocational adjustment. The study suggests that distinct characteristics do exist for the pregnant adolescent in the population studied, but that such characteristics do not indicate family or psychological disturbance in pregnant adolescents. Further, the importance of the meaning of adolescent pregnancy within different cultural and socioeconomic contexts is discussed.     

Appraisals of control and predictability in adapting to a chronic disease

In a sample of 92 patients with rheumatoid arthritis, we examined interrelations among various control appraisals, illness predictability, psychosocial adjustment, mood, and illness status. Perceiving greater personal control over the disease and symptoms and perceiving greater health-care-provider control over symptoms were associated with greater illness predictability. Patients reported more personal control over their symptoms than over the course of the disease and thought that their health care providers had more control over disease course than they did themselves. Multiple regression analyses showed that perceiving greater personal control over one's medical care and treatment was associated with positive mood and psychosocial adjustment. Negative mood was also associated with the belief that providers have greater control over the patient's daily symptoms. Patients who had a more severe disease and expressed greater personal control over its course reported greater mood disturbance and were rated as exhibiting less positive adjustment, but those who had more severe daily symptoms and expressed greater personal control over their symptoms reported less mood disturbance. These findings are discussed in terms of the possible benefits of patients' active participation in their care and the implications of perceiving personal and others' control over more or less controllable aspects of the illness, especially when the illness is more severe.     

The family and the child with epilepsy

Reports documenting psychosocial epiphenomena of chronic illness in individuals with that illness have been common in recent years. Few studies, however, have been concerned with how illness might affect the family. Those that have appeared in the literature often lack critical controls (i.e., control groups) and often fail to investigate possible links between illness-specific variables (i.e. chronicity, inhibition of mobility) and psychosocial outcomes on the family. The present study of 45 families focused on how children with epilepsy affect their families' functioning relative to families with a child with diabetes and families with no chronically ill members. The results suggest several areas of child and family adjustment (i.e. child self-concept, family communication, family cohesion) in which the families of epileptic children have great difficulty. Implications of these results are discussed with regard to differential influences of various chronic illnesses on families and family-based preventive and remedial treatment programs.     

Dissimilarity in mother and adolescent illness representations of type 1 diabetes and negative emotional adjustment

The study explored how two measures of mother–adolescent dissimilarity in illness representations relate to negative emotional adjustment in mothers and adolescents. Eighty-four adolescents with type 1 diabetes (age 11.5–17.5) and their mothers completed the Revised Illness Perceptions Questionnaire and measures of negative emotional adjustment. Adolescents viewed diabetes as less chronic, containing fewer negative emotional representations, and that mother had less control over the illness than did mothers. Mother–adolescent mean differences in representations were not associated with negative adjustment for adolescents; mean differences in coherence were related to negative adjustment for mothers, when controlling the individual's own representations. A measure of dissimilarity based on the sum of squared differences between mother and adolescent was associated with negative adolescent adjustment when controlling adolescent's own representations, but no relations were found for mothers. Dyadic approaches to coping with chronic illness will benefit by understanding how dissimilarity in illness representations between patient and caregiver relate to adjustment.     

Correlates of Maternal and Paternal Adjustment to Chronic Childhood Disease

This study investigated the correlates of psychosocial adjustment in mothers and fathers of children with chronic disease. Participants were 20 mothers and 15 fathers of children with cystic fibrosis, 11 mothers and 9 fathers of children with muscular dystrophy, 18 mothers and 9 fathers of children with asthma, 13 mothers and 8 fathers of children with Type 1 diabetes and 19 mothers and 11 fathers of healthy children. Questionnaires relating to the variables of interest were used. Poorer levels of adjustment were associated with lower levels of social support and family cohesion for mothers and coping by understanding the child’s medical situation, more family life events and lower family cohesion for fathers. These findings suggest that the correlates associated with maternal and paternal psychological adjustment to chronic childhood disease differ. These differences are important to consider when providing care to children with chronic disease and their families.     

Couples and Diabetes: A 30-Year Narrative Review of Dyadic Relational Research

Diabetes is a chronic condition that affects both members of a couple. However, relatively few studies have focused on the entire couple system as the unit of observation when examining the psychosocial impact of this disease. This narrative review examines the literature between 1980 and 2010 that uses the couple as the unit of observation. A total of 49 articles were identified for review. Articles were grouped by their central themes or outcomes: (1) sexual functioning, (2) relationship adjustment and support, (3) culture and spirituality, (4) treatment/education programs, and (5) diabetes as a risk factor. Research and clinical implications such as increasing the utilization of dyadic analytical strategies and the importance of assessing illness burden from each partners’ perspective are discussed. Identified benefits of incorporating the couple dyad for future research and clinical practice included: (1) understanding the influence of variables such as a non-diabetic partner and gender have on diabetes adjustment and management, (2) the role disease severity and management of diabetes by the partner living with diabetes has on spousal support and non-diabetic partner emotional wellbeing, (3) the interdependent nature of couple outcomes in the areas of adjustment to sexual dysfunction, perceived illness burden, and couple satisfaction, as well as, (4) disease as both an individual and a shared experience among couples.     

Comparison of outcome in men and women after treatment in psychiatric security hospitals in Germany

Previous research has shown that forensic psychiatric treatment reduces reoffending, rehospitalization and premature mortality. Treatment outcome varies with diagnosis, but little is known about the influence of sex, psychosocial adjustment and aftercare. To assess these variables, we interviewed male and female patients discharged from three psychiatric security hospitals in Germany in the years 2010–2017. Participants were interviewed at discharge (n = 609) and 1 year later (n = 366) about reoffending, readmissions, substance use and psychosocial adjustment. Among patients with substance use disorder (SUD), 14% reoffended, 20% were re-hospitalized and 60% maintained abstinence. Among patients with severe mental disorder, 5% reoffended and 13% were re-hospitalized. Significant sex differences were found in offenders with SUD. The results suggest that sociodemographic and disorder-related risk factors are associated with treatment success and that female patients with SUD might need a specific treatment approach. Sex-specific aspects, diagnosis and psychosocial adjustment should be considered in forensic psychiatric treatment and risk assessment.     

Starting on haemodialysis: A qualitative study to explore the experience and needs of incident patients

Dialysis can be very stressful with the initial months onto treatment being highly critical in terms of both adaptation and mortality. This qualitative study aimed to explore the lived experiences of incident haemodialysis patients in Singapore. Topics related to the end-stage renal disease diagnosis and haemodialysis treatment were raised with 13 incident haemodialysis patients in the form of semi-structured interviews, and interpretative phenomenological analysis was undertaken as the framework for data analysis. Emotional distress, treatment-related concerns and social support emerged as main issues following a critical review of themes. Our study revealed that incident haemodialysis patients have emotional and informational needs, highlighting the importance of intervention programmes in particular to this patient group to promote better psychosocial adjustment to the disease and its treatment.     

Psychosocial adjustment along the HIV disease continuum

Abstract

Evidence suggests that certain indices of stage of HIV disease are determinants of psychological distress, although information is lacking on how disease stage impacts on multiple domains of adjustment. The present study aimed: (1) to explore differences among clinical stages of HIV on measures of psychosocial adjustment, and (2) to explore the relationship between indices of psychosocial adjustment to HIV and self-report measures of physical health. Ninety six HIV-infected persons and 33 HIV seronegative comparison group participants were interviewed and completed self-administered scales. Participants were divided into four groups (the independent variable): a comparison group and three HIV groups, representing the three clinical indices of illness stage (asymptomatic, early symptomatic and AIDS). Three subjective health indices included number of HIV-related symptoms, global health rating, and T4 count. The dependent variables included 5 psychosocial adjustment measures. Results indicated that social and instrumental domains of adjustment were significantly associated with both clinical stage and all 3 subjective health indices. Levels of psychological distress were associated with number of physical symptoms and global health rating, but were unrelated to clinical stage and T4 count. Emotional and existential concerns were unrelated to all indices of illness stage.     

童年中晚期同伴侵害对儿童心理社会适应影响的纵向分析

采用间隔两年的纵向设计, 通过对1767名儿童的同伴侵害以及孤独、抑郁、攻击、行为不良、同伴接纳、同伴拒绝等心理社会适应指标进行调查, 综合运用变量定向的方法和个体定向的方法考察了童年中晚期儿童心理社会适应发展的结果模式, 以及同伴侵害对儿童心理社会适应发展的影响。结果发现, (1)身体侵害、关系侵害与心理社会适应各指标存在显著的即时与纵向相关关系。(2)儿童心理社会适应结果表现为内化问题、外化问题、同伴拒绝、正常发展4种模式。(3)判别分析显示, 9岁的同伴侵害(主要为身体侵害)能预测同伴拒绝、外化问题适应结果模式, 11岁的同伴侵害(主要为关系侵害)能预测内化问题、同伴拒绝适应结果模式。这些结果表明同伴侵害与儿童心理社会适应间的联系具有异质性, 并且先前和当前的侵害经历以及不同类型的侵害与心理社会适应间的联系因适应领域的不同而存在差异。     

Blood glucose monitoring by diabetic adolescents: compliance and metabolic control

Self-monitoring of blood glucose (SMBG) is used in the management of diabetes to guide insulin and diet adjustments. However, SMBG has not achieved its potential impact on diabetic control, perhaps due to poor compliance. Research on SMBG compliance interventions has been hampered by a lack of reliable and practical methods of behavioral assessment. The appearance of reflectance meters with memory permits precise, yet efficient, measurement of SMBG behaviors, allowing more effective interventions. This study evaluated a behavioral contract for SMBG compliance among diabetic adolescents, using reflectance meters with memory to assess the target behavior. Thirty patients were randomized to either meter-alone or meter-plus-contract conditions; an additional 12 patients served in a conventional-therapy control group. Compliance for the meter-alone group declined sharply during the 16-week intervention, whereas it remained at or above baseline levels for the meter-plus-contract group. Despite the large between-groups differences in SMBG frequency, both groups showed equal, moderate improvement in measures of diabetic control, suggesting that SMBG frequency had little impact on health status in this sample. There were no intervention-specific effects on overall diabetes compliance or patient or parent adjustment to diabetes. Few of the measured patient characteristics were significant predictors of treatment response. Further research into maximizing the therapeutic impact of SMBG is needed.     

An explanatory model of adjustment to type I diabetes based on attachment, coping, and self-regulation theories

The aim of this study was to develop and test a model of adjustment to type I diabetes. Three hundred young adults (172 females and 128 males) with type I diabetes were asked to complete the Adult Attachment Inventory (AAI), the Brief Illness Perception Questionnaire (Brief IPQ), Task-oriented subscale of the Coping Inventory for Stressful Situations (CISS), D-39, and well-being subscale of the Mental Health Inventory (MHI). HbA1c was obtained from laboratory examination. Results from structural equation analysis partly supported the hypothesized model. Secure and avoidant attachment styles were found to have effects on illness perception, ambivalent attachment style did not have significant effect on illness perception. Three attachment styles had significant effect on task-oriented coping strategy. Avoidant attachment had negative direct effect on adjustment too. Regression effects of illness perception and task-oriented coping strategy on adjustment were positive. Therefore, positive illness perception and more usage of task-oriented coping strategy predict better adjustment to diabetes. So, the results confirmed the theoretical bases and empirical evidence of effectiveness of attachment styles in adjustment to chronic disease and can be helpful in devising preventive policies, determining high-risk maladjusted patients, and planning special psychological treatment.     

How do psychosocial challenges associated with living with congenital heart disease translate into treatment interests and preferences? A qualitative approach

Objectives: There is an increasing amount of research being conducted regarding the psychosocial challenges associated with living with congenital heart disease (CHD), however little is known about how these challenges influence the type of psychosocial services patients want. This study investigated (1) the type of services patients want; (2) how they want to access these services; and (3) why they want these services. Methods: Three focus groups with adults with CHD (total of 14 participants aged 19-67) were conducted and thematic analysis was used to identify emerging themes. Results: Participants described wanting to access specific psychosocial services in three broad categories (counselling, connecting with other adults with CHD and psycho-education) and in three main formats (individual/group therapy, mentorship programmes and patient conferences). Reasons for wanting these services were grouped under two overarching themes, namely intrapersonal factors and interpersonal challenges. Conclusions: Psychosocial challenges are part of the everyday lives of adults with CHD, yet they are rarely addressed as part of routine medical care. Patients themselves have clear opinions regarding the psychological services most appropriate to target their experiences of living with CHD.     

中年Ⅱ型糖尿病人记忆损伤特点

本研究主要探讨中年Ⅱ型糖尿病人的记忆损伤特征。研究选取病人和对照各30人,控制年龄(65岁以下。病人组平均53岁,正常组52岁)、教育水平和相关疾病等因素。测试数字符号、数字工作记忆广度、动作记忆和无意义图形再认4项认知任务。结果发现：(1)病人组数字符号测试显著低于正常组;(2)在支持性条件记忆自由回忆中,病人组在有动作演练的高语义关联和无动作演练的低语义关联项目上显著低于对照组。出现分离现象;(3)在线索回忆中,病人组与对照组差异不显著;(4)两组数字工作记忆广度、无意义图形再认的成绩无差异。根据SPT(subject—performed task)研究理论对结果进行了分析,得出结论：中年Ⅱ型糖尿病人记忆的一般性信息加工能力未表现出受损,但特异信息加工受到损伤,并可能预测随年龄及病程进行而表现出一般性信息加工能力受损。     

Peer Victimization in Youth with Tourette’s Syndrome and Chronic Tic Disorder: Relations with Tic Severity and Internalizing Symptoms

The present study analyzed rates of peer victimization in children with a chronic tic disorder as compared to children with type 1 diabetes and healthy controls. The associations among peer victimization, tic symptom severity, and psychological symptoms, as well as the potential mediating relationship between peer victimization, tic severity, and child internalizing symptoms, were also explored. Children with tics displayed higher rates of peer victimization than control groups, and peer victimization in children with tics was positively correlated with tic symptom severity, loneliness, anxiety symptoms, and parent report of child internalizing symptoms. Results also supported the hypothesis that peer victimization mediates the relationship between tic symptom severity and loneliness. Findings highlight the importance of the assessment and treatment of psychosocial variables in children with chronic tic disorders, including social functioning and peer relationships.