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.     

What are the positive consequences of illness?

Abstract

Fifty five people, either currently sick or having recovered from their illness, were recruited if they reported positive consequences of illness. They were questioned about their experiences of illness, 41 by semi-structured interview and 14 by open-ended questionnaire and responses were classified into 17 categories. The categories were similar but slightly more extensive than previous accounts of positive consequences reported in the literature. The content of the interviews and questionnaires was used to construct a 66 item questionnaire about positive consequences of illness which was then completed by 97 patients. A principal components analysis indicated a large first factor accounting for 27% of the variance. Endorsement of items varied between 87% and zero for chronic lung disease patients attending pulmonary rehabilitation. However, all patients endorsed at least one item and the median number of items endorsed was 31. Positive consequences of illness are highly varied and more common than often realised, and this has implications for the concept and measurement of quality of life.     

Predicting short and long-term exercise intentions and behaviour in patients with coronary artery disease: A test of protection motivation theory

The purpose of this study was to examine the utility of protection motivation theory (PMT) in the prediction of exercise intentions and behaviour in the year following hospitalisation for coronary artery disease (CAD). Patients with documented CAD (n?=?787), recruited at hospital discharge, completed questionnaires measuring PMT's threat (i.e. perceived severity and vulnerability) and coping (i.e. self-efficacy, response efficacy) appraisal constructs at baseline, 2 and 6 months, and exercise behaviour at baseline, 6 and 12 months post-hospitalisation. Structural equation modelling showed that the PMT model of exercise at 6 months had a good fit with the empirical data. Self-efficacy, response efficacy, and perceived severity predicted exercise intentions, which, in turn predicted exercise behaviour. Overall, the PMT variables accounted for a moderate amount of variance in exercise intentions (23%) and behaviour (20%). In contrast, the PMT model was not reliable for predicting exercise behaviour at 12 months post-hospitalisation. The data provided support for PMT applied to short-term, but not long-term, exercise behaviour among patients with CAD. Health education should concentrate on providing positive coping messages to enhance patients’ confidence regarding exercise and their belief that exercise provides health benefits, as well as realistic information about disease severity.     

The relationship between self-reported oral symptoms and life-events

Abstract

This paper investigates whether eight specific life-events were related to self-reported chronic (persistent trouble over the last 12 months) and acute (trouble in the last 14 days) oral symptoms in a sample of 3861 civil servants aged 35-44 years. The results of a logistic regression analysis taking age, social class and gender into account showed that a range of life-events—marital or family problems other than divorce, death of a relative, personal serious illness, serious illness of a close relative, major financial difficulty and mugging and robbery—were significantly associated with either acute or chronic oral symptoms. Further analysis showed that marital or family problems other than divorce was found to be the most important life event studied. The results support the argument that marital dissatisfaction leads to poorer physical and psychological health.     

Reduce temptation or resist it? Experienced temptation mediates the relationship between implicit evaluations of unhealthy snack foods and subsequent intake

A more negative implicit evaluation of unhealthy food stimuli and a more positive implicit evaluation of a weight-management goal have been shown to predict lower consumption of unhealthy food. However, the associations between these evaluations, temptation to indulge and consumption of unhealthy food remain unclear. The current study investigated whether temptation would mediate the relationship between implicit food and goal evaluations and consumption (resembling an antecedent-focused route to self-control of eating), or whether those evaluations would moderate the relationship between temptation and consumption (resembling a response-focused route). A sample of 156 women (17–25 years), who tried to manage their weight through healthy eating, completed two implicit association tasks assessing implicit food and goal evaluations, respectively. Intake of four energy-dense snack foods was measured in a task disguised as a taste test, and participants reported the strength of experienced temptation to indulge in the snacks offered. Negative implicit food evaluation was associated with lower snack intake, and temptation mediated this relationship. Implicit goal evaluation was unrelated to both temptation strength and snack consumption. The findings contribute to an understanding of how negative implicit unhealthy food evaluation relates to lower consumption, namely through the mediation of temptation to indulge in those foods.     

Work strain and the post-discharge adjustment of patients following a heart attack

Abstract

The role of work characteristics in determining return to work after an acute coronary event was examined. One hundred and forty nine patients were enrolled. One year post-discharge, 74 had returned to work. Work characteristics (decision latitude, and opportunity for social interaction at work), together with age, depression, and medical prognosis, correctly classified work status in 78% of cases. At 12 months post-discharge, patients who had not returned to work recorded significantly poorer levels of adjustment compared to those who had returned to work. A better quality of life is associated with a lower level of depression pre-hospitalization, ownership of a larger home, being male, and having a more positive work environment. The findings suggest that the pre-illness work environment of the patient is a factor influencing return to work, which needs to be considered in rehabilitation programmes.     

Proximal and distal effects of mortality salience on willingness to engage in health promoting behavior along the life span

The current studies examine proximal and distal mortality salience effects on the willingness to engage in health-promoting activities and explore the roles of age and self-esteem. In Study 1, 164 participants completed a self-esteem scale, were assigned to a mortality salience or a neutral condition, and then completed a scale, tapping their willingness to engage in health promoting activities. Findings revealed that in the proximal mode, mortality salience led the young and middle-aged adults to report higher willingness to promote health behaviors, whereas older adults tended to show a lower willingness to promote their health compared to the control condition. In Study 2, a total of 251 participants completed the same series of questionnaires, including a distracting task immediately after the mortality salience manipulation. Findings revealed that, in the distal mode, whereas death reminders did not affect young adults, mortality salience led middle-aged participants to express higher willingness to conduct health-promoting behaviors than in a control condition. The mortality salience induction did not affect older adults with high self-esteem, but led low self-esteem individuals to report higher willingness to promote their health. The differences between the reactions of the different age groups in both the defense modes are discussed in view of the terror management theory.     

The relationship between employees’ experience of performance management and work engagement within a South African organisation

The study investigated the relationship between employees’ experience of performance management and work engagement. Participants were a convenience sample of employed adults (N=202; females=59%, middle management?=?48%, White?=?54%, tenure more than 9 years?=?48%) in an organisation in the vehicle and asset-based finance industry. They completed the Performance Management Questionnaire (PMQ) and Utrecht Work Engagement Scale (UWES). Multiple regression analysis was used to determine the proportion of variance of work engagement that is explained by employees’ experience of performance management. Results revealed that only empowerment significantly predicted work engagement. These findings suggest that when employees experience performance management as empowering, they are also likely to have higher levels of work engagement.     

Religious Research in Gerontology, 1980–1994: A Systematic Review

ABSTRACT

This article presents results of an NIA-funded systematic review of research on religion and aging published from 1980–1994 in mainstream gerontology and religion journals, including the Journal of Religious Gerontology. Findings are summarized from 73 empirical studies, a subset of the 115 articles included in NIA's bibliography on this topic. In general, these studies use multiethnic samples, include multiple religious dimensions, and focus on age comparative analyses and on analyses of religious effects on life satisfaction, health, and well-being. Also summarized is gerontological research on patterns, predictors, outcomes, and measures of religious involvement, and an agenda for future research is proposed.     

Diagnosing depression in patients with physical diseases using the beck depression inventory (BDI)

Abstract

Four-hundred-and-forty-three patients with a physical illness (355 with coronary heart disease and 88 with chronic pain), 150 unemployed persons and 623 subjects from the normal population in Jämtland, Sweden were tested using the BDI (Beck Depression Inventory). The aim of the study was to investigate whether scores on both the physical and non-physical components of the BDI differed between the patients and the other groups, or whether only the physical component was significantly higher in the patient group, and in such a case whether this could be interpreted as symptomatic of physical disease and not of depression. A cutoff score of ≥ 10 to determine mild depression and two different alternative physical and non-physical components were used. Forty-three percent of the patients with coronary heart disease and 50% of patients with chronic pain were categorized as being at least mildly depressed. Factor analyses indicated that a physical component comprising five items was the most meaningful and could best discriminate the physical symptoms. The patients' scores were significantly higher than those of the other two groups on the physical component but only higher than the normal population sample on the nun-physical component. This supports the idea that the items for physical symptoms in the BDI might be confounding when determining depression in patients with physical diseases. The non-physical component seems to be the best indicator of depression and is recommended as a complement to the total BDI scale when determining the degree of depression in patients suffering from a physical disease.