Psychological Distress in Caregivers of Liver and Lung Transplant Candidates

Although organ transplantation represents a stressful experience for the entire family, surprisingly little research has focused on the adjustment of caregivers. The purpose of this study was to examine what caregivers report to be the greatest benefits and stressors pretransplant, the prevalence of psychological distress and caregiver strain in pretransplant caregivers as compared to normative populations, and the physical, psychological, and demographic variables that predict distress. Fifty-two caregivers of transplant candidates (28 liver and 24 lung) completed a series of questionnaires, including the Psychosocial Adjustment to Illness Scale (PAIS-SR), SF-36 Health Survey, Caregiver Strain Index (CSI), and qualitative questions about benefits and stressors. The most commonly reported benefit of being a caregiver could be categorized as Helping the Patient, and the most common stressors were associated with Uncertainty/Waiting/Fears. Compared to normative samples of caregivers of patients with Alzheimer's disease, caregivers of liver transplant candidates reported more caregiver strain; there were no differences for lung transplant caregivers. Caregiver social functioning was found to be the only significant predictor of caregiver distress, with those caregivers who report greater distress also reporting extreme and frequent interference with normal social activities. Implications of these findings for psychological interventions are discussed.     

Race,gender, and the response to stress: Autoworkers' vulnerability to long-term unemployment

A three-wave panel study of auto plant closings focused on the mental health effects of unemployment on blue-collar workers. This paper explores how the impact of long-term unemployment varies across race and gender. We also examine whether other demographic factors can themselves modify the impactsof race and gender. Dependent variables include two measures of distress and two drinking measures. Results showed that the effect of long-term unemployment on distress and drinking was more severe among less educated workers, and responses of blacks were especially sensitive to level of education. In addition, men showed a greater association of long-term unemployment with depression (and to some extent anxiety) than did women. Marriage affected the responses of men but not of women, and of whites but not of blacks. Explanatory variables—the worker's experiences of financial hardship, other negative life events, and lack of a confidant—largely accounted for male-female differences. We conclude by discussing theoretical implications of these effects and address the limitations of the traditional term “vulnerability” in describing them. A prior version of this paper was presented at the North Central Sociological Association meeting in Dearborn, Michigan, April 25, 1991. Funds for the research were provided by the Michigan Health Care Research and Education Foundation and by the International Union-UAW. We are especially grateful to the men and women of the UAW, whose experiences and views form this investigation. We thank Kiseon Chung, Scott McKearney, David Rauma, and the anonymous reviewers for their comments on earlier drafts.     

Negative social interactions,distress, and depression among those caring for a seriously and persistently mentally III relative

Investigated both positive and negative social interactions and their effect on mental health for 106 individuals caring for a seriously mentally ill family member. Results from mixed-model (hierarchial and stepwise) multiple regression analyses in which caregiver age, socioeconomic status, caregiving demand, and severity of patient symptoms was controlled showed that negative social interaction accounted for a significant portion of variance in the caregivers' feelings of distress and depression. Moderated multiple regression analyses showed that under conditions of high negative interaction, the relationship between demand and distress was intensified. Implications of these findings for the conceptualization and measurement of negative social interaction as well as its clinical implications were discussed. The research for this paper was supported by funds from the Provost's office, University of Pittsburgh, School of Social Work. The authors thank the Pennsylvania Alliance for the Mentally Ill for their support of, and participation in, the study.     

“Hey mom, look at me!”

The degree to which infant and maternal characteristics were related to maternal psychological distress and play competence was examined in 40 mother preterm and full-term dyads. Measures of maternal psychological distress, self-efficacy, infant temperament, and mother-infant interaction in a play situation, were obtained at 4 months corrected for prematurity. Results revealed that maternal self-efficacy was the strongest correlate of maternal psychological distress but was not related to maternal play competence. Interaction effects for unadaptable temperament and infant behavioral involvement were found in the regressions predicting both maternal psychological distress and maternal play competence. Mothers of more adaptable and less behaviorally involved infants reported greater psychological distress and exhibited greater play competence than mothers of more adaptable and involved infants. The results suggest that a lack of concordance between mothers' perceptions of their infants' behavior and actual behavioral experiences adversely affects mothers' affect and the quality of their play interactions.     

The Experience of Caregiving Among Mothers of Adults Suffering from Psychotic Disorders: Factors Associated with Their Psychological Distress

To identify correlates of psychological distress among multiple indicators, 99 women with adult children suffering from a psychotic disorder were interviewed. The women, who were recruited through hospitals and self-help groups, represented different socioeconomic levels. A face-to-face standardized interview was conducted, mainly in the participants' homes. Multiple hierarchical regression analysis showed that dimensions of burden and social support were strongly associated with distress reported by the participants. The negative interactions that participants had with their main confidant or spouse constituted a more powerful correlate than their perception of the quality of this relationship. Furthermore, a perception of their own health as poorer is a strong correlate of their distress. Since no control group was studied simultaneously, these results suggest, but do not prove, the presence of differences between mothers of adults with psychotic disorders and other mothers.     

Psychological Distress and Help Seeking in Rural America

The implications of exposure to acute and chronic stressors, and seeking mental health care, for increased psychological distress are examined. Research on economic stress, psychological distress, and rural agrarian values each point to increasing variability within rural areas. Using data from a panel study of 1,487 adults, a model predicting changes in depressive symptoms was specified and tested. Results show effects by size of place for men but not for women. Men living in rural villages of under 2,500 or in small towns of 2,500 to 9,999 people had significantly greater increases in depressive symptoms than men living in the country or in larger towns or cities. Size of place was also related to level of stigma toward mental health care. Persons living in the most rural environments were more likely to hold stigmatized attitudes toward mental health care and these views were strongly predictive of willingness to seek care. The combination of increased risk and less willingness to seek assistance places men living in small towns and villages in particular jeopardy for continuing problems involving depressed mood.     

Marital Conflict as a Mediator of the Longitudinal Connections between Maternal Emotional Distress and Early Adolescent Maladjustment

In this study, we examined the longitudinal relations among maternal emotional distress, marital conflict, and early adolescent externalizing behaviors and internalizing symptoms during the transition to adolescence. 3 years of self-report data were collected from 136 married mothers and their children, beginning when the children were in 5th grade. Structural equations modeling with latent variables were conducted to examine the nature and directionality of paths between constructs. For mothers, results indicated that marital conflict mediated the relation between prior maternal emotional distress and subsequent early adolescent externalizing behaviors and internalizing symptoms. For early adolescents, a mediating pattern was seen only for externalizing behaviors. In testing the reverse pattern of effects for mothers, marital conflict mediated the relation between prior early adolescent externalizing behaviors and subsequent maternal emotional distress whereas only an indirect pattern of effects existed for internalizing symptoms. Thus, we identified dynamic patterns of familial relations that accounted for the diminished well-being of both early adolescents and their mothers, suggesting that prevention and intervention work during the transition to adolescence should focus on multiple components of family functioning.