Depressed mood and environmental mastery as potential pathways linking family relationship quality and disease self-management for African Americans with hypertension

African Americans are at significantly greater risk of hypertension and worse cardiovascular outcomes than other racialized groups, yet hypertension intervention effects remain limited. Thus, it is necessary to understand the potential mechanisms whereby interventions may be more effectively targeted to improve health. Supported by prior research evidence and guided by the Biobehavioral Family Model, this study examined associations between family relationship quality, psychological wellbeing, and self-management behaviors for African Americans with hypertension. Data were pooled from three Midlife Development in the U.S. projects, resulting in a sample of 317 African Americans (63.4% female, M_age = 53.32) with self-reported high blood pressure in the past 12 months. We tested four cross-sectional multiple mediator models, with depressed mood and environmental mastery mediating associations between family strain and exercise, smoking, problematic alcohol use, and stress-eating. Environmental mastery mediated the association between greater family strain and decreased odds of achieving recommended exercise levels; greater odds of reporting problematic alcohol use; and greater stress-eating. Though family strain was associated with depressed mood in each model, this variable did not serve as an indirect pathway to self-management behaviors. Family strain, and the potential pathway identified via environmental mastery, may be a meaningful predictor of disease self-management for African Americans with hypertension. Longitudinal studies are needed to examine directionality and to support intervention trials for improving self-management and hypertension outcomes.     

Reciprocal relationships between personality traits and psychological well-being

This study used an American sample collected over a period of approximately 2 decades (at 3 time points) to examine the temporal relationships between psychological well-being and personality traits (i.e., neuroticism, extraversion, agreeableness, conscientiousness, and openness to experience). The random-intercept cross-lagged panel model was used to separate between-person and within-person sources of variation. Between-person correlations were comparable to those of previous studies. New insights were gained at the within-person level. There were reciprocal relationships between psychological well-being and openness and extraversion, suggesting the joint development of plasticity-related traits and well-being over time. The relationships between psychological well-being and conscientiousness and agreeableness were unidirectional, with psychological well-being preceding these traits. Despite a strong between-person association between neuroticism and psychological well-being, the two were not related at the within-person level.     

Social support from weak ties: Insight from the literature on minimal social interactions

When people face difficult life events, such as cancer or bereavement, they fare better when they receive support. These “experiencers” are likely to seek and receive support from a wide range of people, from close others to acquaintances. Indeed, the social support literature has long acknowledged the value of having a diverse support network. Research suggests that experiencers often perceive “weak ties” (i.e., acquaintances) as sources of support, and that experiencers sometimes prefer to get support from weak ties rather than strong ties. Providing support can be challenging for all kinds of supporters, however weak ties may be more likely than strong ties to allow worries about their inability to provide effective support to stop them from providing any support at all, thus depriving experiencers of opportunities for additional support. In this paper, we focus on the fact that often the provision of support occurs via a social interaction. We draw on the social psychology literature on minimal social interactions to suggest reasons why potential weak tie supporters might doubt their ability to provide effective support, and to generate advice to encourage potential supporters to reach out. Finally, we suggest future areas of research, with the ultimate goal of helping to expand the support that is available for people experiencing difficult life events.     

Medical hermeneutics: Where is the “text” we are interpreting?

The present paper is a commentary on an article by Drew Leder [1]. Leder identifies a series of texts in the clinical encounter, emphasizes the central role of interpretation in making sense of each of these texts, and articulates ordering principles to guide the interpretive work.The metaphor of clinical work as textual explication, however, creates the expectation that there is a text somewhere to be found. Such an expectation invites doctors and patients to search for the text and runs the risk of conceptualizing patients as more static than they are. If one is to use the textual metaphor, one must appreciate the radical extent to which the clinical encounter is a mutually produced and shifting entity. The qualities of mutuality and indeterminacy are not those one usually associates with texts. One might ultimately be better served by a different metaphor based more directly on uncertainty.     

驾驶员心理品质检测中的杆型人形图法

在汽车驾驶员心理品质检测研究中,我们根据数学中的多变量图分析方法,并汲取简笔画的优点,用19个人形图变量代表检测所得的17种心理品质数据,来具体、形象地再现每个驾驶员心理品质变量的整体关系。这对于检测结果的分类或进行系统化分析具有重要的实用意义。     

The Future of Psychology in Family Medicine

Psychology has been integral to the field of family medicine since its inception as a medical specialty in the 1960s. Psychologists and other behavioral scientists contribute to family medicine in teaching clinical skills, in defining research questions, in developing research methodology, and in creating integrated physical/mental health care delivery systems. Future developments in the field of psychology in family medicine are likely to emphasize development and evaluation of screening measures which identify mental health problems in primary care, development of early intervention for those mental health problems, and more precise measurement of process and quality of care and health outcomes. Psychologists have an important role to fulfill in educating physicians on alternatives to pharmacologic and medical interventions for common presenting problems in primary care. However, current economic forces shaping the practice of medicine may work against further enhancing the efficacy of the physician in dealing with psychosocial issues. The future role of psychology in family medicine is not yet delineated, and while the move toward parity of reimbursement for mental and physical health care delivery may enhance this collaboration, there is a need to continue to evaluate how the psychological well-being of patients is influenced in the evolution of new models of care delivery.