Showing papers in "Health Psychology in 1992"

The stages and processes of exercise adoption and maintenance in a worksite sample.

Abstract: We applied the model of the stages and processes of change to exercise adoption and maintenance. This model has shown promise in advancing theory and treatment of the addictions and other negative health behaviors, but there have been few systematic attempts to apply the model to positive health behaviors, such as exercise adoption. Questionnaires dealing with the stages and processes of exercise change were developed and administered to a sample of 1,172 participants in a worksite health promotion project. The sample was split randomly into halves for (a) initial model development and testing and (b) confirmatory measurement model testing. Additional model confirmation was obtained by examining the hierarchical structure of the processes of change and by conducting Stage x Process analyses. Results suggest that the underlying constructs derived from smoking cessation and other addictive behaviors can be generalized to exercise behavior. Understanding the stages and processes of exercise behavior change may yield important information for enhancing exercise adoption, adherence, and relapse prevention at both individual and public health levels.

Hostility and health: current status of a psychosomatic hypothesis.

Abstract: Recent research has renewed interest in the potential influence of hostility on physical health. This review indicates that the evidence available from prospective studies, although not entirely consistent, suggests that hostile persons may be at increased risk for subsequent coronary heart disease and other life-threatening illnesses. Further, several plausible mechanisms possibly linking hostility and health have been articulated and subjected to initial evaluation. Hostile individuals display heightened physiological reactivity in some situations, report greater degrees of interpersonal conflict and less social support, and may have more unhealthy daily habits. Additional research is needed, and it must address a variety of past conceptual and methodological limitations. Perhaps the most central of these concerns are the assessment of individual differences in hostility and the role of social contexts in the psychosomatic process.

Assessing motivational readiness and decision making for exercise.

Abstract: Motivational and cognitive processes of behavior change with respect to the area of exercise adoption were investigated. A total of 778 men and women, recruited from four worksites, answered a 40-item questionnaire consisting of statements based on constructs from the trans-theoretical model of behavior change. Principal-components analysis identified two factors--one a 6-item component representing avoidance of exercise (Cons), the other a 10-item component representing positive perceptions of exercise (Pros). Analysis of variance showed that the Pros, Cons, and a Decisional Balance measure (Pros minus Cons) were significantly associated with stage of exercise adoption. Results are consistent with applications of the model to smoking cessation and other areas of behavior change. Distinctions between exercise adoption and behaviors such as smoking cessation, weight loss, and alcoholism are discussed.

Patterns of coping with cancer.

Abstract: We identified five patterns of coping in a sample of 603 cancer patients: "seeking or using social support," "focusing on the positive," "distancing," "cognitive escape-avoidance," and "behavioral escape-avoidance." Relationships of these coping patterns to sociodemographic characteristics, medical factors, stress appraisals, psychotherapeutic experience, and emotional distress were tested using correlational and regression techniques. Type of cancer, time since diagnosis, and whether a person was currently in treatment had few or no relationships to coping. The specific cancer-related problem (e.g., pain, fear of future) was also not associated with how individuals coped. Perceptions of its stressfulness, however, were related to significantly more coping through social support and more of both forms of escape-avoidance. Coping through social support, focusing on the positive, and distancing was associated with less emotional distress, whereas using cognitive and behavioral escape-avoidance was associated with more emotional distress. Implications of the results for understanding coping processes and intervention with cancer patients are discussed.

A model of the precaution adoption process: evidence from home radon testing.

Abstract: We present the precaution adoption process model--a stage theory consisting of seven distinct states between ignorance and completed preventive action. The stages are "unaware of the issue," "aware of the issue but not personally engaged," "engaged and deciding what to do," "planning to act but not yet having acted," "having decided not to act," "acting," and "maintenance." The theory asserts that these stages represent qualitatively different patterns of behavior, beliefs, and experience and that the factors that produce transitions between stages vary depending on the specific transition being considered. Data from seven studies of home radon testing are examined to test some of the claims made by this model. Stage theories of protective behavior are contrasted with theories that see precaution adoption in terms of movement along a single continuum of action likelihood.

Prenatal maternal stress and prematurity: a prospective study of socioeconomically disadvantaged women.

Abstract: Developed and tested a biopsychosocial model of birthweight and gestational age at delivery using structural equation modeling procedures. The model tested the effects of medical risk and prenatal stress on these indicators of prematurity after controlling for whether a woman had ever given birth (parity). Subjects were 130 women of low socioeconomic status interviewed throughout pregnancy in conjunction with prenatal care visits to a public clinic. The majority of women were Latino or African-American. Half were interviewed in Spanish. Lower birthweight was predicted by earlier delivery and by prenatal stress. Earlier delivery was predicted by medical risk and by prenatal stress. Parity was not related to time of delivery or to birthweight. Implications of results for the development of biopsychosocial research on pregnancy and on stress are discussed.

Hardiness: a review of theory and research.

Abstract: Although a large body of research on hardiness (a personality construct with dimensions of commitment, control, and challenge) has accumulated, several fundamental issues remain unresolved. Although there are several hardiness scales, the properties of these scales have not been compared. There is debate as to whether hardiness is one or several characteristics. Research studying the pathways through which hardiness exerts its effects has not been comprehensively evaluated. Whereas critics have argued that hardiness does not buffer stress, others have suggested that hardiness buffers for working adults, for males, and in prospective analyses. There is also growing concern that hardiness is related to neuroticism. A review of the literature supports the following conclusions: The Dispositional Resilience Scale (DRS) has several advantages over alternative scales; DRS items form three factors that are consistent with hardiness theory; hardiness dimensions generally show low to moderate intercorrelations; the most common way of categorizing subjects as high or low in hardiness is not consistent with hardiness theory; hardiness does not buffer stress, and it does not buffer stress for working adults, for males, or in prospective analyses; both old and new hardiness scales inadvertently measure neuroticism. Recommendations for future research are provided.

Smoking cessation among self-quitters.

Abstract: We examined cessation among 630 smokers who quit abruptly on their own. Continuous, complete abstinence rates were 33% at 2 days, 24% at 7 days, 22% at 14 days, 19% at 1 month, 11% at 3 months, 8% at 6 months postcessation, and 3% at 6 months with biochemical verification. Slipping (smoking an average of less than 1 cigarette/day) was common (9% to 15% of subjects) and was a strong predictor of relapse; however, 23% of long-term abstainers slipped at some point. These results challenge beliefs that most smokers can initially stop smoking and that most relapse occurs later on postcessation.

The role of gender and taste class in the effects of stress on eating.

Abstract: Participating in a laboratory study of the effects of stress on eating, healthy, nonsmoking men and women were shown a film about industrial accidents (stress condition) or a pleasant travelogue (control condition) and had access to sweet, salty, and bland snack food. Analyses of food consumption data revealed a significant interaction between sex of subject and the stress manipulation: Stress markedly and significantly decreased food consumption by men but resulted in some increased food consumption by women. Across the three food taste categories, men consistently ate less under stress than they did in the control condition. In contrast, women ate nearly twice as much sweet food and more bland food under stress than they did in the control condition, but these effects were not statistically significant. These results indicate that the relationship between stress and eating depends on the sex of the subject and may relate to type of food available. Contrasting generalizations about stress and eating reported in the archived literature can largely be reconciled by considering these interacting variables.

Changing knowledge and attitudes about skin cancer risk factors in adolescents.

Abstract: We examined knowledge, attitudes, and behaviors related to skin cancer, sun exposure, sunscreen use, and use of tanning booths in 903 female and 800 male adolescents. The effectiveness of a brief, school-based intervention designed to increase teens' knowledge and preventive attitudes about skin cancer was also evaluated. Females, older students, and those with high-risk skin types were most likely to use sunscreen and to take precautions. However, overall level of protection was low. Intentions to take precautions were associated with levels of perceived susceptibility to skin cancer, attitudes about the benefits of sun exposure, skin type, and sex. Beyond intentions, sunscreen use was associated with perceived susceptibility and skin type. The one-session, school-based intervention significantly increased knowledge and perceived susceptibility to skin cancer but not behavioral intentions.

Assessing elements of women's decisions about mammography.

Abstract: We investigated motivational and cognitive processes of behavior change with respect to mammography screening. One hundred forty-two women (ages 40 and older) recruited from three worksites answered a 41-item questionnaire consisting of statements based on constructs from the transtheoretical model of behavior change. Principal-components analysis identified two factors: a six-item component representing positive perceptions of mammography (Pros) and a six-item component representing avoidance of mammography (Cons). Analysis of variance showed that Pros, Cons, and a derived Decisional Balance measure (Pros minus Cons) were associated with stage of mammography adoption. Results are consistent with applications of the model to smoking cessation. The model is also discussed as it relates to other theories of behavior change and as a general strategy for analyzing perceptual data pertinent to health-related actions and intentions for behavioral change.

Conditional health threats: health beliefs, decisions, and behaviors among adults.

Abstract: We combined the health belief model with the theory of subjective expected utility to derive hypotheses about the relations among health beliefs and preventive decisions The central implication of this combination of theories is the importance of conceptualizing, measuring, and communicating about health threats in ways that are clearly conditional on action It is important to distinguish, for example, between how susceptible to a disease a person thinks he or she would be if that person were and were not to take a preventive action An experimental study of judgments about a hypothetical preventive action was conducted to test many of the theoretically derived hypotheses A correlation study of dental flossing behavior was conducted to test the hypotheses as they apply to overt behavior rather than to judgment Results of both studies supported most of the tested hypotheses, especially those related to the conditional conceptualization of health threats Implications for theory, research methods, and practical applications are discussed

Smoking cessation and severity of disease: the Coronary Artery Smoking Intervention Study

Abstract: We tested the effectiveness of an individually delivered behavioral multicomponent smoking intervention (SI) against offering advice only (AO) to 267 patients after coronary arteriography. After 6 months, 51% of AO patients and 62% of SI patients reported abstinence. Validated rates were 34% and 45% for AO and SI patients, respectively. Logistic regression analyses, controlling for severity of illness, stage of change, and self-efficacy, among other variables, showed that, at 6 months, the SI had the most effect for patients with more severe coronary artery disease (CAD) who had been admitted with a myocardial infarction (95% confidence interval = 2.05, 124.85). At 12 months, only severity of disease mediated SI effects (95% confidence interval = 3.10, 58.00). Similar results were seen for cotinine-validated cessation. This study confirms the effectiveness of individually administered SI for more seriously ill patients with CAD and raises questions as to how to better intervene with those individuals with less severe disease.

Smoking prevention among urban minority youth: assessing effects on outcome and mediating variables.

Abstract: We tested the effectiveness of a social resistance/competence enhancement approach to smoking prevention among predominantly Hispanic seventh graders (N = 3,153) from 47 New York City schools After blocking on school type (public and parochial) and ethnic composition (percent Hispanic), schools were randomly assigned either to receive the 15-session prevention program or to serve as no-contact controls Using the school as the unit of analysis, significant program effects were found for cigarette smoking, normative expectations concerning peer and adult smoking, smoking prevalence knowledge, social acceptability knowledge, and knowledge of smoking consequences Using structural modeling techniques, a significant relation was found between the normative expectation and knowledge variables affected by the intervention and posttest smoking, suggesting that changes on these variables mediated the impact of the intervention on cigarette smoking This study extends the results of previous prevention research and demonstrates the generalizability of this approach to predominantly Hispanic urban minority students

Adaptation in patients with chronic rheumatoid arthritis: application of a general model.

Abstract: We derived a model of appraisal, coping, and adaptation in patients with rheumatoid arthritis (RA) from the more general theory of Lazarus and Folkman (1984) and examined this model using a longitudinal data set spanning 4 years and involving 239 RA patients (of whom 157 contributed to the primary analyses, with the remainder contributing to various follow-up analyses). This model attempted to identify the short- and long-term adaptational consequences of coping as well as the antecedents (appraisals, beliefs, social support, disease activity, etc.) that promote particular coping styles. Interrelations among the variables were examined using path-analytic techniques. Many observed relations were consistent with the model. Significant relations were subjected to more stringent analyses examining the ability of hypothesized causal variables to predict changes in outcome variables 1 year later. These analyses provided additional support for many observed relations and suggested the existence of a vicious cycle involving helplessness appraisals, passive coping with pain, and psychosocial impairment that promotes maladaptation in the face of RA. Theoretical implications, strengths, and limitations of the study are discussed.

Stress, coping, and high-risk sexual behavior.

Abstract: We examined the relation between stress, coping, and a high-risk sexual behavior (unprotected anal intercourse) in 398 nonmonogamous gay and bisexual men from the AIDS Behavioral Research Project in San Francisco. Unprotected anal intercourse during the previous month, the amount of stress experienced during the previous month in each of 10 domains, six types of coping (self-controlling coping, escape-avoidance, distancing, planful problem-solving, seeking social support, and positive reappraisal), and spiritual beliefs and spiritual activities were assessed through self-report. There was no relation between stress and unprotected anal intercourse. However, there was a relation between coping and unprotected anal intercourse. Subjects who reported unprotected anal intercourse used sex more of the time to help cope with stressful situations than did subjects who did not report unprotected anal intercourse. Unprotected anal intercourse was negatively associated with seeking social support and spiritual activities and positively associated with self-controlling coping, which involves keeping one's feelings to oneself, and positive reappraisal. The findings suggest that social aspects of coping may be a key to understanding differences between those who engage in high-risk sexual behavior and those who do not.

Women and AIDS in the United States: epidemiology, natural history, and mediating mechanisms.

Abstract: The number and proportion of women with the human immunodeficiency virus (HIV)1 and acquired immunodeficiency syndrome (AIDS) have increased rapidly throughout the past decade. Despite these increases, research attention on women with AIDS has been relatively scarce until recently. It is likely that there are important sex differences at all phases of the disease process-from prevention, through viral exposure, diagnosis, and living with HIV, to treatment for AIDS. Therefore, research findings from studies of men may not all be extended reliably to women with HIV and AIDS. In this article, we review the literature on U.S. women in particular and discuss what differentiates these women from their male counterparts with the disease. We begin with an epidemiologic review and description of the natural history of the disease to lay the foundation for a more complete understanding of the biological and psychosocial factors relevant to AIDS in women. The association between psychosocial mechanisms--including stress, control, and social support--and immune-mediated disease outcomes is discussed in detail. Implications for research, prevention, and treatment also are considered.

Social influence, marriage, and the heart: cardiovascular consequences of interpersonal control in husbands and wives.

Abstract: Human and experimental animal research suggests that social stress in general--and chronic, effortful attempts to exert social control in particular--may contribute to cardiovascular disease. We examined the effects of exerting social influence or control on cardiovascular responses in married couples. Compared to husbands discussing a problem with their wives, husbands attempting to influence or persuade their wives displayed larger increases in systolic blood pressure (SBP) before and during the discussion. Furthermore, these physiological effects were accompanied by increases in anger and a more hostile and coldly assertive interpersonal style. Although wives who engaged in social influence attempts displayed generally similar behavior, they did not show the elevated SBP response or anger. We discuss the results in terms of the social context of cardiovascular reactivity and potential marital factors in cardiovascular health.

Culture and health-related schemas: A review and proposal for interdisciplinary integration.

Abstract: We present a comprehensive review of anthropological, sociological, and psychological theory and data on the structure, content, and function of health-related schemas. Health psychology's need to integrate specific variables and principles from the other disciplines is highlighted. Suggestions for future research are offered, and the importance of cultural factors in health beliefs is emphasized.

The health belief model and adolescents with insulin-dependent diabetes mellitus.

Abstract: We tested the predictive utility of the health belief model (HBM) for adherence with a complex, ongoing medical regimen in the context of a chronically ill youthful population (56 adolescent outpatients with insulin-dependent diabetes mellitus; mean age = 14 years). A three-construct model of health beliefs was tested: Threat (perceived susceptibility combined with severity), Benefits-Costs, and Cues to seek treatment. Multiple indicators of compliance were used, and metabolic control was measured by glycosylated hemoglobin. The Benefits-Costs and Cues constructs were related to compliance in the theoretically expected positive direction. Threat interacted with Benefits-Costs in the prediction of compliance and with Cues in the prediction of metabolic control. The greatest compliance was achieved with low perceived Threat and high perceived Benefits-Costs. Poor metabolic control was associated with high Threat and Cues. As age increased, adherence to the exercise, injection, and frequency components of the regimen decreased.

Fear of hypoglycemia: relationship to physical and psychological symptoms in patients with insulin-dependent diabetes mellitus.

Abstract: Among diabetic patients, experience with hypoglycemia ranges from the unpleasant to the life threatening. The aversiveness of these episodes often results in fear. To examine the impact of hypoglycemia on fear, 69 patients with insulin-dependent diabetes mellitus completed the Behavior and Worry subscales of the Hypoglycemia Fear Survey along with measures of psychological symptoms, perceived stress, risk of future hypoglycemic episodes, and glycosylated hemoglobin. Behavior and Worry scores were positively related to psychological symptoms, perceived stress, and previous experiences with hypoglycemia. Fear was unrelated to glycosylated hemoglobin but was significantly higher for patients who had greater variability and lower mean daily blood glucose.

Adult-child interaction during invasive medical procedures.

Abstract: Adult-child interactions during stressful medical procedures were investigated in 43 pediatric patients videotaped during a venipuncture procedure in the course of cancer treatment. Relations among six adult behavior categories (explain, distract, command to engage in coping behavior, give control to the child, praise, and criticize/threat/bargain) and three child behavior categories (momentary distress, cry/scream, and cope) were examined using correlational and sequential analysis. Results indicated that adult distraction resulted in increased child coping and reduced momentary distress and crying. Adult explanations, although a likely response to child distress and crying, did not result in a reduction of these behaviors. Attempts to give the child control reduced child crying. Implications for clinical interventions during painful medical procedures are discussed.

The effect of varied physician affect on recall, anxiety, and perceptions in women at risk for breast cancer: an analogue study.

Abstract: Evaluated the effect of varied physician affect on subject recall, anxiety, and perceptions in a simulated tense and ambiguous medical situation. Forty women at risk for breast cancer viewed videotapes of an oncologist presenting--with either worried or nonworried affect--mammogram results. Although the mammogram results and the oncologist were the same in both presentation, analyses indicated that, compared to the women receiving the results from a nonworried physician, the women receiving the results from a worried physician recalled significantly less information, perceived the clinical situation as significantly more severe, reported significantly higher levels of state anxiety, and had significantly higher pulse rates. These results suggest that physician affect plays a critical role in patient reaction to medical information. Implications for compliance research, patient satisfaction, and physician training are discussed.

Does distraction reduce pain-produced distress among college students?

Abstract: College students in four experiments placed their hands in ice water (the cold-pressor task) and reported their distress. They simultaneously engaged in different reaction-time (RT) tasks that varied in the amount of attention required for successful performance. In each experiment, which differed in numerous procedural details, RT, error-rate, and self-report measures all demonstrated that the distraction tasks differed in the degree of attention required. Greater distraction, however, failed to reduce physiological, self-report, or behavioral responses to the cold-pressor task. These data call into question the hypothesis that attention mediates the process whereby distraction tasks reduce pain-produced distress.

Correlates of hypoglycemic fear in type I and type II diabetes mellitus.

Abstract: We examined whether fear of hypoglycemia in insulin-dependent diabetes mellitus was associated with (a) higher levels of trait anxiety and general fearfulness, (b) difficulty in differentiating symptoms of anxiety and hypoglycemia, and (c) past experience with hypoglycemia. Joslin Diabetes Center outpatients with Type I and Type II diabetes (N = 232), all requiring insulin, were surveyed. Type I patients experienced significantly more fear of hypoglycemia than Type II patients. For the Type I and Type II groups, higher scores on the Worry subscale of the Hypoglycemia Fear Survey (HFS-W) were associated with higher levels of trait anxiety and fear. Higher scores on the Behavior subscale (HFS-B) were associated with higher levels of fear. Among Type I subjects only, HFS-W scores were also positively associated with past hypoglycemic experience and with difficulty in differentiating anxiety and hypoglycemic symptoms. These latter relations remained significant even after the variance resulting from trait anxiety and fear was removed. Other significant associations with HFS-B scores were not observed.

Effectiveness of biofeedback and relaxation training in reducing the side effects of cancer chemotherapy.

Abstract: Assessed the effectiveness of electromyographic (EMG) and skin-temperature (ST) biofeedback and relaxation training (RT) in reducing the aversiveness of cancer chemotherapy. Eighty-one cancer patients, equated on several individual-difference variables, were randomized to one of six groups formed by a 3 (EMG Biofeedback, ST Biofeedback, No Biofeedback) x 2 (RT, No RT) factorial design. Outcome was assessed with physiological, patient-reported, and nurse-reported indices taken over five consecutive chemotherapy treatments. RT patients showed decreases in nausea and anxiety during chemotherapy and physiological arousal after chemotherapy. EMG and ST biofeedback reduced some indices of physiological arousal but had no other effects on chemotherapy side effects. These findings suggest that RT can be effective in reducing the adverse consequences of chemotherapy and that the positive effects found for biofeedback in prior research were due to the RT that was given with the biofeedback, not to the biofeedback alone.

Self-disclosure of HIV infection: preliminary results from a sample of Hispanic men.

Abstract: We examined self-disclosure of HIV infection among 101 seropositive Hispanic men residing in Los Angeles. Results indicated that disclosure was highly selective and presumably influenced by the social, psychological, and material consequences of informing others about one's medical condition. Subjects tended to inform significant others such as parents, friends, and lovers than less significant others such as employers, landlords, and religious leaders. There was a relatively high rate of disclosure (75%) to doctors/dentists who were not treating subjects for HIV infection. Gay and bisexual subjects (89% of the sample) were more inclined to disclose their HIV serostatus to homosexual or bisexual others than to heterosexuals and to inform those who were aware of their sexual orientation. Disclosure increased with severity of disease independently of length of time since testing seropositive. Self-rated negative changes in appearance correlated with disclosure to less significant others. The role of cultural attitudes and values in self-disclosure of HIV infection is discussed.

On becoming involved with drugs: modeling adolescent drug use over time.

Abstract: We tested a model of the process of becoming involved with drugs during junior high. The sample included 698 students who were not using alcohol, cigarettes, or marijuana during Grade 7 (T1); the follow-up data points were 12 and 15 months later (T2 and T3). The final model, which predicted 72% of the variance in drug use at T3, provides support for hypotheses drawn from both social and cognitive theories. Weak familial and school attachments fostered use by increasing the likelihood of exposure to pro-drug social influences (drug use offers); weak bonds with school also directly affected cognitive motivations (lower resistance self-efficacy [RSE] and more positive outcome expectancies). In turn, social influences at T1 played a dominant role in initial use at T2, but cognitive motivations were also significant. At T3, prior use assumed the most prominent position. Drug-specific measures of RSE and expected use directly affected later use of that substance. The results indicate that both generic and drug-specific effects are needed to explain adolescent drug use. Implications for prevention programs are discussed. Language: en

Acute exercise: buffering psychosocial stress responses in women.

Abstract: We evaluated the experimental hypothesis that an acute bout of aerobic exercise (AE) serves as a buffer to psychosocial stress responses in low to moderate physically fit women. Forty-eight (24 White, 24 Black) 25- to 40-year-old women participated in two counterbalanced experimental conditions: an attention control and a 40-min bout of AE at 70% heart rate (HR) reserve. The attention control and AE treatments were followed by (a) 30 min of quiet rest, (b) exposure to mental and interpersonal threat, and (c) 5 min of recovery. Blood pressure (BP) and HR were monitored at baseline, during the stressors, and throughout recovery. Self-reported distress was assessed before each stressor and upon completion of the recovery period. The results provided clear evidence that exercise dampens BP reactivity to psychosocial stress. Additionally, compared with the attention placebo control, AE reduced both the frequency and intensity of anxiety-related thoughts that occur in anticipation of interpersonal threat and challenge.

Mastectomy versus breast conservation surgery: mental health effects at long-term follow-up.

Abstract: Between 1984 and 1989, 129 Stage 1 and Stage 2 breast cancer patients were entered into a behavioral study in Pittsburgh Approximately 70% of these patients had elected to have breast conservation (lumpectomy) surgery, with the remainder choosing mastectomy Using the Profile of Mood States, a measure of perceived social support, and Karnofsky ratings of physical functional status, patients were assessed 3 to 5 days following surgery and again 3 and 15 months following surgery The data were analyzed using a repeated-measures analysis of covariance, adjusting for aggressiveness of chemotherapy Compared to mastectomy patients, patients who received breast conservation surgery were rated as more functional by observers, but they perceived themselves as having less energy and less emotional support, especially over the first 3 months of the recovery period Because there is accumulating evidence that emotional support may act as a stress buffer in various populations and may have survival value, these findings may be particularly troublesome This study shows that breast conservation surgery is not a psychosocial panacea Patients whose breasts are spared, especially younger patients, have psychological symptoms that appear acutely worse in the short run and, in the end, are similar to those of patients who elect to have mastectomies Therefore, patients choosing lumpectomies are not necessarily psychosocially better off than those electing to have mastectomies Additionally, these patients, particularly younger patients, may require greater social support and potential mental health interventions than they seem to be receiving