Showing papers in "Journal of Health and Social Behavior in 1980"

An analysis of coping in a middle-aged community sample

Abstract: This study analyzes the ways 100 community-residing men and women aged 45 to 64 coped with the stressful events of daily living during one year. Lazarus's cognitive-phenomenological analysis of psychological stress provides the theoreticalframework. Information about recently experienced stressful encounters was elicited through monthly interviews and self-report questionnaires completed between interviews. At the end of each interview and questionnaire, the participant indicated on a 68-item Ways of Coping checklist those coping thoughts and actions used in the specific encounter. A mean of 13.3 episodes was reported by each participant. Two functions of coping, problem-focused and emotion-focused, are analyzed with separate measures. Both problemand emotion-focused coping were used in 98% of the 1,332 episodes, emphasizing that coping conceptualized in either defensive or problem-solving terms is incomplete-both functions are usually involved. Intraindividual analyses show that people are more variable than consistent in their coping patterns. The context of an event, who is involved, how it is appraised, age, and gender are examined as potential influences on coping. Context and how the event is appraised are the most potent factors. Work contexts favor problem-focused coping, and health contexts favor emotionfocused coping. Situations in which the person thinks something constructive can be done or that are appraised as requiring more information favor problem-focused coping, whereas those having to be acceptedfavor emotion-focused coping. There are no effects associated with age, and gender differences emerge only in problem-focused coping: Men use more problem-focused coping than women at work and in situations having to be accepted and requiring more information. Contrary to the cultural stereotype, there are no gender differences in emotionfocused coping.

Social support, occupational stress, and health.

Abstract: The present paper is concerned with the buffering hypothesis that social support ameliorate. the impact of occupational stress on job-related strain and health. Previous studies of this hypothesis have yielded conflicting results. Our purpose, therefore, is twofold. First, we summarize the literature in this area and review several studies in detail, all of which found main effects of social support on perceived occupational stress and on some health outcome measures. Three of the studies were specifically designed to examine the buffering effects of support. Of the three, two found little or no evidence for buffering (LaRocco and Jones, 1978a; Pinneau, 1975), whereas the third reported buffering effects (House and Wells, 1978). Second, we attempt to reconcile these different conclusions by reanalyzing one data set-first analyzed by Caplan et al. (1975) and then by Pinneau (1975)-using a moderated regression technique identical to that used in the LaRocco and Jones (1978a) and House and Wells (1978) studies. The data usedfor this analysis consist of a randomly stratified sample of men from 23 occupations (N 636). Our review andfindings support the buffering hypothesis for mental and physical health variables (anxiety, depression, irritation, and somatic symptoms), but, as in the previous three studies, fail to support the buffering hypothesis in regard to job-related strains (job dissatisfaction, boredom, dissatisfaction with work load).

The stigma of obesity: the consequences of naive assumptions concerning the causes of physical deviance.

Abstract: It is proposed that whether or not a physically deviant person is derogated will depend on the extent to which that individual can be blamed or held responsible for his or her appearance. In line with this proposition, two experiments were conducted to examine how adolescent girls' opinions of an obese peer would be influenced by their beliefs about the cause of her obesity. In both studies, subjects were asked to look at afolder containing a photograph and a statement of introduction that a girl from a previous experiment had supposedly written. It was demonstrated that unless the obese target could offer an "excuse" for her weight, such as a glandular disorder, or could report recent successful weight loss, she was given a less positive evaluation, and was less liked, than was a normal-weight target.

The sociogenesis of psychological disorder: an attributional theory.

Abstract: Before social causation explanations of psychological disorder can be considered plausible, the process by which socialfactors may affect the development of disorder must be made explicit in terms of a given theory. This paper formulates an attributional theory intended primarily to explain social status effects, although other applications are possible. The point of departure for this model is the socializing influence of SES on causal attribution tendencies (i.e., fatalism) and the resulting variation in vulnerability to psychological disorder. Data from two panel studies suggest that causal attribution styles could in fact play a central role in the mediation of social causation of disorder. Comparisons of two contrasting versions of the attributional model show that a simple, linear interpretation of the intervening effects offatalism may be the most adequate. The paper concludes with suggestions for elaborations of the basic theory.

Sex differences in depression: do women always have higher rates?

Abstract: Journal of Research in Personality 10:343-57. Sorrentino, R. M., and R. G. Boutilier 1974 "Evaluation of a victim as a function of fate similarity/dissimilarity." Journal of Experimental Social Psychology 10:84-93. Sudnow, D. 1967 "Dead-on-arrival." Trans-Action, November, pp. 36-43. Sutherland, S., and D. Scherl 1970 "Patterns of response among victims of rape." American Journal of Orthopsychiatry 40:503-11.

Affective and instrumental components in the physician-patient relationship: an additional dimension of interaction theory.

Abstract: This study examines the empirical support for the assumptions underlying a previously published model of the professional-client interaction by investigating the affective and instrumental components in the physician-patient relationship. The findings stress the significance, for patients' evaluation of the affective quality and efficacy of medical treatment from general practitioners and hospital physicians, of accompanying the medical treatment with emotional support. In line with the approaches indicating the complex relationship between emotional and physiologicalfactors in disease, it is shown that emotional support not only bridges over patient uncertainty regarding the content and outcome of the treatment, but is a crucial element in patients' evaluation of the treatment itself, its significance increasing with the decrease in patients' social class. The study extends the applicability of the earlier model, which was logically confined to the interaction with the G.P. only, to wider medical settings, such as hospitals.

The experience and reporting of common physical complaints.

Abstract: Data from a sample of young adults first studied in 1961 are used to examine factors influencing reports of common physical complaints in 1977. Among the factors associated with such symptom reports are the child's illness behavior in 1961, retrospective reports of family interaction during childhood, measures of psychological state, and subjective measures of physical health status. Reported parental behavior appears to affect symptom reporting primarily through its influence on subjective psychological and physical health. It is hypothesized that reporting common physical symptoms is part of a pattern of illness behavior and response, shaped by childhood training and responsive to personal stress and the occurrence of body dysfunction.

Neighborhood types and community reaction to the mentally ill: a paradox of intensity.

Abstract: Neighborhood Types and Community Reaction to the Mentally Ill: A Paradox of Intensity STEVEN P. SEGAL JIM BAUMOHL EDWIN W. MOYLES University of California. Berkeley Journal of Health and Social Behavior 1980, Vol. 21 (December):345-359 Employing data from a statewide study of sheltered-care residents and facilities in California. combined with archival data describing the census tracts in which these facilities are located. the authors analyze the impact of community reaction on sheltered-care residents in difierent types of neighborhoods. Findings suggest that conservative middle-class communities are most likely to exhibit extreme negative reactions that can have a deleterious impact on the social integration of residents in community care. Liberal. nontraditional neighborhoods conform most closely to the ideal accepting community. In liberal. nontraditional neighborhoods and conservative working-class neighborhoods a moderate level of community reaction actually facilitates the social integration of sheltered-care residents. Community reaction to the mentally ill has been an oft discussed and researched phenom- enon during the past ten years. and it has been well established that such reaction affects both the ability of the mentally ill to participate in community life and the willingness of local government to provide or permit the provision of services (Segal and Aviram. I978). In this paper we are concerned with the immediate environment of the community-based sheltered-care facility. a residential setting that is intended to provide supervised living for a handicapped group, in this case. the mentally ill. The oldest fonn of sheltered-care facility is the family-care home. which has traditionally aimed to maintain the chronically mentally ill in local areas (Morrissey. I967). Later. halfway houses with more rehabilitative goals devel- This paper was prepared for the conference New Directions for Research on Stigma Toward the Mentally Ill. sponsored by the National Institute of Mental Health, Bethesda. Md., January 24 and 25. I980. Thanks to Mark Kaplan for his comments and assistance. This research is supported in part by the National Institute of Mental Health. Center for Epidemiologic Studies. Grant SROI MH254l7-06 ESR. Address communications to: Dr. Steven P. Segal, School of Social Welfare. University of California. Berkeley, CA 94720. __345 oped as an element of sheltered-care (Apte. I968). 'l1Iese have been joined by board-and- care facilities that have assumed all three functions of community-based sheltered-care: long-term care. transitional care. and place- ment of first resort (Segal and Avir-am. I978). in California there ate approximately l,l55 sheltered-care facilities serving nonretarded individuals between I8 and 65 years old who have had some experience in a psychiatric in- patient ‘setting. Family-care homes constitute 26% of these facilities and serve l4% of all sheltered-care residents. Halfway houses, which have received the greatest attention of the mental health professions, account for only 2% of all facilities and serve only 3% of the state's sheltered-care population. Board-and- care homes. which have developed in an un- planned, ad hoc manner, make up 72% of the state's facilities and serve 82% of Califomia‘s sheltered-care residents (Segal and Aviram, 1978). The community sunounding the sheltered- care facility may be a place in which ex-mental patients find a comfortable home or an oppres- sive one; a place in which their safety is threatened or in which they can feel free to be about; a place in which they can establish re- lationships or in which others are unavailable to them; a place in which their public depen-

Prevalence of psychological distress among Mexican Americans.

Abstract: Data are presentedfrom sample surveys conducted in 1974 (N = 3,119) and 1975 (N = 657) in Alameda County, California, comparing psychological distress among Mexican Americans, blacks, and Anglos. Measures of psychological distress include satisfaction with leisure, marriage, and job, reported happiness, positive and negative affect, and reported episodes of emotional problems and chronic nervous trouble. Based on crude prevalence rates, there are no differences among the ethnic groups in either sample in reported emotional or mental illness, and negative affect. There are differences in happiness, job satisfaction, and chronic nervous trouble in the 1974 study but not the other. In the remaining three comparisons (satisfaction with leisure and with marriage, positive affect) there are significant differences in both studies, Chicanos faring worse than Anglos but somewhat better than blacks. Controlling for the effects of age, sex, education, income, marital status, and physical health status in general reduces but does not eliminate most of these ethnic differences, and in no case is the rate for Chicanos lower than that for Anglos.

Children's health beliefs and acceptance of a dental preventive activity.

Abstract: In a study of participation in a school-based preventive dental program, the relationship between children's beliefs about health and their participation did not follow predictions of the Health Belief Model. Further, perceived efficacy was the only belief altered by an introduction to the program, despite the fact that some children participated in group discussions designed to change other health beliefs as well. The similarity of these data to other data on health beliefs of children and adults is cited. It is suggested that health beliefs are difficult to change and are often unrelated to behavior. It is also suggested that health beliefs and behavior might be parallel developments in the individual that need not be causally related.

Determinants of the social environments of sheltered care settings.

Abstract: A conceptualframework is used to examine the relation of the social environments of sheltered care settings to the type of setting and three other sets of environmental domains: physical and architecturalfeatures, organizational policies and programs, and aggregafe resident and staff characteristics. The framework is illustrated with data from 90 sheltered care facilities. The relative importance of each set of variables as predictors of seven dimensions of the social environment is estimated using multiple regression and partitioning of the explained variance. The results show that: (a) variables from all four sets are related to the social environment, (b) architectural and policy features have the strongest unique effects on social environments, and (c) a substantial portion of the explained variance is shared among combinations of two or more sets of predictors. The findings underscore the utility of focusing on several domains of environmental variables in evaluating sheltered care settings for the elderly.

Factor influencing health service knowledge among the elderly.

Abstract: There is considerable interest in determining user patterns with respect to health services, especially among the elderly. The present research is concerned with determining the factors that are associated with knowledge levels regarding ancillary health services available to the elderly. A survey study of noninstitutionalized senior Canadians reveals that predisposing factors, such as age and health status, are less associated with what the elderly know of relevant health services than are enabling factors, such as education and prior health service use. The implications of these findings are discussed.

The responsible victim: nurses' perceptions of victims of rape.

Abstract: Are victims seen by nurses as being more responsible for the occurrence of a rape than for the occurrence of a violent nonsexual crime? If so, what are some of the determinants of victim blame? The present study considers how judgments made by hospital nurses (N = 312) regarding victim responsibility are influenced by the type of crime (i.e., rape or beating), the victim's marital status, her dress, her relationship with the assailant, evidence of her resistance, the extent of her injuries, and psychological attributes and sociodemographic characteristics of the nurse. Evaluations of victim responsibility were elicited through the use of vignettes. Findings suggest that although nurses make relatively similar assignments of blame to rape and beating victims, the assignment of blame differs significantly for those victims described as "respectable" (married, wore print dress, was not acquainted with assailant, struggled with assailant, suffered serious injuries) and those described as "disrespectable" (divorced, wearing halter top and shorts, casual acquaintance of assailant, no struggle, minor scratches as a result of the crime). Psychological attributes of the nurse emerged as the strongest predictors of victim blaming.

Sex roles and alcohol consumption: a research note.

Abstract: Inconsistencies in the role sets of women in modern societies are believed by some to account for the difference in rates of mental illness between men and women. In an analysis of rates of neurotic disorders and functional psychoses, Gove (1972) found that the higher rates of mental illness for women, compared to those of men, were due to disproportionately high rates among married women. Gove and Tudor (1973) maintain that the reason for this is that married women are more likely to occupy conflicting role sets. They contend that the role of the housewife involves unskilled labor and low status, both of which are often not consonant with a woman's intellectual attainment. In addition, they argue that the married woman who works outside the home occupies a conflicting role set when her employment involves discrimination in the job market and assignment to positions that are not commensurate with her educational background. Gove and Tudor constructed their roleconflict model to explain mental health differences between women and men, but others have questioned this application. A persistent criticism has been that such between-gender

Modeling the quality of women's birth experience.

Abstract: A longitudinal study of 120 couples over the period when they became first-time parents reveals that formal preparation for the birth event (learning in classrooms and from books) improves women's birth enjoyment. Such preparation often involves husbands and encourages them to participate at the birth. A recursive model was estimated supporting the notions that being able to remain in control is a major benefit conferred upon a woman by preparation and that the social support afforded by the husband's presence at the birth contributes both directly and indirectly to the enhancement of the woman's birth experience. The findings are interpreted in line with Janis' stress theory.

Social, economic, and biologic correlates of infant mortality in city neighborhoods.

Abstract: The purpose of this study was to determine the extent to which low infant weight intervenes in associations between infant mortality and social and economic characteristics of populations residing in Cleveland neighborhoods. This objective was achieved by applying hierarchical multiple regression analysis to a proposed causal ordering of variables in which racial composition and low family income were hypothesized to relate directly to illegitimacy and low-birth-weight ratios which in turn were postulated to directly influence neonatal and postneonatal rates. (EXCERPT)

Selection factors in the dispensation of therapy: the Matthew effect in the allocation of mental health resources.

Abstract: This paper suggests that mental health resources are frequently delivered to those who are most desirable as patients in the eyes of service providers rather than to those who are most in need. Analysis of a census of the inpatient population of New York State hospitals finds a strikingly consistent pattern: The younger, more motivated, more communicative, and more competent patients are more likely to receive attention. Less "desirable" patients, those most in need, are more likely to receive no social therapy at all. This is seen to be a manifestation of Merton's "Matthew effect" and a demonstration that even when it comes to the treatment of psychiatric patients, the familiar dictum "advantage accumulates" appears to hold.

Effective social environment and hemodialysis adaptation: a panel analysis.

Abstract: Central to the theoretic orientation of the present panel analysis is the Meadian assumption that the attitudes and behavior of individuals are influenced by those with whom they interact on a continuing basis. By implication, the truth or falsity of that statement is particularly important for the victims of serious chronic illnesses whose ordinary patterns of interaction are disrupted and whose social involvements must be modified. In investigating the specific disease condition of renal failure with its associated treatment procedure, hemodialysis, this research examines whether a relationship exists between social environment-including the attitudes of family, friends, and others contractually yet importantly related-and the chronically ill person's modification of social functioning. Analysis of data collected through structured interviews at two times (T1 and T2) separated by a three-year interval finds statistically significant associations between patients' perceived expectations offamily andfriends and the patients' socialfunctioning, both initially and at the time of reinterview. Although the amount of interactional behavior appears to increase over time, the quality of such interaction clearly decreases. Alienation also increases significantly over time. Partial correlational analysis of the relationships between major variables, controlling for the effect of education, suggests that although the perceived expectations of primarygroup members are clearly associated with socialfunctioning at T1 and T2, the expectations of secondary-group members cannot be so described in either instance. Clinical implications of these findings for the health care professional working with the chronic dialysis patient are discussed.

The coping function of sex-role attitudes during marital disruption.

Abstract: This study of 114 couples seeking help for their marital problems examines the hypothesis that nontraditional sex-role attitudes function as a coping resource to ameliorate the distress of marital disruption. Stress was measured by whether or not the individual's marital goal was congruent with the current situation of living together or apart and with the spouse's marital goal of maintaining the marriage or the separation. Incongruence was found to be related to reported distress for both men and women; incongruence in the living situation had a greater effect on distress than incongruence with the spouse's goal. Nontraditional sex-role attitudes were associated with reduced distress for both men and women, but such sex-role attitudes interacted with the stress measures to reduce reported distress only for women. The finding that nontraditional sex-role attitudes perform a coping function for women but not for men is discussed in terms of its implications for sex-specific and situation-specific coping mechanisms.

Control structure, values, and innovation: a comparative study of hospitals.

Abstract: This comparative study of 12 hospitals in one SMSA was designed to investigate the organizational determinants of social, in contrast to technological, innovations. Major independent variables include: centralization of influence on hospital decision-making; relative influence of administrators, trustees, and medical staff; and social change values of decision-makers. Dependent variables are 20 recent innovations in obstetrical programs and services, labeled social or technological on the basis of judges' ratings. Study results provide substantial empirical support for the conceptual distinction between social and technological innovations and for the proposition that hospital conditions favorable to social innovation differfrom those conducive to technological innovation. Social innovations in obstetrics are most likely to prosper in hospitals where individuals with influence on hospital-wide decisions are ideologically committed to social change. Additional conditions for social innovation include an obstetrical staff who have little influence on hospital-wide decisions, affiliation with a medical school, and frequent medical staff committee meetings. It is suggested that these latter conditions act to increase the flow of communication about innovations, to support the legitimacy of social change, and to increase the influence opportunities available to the hospital's dominant group.

Psychiatry versus societal reaction: a critical analysis.

Abstract: The debate between proponents of clinical psychiatry and those who advocate a societal reaction approach to mental disorders has continued for over twenty years. This paper draws on several crucial empirical studies from research psychiatry to make the following points: (1) levels of reliability and validity in psychiatry are low compared with those in other branches of medicine; (2) they are considerably lower than psychiatry's most ardent advocates claim, but somewhat higher than its most severe critics contend; (3) the functional mental disorders present special problems because of their lack of demonstrable organic pathology and the lack of convergent but independent diagnostic indices; (4) the best empirical evidence suggests that psychiatric and socialfactors interact to determine case outcome and that the latter frequently outweigh the former in their effects; (5) isolating these interaction effects is complicated by the factors mentioned in (3) but can be accomplished by careful research design. Finally, some testable questions that would help to resolve the controversy are proposed.

The socialization of youth into the American mental health belief system.

Abstract: This research brings empirical data to bear on a basic proposition of socialization that has generally been assumed rather than demonstrated: As young people get older and closer to full societal participation, they acquire common-sense views of social life that come increasingly to resemble those of adults in their communities. The operational domain is opinions about mental health/disorder, considered as a facet of popular conceptions ofpsychologicalfunctioning. The mean responses of seniors in each offive diverse Michigan high schools to Nunnally's opinion statements tended to be closest to teacher responses, whereas those offreshmen were furthest (student N = 989, teacher N = 161). Correlations between high schools, and with Seattle students, of over .90, and response patterns exhibited, suggest the occurrence of a stable, pervasive "cultural belief system," rather than a collection of "stereotypes," into which most youth are effectively inducted. This belief system and the associated socialization processes continue to function despite the ferment of change and controversy that characterize this facet of social life. Relationships to sociological perspectives on mental disorder, including labeling theory, are considered.

Group practice affiliation and interphysician consulting pattern within a community general hospital.

Abstract: Much of the research on informal practice relationships among physicians is based upon observations of physicians in solo, fee-for-service forms of practice. This study examines informal relationships for physicians in group practice. Specifically, this study analyzes the within-hospital consulting patterns of physicians in two group practices, one fee-for-service and the other prepaid. Compared with the fee-for-service-group physicians, the prepaid-group physicians (1) engaged in less consulting, (2) utilized nongroup consultants to a greater degree, (3) relied more heavily on medical residents as consultants, and (4) achieved a lower degree of reciprocity in consulting exchange. Physicians in both of the groups exhibited a pattern of mutual avoidance in the choice of consulting partners.