Showing papers in "Journal of Health and Social Behavior in 1983"
TL;DR: The Perceived Stress Scale showed adequate reliability and, as predicted, was correlated with life-event scores, depressive and physical symptomatology, utilization of health services, social anxiety, and smoking-reduction maintenance and was a better predictor of the outcome in question than were life- event scores.
Abstract: This paper presents evidence from three samples, two of college students and one of participants in a community smoking-cessation program, for the reliability and validity of a 14-item instrument, the Perceived Stress Scale (PSS), designed to measure the degree to which situations in one's life are appraised as stressful. The PSS showed adequate reliability and, as predicted, was correlated with life-event scores, depressive and physical symptomatology, utilization of health services, social anxiety, and smoking-reduction maintenance. In all comparisons, the PSS was a better predictor of the outcome in question than were life-event scores. When compared to a depressive symptomatology scale, the PSS was found to measure a different and independently predictive construct. Additional data indicate adequate reliability and validity of a four-item version of the PSS for telephone interviews. The PSS is suggested for examining the role of nonspecific appraised stress in the etiology of disease and behavioral disorders and as an outcome measure of experienced levels of stress.
23,500Â citations
TL;DR: In this paper, it is shown that in the present data, marital status is the most powerful predictor of the mental health variables considered, and data are then used to show that it is the quality of a marriage and not marriage per se that links marriage to positive mental health.
Abstract: Although a large number of studies show a correlation between marital status and mental health, the relative magnitude of the relationship, as compared to the strength of the relationship of other variables related to mental health, is not known. In this empirical evaluation, it is shown that in the present data, marital status is the most powerful predictor of the mental health variables considered. Data are then used to show that it is the quality of a marriage and not marriage per se that links marriage to positive mental health. The paper concludes with a discussion of some of the psychological functions of marriage.
687Â citations
423Â citations
TL;DR: There is no evidence in the Detroit data that combining employment, marriage, and parenthood is harmful to women's health, and implications of the results for women's future health are suggested.
Abstract: A survey of Detroit adults shows that employment, marriage, and parenthood are associated with good physical health for both women and men. Employed married parents tend to have the best health profile, while people with none of these roles tend to have the worst profile. Of the three roles, employment has the strongest effect, and parenthood the weakest. Multiple roles (the combination of job plus family responsibilities) have no special effects on health, either negative or positive. Thus, people with both job and family roles enjoy the health benefits of each role (main effects) and incur no special health disadvantage or benefit (interaction effect) for being so busy. This is true for both women and men. Three explanations are considered: First, health risks may actually be lower for socially active people than for nonactive ones. Second, involved people may have health attitudes which reduce their sensitivity to symptoms and their willingness to take curative health actions. Third, social selection may operate so that healthy people are able to acquire and keep roles more easily than unhealthy people. In sum, there is no evidence in the Detroit data that combining employment, marriage, and parenthood is harmful to women's health. Implications of the results for women's future health are suggested.
420Â citations
TL;DR: Both low fatalism and low inflexibility are found to have a strong moderating influence on the impact of stress, but, perhaps more important, these effects depend both on the type of stress and the symptom outcome considered.
Abstract: In the last ten years, there has been considerable interest in the moderating influence of coping resources on the effects of stress; research has focused mainly on environmental coping resources, such as social support. This paper explores possible interactions between stressors, both acute and chronic, and personal coping resources; interactions are estimated separately for schizophrenic, depression and anxiety symptom clusters. Personal coping resources are conceived of in terms of individual dispositions that may have consequences for either the amount of typical coping effort expended or coping ability. Two related dispositional characteristics are considered: fatalism and inflexibility. Both low fatalism and low inflexibility are found to have a strong moderating influence on the impact of stress, but, perhaps more important, these effects depend both on the type of stress and the symptom outcome considered. These findings are interpreted in terms of a general contingency theory for the role of socialfactors in explaining psychiatric disorder, emphasizing the differences between the types of symptoms involved.
416Â citations
TL;DR: Data from a study of psychological distress in a representative sample of a Midwestern community support the hypothesis that the strain of working and doing the majority of the work associated with raising children increases distress among married women.
Abstract: This study examines the influence of various factors, including role responsibilities and satisfaction, on depressive mood. Various competing hypotheses concerning the factors related to depression are explored using data from a study of psychological distress in a representative sample of a Midwestern community (N = 1,026). Although women reported more distress than men, the largest difference among married people was between employed married men and housewives. Employed married women experienced slightly less distress than housewives, but having minor children in the household was especially stressful for these women and counteracted the advantage of employment. The effects of children in the household on distress were strongest among working women with lower family incomes. These data support the hypothesis that the strain of working and doing the majority of the work associated with raising children increases distress among married women.
398Â citations
TL;DR: A sense of low control is shown to be significantly associated with less self-initiated preventive care, poorer self-rated health, and more illness episodes, more bed confinement, and greater dependence upon the physician.
Abstract: This study documents the wide-ranging significance for health of the person's sense of control, i.e., the sense of mastery vs. fate-orientation. Health behavior is examined in three domains: (1) preventive care; (2) health knowledge and perspectives; and (3) physical status, e.g., acute and chronic illness. A representative metropolitan sample was interviewed at the beginning (1976) and at the close (1977) of a year-long investigation that included telephone call-backs at six-week intervals to trace health-related incidents. A sense of low control is shown to be significantly associated with (I) less self-initiated preventive care; (2) less optimism concerning the efficacy of early treatment; (3) poorer self-rated health; and (4) more illness episodes, more bed confinement, and greater dependence upon the physician. These relationships are also shown to be discriminating, e.g., meaningfully different for men and women, and hence are unlikely to be instrument-generated effects. The results are interpreted in the light of the recent congruence in psychology and sociology on the importance of the sense of control.
392Â citations
TL;DR: The major conclusion is that when social support and personal control are both high, these variables are entirely adequate to explain the relationship, however, they are perhaps not adequate in other circumstances.
Abstract: With the goal of adding to the understanding of the well-known relationship between class position and psychological distress, this study focuses on social support and personal control as two variables that have promise in accounting for this relationship. Using data from a sample of women who had recently given birth, analyses indicate that these two variables are important contributors to the class/distress relationship. Inspection of interaction effects demonstrates that the role and importance of both social support and personal control is conditional and complex, varying across both class grouping and stress level. Our major conclusion is that when social support and personal control are both high, these variables are entirely adequate to explain the relationship. However, they are perhaps not adequate in other circumstances.
297Â citations
TL;DR: Gender and being a parent jointly influence level of symptomatology in psychological distress and the pattern offindings for this variable is understood to support formulations pertaining to the stress of family roles for women.
Abstract: Determinants of sex differences in psychological distress are explored through estimating additive and interactive regression models, The absence of employment or marriage is associated with depression for both men and women. Also, for this measure of distress, an additive model of social-role effects accounts for the observed sex difference, suggesting a structural interpretation of the genderldepression relationship. For the measure of psychophysiologic complaints, the pattern of influences differs. Here, gender and being a parent jointly influence level of symptomatology. Further analysis reveals this effect to be due primarily to sex differences among parents having young children. The pattern offindings for this variable is understood to support formulations pertaining to the stress of family roles for women.
296Â citations
TL;DR: A theory is developed that argues that a high level of commitment to a few life-preserving religious beliefs, values, and practices will lower suicide levels, and a multiple regression analysis of suicide rates from 25 nations indicates that religious commitment is negatively related to the total suicide rate.
Abstract: Research on the relationship of religion and suicide has relied almost exclusively on the concept of religious integration as a causal variable. The present paper proposes an alternative linkage, based on the concept of religious commitment. A theory is developed that argues that a high level of commitment to a few life-preserving religious beliefs, values, and practices will lower suicide levels. Control variables are taken from the industrialization and the neglected genderequality perspectives on suicide. A multiple regression analysis of suicide rates from 25 nations indicates that religious commitment is negatively related to the total suicide rate. However, this relationship holds only forfemales, the group traditionally most committed to religion. Both the industrialization and gender-equality variables were more closely associated with the variance in ageand gender-specific suicide rates than was the religious variable.
233Â citations
TL;DR: While undesirable job and financial experiences increase the likelihood of illness or injury for high and low SES groups, high SES respondents are less likely to experience such events during periods of contraction of the local economy than during expansion.
Abstract: Longitudinal survey data describing 6,190 subjects are analyzed using log-linear methods to determine which, if any, of three hypothesized links between short-term community economic change and illness or injury is correct. The first possible link assumes that economic contraction increases the incidence of undesirable job and financial events that, in turn, increase the incidence of illness and injury. The second possible connection assumes that economic change per se increases the incidence of undesirable job and financial events and, therefore, the incidence of illness and injury. The third connection assumes that economic change per se increases the incidence of all job and financial events and therefore the incidence of illness and injury. The data support the first hypothesized connection, but the process is observed only in middle socio-economic status respondents. While undesirable job and financial experiences increase the likelihood of illness or injury for high and low SES groups, high SES respondents are less likely to experience such events during periods of contraction of the local economy than during expansion. The risk of low SES respondents having undesirable job and financial events did not vary longitudinally with the performance of the local economy.
TL;DR: Data from a two-stage random sample of401 noninstitutionalized elderly individuals residing in 18 census tracts in the south-central part of Metropolitan St. Louis are used to assess the effects of the predisposing, enabling, and need characteristics on ten measures of health services utilization.
Abstract: Data from a two-stage random sample of401 noninstitutionalized elderly individuals residing in 18 census tracts in the south-central part of Metropolitan St. Louis are used to assess the effects of the predisposing, enabling, and need characteristics on ten measures of health services utilization. Hierarchical multiple regression analyses indicate that: (I) Most of the explained variance in health services utilization may be attributed to the need characteristics, suggesting an apparently equitable system; (2) When a comprehensive version of Andersen's behavioral model is fielded, from 12 to 35 percent of the variance in health services utilization can be explained; and (3) Nutritional risk is the most important predictor of the total number of physician visits, visits to physicians in the emergency room, and the occurrence of hospital episodes. The implications of these analyses for modeling the health services utilization of elderly as well as for public policy concerning their health care, are discussed.
TL;DR: Interactions between self-derogation and life events are significant net of the main effects, however, only one of six social-support by life-events interactions is significant.
Abstract: We test models predicting psychological distress as a function of the main effects of selfrejection, deprivation of social support, and life events and as a function of buffering effects of self-esteem and social support with life events. Data are from 1,633 subjects interviewed in the seventh grade and again ten years later. Measures of self-rejection and of deprivation of social support come from the earlier data. Measures of life events refer to events in the ten years that are perceived as (1) bad, (2) disruptive of routine, and (3) imposing expectations that the subject failed to meet. Psychological distress is also measured at the later interview. Regression analyses support the predicted main effects. As well, interactions between self-derogation and life events are significant net of the main effects. However, only one of six social-support by life-events interactions is significant. After considering the contribution of the main effects, we discuss the pattern of interactions. Possible explanations relate to either the meaning offamily support and the substitutability of supportive relationships.
TL;DR: It is suggested that bed availability influences clinical decisions of appropriateness and may override personal preferences in predicting whether patients die at home or in a medical setting.
Abstract: Despite its social, cultural, and psychological salience, few empirical studies have examined the factors influencing site of death. Data describing cancer patients served by hospices participating in the National Hospice Study (NHS) were used to explore the relative importance of patients' sociodemographic, support-network, and physical-health characteristics, as well as health-system factors, in predicting whether patients die at home or in a medical setting. The site of death of 69.9 percent of the 3257 patients was correctly predicted. Whether the hospice serving a patient had beds was the dominant predictor, even when controlling for differences in the types of patients served by hospices with and without beds. Findings suggest that bed availability influences clinical decisions of appropriateness and may override personal preferences.
TL;DR: An exploratory model of variables affecting sexual assault trauma during the acute phase is proposed and tested, using a multivariate statistical analysis, and predicts that trauma level is affected by variables relating to the attack, the victim's demographics, and social support systems.
Abstract: An exploratory model of variables affecting sexual assault trauma during the acute phase is proposed and tested, using a multivariate statistical analysis. As predicted, trauma level is affected by variables relating to the attack, the victim's demographics, and social support systems, but most important are the prior-stress variables. Some demographic variables of the victim affect trauma directly, others indirectly. Thus, sexual assault trauma is a complex phenomenon resulting from an interplay of various independent variables. Implications of these results are discussed in terms of the victimization literature, prevailing stereotypes about rape, methodology of rape studies, and treatment-related issues.
TL;DR: The purpose of this paper is to examine this sex difference in relation to three theoretical perspectives: (1) the sex-role theory, (2) social support theory, and (3) stress theory.
Abstract: Although it is well-documented that women are more likely than men to use prescribed psychotropic drugs, there are conflicting explanations of this pattern. The purpose of this paper is to examine this sex difference in relation to three theoretical perspectives: (1) the sex-role theory, (2) social support theory, and (3) stress theory. Data from the National Medical Care Expenditure Survey confirm that women were more likely than men to obtain a psychotropic drug. The data also showed that for both men and women, the likelihood of obtaining a psychotropic drug is influenced by family role responsibilities, family structure, and stressful events. However, women had a significantly higher likelihood of use than men under similar family circumstances. When sociodemographic and health-statuslaccess-to-care variables were controlled, the association for men between family circumstances and obtaining a psychotropic drug disappeared. For women, however, certain family role responsibilities, structures, and stressful events significantly affected the likelihood of obtaining a psychotropic drug even when sociodemographic and health-statuslaccess-to-care variables were controlled.
TL;DR: The hypotheses that gender-role nonconformity during childhood is associated with social isolation, which in turn is related to subsequent suicidal feelings and attempts, were tested and the data indicated consistently that gender deviance was more benign in women than in men.
Abstract: The hypotheses that gender-role nonconformity during childhood is associated with social isolation, which in turn is related to subsequent suicidal feelings and attempts, were tested. These ideas were explored in a four-group sample of homosexual and heterosexual men and women living in San Francisco. The data indicated that there was support for the hypotheses; however, childhood gender-role nonconformity was more consequential for the later suicidality of men than of women. The data indicated consistently that gender deviance was more benign in women than in men.
TL;DR: It is suggested that labeling theory in relation to mental illness needs to be reconsidered because it underestimated the degree to which patients and ex-patients think favorably about mental illness and posthospital experiences.
Abstract: For years, critics and proponents of the labeling theory approach to mental illness have quarreled over society's reactions to the mentally ill. Heretofore, their debate has paid little attention to patients' reactions to labeling. This report reviews 35 studies dealing with (1) hospitalized patients' attitudes toward the label of mental illness and (2) ex-patients' attitudes toward the stigma or effects of hospitalization. Data are interpreted within the context offive propositions derived from labeling theory. None of the propositions met the criteria for acceptance. Labeling theory underestimated the degree to which patients and ex-patients think favorably about mental illness and posthospital experiences. Labeling theory also incorrectly predicted that patients' attitudes would become more unfavorable during hospitalization, as well as after discharge, and would be less favorable than nonpatients' attitudes. However, consistent with the theory, patients were strongly negative toward generalized labels of mental illness. The findings suggest that labeling theory in relation to mental illness needs to be reconsidered.
TL;DR: Etude comparative chez les mexicains et les anglo-americains, de Mexico and du Texas en utilisant des analyses statistiques tenant compte des facteurs sociaux et culturels.
Abstract: Etude comparative chez les mexicains et les anglo-americains, de Mexico et du Texas en utilisant des analyses statistiques tenant compte des facteurs sociaux et culturels
TL;DR: Patients' descriptions of their current' life situations were content analyzed using nine scales that measure patterns of anxiety, depression, anger, helplessness, competence, sociability and positive feelings, and results seem best interpreted in terms of developmental theories regarding women's greater affiliation needs and abilities.
Abstract: To test hypotheses derived from theories regarding sex differences in illness behavior, health care received, and psychological development across the life span, patients' descriptions of their current' life situations were content analyzed using nine scales that measure patterns of anxiety, depression, anger, helplessness, competence, sociability and positive feelings. Patients had chronic diseases or were awaiting surgery. Two-way analyses of variance were used to compare the responses of 261 males and 318 females offour age groups: young adult (18 to 30 years), adult (31 to 45), middle-aged (46 to 60), and elderly (61 to 85). Women expressed greater separation anxiety and sociability than men. Elderly patients experienced less anxiety, fewer feelings of competence and of helplessness, and fewer positive feelings than did young adults. Older patients reported as many social interactions, but these were more likely to be solidarity interactions in which they were reactors. Results seem best interpreted in terms of developmental theories regarding women's greater affiliation needs and abilities.
TL;DR: Trends in the female:male ratio of attempted suicide are studied by assembling a data set consisting of all published normal population studies of suicide attempts conducted in the United States between 1940 and 1980 and are consistent with a post-War shift in the sex ratio of overall psychopathology.
Abstract: Trends in the female:male ratio of attempted suicide are studied by assembling a data set consisting of all published normal population studies of suicide attempts conducted in the United States between 1940 and 1980. A post-World War II increase in this ratio and a subsequent decrease beginning in the 1960s are documented. The first of these changes is consistent with a post-War shift in the sex ratio of overall psychopathology discovered by Gove and Tudor (1973) in an analysis of "true prevalence" studies. The second is consistent with a shift in the rates of self-reported psychological distress found by Kessler and McRae (1981) in national survey data and by Srole and Fischer (1980) in the Midtown Manhattan Restudy. The implications of the findings for current thinking about the influence of sex roles on mental illness are discussed.
TL;DR: It is concluded that different training programs influence residents' attitudes toward shared decision-making differently and that the surgeons' change to more authoritarian attitudes may reflect the task-oriented, hierarchical nature of their program.
Abstract: To investigate the evolution of attitudes about the sharing of decision-making, residents in medicine and surgery at a university hospital completed a questionnaire that was originally developed to assess attitudes of businessmen. The questionnaire was distributed to residents in their first year of training and again at the end of their third year. In the first year of training, medical and surgical residents had similar attitudes, and medical residents' attitudes did not change during the three years. However, surgical residents in their third year scored significantly lower in each test category than in their first year and than medical residents in the third year-thus showing a change toward more authoritarian attitudes. We conclude that different training programs influence residents' attitudes toward shared decision-making differently and that the surgeons' change to more authoritarian attitudes may reflect the task-oriented, hierarchical nature of their program.
TL;DR: Analysis of 220 emergency room staff members' perceptions of 14 hypothetical patients showed that with the exception of rarity of problem and social distance, the tested factors were significantly related to ratings of rewardingness of patient encounters.
Abstract: Studies suggest that health care providers' evaluation of patients is related to aspects of the presenting problem, i.e., its seriousness, curability, and rarity; the extent to which the problem was self-caused; and to aspects of the patients, i.e., their age, social distance from providers and cooperativeness. Analysis of 220 emergency room staff members' perceptions of 14 hypothetical patients showed that with the exception of rarity of problem and social distance, the tested factors were significantly related to ratings of rewardingness of patient encounters. Results indicated that predictors of reward derived from substance-abusing and non-substance-abusing patients were different. While seriousness of illness was the primary predictor with non-substance-abusers, perceived cooperativeness was primary with substance-abusers. Predictors of rewarding patient encounters also differed according to staff level. Implications of these differences for emergency treatment of substance-abusers is discussed.