RESUMO
OBJECTIVE: To evaluate the psychological adjustment of young adults with IDDM in comparison with similarly aged individuals without chronic illness. RESEARCH DESIGN AND METHODS: An onset cohort of young adults (n = 57), ages 19-26 years, who have been followed over a 10-year period since diagnosis, was compared with a similarly aged group of young adults identified at the time of a moderately severe, acute illness (n = 54) and followed over the same 10-year period. The groups were assessed at 10-year follow-up in terms of 1) sociodemographic indices (e.g., schooling, employment, delinquent activities, drug use), 2) psychiatric symptoms, and 3) perceived competence. In addition, IDDM patients were examined for longitudinal change in adjustment to diabetes. RESULTS: The groups differed only minimally in terms of sociodemographic indices, with similar rates of high school graduation, post-high school education, employment, and drug use. The IDDM group reported fewer criminal convictions and fewer non-diabetes-related illness episodes than the comparison group. There were no differences in psychiatric symptoms. However, IDDM patients reported lower perceived competence, with specific differences found on the global self-worth, sociability, physical appearance, being an adequate provider, and humor subscales. The IDDM patients reported improving adjustment to their diabetes over the course of the 10-year follow-up. CONCLUSIONS: Overall, the young adults with IDDM appeared to be as psychologically well adjusted as the young adults without a chronic illness. There were, however, indications of lower self-esteem in the IDDM patients that could either portend or predispose them to risk for future depression or other difficulties in adaptation.
Assuntos
Doença Aguda/psicologia , Diabetes Mellitus Tipo 1/psicologia , Ajustamento Social , Fatores Socioeconômicos , Adolescente , Adulto , Idade de Início , Consumo de Bebidas Alcoólicas , Boston , Criança , Cocaína , Estudos de Coortes , Crime , Demografia , Educação , Emprego , Família , Feminino , Seguimentos , Humanos , Estudos Longitudinais , Masculino , Abuso de Maconha , Transtornos Mentais/epidemiologia , Transtornos Psicóticos/epidemiologia , Fumar , Transtornos Relacionados ao Uso de SubstânciasRESUMO
Children's concepts about illness causality and bodily functioning change in a predictable way with advancing age. Differences in the understanding of these concepts in healthy children vs children with a chronic illness have not been clearly delineated. This study included 49 children with a seizure disorder, 47 children with an orthopaedic condition, and 96 healthy children, all with normal intelligence and ranging in age from 5 to 16 years. It demonstrates systematic differences in children's general reasoning skills and in their understanding of concepts about illness causality and bodily functioning, as a function of their age and experience of illness. At all ages, children who had a condition with orthopaedic involvement reported less sophisticated general reasoning and concepts about illness than did healthy children; children with a seizure disorder reported similar general reasoning skills to those of healthy children, but considerably less sophisticated concepts about illness. Children's concepts about body functioning did not differ as a function of the presence of a chronic illness. When their different levels of general cognitive reasoning were statistically controlled, children with a chronic illness had somewhat more sophisticated concepts about bodily functioning than did healthy children. Differences in conceptual development among children with different types of illnesses lead to interesting speculations with regard to the effects of particular illness characteristics on children's cognitive development.
Assuntos
Doenças Ósseas/fisiopatologia , Causalidade , Desenvolvimento Infantil/fisiologia , Convulsões/fisiopatologia , Adolescente , Doenças Ósseas/etiologia , Criança , Pré-Escolar , Doença Crônica , Cognição , Feminino , Nível de Saúde , Humanos , Inteligência , Masculino , Convulsões/etiologia , Fatores SocioeconômicosRESUMO
In this article, we show how discrete-time survival analysis can address questions about onset, cessation, relapse, and recovery. Using data on the onset of suicide ideation and depression and relapse into cocaine use, we introduce key concepts underpinning the method, describe the action of the discrete-time hazard model, and discuss several types of main effects and interactions that can be included as predictors. We also comment on practical issues of data analysis and strategies for interpretation and presentation.
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Acontecimentos que Mudam a Vida , Determinação da Personalidade/estatística & dados numéricos , Desenvolvimento da Personalidade , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Cocaína , Transtorno Depressivo/mortalidade , Transtorno Depressivo/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Recidiva , Fatores de Risco , Transtornos Relacionados ao Uso de Substâncias/psicologia , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Suicídio/psicologia , Suicídio/estatística & dados numéricos , Análise de Sobrevida , Resultado do Tratamento , Prevenção do SuicídioRESUMO
This longitudinal study provides an example of the use of exploratory growth modeling to examine changes over time in the functioning of 172 families who underwent treatment in an innovative prevention program, Project Good Start. Two types of research question are addressed: a within-family question (Does family functioning change over time in families at risk of maltreatment who are receiving special early support services?) and a between-family question (Are changes in family functioning systematically related to selected characteristics of family background and treatment?). Results of the study highlight the heterogeneity across families in the direction and rate of family function change and its systematic relationship with the family profile on entry into intervention. Although treatment seems successful in stabilizing and improving the family functioning of most at-risk families, problems of violence/maltreatment and distressed parenting act to defer successful treatment.
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Maus-Tratos Infantis/prevenção & controle , Família/psicologia , Estudos Longitudinais , Modelos Estatísticos , Projetos de Pesquisa/estatística & dados numéricos , Adolescente , Adulto , Feminino , Humanos , Lactente , Masculino , Apoio Social , Estatística como Assunto , ViolênciaRESUMO
Investigation of the adjustment of children with a chronic illness has been complicated by an imprecise definition of adjustment, immense diversity in the kinds of chronic illnesses studied, and multiple instruments and sources of measurement of the child's behavior. In this study we have used a composite construct of adjustment, looked separately at reports from three separate observers of children's behavior, and limited our investigation to a few discrete types of illnesses. The investigation explores the contribution of selected characteristics of mothers and of families to children's adjustment as reported by children, their mothers, and their teachers. Family interactions were important to the psychological adjustment of all children (healthy or with a chronic illness and independent of age and socioeconomic status) as reported by all three observers. The mother's self-esteem and reported size of her social network were not associated with children's adjustment, but the mother's health locus of control beliefs interacted with the child's intelligence to predict children's adjustment. The pattern of these associations was different for different illness groups and for each of the three observers.
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Doença Crônica , Comportamento Materno , Ajustamento Social , Adaptação Psicológica , Adolescente , Adulto , Criança , Desenvolvimento Infantil , Pré-Escolar , Família , Feminino , Humanos , Controle Interno-Externo , Masculino , Relações Mãe-Filho , Psicologia da CriançaRESUMO
Research suggests that perinatal screening and early intervention may reduce the incidence of maltreatment and improve the parenting in at-risk families. The question of whether families with different sets of entry-level characteristics differ in the way that they respond to intervention is asked in this paper. We investigated whether entry-level family functioning and family problems had an impact on length of time in treatment and the improvement or deterioration of family functioning over time. In our analyses, we used entry-level characteristics to classify families into five homogeneous groups--situationally stressed, chronically stressed, emotionally stressed, multirisk, and violent multirisk--and we found that treatment duration and rate of change in family functioning over time differed in clinically important ways across these groups. Our findings suggest that treatment is likely to be successful in stabilizing and slowly improving the family functioning of the majority of families at risk of child maltreatment.
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Maus-Tratos Infantis/prevenção & controle , Família , Adolescente , Adulto , Maus-Tratos Infantis/etiologia , Etnicidade , Terapia Familiar , Feminino , Humanos , Masculino , Projetos de Pesquisa , Apoio Social , Estresse Psicológico/complicações , Estresse Psicológico/psicologia , ViolênciaRESUMO
The authors use longitudinal data from the National Longitudinal Survey of Youth to investigate whether the wage trajectories of male high school dropouts are affected by the acquisition of the General Educational Development (GED) credential, by postsecondary education, and by training. The authors show that acquisition of the GED results in wage increases for dropouts who left school with weak skills, but not for dropouts who left high school with stronger skills. College and training provided by employers are associated with higher wages for male dropouts.
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Educação/economia , Renda , Evasão Escolar/educação , Adolescente , Adulto , Humanos , Capacitação em Serviço , Estudos Longitudinais , Masculino , Análise de Regressão , Fatores Socioeconômicos , Estados UnidosRESUMO
Many research questions in aging research treat time as the outcome variable. Researchers ask how much time must pass before a specific type of change or event occurs, and whether these times differ by characteristics of the subjects' background, training and treatment. Because of serious technical problems that arise when analyzing duration data, specially derived statistical methods--the methods of survival analysis--are required to answer the questions. In this paper, we introduce the conceptual framework of these new methodologies for analyzing duration data. We begin by identifying the types of research question that might appropriately treat time as an outcome. We then describe the new statistical methods for addressing such questions, provide a broad overview of their application, and identify relevant published sources containing additional background and technical information.
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Envelhecimento , Análise de Sobrevida , Humanos , Modelos Estatísticos , Modelos de Riscos Proporcionais , Pesquisa , Estatística como Assunto/métodosRESUMO
Many questions arising in drug abuse prevention and intervention studies focus on whether and, if so, when events occur. When do adolescents start using drugs? Does participation in a drug prevention program at school decrease the risk that high school students will initiate drug use? Does failure to participate in a relapse prevention program at a community health center increase the risk that newly abstinent ex-abusers will start using drugs again? Research questions about event occurrence present unique design and analytic difficulties. The fundamental problem is how to handle censored observations, observations of those people who do not experience the target event during data collection. The methods of survival analysis overcome these difficulties and allow prevention researchers to describe patterns of occurrence, compare these patterns among groups, and build statistical models of the risk of occurrence over time. In this chapter, the authors present a nonmathematical introduction to survival analysis for drug abuse prevention researchers. After developing the basic concepts, they focus on two topics-study design and data analysis-and identify for each the key issues researchers face and provide guidelines for making informed decisions about them. In the process, the authors review how prevention researchers have used the methods to date and point towards new directions for the application of these methods.
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Transtornos Relacionados ao Uso de Substâncias/prevenção & controle , Análise de Sobrevida , Coleta de Dados , Humanos , Modelos de Riscos Proporcionais , Recidiva , Projetos de PesquisaRESUMO
Methodologists have recently shown how the methods of individual growth modeling and covariance structure analysis can be integrated, bringing the flexibility of the latter to bear on the investigation of inter-individual differences in change. The individual growth-modeling framework uses a pair of hierarchical statistical models to represent: (a) individual status as a function of time, and (b) inter-individual differences in true change. Under the covariance structure approach, these level- I and level-2 models can be reformatted as the "measurement" and "structural" components of the general LISREL model with mean structures. Consequently, a covariance structure analysis of longitudinal panel data can provide maximum-likelihood estimates for all level-2 parameters. In this article, using longitudinal data drawn from a school-based alcohol prevention trial, we demonstrate how the new approach can be used to investigate the inter-relationships among simultaneous individual changes in two domains - positive arid negative alcohol expectancies - over the course of early to mid-adolescence, for both boys and girls. We represent individual change over time in positive expectancies with a piecewise growth model, and in negative expectancies with a straight-line growth model. Then, we use multi-sample covariance structure analysis to ask whether individual changes in positive and negative expectancies are related to each other and whether the pattern of inter-relationships differs by gender. Our approach can easily be generalized to more than two domains and has a variety of other advantages that we document in the discussion.
RESUMO
The utility and flexibility of recent advances in statistical methods for the quantitative analysis of developmental data--in particular, the methods of individual growth modeling and survival analysis--are unquestioned by methodologists, but have yet to have a major impact on empirical research within the field of developmental psychopathology and elsewhere. In this paper, we show how these new methods provide developmental psychopathologists with powerful ways of answering their research questions about systematic changes over time in individual behavior and about the occurrence and timing of life events. In the first section, we present a descriptive overview of each method by illustrating the types of research questions that each method can address, introducing the statistical models, and commenting on methods of model fitting, estimation, and interpretation. In the following three sections, we offer six concrete recommendations for developmental psychopathologists hoping to use these methods. First, we recommend that when designing studies, investigators should increase the number of waves of data they collect and consider the use of accelerated longitudinal designs. Second, we recommend that when selecting measurement strategies, investigators should strive to collect equatable data prospectively on all time-varying measures and should never standardize their measures before analysis. Third, we recommend that when specifying statistical models, researchers should consider a variety of alternative specifications for the time predictor and should test for interactions among predictors, particularly interactions between substantive predictors and time. Our goal throughout is to show that these methods are essential tools for answering questions about life-span developmental processes in both normal and atypical populations and that their proper use will help developmental psychopathologists and others illuminate how important contextual variables contribute to various pathways of development.
Assuntos
Transtornos do Comportamento Infantil/psicologia , Transtornos Mentais/psicologia , Desenvolvimento da Personalidade , Meio Social , Adolescente , Criança , Pré-Escolar , Coleta de Dados , Feminino , Humanos , Lactente , Estudos Longitudinais , Masculino , Modelos Estatísticos , Modelos de Riscos Proporcionais , Psicopatologia , Projetos de PesquisaRESUMO
An onset cohort of children and adolescents with insulin-dependent diabetes mellitus (IDDM) and their parents were studied. Aspects of family environment were evaluated at study inception, and their influence on the initial level of, and change in, glycemic control over 4 years was examined. Family measures of expressiveness, cohesiveness, and conflict were linked to differences in the longitudinal pattern of glycemic control. In particular, the encouragement to act openly and express feelings directly (expressiveness) seemed to ameliorate deterioration of glycemic control over time in both boys and girls. Boys were especially sensitive to variations in family cohesiveness and conflict; those from more cohesive and less conflicted families showed less deterioration in glycemic control. This study demonstrated the important influence of family psychosocial factors present at diabetes onset on glycemic control in children and adolescents over the first 4 years of IDDM.
Assuntos
Glicemia/metabolismo , Diabetes Mellitus Tipo 1/psicologia , Família/psicologia , Cooperação do Paciente/psicologia , Papel do Doente , Meio Social , Adaptação Psicológica , Adolescente , Automonitorização da Glicemia/psicologia , Criança , Conflito Psicológico , Diabetes Mellitus Tipo 1/sangue , Feminino , Seguimentos , Hemoglobinas Glicadas/metabolismo , Humanos , Controle Interno-Externo , Masculino , Determinação da Personalidade , Estudos ProspectivosRESUMO
Past cross-sectional studies have suggested that young adults with insulin-dependent (Type 1) diabetes mellitus (IDDM) may experience problems in their close peer relationships. For 10 years, we have followed an onset cohort of children and adolescents with IDDM (n = 57) and an age-matched group who were originally recruited after an acute illness, accident, or injury (n = 54). Now aged 19-26 years, these two groups were compared in terms of their friendship patterns, dating and love experiences, and sense of loneliness. All subjects in both groups had at least one friend. However, the IDDM group reported fewer friendships overall. The difference was accounted for by the number of less intimate friends. The two groups had similar frequencies of current romantic partners (IDDM = 63%; comparison group = 64%). While dating attitude and dating assertiveness did not differ between groups, some differences were found in terms of experiences of a primary love relationship. IDDM patients experienced less trust and sense of intimate friendship in these love relationships. No differences in loneliness were found. The preponderance of our findings indicate that the two groups had similar patterns and experiences of close peer relationships. Thus, the study does not suggest that IDDM leads to serious problems in forming social relationships for these patients during the transition to young adulthood. On the other hand, the IDDM patients' lower level of trust and intimacy within love relationships are consistent with other findings from this study suggesting specific areas of lowered self-worth that appear in social relationships.
Assuntos
Diabetes Mellitus Tipo 1/psicologia , Relações Interpessoais , Adolescente , Criança , Estudos de Coortes , Emoções , Feminino , Seguimentos , Humanos , Masculino , Classe SocialRESUMO
In this paper we determine whether individual and family psychosocial functioning predicts the risk for recurrent acute diabetic complications. An onset-cohort of 61 children and adolescents with Type 1 diabetes received conventional diabetes care. Episodes of ketoacidosis and of severe hypoglycemia were recorded for 8 years, and glycaemic control was measured by glycohaemoglobin. Measures of psychosocial functioning of the patient and parents were obtained during the first year. Over 8 years, 28% of subjects had at least one episode of ketoacidosis, and 21% had at least one episode of hypoglycaemia. The odds of observing recurrent hypoglycaemia versus recurrent ketoacidosis was 14 times greater in boys than in girls (Fisher's exact test p < 0.05). Girls with recurrent ketoacidosis had more behaviour problems and lower social competence, they reported higher levels of family conflict, and their parents reported lower levels of family cohesion, expressiveness and organization in year one. These relationships were independent of any association with poor glycaemic control. Recurrent hypoglycaemia in boys was generally unrelated to individual and family functioning or glycohaemoglobin. Despite our small sample size, our findings are suggestive of relationships that may lead to early identification of patients who are prone to recurrent ketoacidosis, and to the development of early intervention strategies.