Adult attachment insecurity and associations with diabetes distress, daily stressful events and self-management in type 1 diabetes.

Anxious and avoidant attachment may be detrimental for diabetes distress and management. Additionally, individuals' perceptions of their partner's involvement may affect these associations. The study explored cross-sectionally and at the daily level whether anxious and avoidant attachment associated with diabetes distress or stressors and diabetes management, and whether higher perceived collaboration and support (C&S) moderated associations between attachment and diabetes management. Individuals with type 1 diabetes (N = 199; M age = 46.82; 52.3% women) completed measures of diabetes distress, diabetes-related C&S, self-care, average blood glucose (hemoglobin A1c), and attachment insecurity, and daily diary measures of diabetes-related C&S, diabetes stressors, mean blood glucose, and self-care. Higher anxious and avoidant attachment associated with higher diabetes distress. Higher anxious attachment associated with more daily stressors. Anxious attachment associated with lower self-care. C&S did not moderate any associations. Findings highlight the need to consider attachment when designing interventions to reduce diabetes-related distress.

Characterizing the transition from paediatric to adult care among emerging adults with Type 1 diabetes.

AIMS: The goals of the study were to describe the transition of youth with Type 1 diabetes from paediatric to adult healthcare services, examine the link of this transition with self care and glycaemic control, and distinguish youth who received medical treatment from different physicians in terms of demographic and parent relationship variables. METHODS: Youth with Type 1 diabetes (n = 118) were enrolled in a prospective study that examined the transition from the paediatric to adult healthcare systems and were evaluated during their senior year of high school (time 1) and 1 year later (time 2). Data on self care, glycaemic control and parent relationship were collected. RESULTS: The majority of youth saw a paediatric endocrinologist at both assessments (n = 64); others saw an adult care physician at both assessments (n = 26) or transitioned from a paediatric endocrinologist to an adult care physician (n = 19). Nine youth saw no physician between time 1 and time 2. There were group differences in demographic and parent relationship variables and self-care behaviour and glycaemic control related to the transition of care. Youth who remained in the paediatric healthcare system had the best self care and did not experience declines in glycaemic control over time. CONCLUSIONS: Early transition from the paediatric healthcare system to the adult healthcare system is associated with psychosocial variables and worse glycaemic control. Future research should identify factors that determine optimal timing and strategies to avoid deterioration of care and control during this transition.

Education and peer discussion group interventions and adjustment to breast cancer.

BACKGROUND: We report a clinical trial comparing the effectiveness of education-based and peer discussion-based group interventions on adjustment to breast cancer. METHODS: Women with stage I, II, or III breast cancer (n = 312) were randomly assigned to 1 of 4 group conditions: control, education, peer discussion, or education plus peer discussion (combination). Seven groups (each comprising 8-12 women) were conducted in each of the 4 conditions (28 groups total). Adjustment was measured before the intervention, immediately after the intervention, and 6 months after the intervention. RESULTS: Consistently positive effects on adjustment were seen in the education groups both immediately following and 6 months after the intervention. There were no benefits of participation in peer discussion groups, and some indications of adverse effects on adjustment at both follow-up examinations. The effects could be explained by changes in self-esteem, body image, and intrusive thoughts about the illness. CONCLUSIONS: Education-based group interventions facilitated the initial adjustment of women diagnosed with early stage breast cancer. There was no evidence of benefits from peer discussion group interventions.

Applicability of cognitive adaptation theory to predicting adjustment to heart disease after coronary angioplasty.

The purpose of this study was to determine whether cognitive adaptation theory (i.e., cognitively responding to challenges to world assumptions) would predict positive adjustment to heart disease in the face of a recurrent event. Men and women who were treated for a coronary event with percutaneous transluminal coronary angioplasty (N = 278) were interviewed in the hospital and then 6 months later. Indicators of cognitive adaptation theory (self-esteem, optimism, mastery) and adjustment were assessed. In general, cognitive adaptation indicators predicted positive adjustment, sometimes showing stronger relations for those who faced a recurrent event. In addition, patients' cognitions were robust over time, meaning that they were not affected by recurrent events. Patients' beliefs about the angioplasty decision, however, showed differential relations to adjustment, depending on whether they sustained a recurrence.

Social support and adjustment to cancer: reconciling descriptive, correlational, and intervention research.

Several research literatures are reviewed that address the associations of emotional, informational, and instrumental social support to psychological adjustment to cancer. Descriptive studies suggest that emotional support is most desired by patients, and correlational studies suggest that emotional support has the strongest associations with better adjustment. However, the evidence for the effectiveness of peer discussion groups aimed at providing emotional support is less than convincing. Moreover, educational groups aimed at providing informational support appear to be as effective as, if not more effective than, peer discussions. Reasons for inconsistencies between the correlational and intervention literatures are discussed, and future directions are outlined.

Group support interventions for women with breast cancer: who benefits from what?

Research on the benefits of social support groups has been inconclusive. One reason is that individual differences in intervention responses have rarely been examined. The authors determined the extent to which individual difference variables moderated the effects of an information-based educational group and an emotion-focused peer discussion group on the mental and physical functioning of women with breast cancer (n = 230). The authors administered the SF-36 (S.E. Ware, K.K. Snow, M. Kosinski, & B. Gandek, 1993), a multidimensional quality of life instrument, pre- and postintervention. Educational groups showed greater benefits on the physical functioning of women who started the study with more difficulties compared with less difficulties (e.g., lacked support or fewer personal resources). Peer discussion groups were helpful for women who lacked support from their partners or physicians but harmful for women who had high levels of support. Implications of these results for clinical interventions are discussed.

Long-term effects of educational and peer discussion group interventions on adjustment to breast cancer.

The authors report a 3-year follow-up of the effects of 8-week support group interventions on the quality of life of women with early stage breast cancer. Shortly after diagnosis, women were randomly assigned to 1 of 4 conditions: control, education, peer discussion, and education plus peer discussion. The education group intervention focused on providing information to enhance control over the illness experience, whereas the peer discussion group intervention focused on providing emotional support through the expression of feelings. Consistent with the results that emerged 6 months after the interventions (V. S. Helgeson, S. Cohen, R. Schulz, & J. Yasko, 1999), the authors found that the benefits of the education intervention were maintained over a 3-year period (N=252), although effects dissipated with time. The authors continued to find no benefits of the peer discussion intervention, either alone or in combination with education.

Implications of agency and communion for patient and spouse adjustment to a first coronary event.

The present study examined the effects of agency and communion on psychological adjustment to a 1st coronary event. Patients were interviewed about agency and communion and psychological adjustment in the hospital shortly before discharge (Time 1) and then reinterviewed along with spouses in their homes 3 months after discharge (Time 2). It was hypothesized that the extreme agentic orientation (unmitigated agency) and the extreme communal orientation (unmitigated communion) would be associated with poor adjustment for patients and spouses but that agency would promote self adjustment and communion would promote partner adjustment. In general, results confirmed predictions. It was suggested that the most distressed couples consist of a patient high in unmitigated agency and a spouse high in unmitigated communion. Although patients in such couples did not evidence the most distress, spouses did.

Moderators of the relation between perceived control and adjustment to chronic illness.

It was predicted that the relation between perceived control and adjustment to chronic illness would be stronger when (a) perceptions of control were based in reality and (b) the threat was severe. Perceived control was assessed during the hospitalization of 80 first cardiac event patients, and adjustment was assessed during hospitalization and 3-month follow-up. Results indicated that perceptions of vicarious control (perception that other people and things have control) were related to better adjustment only for patients who had undergone invasive procedures by physicians. The relation between control and adjustment was stronger under more severe threat conditions (poor prognosis and rehospitalization).

Distinctions of unmitigated communion from communion: self-neglect and overinvolvement with others.

The authors sought to distinguish unmitigated communion, a focus on others to the exclusion of the self, from communion, a positive caring orientation toward others. Across four studies, the authors showed that unmitigated communion and communion are correlated, but that unmitigated communion is distinct from communion in terms of a negative view of the self, turning to others for self-evaluative information, and psychological distress. They also sought to explain the relation of unmitigated communion to distress. It was found that unmitigated communion individuals' reliance on others for self-esteem leads to overinvolvement with others and a neglect of the self, which, in turn, account for the relation of unmitigated communion to distress.

The effects of masculinity and social support on recovery from myocardial infarction.

Ninety post-myocardial infarction (MI) patients were interviewed to assess masculinity/femininity and social support shortly before hospital discharge. Patients were contacted 1 year following MI to obtain information about rehospitalization and/or death, post-MI chest pain, and perceived health. After controlling for traditional coronary risk factors, MI severity, and psychological distress, lack of disclosure to one's spouse predicted worse recovery on all three indices. Exploratory analyses revealed that males (n = 63) who disclosed to their spouses were rehospitalized less often than females (n = 14) who disclosed to their spouses, and married patients who engaged in less spouse disclosure (n = 32) were significantly more likely to be rehospitalized than either unmarried patients (n = 14) or married patients who engaged in more spouse disclosure (n = 41). Masculinity predicted more severe post-MI chest pain but was unrelated to rehospitalization and perceived health.

The origin, development, and current state of the literature on type A behavior.

Coronary heart disease remains the leading cause of morbidity and mortality in the United States today. Type A behavior pattern has emerged as an important contributor to coronary heart disease. This review describes the development of the concept of type A behavior, definitions, and measurement. Early research that led to the prominence of type A behavior is reviewed, as are recent trends in the literature. Supporting theories such as the Western civilization work ethic, enhanced need for control, self-involvement, and ambiguous standards of evaluation are presented. The controversy over changing type A behavior is also discussed.

Cognitive adaptation as a predictor of new coronary events after percutaneous transluminal coronary angioplasty.

OBJECTIVE: We tested whether the psychological components of cognitive adaptation theory would predict new coronary events after a first percutaneous transluminal coronary angioplasty (PTCA). METHODS: A consecutive sample of patients treated successfully with PTCA were enrolled in the study. Of 343 patients approached, 303 (88%) agreed to participate and were interviewed shortly before hospital discharge. We measured the components of cognitive adaptation theory (optimism, self-esteem, and mastery) during the interview. Five patients were excluded from the analysis because of early, in-hospital reocclusion. New cardiac events (coronary artery bypass grafting, PTCA, myocardial infarction, or disease progression) were examined within 6 months of the first PTCA. We obtained 6-month follow-up data on 98% of patients. RESULTS: The cognitive adaptation index predicted new cardiac events, even when demographic variables and medical variables thought to predict restenosis were statistically controlled (p = .02). CONCLUSIONS: These results suggest that persons who respond to their illness by perceiving control over their futures, by having positive expectations about their futures, and by holding a positive view of themselves seem to be at less risk for a new cardiac event after a first PTCA.

A theory of unmitigated communion.

Research has established that women suffer more often than men from depression. Sex role socialization has been offered as one explanation for this sex difference, but traditional measures of female gender-related traits are not related to depressive symptoms. We argue that thus far research has failed to distinguish the traditional measure of female gender-related traits, communion, from another set of gender-related traits, unmitigated communion. Unmitigated communion is a focus on and involvement with others to the exclusion of the self. Unmitigated communion, but not communion, is related to psychological distress, including depressive symptoms, and accounts for sex differences in distress. We examine the relation of unmitigated communion to communion as well as other personality constructs and then describe the cognitive and behavioral features of unmitigated communion. We note the implications of unmitigated communion for physical and psychological well-being and speculate on possible origins.

The implications of unmitigated agency and unmitigated communion for domains of problem behavior.

Agency and communion are broad dimensions of personality that reflect a focus on the self and a focus on others, respectively. In this article, we distinguish unmitigated agency, a focus on the self to the exclusion of others, flom agency, and we distinguish unmitigated communion, a focus on others to the exclusion of self, from communion. We argue that it is unmitigated agency and unmitigated communion that are linked to domains of problem behavior, in particular relationship difficulties and poor health behavior. Unmitigated agency and unmitigated communion are associated with a lack of support from others, a reluctance to ask others for help, and a range of poor health behaviors. The reasons for these links differ. The links to problem behavior for unmitigated communion individuals stem from their tendency to subjugate their own needs to the needs of others and their dependence on others for esteem. The links to problem behavior for unmitigated agency individuals stem from their unwillingness to attend to relationships and their negative view of others.

Early quality of life in patients with localized prostate carcinoma: an examination of treatment-related, demographic, and psychosocial factors.

BACKGROUND: Men with localized prostate carcinoma are faced with important treatment decisions, and quality of life (QoL) information has become a crucial element of decision making. The first objective of this study was to compare the early, health-related QoL (HRQoL) of men with localized prostate carcinoma who were treated with radical prostatectomy, external beam radiotherapy, or brachytherapy. A second objective was to identify demographic and psychosocial variables that predict HRQoL. METHODS: Two-hundred fifty-six men with localized prostate carcinoma were interviewed within 7 weeks of treatment initiation. The interview included measures of prostate-specific HRQoL (the University of California-Los Angeles Prostate Cancer Index), general HRQoL (the SF-36), and psychosocial variables. RESULTS: After adjusting for covariates, treatment group differences were found for both prostate specific HRQoL and general HRQoL. Men who underwent prostatectomy reported more urinary and sexual problems and more general physical dysfunction compared with men who were treated with either form of radiation therapy. Men who were treated with brachytherapy reported the fewest problems in sexual function and the least general physical dysfunction. Few treatment group differences were found in mental functioning. Both demographic factors and psychosocial factors predicted HRQoL. Older men and African-American men reported more physical problems than younger men and Caucasian men, respectively. A supportive social environment, high self-efficacy, and high self-esteem were predictive of better HRQoL. CONCLUSIONS: Shortly after undergoing treatment for localized prostate carcinoma, men who underwent radical prostatectomy, older men, and African-American men are at heightened risk for experiencing prostate-specific and general deficits in HRQoL. Having psychosocial resources from which to draw may enhance HRQoL.

Temporal patterns of parturition in mammals in captivity.

Previous research indicates that many primate species are more likely to give birth at night than during the day. This study attempted to determine whether temporal patterns of birth are discernible in a number of non-primate mammals. In addition, it sought to relate time of birth to the sleep/wake cycle and to the level of predation on the species. Data were collected and analyzed on birth hours in 26 mammalian species from two Chicago area zoos . Although temporal patterns of parturition were discernible for many species, the hypothesis that most birth would occur during the restive phase was not supported. However, a significant positive correlation between level of predation and the likelihood that birth would occur during the restive phase was found (n = 0.40). These findings are discussed in terms of predator/prey interaction and the protection (or lack of protection) that restive birthing might afford the mother and offspring at this vulnerable time.