Self-esteem as a mediator between spousal support and depressive symptoms: a comparison of healthy individuals and individuals coping with arthritis.

This study examined whether self-esteem mediated the effects of both self-reported positive and negative marital interactions on depressive symptoms and whether the relationships among marital interactions, self-esteem, and depressive symptoms were stronger for individuals (n = 90) coping with arthritis compared with individuals (n = 90) not coping with a chronic illness. Data were drawn from the 1986 Americans' Changing Lives national survey. The results of multigroup structural equation analysis suggest that mediation depends on the type of marital interaction being considered and the group being examined. For the arthritis group, self-esteem mediated the relationship between negative marital interactions and depressive symptoms, whereas for the healthy group self-esteem played no role in mediating the relationship between marital interactions and depressive symptoms. Findings underscore the importance of testing moderated-mediation models of social support.

Emotional and physical intimacy in coping with lupus: women's dilemmas of disclosure and approach.

This study examined whether self-rated physical and emotional intimacy of 74 women with their heterosexual partner, during an illness episode of lupus, was related to their affect and relationship satisfaction. It was predicted that greater intimacy would be related to better psychosocial adjustment. Women who engaged in physically intimate behavior with their partner more often reported greater relationship satisfaction. Women who frequently avoided or who were often the initiators of physical intimacy, however, reported greater negative affect. Concerning emotional intimacy, women who disclosed more information about illness symptoms and women who concealed more information about their symptoms and feelings experienced the highest levels of negative affect. Results identify dilemmas that women with recurrent illness may face when trying to maintain intimacy during illness periods.

Long-term effects of HIV counseling and testing for women: behavioral and psychological consequences are limited at 18 months posttest.

Behavioral and psychological consequences of HIV counseling and testing (HIV C&T) for women were examined in a longitudinal, prospective study. Women who received HIV C&T at community health clinics (n = 106) and a comparison group of never-tested women (n = 54) were interviewed five times over 18 months. There was no change in risk behaviors as a consequence of testing: tested and untested women engaged in high-risk sexual behavior at baseline and 18 months later. Tested women reported more anxiety, depression, and intrusive thoughts about AIDS than did untested women. Although tested women were more concerned about AIDS, their potential risk factors over the study period generally were equivalent to those for untested women. HIV counseling and testing should be considered one aspect of a broader program of HIV prevention. Identification of alternative interventions must be a public health priority.

"A grief observed": the experience of HIV-related illness and death among women in a clinic-based sample in New Haven, Connecticut.

This study examined how women in a clinic-based sample in New Haven, Connecticut, (N = 168), have been affected by the AIDS epidemic. The aims of this study were to (a) document the proportion of women who knew individuals who were HIV positive, who were symptomatic with AIDS, or who had died from AIDS; (b) compare the demographics of women who knew someone infected with HIV with those of women who did not know anyone infected with HIV; and (c) examine prospectively the effects of the number of AIDS-related losses on women's mental health. Many women have been deeply affected by the AIDS epidemic: Nearly 3/4 of the women in this study knew at least 1 person who had died of AIDS. Women who experienced multiple AIDS-related losses over the course of the study were significantly more anxious than those who experienced no loss or 1 loss. Implications for clinical interventions are discussed.

How shared are age-related influences on cognitive and noncognitive variables?

Several theories have suggested that age-related declines in cognitive processing are due to a pervasive unitary mechanism, such as a decline in processing speed. Structural equation model tests have shown some support for such common factor explanations. These results, however, may not be as conclusive as previously claimed. A further analysis of 4 cross-sectional data sets described in Salthouse, Hambrick, and McGuthry (1998) and Salthouse and Czaja (2000) found that although the best fitting model included a common factor in 3 of the data sets, additional direct age paths were significant, indicating the presence of specific age effects. For the remaining data set, a factor-specific model fit at least as well as the best fitting common factor model. Three simulated data sets with known structure were then tested with a sequence of structural equation models. Common factor models could not always be falsified--even when they were false. In contrast, factor-specific models were more easily falsified when the true model included a unitary common factor. These results suggest that it is premature to conclude that all age-related cognitive declines are due to a single mechanism. Common factor models may be particularly difficult to falsify with current analytic procedures.

Balancing parent care with other roles: interrole conflict of adult daughter caregivers.

This study examined interrole conflict experienced by 278 women who simultaneously occupied 4 roles: parent care provider, mother to children at home, wife, and employee. Compared with women who experienced no conflict between parent care and their other roles, women reporting parent care conflict tended to have fewer socio-economic resources, to have older children, and to be caring for parents with greater impairment. Women who reported conflicts between parent care and employment were older; had more education; had marriages of longer duration; and had older, more self-sufficient children than women who reported conflict between the parent care role and the mother role. Some evidence was found for the hypothesis that interrole conflict between parent care and other roles mediates the relationship between parent care stress and psychosocial well-being. Results suggest that one way parent care stress exerts its deleterious effects on the well-being of adult daughters is through the incompatible pressures of parent care and other roles.

Physicians' predictions of elderly outpatients' preferences for life-sustaining treatment.

BACKGROUND: Research has shown that physicians are poor predictors of patients' life-sustaining treatment preferences. Our study examined the association between three aspects of physician experience and their ability to accurately predict patients' preferences for two different life-sustaining treatments in the event of two serious medical conditions. METHODS: Seventeen physicians predicted the treatment preferences of 57 patients and then interviewed patients regarding their actual treatment preferences. Physicians' professional experience, length of their relationship with the patient, and experience with direct feedback were measured to determine the association of these factors with the accuracy of the physicians' predictions. RESULTS: Physicians became more accurate predictors as they interviewed more patients and received direct feedback regarding the accuracy of their predictions (P < .001). Residents were more accurate than faculty in predicting patients' preferences (P < .05). CONCLUSIONS: Increased experience with life-sustaining treatment discussions improved the physicians' abilities to accurately predict patient preferences. Although possibly resulting from small sample size, neither greater professional experience nor longer relationship with a patient improved the accuracy of physicians' predictions. Future research should examine whether discussing end-of-life issues with patients more often makes physicians more sensitive predictors of patients' life-sustaining treatment preferences.

Elderly outpatients respond favorably to a physician-initiated advance directive discussion.

BACKGROUND: Little is known about the emotional impact of physician-initiated advance directive discussions. METHODS: One hundred ambulatory patients aged 65 years and older were randomly assigned to receive either a physician-initiated discussion of advance directive choices of a discussion of health promotion issues. Prediscussion, immediate postdiscussion, and 1-week postdiscussion measures of positive and negative affect were measured for both groups. RESULTS: Neither discussion topic resulted in adverse emotional or attitudinal responses. Only the advance directive participants showed positive affective and attitudinal responses to the discussion, including an increase in positive affect, an increased sense of physician-patient understanding, and increased thought and discussion about life-support issues in the week following the discussion. For those participants receiving the advance directive discussion, longer physician-patient relationships and higher educational levels significantly predicted a more positive affective response. Lower scores on indices of mental and physical health and a stronger belief that physicians should discuss advance directive issues significantly predicted a more negative affective response to the advance directive discussion. CONCLUSIONS: Physicians should anticipate positive emotional responses when they initiate advance directive discussions with their elderly outpatients. Advance directive discussions will be received most positively by patients who enjoy good psychological and physical health and when initiated in the context of an established physician-patient relationship.

Elderly outpatients' understanding of a physician-initiated advance directive discussion.

OBJECTIVE: To examine elderly outpatients' understanding of advance directives (ADs), cardiopulmonary resuscitation (CPR), and artificial nutrition and hydration (ANH) with and without the benefit of a physician-initiated discussion. DESIGN: Randomized controlled trial. SETTING: University-affiliated, community-based, urban family practice residency training program. PATIENTS: One hundred patients aged 65 and older, consecutively sampled and randomly assigned to one of two discussion groups. INTERVENTIONS: Physicians' discussions based on a prepared script consisting of AD issues or health promotion issues. MAIN OUTCOME MEASURES: Test of comprehension of AD, CPR, and ANH information, using open-ended and yes-or-no questions. RESULTS: Patients in the AD and health promotion discussion groups showed good basic understanding. Younger and better-educated patients had a better working knowledge of AD-related information. Understanding of ADs was higher when the physician spent more time talking about AD-related issues after the discussion was completed. CONCLUSIONS: Many elderly outpatients have a good basic understanding of ADs, CPR, and ANH, even without explicit explanations from physicians. However, younger, better-educated patients and those who had longer unstructured discussions had greater AD-related knowledge. These factors need to be considered when framing discussions with patients about ADs and life-sustaining treatments.