The link of social support and postpartum depressive symptoms in African-American women with low incomes.

PURPOSE: To describe the relationship between postpartum support and depressive symptoms in a sample of African-American women of low socioeconomic status. DESIGN: Descriptive correlational design using a convenience sample. METHOD: Fifty-seven African-American women at 4 to 6 weeks' postpartum were interviewed as they waited for their infant to receive a well-baby exam. Identification of amount and type of postpartum support received, as well as the importance of each type of support was measured using the Postpartum Support Questionnaire. Depressive symptoms were measured using the CES-D depression instrument. RESULTS: There was a high incidence of symptoms of depression, and depressive symptoms were associated with support being very important to the woman. CLINICAL IMPLICATIONS: Importance of support is a better predictor of outcomes than how much support a woman receives. Communication of need for support and establishing boundaries with family members are recommended.

Covert self-reinforcers, fear of consequences, and health behavior.

A sample of 125 U.S. college students reported how frequently they exercised vigorously; wore seat belts in automobiles; and avoided consumption of red meat and foods high in dietary cholesterol, saturated fat, and salt. They also reported their fears of long-term negative effects from the unhealthful alternatives and both the frequencies and intensities of 6 self-administered covert consequences: 3 positive for healthful behaviors and 3 negative for the unhealthful alternatives. Diet-related health behaviors were best predicated by a single scale composed of all 12 covert-consequence items. Factor analyses suggested the use of 2 scales for exercise and use of seat belts: 1 rating positive consequences and the other rating negative consequences. For both behaviors, only the positive-item scale predicted in multiple regression. Fear was correlated with all health behaviors except exercise, but it contributed independently only to red-meat avoidance.

Predictors of health behavior from an behavior-analytic orientation.

The frequencies of American college students' positive self-talk, emotional reactions, and other positive thoughts for engaging in five health behaviors were assessed and found to be highly correlated; they then were combined into a composite measure. A similar composite resulted for negative self-talk, emotional reactions, and other negative thoughts for engaging in unhealthy alternative behaviors. Effortfulness and pleasantness of the health behaviors were also assessed. One or (in some cases) both composites, effortfulness, and pleasantness were substantially related to vigorous exercise, use of seat belts, and avoidance of alcoholic beverages. Mild exercise and avoidance of junk food were less well predicted.

The Postpartum Support Questionnaire: reliability and validity.

Support has been found to be related to perinatal health, resulting in the development of the Postpartum Support Questionnaire based on the four categories of support (informational, material, emotional and comparison) identified by House (1981) and Cronenwett (1985). Data from four studies (N = 207) provided evidence of the psychometric properties of the instrument. Internal consistency reliability was demonstrated (alpha = .90 to .94 for total instrument). Test-retest reliability ranged from .69 to .79 for total scores and .30 to .79 for for categories of support. Measures of concurrent validity with the Personal Resource Questionnaire .85 were .42 and .48 at 6 and 8 weeks postpartum. Confirmatory factor analysis using LISREL 7 supported the four categories of support, but the use of these factors separately remains to be demonstrated.

Comparison of the quality of life between HIV-positive haemophilia patients and HIV-negative haemophilia patients.

In a prospective study, we tested the hypothesis that an already reduced quality of life in haemophilia patients is further diminished in those haemophilia patients who contracted the human immunodeficiency virus (HIV) as a result of transfusion of coagulation factor preparations. From an available pool of 92 males with haemophilia A or B, 18 patients seropositive for HIV infection and 11 seronegative patients were randomly selected for the study. We applied two instruments to measure the quality of life (QOL) in our patients. The first instrument was the quality of well-being (QWB) scale that unifies QOL into a single score based upon an assessment of the patient's symptoms and health-related reductions in mobility, physical activity and social activity. The second instrument was SF-36, the questionnaire from the Medical Outcome Study (MOS) that measures six dimensions of health status (physical functioning, role functioning, social functioning, pain, mental health and health perception). Measurements were obtained with both instruments at three interviews with each patient over a 1-year interval. As expected, HIV disease reduces QOL in haemophiliacs. The number of bleeding episodes within 2 months of interview was increased in the HIV-positive cohort but not within 6 days of interview, indicating that HIV disease independently affects QOL in haemophilia patients. In a typical 30-year-old patient, haemophilia itself has reduced quality of their lives by 9.3 years, and HIV disease additionally from 8.5 to 20 years. On the MOS scales, the two patient groups differed significantly only in the dimensions of health perception and pain magnitude. Although HIV disease led to a decrement in QOL of haemophilia patients, it also appears that haemophilia patients are able to develop coping skills to prevent more drastic effects of HIV disease on their QOL. Future studies will need to explore the nature and mechanisms of this 'buffering' effect.

Social support and postpartum depression.

Discrepancies between prenatal social support expectations and subsequent perceptions of support actually received were examined in relation to postpartum depression. Low-risk primiparous women (N = 105) were surveyed 1 month before and 1 month after delivery. Almost half of the women prenatally and one third postpartially had depression scores which would lead them to be classified as possibly depressed (CES-D scores of 16 or greater). In multiple regression, two social support discrepancy measures, prenatal depression and postpartal closeness to husband, correlated with postpartal depression and accounted for nearly 40% of its variance. The generalizability of the findings should be further explored, but the findings suggest the need for attention to prenatal expectations of postpartum support as a way to influence the incidence of postpartum depression. In addition, continued efforts to identify causes of postpartum closeness with the spouse are needed.

Guilt and help from friends: variables related to healthy behavior.

American college students' self-reported status regarding 13 health-related behaviors, and several potential predictors of healthy behavior were assessed. Healthy behaviors were, at best, weakly related to being informed about or agreeing with a rule that the unhealthy alternatives were dangerous. Healthy behaviors were more strongly related to reports that guilty feelings would result from choosing the unhealthy alternatives and that friends would help with the healthy behaviors. Higher levels of reported self-control also predicted healthier behavior.

The relationship among locus of control, coping styles, and psychological symptom reporting.

One hundred two subjects provided locus of control, coping style, psychological symptom, and related information. While locus of control and other predictors were related individually to reports of symptomatology, multiple regressions showed only direct coping strategies and lower reported perceptions of stressfulness as consistently predicting reduced symptom reporting; they generally predicted 25 to 35% of the variance in symptomatology. Direct coping, in turn, was found to be predicted strongly by the combination of increased age, perceptions of the controllability of situations, and an internal locus of control. Older subjects reported fewer attributions to chance locus of control, more direct coping, and less symptomatology, which suggests a possible developmental trend toward better adjustment in these relatively young adults.

An exploration of factors predicting the effects of aerobic conditioning on mood state.

This study explored variables which predict effects of an aerobic exercise program on mood. Adult members of an eight-week conditioning program improved significantly in mood, in comparison with non-exercising controls, immediately after and three months after the program. Mood improvement was predicted by initial mood, with improvement limited to the most mood-disturbed subjects. It was not, however, predicted by improvement on cardiovascular or other physical indices, by other psychological or demographic ratings, or by beliefs and expectations about physical fitness or about mood state.

A graphical judgmental aid which summarizes obtained and chance reliability data and helps assess the believability of experimental effects.

Interval by interval reliability has been criticized for "inflating" observer agreement when target behavior rates are very low or very high. Scored interval reliability and its converse, unscored interval reliability, however, vary as target behavior rates vary when observer disagreement rates are constant. These problems, along with the existence of "chance" values of each reliability which also vary as a function of response rate, may cause researchers and consumers difficulty in interpreting observer agreement measures. Because each of these reliabilities essentially compares observer disagreements to a different base, it is suggested that the disagreement rate itself be the first measure of agreement examined, and its magnitude relative to occurrence and to nonoccurrence agreements then be considered. This is easily done via a graphic presentation of the disagreement range as a bandwidth around reported rates of target behavior. Such a graphic presentation summarizes all the information collected during reliability assessments and permits visual determination of each of the three reliabilities. In addition, graphing the "chance" disagreement range around the bandwidth permits easy determination of whether or not true observer agreement has likely been demonstrated. Finally, the limits of the disagreement bandwidth help assess the believability of claimed experimental effects: those leaving no overlap between disagreement ranges are probably believable, others are not.

Back to basics: Percentage agreement measures are adequate, but there are easier ways.

Percentage agreement measures of interobserver agreement or "reliability" have traditionally been used to summarize observer agreement from studies using interval recording, time-sampling, and trial-scoring data collection procedures. Recent articles disagree on whether to continue using these percentage agreement measures, and on which ones to use, and what to do about chance agreements if their use is continued. Much of the disagreement derives from the need to be reasonably certain we do not accept as evidence of true interobserver agreement those agreement levels which are substantially probable as a result of chance observer agreement. The various percentage agreement measures are shown to be adequate to this task, but easier ways are discussed. Tables are given to permit checking to see if obtained disagreements are unlikely due to chance. Particularly important is the discovery of a simple rule that, when met, makes the tables unnecessary. If reliability checks using 50 or more observation occasions produce 10% or fewer disagreements, for behavior rates from 10% through 90%, the agreement achieved is quite improbably the result of chance agreement.

Control of responding by the elements of a compound discriminative stimulus and by the elements as individual discriminative stimuli.

In the first of two studies, the responding of four albino rats was differentially reinforced in the presence of noise and light together and then tested in the presence of the noise and the light separately during extinction. The light exercised substantially more control of responding than did the noise. In the second study the responding of a similar group of four rats was differentially reinforced in the presence of the noise and the light separately. Control of responding by the light developed more rapidly than control by the noise. Results suggest that levels of control by stimuli after differential reinforcement with respect to the stimuli together can be predicted by the rates of development of control during differential reinforcement with respect to the stimuli separately.