Psychosocial predictors of labor/delivery complications and infant birth weight: a prospective multivariate study.

Using a multidimensional approach to measure stress, this study prospectively examined the influence of maternal stress, social support and coping styles on labor/delivery complications and infant birth weight. Beginning in the third month of pregnancy, stress was assessed monthly. In each trimester, data on social support, coping strategies, lifestyle behaviors and pregnancy progress were collected. One month following delivery, information on labor, delivery and infant status was obtained. The final sample consisted of 80 women. The results demonstrated that women who experienced greater stress during pregnancy had a more difficult labor/delivery, even after controlling for parity. Younger maternal age was also linked with intrapartum complications. Perceived prenatal social support emerged as a predictor of infant birth weight. Women who reported less satisfaction with their social support in the second trimester gave birth to infants of lower birth weight. The results suggest an association between specific psychosocial variables and negative birth outcomes.

Psychosocial correlates of prepartum and postpartum depressed mood.

BACKGROUND: The aim of the present study was to delineate the influence of maternal stress, social support and coping styles on depressed mood during pregnancy and the early postpartum period. METHODS: Beginning in the third month of pregnancy, data on numerous variables including daily stress (Hassles), state-anxiety (STAI-state), pregnancy-specific stress (PEQ) and depressed mood (DACL) were collected monthly. In each trimester social support (SSQ), coping strategies (CISS) and pregnancy progress were assessed. Approximately 4-5 weeks following delivery, information on labor, delivery and infant status was collected and the DACL and the Edinburgh Postnatal Depression Scale (EPDS) were administered. The final sample consisted of 80 women. RESULTS: Approximately 16% of the women in this sample experienced depressed mood in the postpartum and 25% of the sample reported depressed mood only during pregnancy. Women depressed only during pregnancy and those depressed in the postpartum reported more emotional coping and higher trait and state anxiety during gestation. More hassles during pregnancy was related to prepartum depressed mood, but not postpartum depressed mood. Consistent with the literature, the best predictor of postpartum depressed mood was depressed mood during pregnancy. LIMITATIONS: The sample size was relatively small and we relied solely on self-reported depressive symptomology. CONCLUSIONS: The findings point to specific psychosocial variables which can be targeted early in pregnancy to reduce the rate of depressed mood in the prepartum and postpartum periods.

Variations in stress levels over the course of pregnancy: factors associated with elevated hassles, state anxiety and pregnancy-specific stress.

This prospective study tracked hassles, pregnancy-specific stress, and state anxiety during pregnancy. A second objective was to identify predictors of each stress dimension. Pregnant women (n=161) completed the Hassles Scale, the Pregnancy-Specific Stress Questionnaire (PEQ), and the state-anxiety scale (STAI-state) monthly, beginning in the third month of pregnancy. Hassles were found to be stable throughout the pregnancy. Women reported significantly higher pregnancy-specific stress in the first and third trimester of pregnancy, whereas state anxiety increased in the third trimester compared with the first and second trimesters. Poorer marital adjustment predicted higher Hassles during pregnancy and higher PEQ and STAI-state in the third trimester. Women who reported that the pregnancy would have a negative impact on their career scored higher on Hassles during pregnancy and higher on the PEQ in the third trimester. The occurrence of a gestational complication during pregnancy was related to higher pregnancy-specific stress in the third trimester. Younger women also reported higher PEQ results in the third trimester. The data provide support for a multidimensional conceptualization of stress during pregnancy.

A prospective study of the impact of psychosocial and lifestyle variables on pregnancy complications.

This prospective study examines the influence of maternal stress, social support and lifestyle variables reported over the course of pregnancy on subsequent gestational and intrapartum complications. Demographic and biomedical factors were also studied. One hundred and two women were followed on a monthly basis beginning in the third month of pregnancy. Measures of daily stress (hassles), state-anxiety (STAI-state) and pregnancy-specific stress were taken monthly. Pregnancy progress and lifestyle behaviors such as smoking, caffeine and alcohol intake were assessed by trimester. One month following delivery, a telephone interview was conducted to inquire about the labor/delivery and infant status. Sixty-three per cent of the women experienced a pregnancy complication. Three groups consisting of women who experienced gestational complications, intrapartum complications only, and no complications were formed. Women who subsequently experienced gestational complications reported over the course of their pregnancy higher levels of state-anxiety, daily hassles and pregnancy-specific stress beginning in the third month of pregnancy. Women who experienced complications during the intrapartum period only reported higher daily hassles during pregnancy and consumed more caffeinated beverages compared to the other groups. Primiparous women were more likely to experience gestational and/or intrapartum complications than multiparous women. These findings support a role for psychosocial variables in pregnancy complications. The results indicate that certain psychosocial and lifestyle variables may be differentially associated with complications occurring at various phases of pregnancy.

What do older good and poor sleepers do during periods of nocturnal wakefulness? The Sleep Behaviors Scale: 60+.

To determine whether older good and poor sleepers with and without insomnia complaints differ in the nature of activities they engage in during periods of nocturnal wakefulness, the authors developed and evaluated the Sleep Behaviors Scale: 60+. Good sleepers (n = 163), low-distress poor sleepers (n = 49), and high-distress poor sleepers (n = 28) were compared on this measure as well as on sleep parameters, personality, lifestyle, and cognitive-affective variables. Findings indicate good psychometric properties for the new measure, offer a rationale for examining the frequency of the nocturnal behaviors reflected by the measure's 4 subscales (Active Behaviors, Relaxation, Cognitive Arousal, and Medication), and suggest a possible role for these behaviors in the etiology and treatment of insomnia.

Poor sleepers who do not complain of insomnia: myths and realities about psychological and lifestyle characteristics of older good and poor sleepers.

Psychological adjustment, lifestyle, and sleep parameters were investigated in 634 older community residents. Participants were divided into three categories: good sleepers, poor sleepers experiencing high distress, and poor sleepers experiencing minimal distress. Results indicate that (1) highly distressed poor sleepers manifested an anxious, depressed, negative cognitive-affective set; (2) many coped well with age related changes in sleep quality--they resembled good sleepers in the relative absence of psychological maladjustment they displayed; (3) the three groups had similar lifestyles, but they differed in the cognitive-affective evaluation of their activities, (4) the insomnia complaint is itself multifaceted and is comprised of three distinct elements--difficulty sleeping, distress, and daytime fatigue; (5) sleep practices (e.g., naps, bedtimes) are not implicated in chronic poor sleep; and (6) many commonly held assumptions about sleep disruptions in older individuals are myth rather than reality. Implications for better understanding and treating insomnia in older individuals are discussed.

Reactions to infertility based on extent of treatment failure.

OBJECTIVE: To examine the relationship between amount of treatment failure and personal and marital distress. DESIGN: In this cross-sectional design, three groups of women (n = 91) with varying amounts of treatment failure experience were compared on measures of general and infertility-related distress and marital and sexual distress. RESULTS: The relationship between treatment failure experience and personal and marital distress was found to be curvilinear. The group that had a moderate amount of treatment failure experienced the most distress whereas the distress level of those without or with a high amount of treatment failure experience was comparable. The results also showed that the relationship between amount of treatment failure and distress was independent of age, years infertile, or years in treatment. CONCLUSION: The findings of this study provide support for infertility theories that suggest that infertility is a process rather than a series of independent emotional events and suggest that the distress women experience during infertility is a necessary part of their evolution toward acceptance of their infertility.

The effects of female sexual response in coitus on early reproductive processes.

Research has shown that infertility and its medical investigation are stressful for couples and have adverse effects on sexual functioning. The purpose of this study was to examine how female sexual functioning could influence aspects of the reproductive process. This question was examined within the context of the postcoital test (PCT) routinely performed during the infertility investigation. The sample consisted of 85 women with a mean age of 30 years (SD = 3.8 years) and a mean infertile period of 2.5 years (SD = 1.1 years). Prior to the physiological examination, women completed a battery of questionnaires about their sexual functioning during the scheduled encounter engaged in for purposes of the PCT and during other nonscheduled encounters. The results indicated that the PCT contributed to deterioration in female sexual functioning, and in turn, a poor sexual response was associated with poorer physiological results. The implications of sexual behavior influencing physiohormonal reproductive factors are discussed.

Evaluation of the sexual consequences of surgery: retrospective and prospective strategies.

To assess the impact of a stressor, it is desirable to evaluate affected individuals' status both prior to and following a stressful event. Because of the difficulties inherent in prospective designs, investigators often ask people who have experienced an aversive event to evaluate their prestressor adjustment retrospectively. Do such retrospective evaluations provide a reasonable alternative to prospective assessment? To answer this question we compared retrospective and prospective data gathering procedures in the evaluation of sexual adjustment after prostate surgery. One hundred fifty-two married males who had undergone prostatectomy for benign prostatic enlargement completed a battery of measures which evaluated pre- and postsurgical sexual adjustment either prospectively (i.e., before and after surgery) or retrospectively (i.e., ratings made after surgery of both pre- and postsurgical adjustment). Retrospective assessment indicated considerable sexual deterioration pre- to postsurgery. In subjects tested prospectively, however, the results showed that surgery had little impact on sexual adjustment. Moreover, direct comparisons of retrospective and prospective methodologies reveal that discrepancies are due to differences in evaluations of presurgery status, with retrospective evaluation yielding more favorable ratings than prospective assessment. The results highlight a variety of biases which may affect self-ratings of pre- and post-stressor adaptation and show that discrepancies associated with the two methodologies have important implications for understanding the impact of a stressor on adjustment.

Prostatectomy and inguinal hernia repair: a comparison of the sexual consequences.

This study investigated whether psychosexual changes found after surgery for benign prostatic enlargement relate specifically to the prostatectomy procedure or to the stresses of surgery in general. The sexual adjustment of 91 married men (ranging in age from 51 to 77) who had undergone either transurethral prostatectomy or inguinal hernia repair was compared using the same measures and experimental design. Results show that both surgeries appeared to result in relatively minor but widespread negative consequences for sexual adjustment and expression. Findings on both individual and couple sexual adjustment suggest that the psychosexual consequences of the two procedures do not differ substantially. As expected, the one exception was retrograde ejaculation, which was more likely to be experienced by men who had undergone prostate surgery. The results illustrate the necessity of conducting comparative studies when evaluating the sexual consequences of surgical procedures and highlight the importance of taking age into consideration when conducting research on the effects of surgery on older men.

Transurethral prostatectomy: differential effects of age category and presurgery sexual functioning on postprostatectomy sexual adjustment.

Sexual functioning and adjustment of 72 aging married males who had undergone transurethral prostatectomy were examined retrospectively according to their pre- and postsurgery status. Results indicate that although transurethral prostatectomy was generally associated with deterioration in various aspects of sexual expression, grouping subjects according to age and presurgery sexual adjustment qualified these general findings dramatically. For example, more younger than older males retained or attained good sexual adjustment after surgery. Furthermore, while older males with good presurgery sexual adjustment maintained good couple sexual functioning, they manifested greater loss of sexual self-confidence and individual sexual capacity than did their younger counterparts. In addition, the findings suggest that the question "Does transurethral prostatectomy affect sexual function?" must be rephrased to take into account changes in the cognitive, capacity, and affective domains as well as in the couple behavior and adjustment dimensions of sexual expression.

Self-monitoring and self-focus in erectile dysfunction.

Self-focused attention can cause anxiety and poor performance in those with low self-efficacy expectations. Self-monitoring is frequently used in sex therapy assessment. If self-monitoring is conceptualized as a self-focusing manipulation, it would be expected to cause "spectatoring," anxiety and deterioration in individuals with erectile dysfunction. Therefore, this investigation explored the relationship between the dispositional tendency to focus attention on the self (self-consciousness) and sexual behavior in males with erectile dysfunction, and evaluated the effects of self-monitoring on erectile dysfunctional males who differed in dispositional self-consciousness. Results indicate that (a) individuals with erectile dysfunction were less dispositionally self-conscious than nondysfunctional individuals, (b) self-monitoring had no adverse effects on any aspect of sexuality investigated, and (c) manipulated and dispositional self-focus had no interactive effects. Implications of these results for sex therapy and for a better understanding of etiological and maintaining factors in sexual dysfunction are discussed.

Measurement of therapy outcome and maintenance of gains in the behavioral treatment of secondary orgasmic dysfunction.

Choice of therapeutic goals and criteria used for evaluation of therapeutic outcome represent fundamental conceptual and methodological issues. The present investigation examined the relationship between how data were obtained (by retrospective questionnaire or ongoing daily self-monitoring), what outcome criteria were used (behavioral or cognitive-affective), whose data were being analyzed (the female or male partner), and when measurements were taken (at posttherapy or follow-up) in a sample of 23 couples with the problem of secondary orgasmic dysfunction in the wife. The results indicate that retrospective measurement was more optimistic than ongoing; cognitive-affective changes were twice as likely to occur as changes in behaviors; females benefited more than males; and there were considerable losses of therapeutic gains at follow-up. These results underscore the need for multiple measurement techniques and highlight the multidimensional quality of the sexual experience.

Androgen enhances sexual motivation in females: a prospective, crossover study of sex steroid administration in the surgical menopause.

Various parameters of sexual functioning were assessed in a prospective, crossover investigation of 53 surgically menopausal women. Patients randomly received either an estrogen-androgen combined preparation, an estrogen-alone drug, an androgen-alone drug, or a placebo. Also included were a group of women who had undergone hysterectomy and whose ovaries had been left intact. Two treatment phases, each of 3 months' duration, were separated by an intervening placebo month. Additionally, plasma levels of total estrogens and testosterone were assayed four times during the study concurrent with monitoring of sexual behaviors. It was clear that exogenous androgen enhanced the intensity of sexual desire and arousal and the frequency of sexual fantasies in hysterectomized and oophorectomized women. However, there was no evidence that testosterone affected physiologic response or interpersonal aspects of sexual behavior. These findings suggest that the major impact of androgen in women is on sexual motivation and not on sexual activity per se.

An analysis of the effectiveness of two components in the treatment of erectile dysfunction.

This study compared the effectiveness of two components, a ban on sexual intercourse and communication of sexual preferences, in the treatment of couples in which the male was experiencing erectile dysfunction. Sixteen couples were randomly assigned to one of two treatment conditions. In one condition spouses were asked to refrain from intercourse and to make an effort to communicate sexual tastes and preferences during noncoital erotic interaction. Couples in the second condition were assigned only the communication portion of the therapeutic instructions given to the first group. The treatment consisted of written instructions concerning tasks to be carried out at home. Therapist contact was minimal. Following a 1-month baseline period of self-monitoring using a daily record-keeping form, couples underwent a 1-month treatment period and follow-up testing after another month. Male subjects also underwent an endocrinological examination to ascertain testosterone and related hormone levels prior to participating in the treatment. Both treatment groups reported significant improvement in several measures of erectile functioning, general sexual functioning, and marital adjustment. However, the ban on intercourse did not add to the effectiveness of encouraging sexual communication, indicating that the former component probably did not contribute to change. Two pretreatment measures, the Sexual Interaction Inventory and testosterone level, were found to predict treatment outcome with sufficient accuracy to permit selection of future patients who might benefit from this type of treatment format. The effectiveness of a treatment consisting of written instructions with minimal therapist contact for males with erectile dysfunction have important cost-benefit implications.

Ejaculatory incompetence: a theoretical formulation and case illustration.

Three theoretical formulations of ejaculatory incompetence have been proposed in the literature. They include: (1) aversive conditioned inhibition of the ejaculatory reflex, (2) an "autosexual" orientation associated with discrepant levels in the cognitive and physiological dimensions of sexual arousal, and (3) a discriminative learning model. These three models are discussed in relation to their theoretical and therapeutic implications. Clinical data supporting the discriminative view is presented.

A comparison of three therapeutic formats in the treatment of secondary orgasmic dysfunction.

The goal of the present study was to compare the effectiveness of three therapeutic formats: Standard Couple Therapy, Group Therapy, and Minimal Contact Bibliotherapy (self-help) in the treatment of 23 couples in which the wife was suffering from secondary orgasmic dysfunction. The results indicate that a cognitive-behavioral sex therapy program is clearly effective in changing a wide range of subjective satisfaction and behavioral measures, with concurrence of the husbands' and wives' data providing further strength to these findings. Differences in outcome which were elicited in the three experimental treatment conditions were mainly in favor of the Standard Couple condition. Since such differences were neither frequent nor great, practical issues related to increasing the effectiveness of less time-consuming treatment formats are discussed. In addition, the theoretical implications of using global versus specific therapy outcome criteria are explored.

Methodological issues in the study of sex therapy: effective components in the treatment of secondary orgasmic dysfunction.

Three components commonly utilized in sex therapy for secondary orgasmic dysfunction (Sensate Focus I, Sensate Focus II, and ban on intercourse) were studied, with the aim of not only exploring their effects on therapy outcome but also, in part, of sensitizing investigators to the benefits of incorporating component analyses within larger investigations of therapy outcome. The subjects were 23 married couples with the problem of secondary orgasmic dysfunction in the wife. Subjects were administered a multicomponent therapy program over a 14-week period. Daily self-monitoring data were analyzed to assess the impact of Sensate Focus exercises and banning intercourse on both broad (e.g., enjoyment) and narrow (e.g., orgasmic response) criteria of therapeutic effectiveness. Results indicated that for females, sensate focus exercises, in combination with a ban on intercourse, led to a significant increase in level of enjoyment for subsequent noncoital sexual caressing as well as intercourse. Orgasmic responsiveness, however, was not affected. The methodological issues of broad versus narrow therapeutic effects, compliance with treatment, and cost-effective techniques for the study of sex therapy components are discussed.

Xenogeneic skin and kidney transplants in a closely related canine system, fox-dog.

Fox kidney and skin grafts were transplanted into dog recipients. Fox kidneys, transplanted en bloc into untreated dogs, survived 6.2 +/- 0.4 days. The skin transplants survived 5.9 +/- 1.4 days. The grafted kidneys showed almost normal function before rejection. Both skin and kidney rejection were mediated through a cellular mechansim. Performed natural antibodies against donor tissue were not present in the serum of the recipients. These results combined with absorption studies suggested a close relationship between fox and dog, but different number and morphology of chromosomes, immunoelectrophoretic patterns of serum proteins, and disparities of the transplantation antigens proved that the fox is a species quite separate from the dog. It was concluded that the fox-dog system, with its similarity to the chimpanzeeman relationship, offers a unique model to study clinically applicable methods of managing xenografts between closely related species.