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BACKGROUND: The objective of this study was to examine the association between self-rated health (SRH) and physical, functional, social and mental health measures in community dwelling elderly people needing nursing care. Of special interest was how coping resources (SOC) influenced this relationship. Self-rated health is a good predictor of future health status as measured by mortality and morbidity, decline of functional abilities, use of healthcare, and nursing home placement. The high mean age and the relatively high level of care-dependency in this sample, make this investigation important. METHODS: A hierarchical regression analysis was applied in a cross sectional sample of 242 elderly (mean age 84.6 years). RESULTS: Subjective health complaints (SHC) in both sexes, and psychological distress (only in men), was associated directly with SRH. Coping resources associated with SRH directly, and indirectly through subjective perceived health (SHC and GHQ) but only in men. The influence of registered illness was mediated through the effects of subjectively perceived health in both women and men. Sex differences moderated the effects of SOC on SRH. CONCLUSION: Subjectively perceived health was more important in the perception of SRH than objective health measures. Men, in contrast to women, tend to convert physical illness into emotional distress.

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Relationships between anxiety, social support, coping, and defence, in connection to mental health, were studied among patients with suspected breast cancer, awaiting diagnosis. Data were collected by questionnaires from 117 women, 25-76 years of age (mean: 53.6 years) who had undergone breast biopsy. Instruments used were: the Social Provisions Scale (SPS); the state scale of State-Trait Anxiety Scale (STAI); and CODE [based on the Utrecht Coping List (UCL) and Defence Mechanisms Inventory (DMI)]. The results showed that patients reported elevated levels of anxiety and high levels of social support. Yet, anxiety was strongest and negatively related to 'instrumental coping', followed by 'cognitive defence'. 'Defensive hostility' was unrelated to anxiety. Unexpectedly, 'emotion-focused coping' and social provisions were unrelated to anxiety. Social provisions were somewhat related to 'instrumental coping', but sparsely related to 'emotion-focused coping', unrelated to 'cognitive defence' and partly negatively related to 'defensive hostility'. Hence, social support and 'emotion-focused coping' did not in themselves repress anxiety. 'Instrumental coping' did, even in a situation where nothing could be done. Social support is suggested to be the product of an 'instrumental coping style', not necessarily contributing to it. Clinical consequences for professional information and support to patients with different coping styles are suggested.

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It has long been recognized that infrequent micturition and incomplete emptying of the bladder in children represent important factors in the causation of incontinence during the day, and of urinary tract infections (UTI). Behaviour modification is well documented, both as an individual- and a group intervention. The purpose of our study was to develop a programme for group intervention with children, with the aim of improving the children's micturition habits and thereby changing the frequency of wettings, the amount of residual urine, and the UTI frequency. The children responded quickly to the intervention. The amount of residual urine was unaffected, but there are methodological problems in measuring this. There were, however, significant reductions in incontinence and UTI, although there was a tendency to relapse of incontinence over time, probably because of lack of continued follow-up. It is tentatively concluded that the described behavioural intervention seemed effective in improving children's micturition habits, thereby changing the frequency of wettings, and the frequency of urinary tract infections. The treatment seems to be suitable for nursing intervention, either within a hospital setting, or on an outpatient, primary care basis.

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The effect of gender role on coping with conjugal bereavement was studied in 44 Norwegian widows. A "traditional" and a "modern" feminine gender role were juxtaposed. Information was collected by two semi-structured interviews concerning coping with bereavement, and by a health inventory (UHI). The information was analysed qualitatively in relation to central elements in the coping process (appraisals, problems, coping strategies, self-evaluations of coping, future expectancies of coping, and relevance of external resources). The findings revealed considerable differences in coping between the two gender roles, favouring the modern feminine gender role.

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Coping was examined as an intervening variable between the stressor of bereavement and its effects on subjective health and immunity in thirty-nine recently bereaved Norwegian women. Coping was defined as: "positive response outcome expectancies". Data were collected approximately one month after the death of the husband, and twelve months thereafter. Data collected were: expected coping success (self-scoring), subjective health (UHI), anxiety and depression (GWB), and immunoglobulins (IgA, IgM, IgG) with components (C3, C4). Statistics were: frequencies, paired t-test, ANOVA, and MANOVA. Permissions and confidentiality were in accordance with the Helsinki-declaration. Coping was found to be related strongly to health and to health changes. Few relations were found between immunity and health. Coping, health, and anxiety and depression formed a triangle of interrelations. It was concluded that coping defined as "positive response outcome expectancies" may be a predictor of the adaptational outcome after a crisis.

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Freud's concept of defence mechanisms means a perceptual, emotional or cognitive distortion of the inner or outer reality. The opposite of defence mechanisms is coping mechanisms. The adaptiveness/maladaptiveness of defences are disputed. Various fields of research have given evidence to their maladaptiveness as ways of dealing with threatening stimuli. It has been found that defences can lead to insensitivity to danger signals, lowered coping capacity to life stresses with increased vulnerability to "psychosomatic diseases", delay in seeking help for somatic symptoms, denial of death in dying patients, their relatives and medical attendants, and delayed or complicated grief reactions.

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