RESUMEN
Bereaved spouses comprise a population at risk for psychological distress. Evidence suggests that spouses 55 years of age and younger are at increased risk of morbid outcomes, including major depressive episodes. Although the emotional impact of the sudden loss of a spouse has been well studied, less attention has been paid to the psychological impact of loss that is foreseeable, as in the case of a serious illness. In this study, data were obtained from pre-death interviews with 103 well spouses of terminally ill cancer patients. Subjects were white, 55 years of age or younger, and living with the patient and their child(ren) aged 7 to 16 years old. Depressive distress was assessed using the Brief Symptom Inventory. Fifty eight percent of males and 42% of females had scores for depressive distress in a clinically significant range. Regression analyses revealed gender was the most important predictor of the level of depressive distress reported, followed by patient's functional status and whether the well spouse quit work as a result of the patient's illness. The number of children 18 years or younger living in the household was inversely related to the level of depressive distress. The results of this analysis suggest that a large proportion of well spouses of patients with cancer who are also the parents of school-aged children may experience significant depressive distress during the terminal phase of their spouse's illness. These findings are important for planning future programs and improving existing ones for the spouses of terminal cancer patients.
Asunto(s)
Depresión/psicología , Neoplasias/psicología , Esposos/psicología , Cuidado Terminal/psicología , Actividades Cotidianas , Adolescente , Adulto , Niño , Femenino , Pesar , Humanos , Masculino , Persona de Mediana Edad , Análisis de Regresión , Encuestas y CuestionariosRESUMEN
A two-stage study was undertaken of outpatients with advanced cancer who were receiving chemotherapy. In Stage 1 of the study, their needs for practical services and the barriers to those needs being met were assessed. Based on these results, an intervention was designed to reduce the prevalence of patients' unmet needs. The intervention was an automated telephone needs assessment coupled with social worker follow-up. The efficacy of this intervention was evaluated using an independent sample in Stage 2 in an experimental trial. Patients in the experimental group (n = 109), who received three automated surveys, reported fewer unmet needs in a subsequent comprehensive assessment than those in the control group (n = 130). The computerized telephone outreach system proved to be a cost-effective and reliable method for the early identification of unmet patient needs soon after they emerge and efficient deployment of limited professional staff.
Asunto(s)
Sistemas de Computación , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Necesidades y Demandas de Servicios de Salud , Neoplasias/terapia , Servicio de Asistencia Social en Hospital/organización & administración , Anciano , Instituciones Oncológicas/organización & administración , Estudios de Evaluación como Asunto , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Neoplasias/tratamiento farmacológico , Neoplasias/psicología , Ciudad de Nueva York , Evaluación de Procesos y Resultados en Atención de Salud , Pacientes Ambulatorios/psicología , Evaluación de Programas y Proyectos de Salud , Apoyo Social , TeléfonoRESUMEN
Although a substantial number of children experience serious parental illness and death, the adjustment problems attendant to the stress of having a fatally ill parent have not been examined systematically. This paper compares the psychosocial adjustment of 62 school-aged children with a terminally ill parent (study sample) with that of children in a community sample, using several standard rating scales. Study children had significantly higher levels of self-reported depression (Children's Depression Inventory) and anxiety (State-Trait Anxiety Inventory) and lower self-esteem (Self-Esteem Inventory). Parents also reported study children's significantly higher behavior problems and lower social competence (Child Behavior Checklist). Increased professional attention to this vulnerable population is encouraged.
Asunto(s)
Adaptación Psicológica , Aflicción , Trastornos Reactivos del Niño/psicología , Hijo de Padres Discapacitados/psicología , Neoplasias/psicología , Cuidado Terminal/psicología , Adolescente , Niño , Femenino , Humanos , Masculino , Determinación de la PersonalidadRESUMEN
A brief, standardized intervention program to facilitate children's adjustment to the terminal illness and death of a parent posed the following implementation problems: estimation of patient life expectancy; engagement of the family in crisis; adhesion to the parental guidance model; and termination of formal clinical intervention. Resolution of these issues is described, and adaptation of such programs to other high-risk populations is considered.
Asunto(s)
Trastornos de Adaptación/prevención & control , Trastornos Reactivos del Niño/prevención & control , Terapia Familiar/métodos , Pesar , Privación Materna , Privación Paterna , Psicoterapia Breve/métodos , Síndrome de Inmunodeficiencia Adquirida/psicología , Adaptación Psicológica , Trastornos de Adaptación/psicología , Niño , Trastornos Reactivos del Niño/psicología , Humanos , Neoplasias/psicología , Relaciones Padres-Hijo , Cuidado Terminal/psicologíaRESUMEN
The problems that people experience in social roles can be regarded as either causes or consequences of psychological symptoms. To reflect one of these possibilities, Pearlin et al. (1981) developed measures of "role strains" which are considered sources of psychopathology. To reflect the other position, Dohrenwend et al. (1981) constructed measures of "role functioning" which are seen as consequences of psychopathology. We show that the measures developed by these two teams of investigators are similar in content and show substantial empirical overlap despite the different meanings attributed to them. In an effort to understand whether these highly correlated measures assess, "role strain" or "role functioning," we conduct an exploratory analysis of marital and housework role problems, using a small panel sample of New York City residents. Specifically, we use instrumental variables to identify reciprocal effects between psychological distress and each role area. We find that the relationship between housework role problems and distress is more consistent with Pearlin et al.'s interpretation, whereas the relationship between marital problems and distress is more consistent with that of Dohrenwend et al. Investigators interested in measuring either role strain or role functioning must bear in mind the strong possibility of contamination from the other construct.
Asunto(s)
Trastornos Mentales/psicología , Rol , Escolaridad , Estudios de Seguimiento , Humanos , Acontecimientos que Cambian la Vida , Trastornos Mentales/diagnóstico , Trastornos Mentales/epidemiología , Ciudad de Nueva York/epidemiología , Grupos Raciales , Medio Social , Estrés Psicológico/etiología , Estrés Psicológico/psicología , Estados UnidosRESUMEN
Healthy parents' perceptions of their competence to meet children's needs during the terminal illness of the other parent were measured on five major domains of parent-child relationships and parental functioning central to children's healthy development. Significant declines from pre-illness competence were perceived, of which the greatest were in emotional sensitivity and responsiveness, and ability to set limits and impose discipline. Implications for the development of preventive intervention strategies are discussed.
Asunto(s)
Pesar , Matrimonio , Neoplasias/psicología , Relaciones Padres-Hijo , Desarrollo de la Personalidad , Cuidado Terminal/psicología , Adolescente , Adulto , Niño , Femenino , Humanos , Individualidad , Masculino , Privación Materna , Persona de Mediana Edad , Privación Paterna , Pruebas de Personalidad , AutoimagenRESUMEN
The death of a parent seriously threatens children's social and emotional development. When the death can be anticipated, early intervention may facilitate children's adjustment. A prevention program designed to enable parents to foster their children's necessary grief work and resolution of the loss is described.
Asunto(s)
Trastornos Reactivos del Niño/prevención & control , Pesar , Privación Materna , Privación Paterna , Adaptación Psicológica , Niño , Trastornos Reactivos del Niño/psicología , Humanos , Matrimonio , Neoplasias/psicología , Relaciones Padres-Hijo , Apoyo Social , Asistencia Social en Psiquiatría , Cuidado Terminal/psicologíaRESUMEN
A longitudinal study of patterns of sexual behavior among asymptomatic, homosexual males in New York City was conducted. Participants were interviewed at two time points, 6 months apart. Based on their reports of sexual behavior during a recent 'typical' month, respondents were classified at each time point as engaging in safer (or low-risk) sexual practices versus high-risk sexual behaviors. Discriminant analysis was employed to distinguish the 53 males classified as risky at both time 1 and time 2 from the 47 males classified as safer in both periods. Statistically significant discrimination was achieved with 10 psychosocial predictor variables, four of which were significant while controlling for all other variables in the model. Of these predictors, drug use within sexual contexts was particularly noteworthy, since it provided the greatest relative contribution to the discriminant function and appears to be an important candidate for educational intervention. Other significant variables included perceived adequacy of emotional support, number of years engaged in regular sexual intercourse with other males, and perceived difficulty in modifying sexual behavior. Self-esteem and alcohol consumption approached significance.
Asunto(s)
Homosexualidad/psicología , Conducta Sexual , Síndrome de Inmunodeficiencia Adquirida/prevención & control , Adulto , Consumo de Bebidas Alcohólicas , Terapia Conductista , Humanos , Estudios Longitudinales , Masculino , Ciudad de Nueva York , Factores de Riesgo , Autoimagen , Parejas Sexuales/psicología , Apoyo Social , Trastornos Relacionados con Sustancias/psicologíaRESUMEN
The feasibility of using a computer-automated telephone outreach system to routinely assess the needs of chemotherapy outpatients was evaluated. The automated intervention was designed as a cost-efficient strategy for assessing patients' needs on a periodic basis so that emerging needs could be identified in a timely way. Ninety-seven chemotherapy outpatients were surveyed at least once over the telephone by a computer in a high-quality, digitally stored voice asking 12 questions regarding the patients' "concrete" needs. Early results of this larger ongoing study, in which patients are scheduled to be called every 4 to 6 weeks for approximately four months, indicated that computer-automated surveys had broad-based acceptance among our outpatients and that patients were able to comply accurately with the survey's instructions. Furthermore, the speech recognition system was found to be reliable, and patients' response patterns to the automated surveys valid. Nonparticipation in this study (28.0%) was not substantially higher than in our previous research within this patient population and neither nonparticipation nor attrition appeared significantly attributable to the automation itself. This method offers the potential for cost-efficient, universal, and ongoing assessment of patient needs, facilitating timely intervention, and efficient use of professional staff.