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Biomedical subjects

G E Vaillant

Publications and source records attributed to G E Vaillant.

At least 19 recordsLinked to original sources
PubMed2001

Healthy aging among inner-city men.

OBJECTIVE: Until now, prospective studies of aging have begun with 50- to 60-year olds, not adolescents. Premature deaths, childhood variables, and alcohol abuse have been often ignored. So has positive aging. As people live longer, gerontology needs to understand the determinants of health as well as illness in the later years. METHOD: The present study follows a cohort of adolescent boys (332 inner-city youths) for 60 years or until death. Complete physical exams were obtained every 5 years and psychosocial data every 2 years. Predictor variables assessed prior to age 50 include six variables reflecting uncontrollable factors--parental social class, environmental strengths, number of family problems, major depression, ancestral longevity, and premorbid physical health at age 50--and six variables reflecting (at least some) personal control: alcohol abuse, smoking, marital stability, body mass index, coping mechanisms, and education. The four outcome variables chosen to assess healthy aging at 70 reflected both "mind" and "body." They included objectively assessed variables (death and/or disability prior to 70, and objective mental health) and two subjectively assessed variables (perceived instrumental activities of daily living and life enjoyment). RESULTS: Multivariate analysis suggested that positive aging at 70 could be predicted by variables assessed prior to age 50. More hopeful still, if the six variables under some personal control were controlled, depression was the only uncontrollable variable that affected the quality of subjective and objective aging. CONCLUSIONS: First, we may have greater personal control over our biopsychosocial health after retirement than previously recognized. Second, in this cohort, psychiatric rather than sociological predictors appeared more important.

Adolescent↗
PubMed2001

Successful aging.

OBJECTIVE: Until now, prospective studies of aging have begun with 50-60-year-olds, not adolescents. Premature death, childhood variables, and alcohol abuse have been often ignored, as has successful aging. METHOD: The authors reviewed the existing literature on health in late life in order to highlight that, increasingly, successful aging is not an oxymoron. The present study followed two cohorts of adolescent boys (237 college students and 332 core-city youth) for 60 years or until death. Complete physical examinations were obtained every 5 years and psychosocial data every 2 years. Predictor variables assessed before age 50 included six variables reflecting uncontrollable factors: parental social class, family cohesion, major depression, ancestral longevity, childhood temperament, and physical health at age 50 and seven variables reflecting (at least some) personal control: alcohol abuse, smoking, marital stability, exercise, body mass index, coping mechanisms, and education. The six outcome variables chosen to assess successful aging at age 70-80 included four objectively assessed variables (physical health, death and disability before age 80, social supports, and mental health) and two self-rated variables (instrumental activities of daily living and life enjoyment). RESULTS: Multivariate analysis suggested that "good" and "bad" aging from age 70-80 could be predicted by variables assessed before age 50. More hopeful still, if the seven variables under some personal control were controlled, depression was the only uncontrollable predictor variable that affected the quality of subjective and objective aging. CONCLUSIONS: One may have greater personal control over one's biopsychosocial health after retirement than previously recognized.

Adolescent↗
PubMed2000

Adaptive mental mechanisms. Their role in a positive psychology.

Psychology needs a metric for positive mental health that would be analogous to the IQ tests that measure above-average intelligence. The Defensive Function Scale of the DSM-IV offers a possible metric. In the present article the author links the transformational qualities of defenses at the mature end of the Defensive Function Scale--altruism, suppression, humor, anticipation, and sublimation--to positive psychology. First, the methodological problems involved in the reliable assessment of defenses are acknowledged. Next, the use of prospective longitudinal study to overcome such difficulties and to provide more reliable definition and measurement of defenses is outlined. Evidence is also offered that, unlike many psychological measures, the maturity of defenses is quite independent of social class, education, and IQ. Last, evidence is offered to illustrate the validity of mature defenses and their contribution to positive psychology.

Adaptation, Psychological↗
PubMed2000

Social/emotional intelligence and midlife resilience in schoolboys with low tested intelligence.

Seventy-three inner-city boys with a mean IQ of 80 were followed prospectively from age 14 until age 65. Their adult adjustment was compared to a socioeconomically matched sample of 38 boys with a mean IQ of 115. Although childhood social disadvantage did not distinguish the groups with low and high IQs, half of the low-IQ men enjoyed incomes as high and had children as well-educated as did the high IQ men. These resilient low-IQ men were more likely to be generative, to use mature defenses, and to enjoy warm object relations than the high IQ group as a whole.

Adaptation, Psychological↗
PubMed2000

Delinquency and mortality: A 50-year follow-up study of 1,000 delinquent and nondelinquent boys.

OBJECTIVE: It is well established that until age 40 years, delinquent individuals have roughly twice the mortality of nondelinquent individuals and that the excess deaths are largely due to accidents, violence, and substance abuse. The present study examined if the increased mortality of delinquent subjects continues until age 65 years and, if so, why. METHOD: The authors followed 475 delinquent and 456 matched nondelinquent comparison boys from age 14 years until age 65 years. RESULTS: Thirteen percent (N=62) of the delinquent and only 6% (N=28) of the nondelinquent subjects died unnatural deaths. By age 65 years, 29% (N=139) of the delinquent and 21% (N=95) of the nondelinquent subjects had died from natural causes. In a univariate analysis, frequency of delinquency, abuse of alcohol, adult crime, dysfunctional home environment, and poor education were significantly related to death, especially to unnatural death. However, when delinquency and alcohol abuse were controlled by logistic regression, education, dysfunctional upbringing, and adult criminality made no further contributions to mortality. CONCLUSIONS: Although delinquency is strongly associated with premature mortality, the etiological links remain unclear. Alcohol abuse and poor self-care in adulthood (e.g., infections or accidents) account for most of the modest variance in mortality that could be accounted for.

Adolescent↗
PubMed1998

Are social supports in late midlife a cause or a result of successful physical ageing?

BACKGROUND: Many studies have noted a strong association between poor social support and premature mortality. A limitation of such studies has been their failure to control adequately for confounders that damage both social supports and physical health. METHODS: A 50-year prospective multivariate study of 223 men was used to examine the possible causal relationships between social supports and health. Alcohol abuse, prior physical health and mental illness prior to age 50 were controlled. Relative social supports were quantified over the period from age 50 to 70. RESULTS: Adequacy of social supports from age 50 to 70 was powerfully correlated with physical health at age 70 (P < 0.001). However, such social supports were also powerfully predicted by alcohol abuse (P < 0.001), smoking (P < 0.001) and indicators of major depressive disorder (P < 0.01) assessed at age 50. When prior smoking, depression and alcohol abuse were controlled, then the association of physical health with social supports was very much attenuated. Some facets of social support like religion and confidantes were unassociated with health even at a univariate level. Surprisingly, in this sample friends seemed more important for sustained physical health than closeness to spouse and to children. CONCLUSIONS: While social supports undoubtedly play a significant role in maintaining physical well-being in late life, much of the association between poor social supports and mortality may be mediated by alcoholism, smoking and pre-morbid psychopathology.

Activities of Daily Living↗
PubMed1998

A 50-year longitudinal study of defense use among inner city men: a validation of the DSM-IV defense axis.

The patterns of use of defense mechanisms by 306 inner-city men were rated from interviews at age 47 and these ratings were analyzed by cluster analysis. Five clusters resulted. The correlates of cluster membership were examined using data from the 50-year longitudinal study of these men. One cluster exhibited the greatest use of mature defenses; the men in this cluster functioned best on all psychosocial and health variables. Two clusters of men used primarily neurotic defenses; these men functioned at an intermediate level on all outcomes. The men in two clusters primarily used immature defenses. The men in one of these clusters used primarily action defenses, whereas the men in the other cluster were the greatest users of projection and fantasy. In general, the men in both these clusters functioned worse than those in the other three. However, the users of action defenses exhibited greater sociopathy, alcohol problems, and marital instability. The findings provide general support for the DSM-IV hierarchy for nonpsychotic defenses, with mature defenses at the top, neurotic defenses in the middle, and action defenses toward the bottom. In particular, the study supports the DSM-IV distinction of action defenses from other immature defenses.

Adaptation, Psychological↗
PubMed1998

Anonymity, neutrality, and confidentiality in the actual methods of Sigmund Freud: a review of 43 cases, 1907-1939.

OBJECTIVE: The aim of this historical study was to examine the methods actually used by Sigmund Freud in his practice of psychoanalysis in his mature years (1907-1939) and to assess the relationship between these methods and Freud's published recommendations concerning anonymity, neutrality, and confidentiality. METHOD: The authors used both published and unpublished sources, including reports or autobiographies by analysands, letters by analysands, interviews of analysands, letters by Freud, published works by Freud, and clinical records of subsequent treatment. RESULTS: Information concerning Freud's actual methods was found in 43 cases, including 10 clinical psychoanalyses, 19 didactic analyses, and 14 with combined clinical and didactic purposes. These 43 cases probably encompassed a majority of Freud's psychoanalytic hours during these years. Deviations from Freud's recommendations were found to the following extent: for anonymity, 43 cases (100%); for neutrality, 37 cases (86%); for confidentiality, 23 cases (53%). In addition, there were significant extra-analytic relations between Freud and 31 of these analysands (72%). CONCLUSIONS: These results show a substantial disparity between Freud's recommendations and his actual methods. Freud's prescribed method, as defined by his recommendations, was not tested or used in his practice. Freud's actual method was never explicitly described in his writings and cannot be replicated.

Austria↗
PubMed1998

Natural history of male psychological health, XIV: Relationship of mood disorder vulnerability to physical health.

OBJECTIVE: A 55-year prospective study attempted to determine the antecedents and consequences of positive mental and physical health in adult men. A substudy was conducted to look at the late-life physical health of men selected to be as unlike men with major depressive disorder as possible. METHOD: Of 237 men selected for health and followed since college, 64 undistressed men had never used mood-altering drugs or consulted a psychiatrist before the age of 50. The health at age 70 of these 64 men was compared with that of 20 men classified as depressed at age 70, 109 men classified as neither healthy nor depressed at age 70, and 44 men classified as having alcohol dependence or abuse at age 70. RESULTS: At age 70, the 64 undistressed men enjoyed significantly better health than the 109 men in the intermediate group. Only three (5%) of the 64 undistressed men were dead or disabled by age 70, compared with 30 (28%) of the 109 men in the intermediate group and nine (45%) of the 20 depressed men. The mean age of the subjects' maternal grandfathers at death also significantly differentiated the three groups. The differences in longevity among the three groups could not be explained by personality disorder, by cigarette, dietary, or alcohol abuse, or by longevity of the subjects' other first-degree ancestors. CONCLUSIONS: These findings lend support to the hypothesis that risk of affective disorder may lie along a continuum. At one extreme may be men with stable lifestyles, a lifelong resistance to mood disorder, and unusually good physical health in late life. At the other extreme of the continuum may be men with vulnerability to mood disorder and accelerated physical aging.

Adult↗
PubMed1998

Field trial of a diagnostic axis for defense mechanisms for DSM-IV.

Following critiques that the DSM multiaxial system lacks psychodynamic information useful for treatment, an axis for defense mechanisms was developed for DSM-IV, including up to 7 individual defenses from a glossary of 27, and 3 predominant defense levels from a list of 7. We tested the feasibility, reliability, and discriminability of the proposed axis. Clinician and psychiatric resident volunteers were trained at two U.S. and one Norwegian sites. After conducting initial interviews on 107 patients, they rated the DSM-III-R and defense axes, as did a second blind rater. Median kappa reliabilities were .42 (individual defenses), and .47 (defense levels). A summary measure, Overall Defensive Functioning (ODF), had similar reliability to current GAF (IR .68 vs. .62), similar 1-month stability (.75 vs. .78), but greater 6-month stability (.51 vs. .17). Independent of Axis III, ODF had small to moderate associations with other Axes and symptoms. Our findings indicate that the defense axis is a feasible, acceptably reliable, and nonredundant addition to DSM-IV, which may prove useful for planning and conducting treatment.

Adult↗
PubMed1997

Does depression generate negative life events?

This prospective study investigated whether major depressive disorder can cause negative life events. One hundred and thirteen normal college men have been followed biennially from age 26 until age 62. Fourteen major negative life events were assessed retrospectively by a self-report checklist. A blind rater read each man's complete records over the 35 years and used the same checklist prospectively. The negative life events were divided into dependent and independent groups according to whether the men's own behavior could have played a role in causing the events. In comparison with the normal control group, depressed individuals had a higher density of dependent negative life events after their first episode of depression. This difference did not exist for the occurrence of independent negative life events. Independent negative life events tended to be related to help seeking behaviors rather than to depression. This study confirmed our hypothesis that affective spectrum disorder can generate self-induced negative life events, which may contribute to the chronicity of the disorder.

Adult↗
PubMed1996

A long-term follow-up of male alcohol abuse.

BACKGROUND: This study attempted to determine the course of male alcohol abuse from the age of 40 years to 60 or 70 years, to estimate the duration of abstinence required for stable remission and to study the hypothesis of progression of symptoms in chronic alcohol abuse. METHODS: The subjects were 268 former Harvard University (Cambridge, Mass) undergraduates (college sample) and 456 nondelinquent inner-city adolescents (core city sample) who had been repeatedly studied in multidisciplinary fashion since 1940. Since 47 years of age, these men have been followed up biennially by questionnaire and every 5 years by physical examination. At some point during their lives, 55 (21%) of the college and 150 (33%) of the core city men met DSM-III criteria for alcohol abuse. The college cohort has been followed until the age of 70 years, the core city cohort until age 60 years. The dependent variables were mortality and alcohol abuse status every 5 years. RESULTS: By 60 years of age, 18% of the college alcohol abusers had died, 11% were abstinent, 11% were controlled drinkers, and 59% were known to be still abusing alcohol. By 60 years of age, 28% of the core city alcohol abusers had died, 30% were abstinent, 11% were controlled drinkers, and only 28% were known to be still abusing alcohol. CONCLUSIONS: In three respects the two socially divergent samples resembled each other. After abstinence had been maintained for 5 years, relapse was rare. In contrast, return to controlled drinking without eventual relapse was unlikely. Alcohol abuse could continue for decades without remission or progression of symptoms. The samples differed in that the core city men began to abuse alcohol when younger and, although they were more likely than the college men to become alcohol dependent, the core city men were twice as likely to achieve stable abstinence.

Adult↗
PubMed1996

1995 IPA/Bayer Research Awards in Psychogeriatrics. Late-life consequences of affective spectrum disorder.

Recent research suggests that affective disorder is associated with increased mortality and physical morbidity, but the reasons for this association remain uncertain. This report describes a 50-year prospective study of 240 men evaluated from the time they were university students in 1940-1942. A family history of mental illness was obtained and the men's habits, psychological adjustment, and marital and occupational satisfaction were followed every 2 years and their objective physical health was tracked every 5 years until age 70. Twenty-five men were identified as having affective spectrum disorder prior to age 53. Of the variables studied, the presence of affective spectrum disorder was the most powerful predictor of poor psychosocial outcome at age 65 and one of the most powerful predictors of poor physical health. Alcohol abuse and cigarette abuse accounted for the observed increased rates of heart disease and cancer. When alcohol abuse, smoking, and suicide were controlled for, affective disorder made a significant contribution to physical morbidity by age 70, but not to mortality from natural causes. Affective spectrum disorder, even in an educated population without antisocial trends, carries a profound negative risk to late-life physical and social adjustment.

Adaptation, Psychological↗
PubMed1996

Antecedents and consequences of negative life events in adulthood: a longitudinal study.

OBJECTIVE: This study investigated whether negative life events affected subjects' long-term physical and mental health. METHOD: One hundred thirteen normal college men completed biennial follow-up questionnaires from age 26 until age 62. At age 62 they retrospectively assessed 16 major negative life events with a self-report checklist. A blind rater read each man's complete records over the 35 years and completed the same checklist prospectively. The men had independent physical examinations at age 65. RESULTS: It was demonstrated that negative life events affect men's psychological health more than their physical health. The correlation of negative life events with physical health was so low that no significant relationship between the two variables could be established. Negative life events were significantly associated with affective spectrum disorder and its relevant indicators. Further, the Cox proportional hazards model revealed that negative life events, family history of depression, and psychosocial stability during the college years were independent and statistically significant predictors of depression. CONCLUSIONS: This study supports the widely held belief that biological factors (heredity), psychological factors (unstable personality), and social factors (negative life events) are all etiologically related to depression.

Adult↗
PubMed1996

Natural history of male psychological health, XIII: Who develops high blood pressure and who responds to treatment.

OBJECTIVE: This study was an effort to clarify both the psychological contributions to and the long-term consequences of uncomplicated essential hypertension. METHOD: The subjects were 193 healthy college students selected as sophomores and prospectively followed for over 50 years. Independent assessments of physical and mental health were made. RESULTS: Although objective indices of psychopathology predicted both physical morbidity and mortality, they did not predict hypertension. When pyknic somatotype, college diastolic blood pressure, and well-integrated personality in college were controlled, no other preadult variable predicted hypertension. As expected, heart disease, obesity, and alcohol abuse were each correlated with hypertension. After roughly 20 years, 14 of the 41 men with treated hypertension were in stable remission, and 13 men had developed cardiac complications. No differences between these groups could be discerned. CONCLUSIONS: Over time, hypertension appeared to be more a product of biological than of psychosomatic variables. Good psychological health did not diminish the risk of hypertension.

Adult↗
PubMed1995

A 50-year prospective study of the psychological sequelae of World War II combat.

OBJECTIVE: The authors took advantage of a 50-year prospective study of World War II veterans to examine the predictors and correlates of combat exposure, symptoms of posttraumatic stress disorder (PTSD), and trait neuroticism. METHOD: The subjects were 107 veterans who had been extensively studied before and immediately after serving overseas in World War II. All served as members of the study until the present time, and 91 completed questionnaires of both PTSD symptoms and neuroticism. RESULTS: In this study group, variables associated with positive psychosocial health in adolescence and at age 65 predicted combat exposure. Combat exposure and number of physiological symptoms during combat stress--but not during civilian stress--predicted symptoms of PTSD in 1946 and 1988. Combat exposure also predicted early death and study attrition. Psychosocial vulnerability in adolescence and at age 65 and physiological symptoms during civilian stress--but not during combat stress--predicted trait neuroticism at age 65. CONCLUSIONS: Combat exposure predicted symptoms of PTSD but not nonspecific measures of psychopathology. Premorbid vulnerability predicted subsequent psychopathology but not symptoms of PTSD.

Adult↗
PubMed1994

Ego mechanisms of defense and personality psychopathology.

It is often not just life stress but also a person's idiosyncratic response to life stress that leads to psychopathology. Thus, despite problems in reliability, the validity of defenses makes them a valuable diagnostic axis for understanding psychopathology. By including a patient's defensive style as part of the diagnostic formulation, the clinician is better able to comprehend what seems initially most unreasonable about the patient and to appreciate what is adaptive as well as maladaptive about the patient's defensive distortions of inner and outer reality. Clinical appreciation of the immature defenses (e.g., hypochondriasis, fantasy, dissociation, acting out, projection, and passive aggression) is particularly useful in classifying and caring for individuals with personality disorders.

Defense Mechanisms↗