Biomedical subjects

J T Mullan

Publications and source records attributed to J T Mullan.

9 recordsLinked to original sources

PubMed2001

Contributors to depression in Latino and European-American patients with type 2 diabetes.

OBJECTIVE: To determine the independent and cumulative contributions of diabetes and other life stresses on depression and anxiety in Latino and European-American (EA) patients with diabetes. RESEARCH DESIGN AND METHODS: A total of 75 Latino and 113 EA patients with type 2 diabetes, recruited from managed care settings, were assessed regarding three groups of potential stresses: demographics (age, sex, and education), disease status (functional impact, time since diagnosis, comorbidities, HbA(1c), and BMI), and family stress (financial stress, spouse conflict resolution, and family closeness). Dependent variables were depression (Center for Epidemiological Studies-Depression scale [CES-D]) and anxiety (Symptom Checklist [SCL-90]). Multiple regression equations assessed the independent contribution of each predictor on depression and anxiety. RESULTS: For both ethnic groups, education, functional impact, and financial stress significantly and independently predicted depression; poor spouse conflict resolution was a fourth significant predictor for EA patients only. The equations accounted for a high percentage of variance (43- 55%). Excluding education, the same variables predicted anxiety for both ethnic groups. The disease status and family stress variable groups significantly predicted outcomes independently. The relationships among these variables and depression and anxiety generally occurred for all patients, not only for those classified as likely depressed. CONCLUSIONS: The findings suggest the utility of considering many life stresses, not just diabetes alone, that combine to affect depression and anxiety. We suggest that these effects are experienced cumulatively as general psychological distress for all patients with diabetes, not just those classified as likely depressed. Taken together, the findings emphasize a life-centered, patient-focused approach to the treatment of depression, rather than an exclusive disease-related perspective.

Adult↗

PubMed2000

Differences in personal models among Latinos and European Americans: implications for clinical care.

OBJECTIVE: To describe and contrast the personal models of type 2 diabetes in European Americans (EAs) and Latinos and to highlight differences that require a reorientation of clinical care. RESEARCH DESIGN AND METHODS: A total of 116 EAs and 76 Latino individuals with type 2 diabetes were interviewed about their personal model of diabetes. Responses to open-ended questions about the perceived cause, nature, seriousness, course, and future course of diabetes and its impact on everyday life were analyzed using an iterative process, and categories of response were established. Responses were examined within ethnic group, and comparisons across ethnic groups were made for clinically significant differences. RESULTS: Disease descriptions about the nature of the disease were categorized as experiential, biomedical, or psychosocial. Disease descriptions varied significantly by ethnicity (chi2 = 35.92, 2 df, P < 0.001), with more Latinos using an experiential model and more EAs using a biomedical model. Significant differences in life changes caused by the disease were found, with EAs reporting changes in exercise and spontaneity and Latinos in fatigue and mood. Individuals with diabetes from both ethnic groups gave comparable assessments about the cause, seriousness, and effectiveness of treatments for the disease. CONCLUSIONS: Clinical practice that attends to the concerns and experiences of individuals with diabetes from diverse ethnic groups is warranted. Broad assessment of personal models in diverse ethnic groups is recommended.

Affect↗

PubMed2000

The family and disease management in Hispanic and European-American patients with type 2 diabetes.

OBJECTIVE: To determine the relationship between the characteristics of families involved in disease management and the self-care practices of Hispanic and European-American (EA) patients with type 2 diabetes. RESEARCH DESIGN AND METHODS: A total of 74 Hispanic patients and 113 EA patients with type 2 diabetes recruited from managed care settings were assessed on three domains of family life (family structure/organization, family world view, and family emotion management [four scales]) and five areas of disease management (biological, general health and function status, emotional tone, quality of life, and behavioral [seven scales]). Analyses assessed the independent associations of patient sex, family, and sex by family interactions with disease management. RESULTS: Both sex and the three domains of family life were related to disease management, but the results varied by ethnic group. For EA patients, sex, family world view, and family emotion management were related to disease management (scores for Family Coherence were negatively associated with HbA1c level and depression, and poor scores for Conflict Resolution were linked with high depression); for Hispanic patients, sex and family structure/organization were related to disease management (high scores for Organized Cohesiveness were associated with good diet and exercise, and high scores for Family Sex-Role Traditionalism were related to high quality of life). No significant interactions with sex occurred. CONCLUSIONS: Characteristics of the family setting in which disease management takes place are significantly linked to patient self-care behavior, and these linkages vary by patient ethnicity. A family's multiple independent dimensions provide multiple targets for intervention, and differences in family norms, structures, and emotion management should be considered to ensure that interventions are compatible with the setting of disease management.

Adult↗

PubMed1998

Sources and determinants of social support for caregivers of persons with AIDS.

This study examines the determinants of social support among a sample of 642 caregivers of persons with AIDS living in San Francisco and Los Angeles. Respondents include both traditional family caregivers (mothers, spouses, other relatives) and non-traditional caregivers (friends, homosexual partners). Multiple regression analyses are conducted to assess the independent effects of six sets of variables on emotional and instrumental support: social-structural factors (age, education, employment status), caregiver's relationship to the person with AIDS, situational variables (caregiver's HIV status, patient's functional disability, interpersonal conflict), social network factors (contact with family, contact with friends, community integration), personal resources (mastery, caregiving competence), and use of formal community services (patient-directed services, caregiver-directed services). A number of factors and conditions appear to be relevant for caregiver support. For example, results indicate that network factors, including frequency of contact, conflict, and community integration, are importantly related to caregivers' perceptions of emotional support. There is also a trend suggesting lower emotional support among traditional family caregivers, relative to nonfamily caregivers, within gender categories. With respect to instrumental assistance with caregiving, factors that place greater demands and time constraints on caregivers, such as being employed and caring for an AIDS patient with greater functional limitations, appear to increase the level of informal instrumental support the caregiver receives. Partners and spouses, however, receive significantly lower instrumental assistance, independent of other factors. Implications of the findings are discussed.

Acquired Immunodeficiency Syndrome↗

PubMed1996

Transitions in the caregiving career: effects on sense of mastery.

Although a sense of mastery is usually treated as a stable personal resource that can moderate the effects of stress on well-being, in this article we are interested in mastery as an outcome, examining the impact of transitions in the careers of Alzheimer's caregivers on their sense of mastery. Using longitudinal data collected from 456 spouses and adult children caring for a family member with Alzheimer's disease, we found that for those who continue to care for their relative, mastery declines; for those who place their relative in a care facility, mastery remains unchanged; and for those who experience the death of their relative, mastery increases. A series of regression analyses revealed different patterns of predictors of change in mastery over time and across transitions.

Alzheimer Disease↗

PubMed1992

The bereaved caregiver: a prospective study of changes in well-being.

This study analyzes short-term bereavement adaptation among caregivers to spouses or parents with a progressive dementia, assessing changes in depression, mastery, overload, and guilt to examine the impact of bereavement on caregivers, and the characteristics of caregiver experience that affect bereavement adaptation. The bereavement group, as compared with active caregivers, dropped substantially in overload and increased in mastery and guilt. Depression showed a curvilinear trend, declining from the time of death and then rising to preloss levels by the end of the year. Caregiver stressors, baseline adaptation, relationship difficulties, and psychological preparation were all related to changes in well-being.

Aged↗

PubMed1990

Caregiving and the stress process: an overview of concepts and their measures.

This paper views caregiver stress as a consequence of a process comprising a number of interrelated conditions, including the socioeconomic characteristics and resources of caregivers and the primary and secondary stressors to which they are exposed. Primary stressors are hardships and problems anchored directly in caregiving. Secondary stressors fall into two categories: the strains experienced in roles and activities outside of caregiving, and intrapsychic strains, involving the diminishment of self-concepts. Coping and social support can potentially intervene at multiple points along the stress process.

Adult↗

PubMed1981

The stress process.

Explore the source record for details and available documents.

Adaptation, Psychological↗

PubMed1978

Does help help? The adaptive consequences of obtaining help from professionals and social networks.

This study reports on a longitudinal analysis of changes in adaptation associated with seeking help on a representative sample of Chicago area adults who had experienced one of three transitions or four crises during the interval between 1972 and follow-up 1976--77 interviews. For each event, respondents are classified into three groups according to their help-seeking behavior: those who went to professionals, those who went only to their social networks, and those who had the event but sought no help. Nine measures of adaptation are used: symptoms of anxiety and depression and strains and stresses in four role areas. Statistical controls equate the groups on demographic characteristics, perceived stress, personal resources, access to help, and elapsed time since the event. There are no consistent statistical significant differences among the groups. No evidence is found that help-seeking has positive adaptive consequences. The findings are not likely to result from an inadequate sample, outcome measures, or statistical controls, but could result from insufficient information on the kind, quality, and duration of the help provided.

Adaptation, Psychological↗