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Lisa F Berkman

Publications and source records attributed to Lisa F Berkman.

At least 37 records · Page 2Linked to original sources
PubMed2004

Social integration and mortality: a prospective study of French employees of Electricity of France-Gas of France: the GAZEL Cohort.

The authors investigated associations between social integration and all-cause and cause-specific mortality among French employees of Electricity of France-Gas of France. A total of 12,347 men aged 40-50 years in 1989 and 4,352 women aged 35-50 years in 1989 comprised the sample. In age-adjusted survival analyses for all causes of death, men who were least socially integrated were 4.42 times as likely to die during follow-up (1993-1999) as those with the highest level of integration (p < 0.0001). After adjustment for age, occupation, smoking, alcohol consumption, body mass index, self-reported health, depressive symptoms, and region of France, relative risks for men ranging from the least socially integrated to the most socially integrated were 2.70 (95% confidence interval (CI): 1.17, 6.23), 1.95 (95% CI: 1.25, 3.04), and 1.37 (95% CI: 0.92, 2.04) in comparison with the most integrated men. In multivariate cause-specific analyses, isolated men had elevated risks of dying from cancer (relative risk = 3.60) and from accidents and suicide (relative risk = 3.54). Among women, in multivariate analyses, the relative risk was 3.64 (95% CI: 0.72, 18.58). The small number of deaths among women (n = 29) limited statistical power and prohibited cause-specific analyses. These results suggest that in this employed cohort of middle-aged men and women, social integration is an important predictor of mortality.

Adult↗
PubMed2004

Employment status, social ties, and caregivers' mental health.

The purpose of this study of mid-life and older women was to assess the relation between informal care provision and depressive symptoms, taking into account concurrent demands on women's time (including multiple caregiving roles and employment outside the home) as well as participants' access to potentially supportive social ties. This cross-sectional study included women ages 46-71, free from major disease, who provided complete health and social information in the 1992 Nurses' Health Study follow-up survey (n = 61,383). In logistic regression models predicting depressive symptoms, we examined the interaction between employment outside the home and informal care provision for a disabled or ill spouse or parent. We also investigated level of social ties, measured with the Berkman-Syme Social Network Index, as a potential modifier of the association between informal care provision and depressive symptoms. In all analyses, higher weekly time commitment to informal care for a spouse or parent was associated with increased risk of depressive symptoms. This relationship persisted whether women were not employed outside the home, were employed full-time, or were employed part-time. Higher weekly time commitment to informal care provision was associated with increased risk of depressive symptoms whether women were socially integrated or socially isolated. However, both informal care provision and social ties were potent independent correlates of depressive symptoms. Therefore, women who reported high spousal care time commitment and few social ties experienced a dramatic elevation in depressive symptoms, compared to women with no spousal care responsibilities and many social ties (OR for depressive symptoms=11.8; 95% CI 4.8, 28.9). We observed the same pattern among socially isolated women who cared for their parent(s) many hours per week, but the association was not as strong (OR for depressive symptoms=6.5; 95% CI 3.4, 12.7). In this cross-sectional study, employment status did not seem to confer additional mental health risk or benefit to informal caregivers, while access to extensive social ties was associated with more favorable caregiver health outcomes.

Adult↗
PubMed2004

Cumulative biological risk and socio-economic differences in mortality: MacArthur studies of successful aging.

Previous research has suggested that socio-economic status (SES) differences in mortality are only partially explained by differences in life-style, psychological and social factors. Seven year mortality data (1988-1995) from the MacArthur Study of Successful Aging, a longitudinal study of adults, aged 70-79, from New Haven, CT; East Boston, MA; and Durham, NC; were used to test the hypothesis that a cumulative measure of biological dysregulation ("allostatic load"), reflecting multiple regulatory systems, would serve as a further mediator of SES differences in mortality. Logistic regression analyses revealed that a cumulative index of biological risk explained 35.4% of the difference in mortality risk between those with higher versus lower SES (as measured by less than high school education versus high school or greater educational attainment). Importantly, the cumulative index provided independent explanatory power, over and above a measure of doctor-diagnosed disease, though the latter also contributed to education-related variation in mortality risks. The summary measure of biological risk also accounted for more variance than individual biological parameters, suggesting the potential value of a multi-systems view of biological pathways through which SES ultimately affects morbidity and mortality.

Adaptation, Physiological↗
PubMed2004

Prospective study of job insecurity and coronary heart disease in US women.

PURPOSE: To examine prospectively the relationship between job insecurity and incidence of coronary heart disease (CHD) among women. METHODS: We conducted the study in 36,910 women from the Nurses' Health Study, a prospective cohort of female registered nurses residing in 11 US states. These women were 46 to 71 years old, and did not have diagnosed CHD, stroke, or cancer at baseline (1992). We collected information on job insecurity in 1992 and coronary heart disease incidence between baseline (June 1, 1992) and return of the 1996 questionnaire. RESULTS: During 4 years of follow-up, we documented 154 incident cases of CHD (113 non-fatal cases of myocardial infarction (MI) and 41 CHD deaths). After adjustment for a wide array of potential confounders, the relative risk (RR) of total CHD over 2-year follow-up was 1.35 (95% CI, 0.78-2.34) and 1.04 (95% CI, 0.69-1.57) over 4-year follow-up. Job insecurity appeared to significantly increase the risk of non-fatal MI in the short term (2-year follow-up: RR=1.89, 95% CI, 1.03-3.50), though not over a longer follow-up period (RR=1.28, 95% CI, 0.82-2.00), nor fatal CHD in the short term (RR=0.49, 95% CI, 0.22-2.08). CONCLUSIONS: These data suggest that job insecurity may increase the short-term risk of non-fatal MI in women.

Aged↗
PubMed2003

Depression as a risk factor for mortality after acute myocardial infarction.

The ENRICHD clinical trial, which compared an intervention for depression and social isolation to usual care, failed to decrease the rate of mortality and recurrent acute myocardial infarction (AMI) in post-AMI patients. One explanation for this is that depression was not associated with increased mortality in these patients. The purpose of this study was to determine if depression was associated with an increased risk of mortality in a subsample of the ENRICHD trial's depressed patients compared with a group of nondepressed patients recruited for an ancillary study. Three hundred fifty-eight depressed patients with an acute AMI from the ENRICHD clinical trial and 408 nondepressed patients who met the ENRICHD medical inclusion criteria were followed for up to 30 months. There were 47 deaths (6.1%) and 57 nonfatal AMIs (7.4%). After adjusting for other risk factors, depressed patients were at higher risk for all-cause mortality (hazard ratio 2.4, 95% confidence interval 1.2 to 4.7) but not for nonfatal recurrent infarction (hazard ratio 1.2, 95% confidence interval 0.7 to 2.0) compared with nondepressed patients. In conclusion, depression was an independent risk factor for death after AMI, but it did not have a significant effect on mortality until nearly 12 months after the acute event, nor did it predict nonfatal recurrent infarction.

Aged↗
PubMed2003

Effects of treating depression and low perceived social support on clinical events after myocardial infarction: the Enhancing Recovery in Coronary Heart Disease Patients (ENRICHD) Randomized Trial.

CONTEXT: Depression and low perceived social support (LPSS) after myocardial infarction (MI) are associated with higher morbidity and mortality, but little is known about whether this excess risk can be reduced through treatment. OBJECTIVE: To determine whether mortality and recurrent infarction are reduced by treatment of depression and LPSS with cognitive behavior therapy (CBT), supplemented with a selective serotonin reuptake inhibitor (SSRI) antidepressant when indicated, in patients enrolled within 28 days after MI. DESIGN, SETTING, AND PATIENTS: Randomized clinical trial conducted from October 1996 to April 2001 in 2481 MI patients (1084 women, 1397 men) enrolled from 8 clinical centers. Major or minor depression was diagnosed by modified Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria and severity by the 17-item Hamilton Rating Scale for Depression (HRSD); LPSS was determined by the Enhancing Recovery in Coronary Heart Disease Patients (ENRICHD) Social Support Instrument (ESSI). Random allocation was to usual medical care or CBT-based psychosocial intervention. INTERVENTION: Cognitive behavior therapy was initiated at a median of 17 days after the index MI for a median of 11 individual sessions throughout 6 months, plus group therapy when feasible, with SSRIs for patients scoring higher than 24 on the HRSD or having a less than 50% reduction in Beck Depression Inventory scores after 5 weeks. MAIN OUTCOME MEASURES: Composite primary end point of death or recurrent MI; secondary outcomes included change in HRSD (for depression) or ESSI scores (for LPSS) at 6 months. RESULTS: Improvement in psychosocial outcomes at 6 months favored treatment: mean (SD) change in HRSD score, -10.1 (7.8) in the depression and psychosocial intervention group vs -8.4 (7.7) in the depression and usual care group (P<.001); mean (SD) change in ESSI score, 5.1 (5.9) in the LPSS and psychosocial intervention group vs 3.4 (6.0) in the LPSS and usual care group (P<.001). After an average follow-up of 29 months, there was no significant difference in event-free survival between usual care (75.9%) and psychosocial intervention (75.8%). There were also no differences in survival between the psychosocial intervention and usual care arms in any of the 3 psychosocial risk groups (depression, LPSS, and depression and LPSS patients). CONCLUSIONS: The intervention did not increase event-free survival. The intervention improved depression and social isolation, although the relative improvement in the psychosocial intervention group compared with the usual care group was less than expected due to substantial improvement in usual care patients.

Adaptation, Psychological↗
PubMed2003

Education, other socioeconomic indicators, and cognitive function.

The authors investigated the relation of educational attainment, husband's education, household income, and childhood socioeconomic status to cognitive function and decline among community-dwelling women aged 70-79 years. Information on exposures was self-reported, except for income (which was derived from census tract data). Between 1995 and 2000, six cognitive tests were administered to 19,319 Nurses' Health Study participants. Second assessments began in 2001 and are ongoing; as of April 2002, information was complete for 15,594 women. The authors used logistic regression to calculate multivariate-adjusted odds of a low baseline score (bottom 10%) and substantial decline (worst 10%), and linear regression was used to estimate adjusted mean differences in score and in decline across various levels of education and socioeconomic status. On a global score combining the results of all tests, women with a graduate degree had significantly decreased odds of a low baseline score (odds ratio = 0.49, 95% confidence interval: 0.36, 0.66) and decline (odds ratio = 0.65, 95% confidence interval: 0.50, 0.86) in comparison with women with a Registered Nurse diploma. Significantly lower mean scores and less mean decline were observed among women with a bachelor's or graduate degree than among women with a Registered Nurse diploma. Much weaker associations were evident for other socioeconomic variables. Thus, among well-educated women, educational attainment predicted cognitive function and decline, although other measures of socioeconomic status had little relation.

Aged↗
PubMed2003

Social engagement and disability in a community population of older adults: the New Haven EPESE.

This paper examines the effect of social engagement on disability among community-dwelling older adults in 1982-1991. Data were collected from the New Haven, Connecticut, site of the Established Populations for Epidemiologic Studies of the Elderly. Baseline social engagement was measured by using 11 items related to social and productive activity. Disability data consisted of a six-item measure of activities of daily living, a three-item measure of gross mobility, and a four-item measure of basic physical functions. Nine waves of yearly disability data were analyzed by using generalized estimating equations models. After adjustment for age, gender, race, and physical activity, significant cross-sectional associations (p's < 0.001) were found between social engagement and all three measures of disability, with more socially engaged older adults reporting less disability. Social engagement also showed small, but negative interaction effects with follow-up-time outcomes (p's < 0.01), indicating that the protective effect of social engagement decreased slightly during follow-up. Results suggest a strong, but not necessarily causal association of social engagement with disability. Promotion of social engagement may still be important for the prevention of disability.

Activities of Daily Living↗
PubMed2003

Social relations and self-reported health: a prospective analysis of the French Gazel cohort.

Social networks and social support are strongly associated with health, yet the pathways between social relations and health are not well understood. In one of the very few studies on this issue conducted in France, we used data from the French GAZEL cohort of employees of the national gas and electricity company, to (1) explore the relationship between the structure and function of the social environment upon self-reported health and (2) test the hypothesis that social relations directly affect health. In a prospective analysis over a 12-month follow-up period, we found that a lack of social support and dissatisfaction with social relations are predictive of poor health status, while weak social networks are not. Thus, functional aspects of social relations are better predictors of poor health than the structure of social interactions. Low social support was an independent risk factor for poor health in men and women: for men the effect was strongest among individuals who held a high occupational status, for women among those in high and low occupational groups. This study suggests that in France social relations exert an independent effect on health, modified by gender and socio-economic factors. Our results indicate that both clinicians in their practice and researchers may do well to focus increased attention on the health impact of social support.

Adult↗
PubMed2003

Caregiving and risk of coronary heart disease in U.S. women: a prospective study.

BACKGROUND: A growing number of women provide care to disabled or ill relatives. Many studies have linked caregiving to psychiatric morbidity, lower perceived health status, elevated blood pressure, and poorer immune function. However, no studies have examined the association between caregiving and cardiovascular disease incidence. METHODS: We conducted the study in 54,412 women from the Nurses' Health Study, a prospective cohort of female registered nurses residing in 11 U.S. states. These women were aged 46 to 71 years and did not have diagnosed coronary heart disease (CHD), stroke, or cancer at baseline (1992). We collected information on caregiving responsibilities in 1992 and coronary heart disease between baseline (June 1, 1992) and return of the 1996 questionnaire. RESULTS: During 4 years of follow-up, we documented 321 incident cases of CHD (231 nonfatal cases of myocardial infarction and 90 CHD deaths). In multivariate analyses controlling for age, smoking, exercise, alcohol intake, body mass index, history of hypertension, diabetes mellitus, and other covariates, caregiving for disabled or ill spouse for > or =9 hours per week was associated with increased risk of CHD (RR, 1.82; 95% confidence interval, 1.08-3.05). However, caregiving for disabled or ill parents or disabled or ill others was not significantly associated with increased risks of CHD. CONCLUSION: These data indicate that high levels of caregiving burden for ill spouses may increase the risk of CHD among women.

Aged↗
PubMed2002

Socioeconomic status and mortality among the elderly: findings from four US communities.

The effect of socioeconomic status (SES) on mortality was examined in the community-dwelling elderly. Data were obtained from four population-based studies that enrolled elderly residents of four US communities (East Boston, Massachusetts; New Haven, Connecticut; east-central Iowa; and the Piedmont region of North Carolina) and followed them for 9 years, starting in 1982 or 1986. Higher SES, whether measured by education, by household income, or by occupational prestige, was generally associated with lower mortality. However, the pattern of findings varied by gender and by community. For men, all three SES indicators were associated with mortality in the majority of cohorts. For women, this was true only for income. SES-mortality associations were attenuated but not eliminated after adjustment for behavior and health status. SES-mortality associations were stronger in New Haven and North Carolina than in East Boston and Iowa. The latter communities are more homogeneous with respect to ethnicity, urbanization, and occupational history than the former. Future research should investigate the relative validity of traditional SES measures for men and women and develop more balanced assessment methods. These findings also suggest that it is important to consider not only individual characteristics but also community attributes that mediate or modify the pathways through which socioeconomic conditions may influence health.

Aged↗
PubMed2002

Social networks and health-related quality of life in breast cancer survivors: a prospective study.

PURPOSE: To examine prospectively the influence of social networks on health-related quality of life (HRQoL) among breast cancer survivors. METHODS: Social networks and HRQoL were assessed among women free of breast cancer in the Nurses' Health Study (NHS). Women who developed breast cancer over a 4-year follow-up (n=708) completed detailed questions related to treatment together with an assessment of general and cancer-specific HRQoL. RESULTS: On average, socially isolated women were more adversely affected by breast cancer--their role function was lower by 14 points, vitality lower by 7 points, and physical function lower by 6 points compared to the most socially integrated women. CONCLUSION: Prediagnosis level of social integration is an important factor in future HRQoL among breast cancer survivors, and appears to explain more of the variance in HRQoL than treatment or tumor characteristics. Rehabilitation programs should incorporate interventions that address the availability of adequate social support among breast cancer survivors.

Aged↗
PubMedDate not supplied

Psychosocial treatment within sex by ethnicity subgroups in the Enhancing Recovery in Coronary Heart Disease clinical trial.

OBJECTIVE: Intervening in depression and/or low perceived social support within 28 days after myocardial infarction (MI) in the Enhancing Recovery in Coronary Heart Disease (ENRICHD) clinical trial did not increase event-free survival. The purpose of the present investigation was to conduct post hoc analyses on sex and ethnic minority subgroups to assess whether any treatment subgroup is at reduced or increased risk of greater morbidity/mortality. METHODS: The 2481 patients with MI (973 white men, 424 minority men, 674 white women, 410 minority women) who had major or minor depression and/or low perceived social support were randomly allocated to usual medical care or cognitive behavior therapy. Total mortality or recurrent nonfatal MI (ENRICHD primary endpoint) and cardiac mortality or recurrent nonfatal MI (secondary endpoint) were analyzed as composite endpoints by group for time to first event using Cox proportional hazards regression. RESULTS: There was a trend in the direction of treatment efficacy for white men for the primary endpoint (hazard ratio [HR], 0.80; 95% confidence interval, 0.61-1.05; p =.10) and a significant (p <.006, Bonferroni corrected) effect for the secondary endpoint (HR, 0.63; 95% CI, 0.46-0.87; p =.004). In contrast, the HRs for each of the other three subgroups were nonsignificant. The magnitude of differences in treatment effects between white men and the other subgroups remained significant for the secondary endpoint (p =.04) after adjustment for age, education, living alone, antidepressant use, comorbidity score, cardiac catheterization, ejection fraction, history of hypertension, and major depression. CONCLUSIONS: White men, but not other subgroups, may have benefited from the ENRICHD intervention, suggesting that future studies need to attend to issues of treatment design and delivery that may have prevented benefit among sex and ethnic subgroups other than white men.

Cognitive Behavioral Therapy↗
PubMedDate not supplied

The Families In Recovery From Stroke Trial (FIRST): primary study results.

OBJECTIVE: Social support and family ties are strong predictors of functional recovery after stroke; however, development of successful psychosocial intervention programs has been difficult. This study examined whether a family-systems intervention designed to influence social support and self-efficacy affects functional outcome in older stroke patients. METHODS: Two hundred ninety-one community-residing survivors of ischemic stroke or nontraumatic cerebral hemorrhage from eight acute-care hospitals and rehabilitation centers were randomized to either psychosocial intervention (PSI) or usual care (UC). PSI involved up to 16 sessions conducted in the home by a mental health worker. Functional recovery (measured by the Barthel Index [BI] at 6 months postrandomization, inability to assess functioning because of illness or death) was the primary end point. RESULTS: Functional recovery did not differ between UC and PSI in intention-to-treat analyses. In adjusted logistic regression, the odds of being functionally independent at 6 months was 60% higher in the intervention group, but this difference was not statistically significant (p = .31). Subgroup analyses revealed that PSI may be more effective in subjects with better psychologic and cognitive functioning and who required less inpatient rehabilitation. CONCLUSION: This study does not provide evidence for the efficacy of psychosocial intervention to improve functional recovery in stroke. Although PSI showed greater improvement than UC, the differences were not statistically significant.

Caregivers↗
PubMedDate not supplied

Social integration is associated with fibrinogen concentration in elderly men.

OBJECTIVE: The objective of this study was to determine whether social integration is associated with plasma concentrations of fibrinogen in an elderly population. METHODS: Participants (ages 70-79; n = 375 men and 425 women) were part of the MacArthur Successful Aging Study, a longitudinal study from three community-based cohorts in the United States, who have relatively high physical and cognitive functioning. Social integration was measured using a social integration score, which assessed marital status, number of contacts with family and friends, frequency of religious service attendance, and participation in voluntary organizations. Fibrinogen concentrations were measured in plasma using an automated clot-rate assay. Cross-sectional multivariate logistic regression analyses were performed. RESULTS: Social integration was significantly associated with elevated concentrations of fibrinogen (>336 mg/dL) in men after adjusting for smoking, alcohol consumption, physical activity, body mass index, comorbidity, physical functioning, depression, age, race, and education (odds ratio [OR] = 2.29, 95% confidence interval [CI] = 1.07-4.89, p = .03 for having elevated fibrinogen in the least integrated quartile versus the most integrated quartile). There was no significant association between social integration and fibrinogen in women (multivariate-adjusted OR = 0.57, 95% CI = 0.27-1.21, p = .15). CONCLUSIONS: Social integration is associated with fibrinogen concentrations in elderly men. This provides evidence of a biologic mechanism that may help explain the observed associations between social integration and mortality in men. There may be gender differences in the physiological pathways by which social integration influences health.

Age Factors↗