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Biomedical subjects

S R Beach

Publications and source records attributed to S R Beach.

At least 19 recordsLinked to original sources
PubMed2001

Involvement in caregiving and adjustment to death of a spouse: findings from the caregiver health effects study.

CONTEXT: Most deaths in the United States occur among older persons who have 1 or more disabling conditions. As a result, many deaths are preceded by an extended period during which family members provide care to their disabled relative. OBJECTIVE: To better understand the effect of bereavement on family caregivers by examining predeath vs postdeath changes in self-reported and objective health outcomes among elderly persons providing varying levels of care prior to their spouse's death. DESIGN AND SETTING: Prospective, population-based cohort study conducted in 4 US communities between 1993 and 1998. PARTICIPANTS: One hundred twenty-nine individuals aged 66 to 96 years whose spouse died during an average 4-year follow-up. Individuals were classified as noncaregivers (n = 40), caregivers who reported no strain (n = 37), or strained caregivers (n = 52). MAIN OUTCOME MEASURES: Changes in depression symptoms (assessed by the 10-item Center for Epidemiological Studies-Depression [CES-D] scale), antidepressant medication use, 6 health risk behaviors, and weight among the 3 groups of participants. RESULTS: Controlling for age, sex, race, education, prevalent cardiovascular disease at baseline, and interval between predeath and postdeath assessments, CES-D scores remained high but did not change among strained caregivers (9.44 vs 9.19; P =.76), while these scores increased for both noncaregivers (4.74 vs 8.25; F(1,116) = 14.33; P<.001) and nonstrained caregivers (4.94 vs 7.13; F(1,116) = 4.35; P =.04). Noncaregivers were significantly more likely to be using nontricyclic antidepressant medications following the death than the nonstrained caregiver group (odds ratio [OR], 12.85; 95% confidence interval [CI], 1.02-162.13; P =.05). The strained caregiver group experienced significant improvement in health risk behaviors following the death of their spouse (1.47 vs 0.66 behaviors; F(1,118) = 20.23; P<.001), while the noncaregiver and nonstrained caregiver groups showed little change (0.27 vs 0.27 [P =.99] and 0.46 vs 0.27 [P =.39] behaviors, respectively). Noncaregivers experienced significant weight loss following the death (149.1 vs 145.3 lb [67.1 vs 65.4 kg]; F(1,101) = 8.12; P =.005), while the strained and nonstrained caregiving groups did not show significant weight change (156.2 vs 155.2 lb [70.3 vs 69.8 kg] [P =.41] and 156.2 vs 154.0 lb [70.3 vs 69.3 kg] [P =.12], respectively). CONCLUSIONS: These data indicate that the impact of losing one's spouse among older persons varies as a function of the caregiving experiences that precede the death. Among individuals who are already strained prior to the death of their spouse, the death itself does not increase their level of distress. Instead, they show reductions in health risk behaviors. Among noncaregivers, losing one's spouse results in increased depression and weight loss.

Aged↗
PubMed2001

Attributions in marriage: examining the entailment model in dyadic context.

The entailment model of attributions is examined for the first time using a dyadic approach and longitudinal data. In a sample of 229 married partners with children, causal attributions were distinguished empirically from responsibility attributions and, consistent with the entailment model, the effect of causal attributions on conflict was mediated through attributions of responsibility. Only 1 path was influenced by spouse gender. Examination of cross-spouse effects revealed significant effects and provided a better fit than a model with no cross-spouse effects. The importance of including cross-spouse effects in attributional models is discussed.

Adaptation, Psychological↗
PubMed2001

HIV infection and depressive symptoms: an investigation of African American single mothers.

Risk for depressive symptoms among HIV-infected African American single mothers (n = 96), relative to demographically matched non-infected single mothers (n = 120), was examined, using both self-report and clinician-rated scales of depression. Assessment of depressive symptoms occurred at two points separated by one year. Findings revealed that HIV-infected mothers were at greater risk for depressive symptoms at both assessments, regardless of method of assessment. Moreover, HIV-infected mothers remained at greater risk when analyses were limited to cognitive and affective symptoms of depression, decreasing the likelihood that the difference between the two groups was due to greater endorsement of somatic symptoms of depression by the HIV-infected group.

Adult↗
PubMed2001

Disease status in African American single mothers with HIV: the role of depressive symptoms.

The association between depressive symptoms and 2 measures of HIV disease status in 73 African American single mothers was examined. Hierarchical multiple regression analyses revealed that clinician-rated depressive symptoms predicted subjective, but not objective, parameters of disease status 12 to 14 months later. More symptoms of depression at the 1st assessment predicted an increase in physical complaints over the course of the study. Results suggest that researchers and clinicians interested in enhancing quality of life among African American single mothers with HIV infection, an understudied population within the HIV-AIDS literature, should consider both subjective and objective measures of the disease.

Adult↗
PubMed2000

Association between depression and mortality in older adults: the Cardiovascular Health Study.

BACKGROUND: Studies of the association between depressive symptoms and mortality in elderly populations have yielded contradictory findings. To address these discrepancies, we test this association using the most extensive array of sociodemographic and physical health control variables ever studied, to our knowledge, in a large population-based sample of elderly individuals. OBJECTIVE: To examine the relation between baseline depressive symptoms and 6-year all-cause mortality in older persons, systematically controlling for sociodemographic factors, clinical disease, subclinical disease, and health risk factors. METHODS: A total of 5201 men and women aged 65 years and older from 4 US communities participated in the study. Depressive symptoms and 4 categories of covariates were assessed at baseline. The primary outcome measure was 6-year mortality. RESULTS: Of the 5201 participants, 984 (18.9%) died within 6 years. High baseline depressive symptoms were associated with a higher mortality rate (23.9%) than low baseline depression scores (17.7%) (unadjusted relative risk [RR], 1.41; 95% confidence interval [CI], 1.22-1.63). Depression was also an independent predictor of mortality when controlling for sociodemographic factors (RR, 1.43; 95% CI, 1.23-1.66), prevalent clinical disease (RR, 1.25; 95% CI, 1.07-1.45), subclinical disease indicators (RR, 1.35; 95% CI, 1.15-1.58), or biological or behavioral risk factors (RR, 1.42; 95% CI, 1.22-1.65). When the best predictors from all 4 classes of variables were included as covariates, high depressive symptoms remained an independent predictor of mortality (RR, 1.24; 95% CI, 1.06-1.46). CONCLUSIONS: High levels of depressive symptoms are an independent risk factor for mortality in community-residing older adults. Motivational depletion may be a key underlying mechanism for the depression-mortality effect.

Aged↗
PubMed2000

Negative and positive health effects of caring for a disabled spouse: longitudinal findings from the caregiver health effects study.

Data from the first 2 waves of the Caregiver Health Effects Study (n = 680) were analyzed to examine the effects of changes in caregiving involvement on changes in caregiver health-related outcomes in a population-based sample of elders caring for a disabled spouse. Caregiving involvement was indexed by levels of (a) spouse physical impairment, (b) help provided to the spouse, and (c) strain associated with providing help. Health-related outcomes included perceived health, health-risk behaviors, anxiety symptoms, and depression symptoms. Increases in spouse impairment and caregiver strain were generally related to poorer outcomes over time (poorer perceived health, increased health-risk behaviors, and increased anxiety and depression), whereas increased helping was related to better outcomes (decreased anxiety and depression). Results suggest that caring for a disabled spouse is a complex phenomenon that can have both deleterious and beneficial consequences.

Aged↗
PubMed2000

Individual and crossover effects of stress on adjustment in medical student marriages.

High-stress individuals may benefit from social support, although their support providers may be adversely affected via stress crossover effects. Individual and crossover effects of perceived stress within medical student marriages (n = 30) were investigated. Perceived spousal support was positively associated with individuals' own marital and emotional adjustment, attenuating stress effects. With regard to crossover effects, medical students' perceived stress was significantly associated with their spouses' emotional adjustment. Further, medical students' own emotional adjustment fully mediated this crossover effect. Results suggest that the contagion of negative affect may serve as a key mechanism through which stress crossover effects operate in marriage.

Adaptation, Psychological↗
PubMed2000

Maternal and paternal parenting during adolescence: forecasting early adult psychosocial adjustment.

This study investigated the relationship of maternal and paternal parenting behavior (acceptance and firm control) during adolescence to four domains of early adult functioning (internalizing problems, externalizing problems, prosocial competence, and cognitive competence). Twenty-one females and 29 males from intact families, along with their mothers and fathers, participated. Assessments were conducted in adolescence and early adulthood, separated by approximately five and one-half years. Higher levels of maternal firm control during adolescence were associated with more secure early adult romantic attachment and lower levels of educational achievement. There were no main effects for fathers, but paternal parenting behavior interacted with maternal parenting behavior to predict both early adult romantic attachment and delinquency. Clinical implications and directions for future research are discussed.

Adaptation, Psychological↗
PubMed1999

Caregiving as a risk factor for mortality: the Caregiver Health Effects Study.

CONTEXT: There is strong consensus that caring for an elderly individual with disability is burdensome and stressful to many family members and contributes to psychiatric morbidity. Researchers have also suggested that the combination of loss, prolonged distress, the physical demands of caregiving, and biological vulnerabilities of older caregivers may compromise their physiological functioning and increase their risk for physical health problems, leading to increased mortality. OBJECTIVE: To examine the relationship between caregiving demands among older spousal caregivers and 4-year all-cause mortality, controlling for sociodemographic factors, prevalent clinical disease, and subclinical disease at baseline. DESIGN: Prospective population-based cohort study, from 1993 through 1998 with an average of 4.5 years of follow-up. SETTING: Four US communities. PARTICIPANTS: A total of 392 caregivers and 427 noncaregivers aged 66 to 96 years who were living with their spouses. MAIN OUTCOME MEASURE: Four-year mortality, based on level of caregiving: (1) spouse not disabled; (2) spouse disabled and not helping; (3) spouse disabled and helping with no strain reported; or(4) spouse disabled and helping with mental or emotional strain reported. RESULTS: After 4 years of follow-up, 103 participants (12.6%) died. After adjusting for sociodemographic factors, prevalent disease, and subclinical cardiovascular disease, participants who were providing care and experiencing caregiver strain had mortality risks that were 63% higher than noncaregiving controls (relative risk [RR], 1.63; 95% confidence interval [CI], 1.00-2.65). Participants who were providing care but not experiencing strain (RR, 1.08; 95 % CI, 0.61-1.90) and those with a disabled spouse who were not providing care (RR, 1.37; 95% CI, 0.73-2.58) did not have elevated adjusted mortality rates relative to the noncaregiving controls. CONCLUSIONS: Our study suggests that being a caregiver who is experiencing mental or emotional strain is an independent risk factor for mortality among elderly spousal caregivers. Caregivers who report strain associated with caregiving are more likely to die than noncaregiving controls.

Activities of Daily Living↗
PubMed1999

Conflict in marraige: implications for working with couples.

The investigation of marital conflict has reached a crossroads. Over 25 years of research on marital conflict behavior yields a relatively clear picture of its topography, but its relevance for changing the marital relationship remains controversial. We can continue to amass observations in a relatively atheoretical manner and hope that patterns capable of guiding clinical activity will emerge, or we can begin creating a unified theoretical framework to indicate new directions for clinical activity and empirical investigation. Before exploring the latter option, this chapter reviews briefly the impact of marital conflict on mental, physical, and family health and what is known about the nature of conflict in marriage. After highlighting some recent theoretically grounded advances, we illustrate how conceptualizing marital conflict behavior as goal directed provides an integrative theoretical framework for treatment, prevention, and marital conflict research.

Journal Article↗
PubMed1998

Marital therapy in the treatment of depression: toward a third generation of therapy and research.

Two generations of outcome research demonstrate the potential efficacy of marital therapy in the treatment of depression. After reviewing treatment outcome studies on marital therapy for depression, we examine basic research linking aspects of the marital relationship to depressive symptoms. In doing so, we highlight a number of theoretical perspectives and research findings that can inform work with couples in which one spouse is depressed. Finally, we identify potential innovations that may lead to a third generation of marital interventions for depression and several avenues of inquiry for a third generation of outcome research on marital therapy for depression.

Conflict, Psychological↗
PubMed1998

Life events, relationship quality, and depression: an investigation of judgment discontinuity in vivo.

Relationships among stressful life events, negative affect, and judged quality of intimate relationships were explored. Three studies and a mini-meta-analysis revealed that as negative life events increased, judgments of close relationships gradually became less favorable, jumped back toward positivity, and then, again, gradually became less favorable. The same methods of analysis revealed a relationship between negative life events and negative affect with no evidence of significant discontinuities. Moreover, the correlation between relationship satisfaction and negative affect (with negative events held constant), was maximized at the point of relationship-judgment discontinuity. Although the findings are complex, they are consistent with the authors' theoretical account and represent an initial attempt to conceptualize the effect of negative life events in light of the recent social judgment literature.

Adolescent↗
PubMed1998

Pleasure and pain in doing well, together: an investigation of performance-related affect in close relationships.

In a series of four studies, the self-evaluation maintenance (SEM) model is used to predict peoples' self-reported affective responses to doing better or worse than their partners. Both self-protective reactions to comparison (i.e., those predicted by the original SEM model) and empathic reactions to the partner's response (i.e., those predicted by the extended SEM model) were obtained. In addition, as predicted on the basis of both models, comparisons with romantic partners resulted in a different pattern of self-reported affect than did comparisons with strangers. Unexpectedly, it appeared that empathic effects were minimal or absent among dating partners when comparisons were in areas of high self-relevance.

Achievement↗
PubMed1996

Subclinical depression and performance at work.

The relationship between subclinical depression and the fulfillment of important work roles is the focus of this study. The analysis controls for social processes (i.e., interpersonal stress) that may precede the development of depressive symptomatology and potential depressive distortion associated with self-report of symptoms and performance. Using interview data collected from 265 community-dwelling adults, multiple regression analyses indicated that depressive symptomatology was significantly related to externally rated performance at work. This relationship was independent of other important social influences of interpersonal stress attributed to coworkers, spouses and others, and job stress related to dissatisfying work. Subclinical depression thus appeared related to decrements in job performance. Further, this effect was not entirely due to other social influences not measured in previous studies or to the problem of depressive mood affecting the direction of self-report measures.

Adult↗
PubMed1996

Attributions and behavior in functional and dysfunctional marriages.

The study examined whether spouses' attributions for partner behavior are related to their own behavior by assessing their attributions and observing the problem-solving discussions of couples in which (a) neither spouse was depressed or maritally distressed, (b) the wife was depressed and both spouses were maritally distressed, and (c) the wife was not depressed and both spouses were maritally distressed. To the extent they made maladaptive attributions, wives displayed less positive behavior and more negative behavior. Husbands' attributions and behavior were unrelated, and associations between attributions and behavior were not moderated by marital distress and depression. These results highlight the need to clarify how partner behavior contributes to the attributions spouses make and to reexamine interventions designed to modify attributions in marital therapy.

Adult↗
PubMed1995

Excuses, excuses: accounting for the effects of partner violence on marital satisfaction and stability.

For both theoretical and practical reasons, it is important to understand processes that lead to marital dissatisfaction and dissolution among women who are targets of relationship violence. Because attributional tendencies may often forecast marital behavior and because alcohol use is often seen as providing an excuse for deviant behavior, we examine two potential moderators of the associations between husband violence and wife marital outcomes: wife attributional style and husband problem drinking tendencies. A community sample of married couples (N = 66) completed a comprehensive battery of marital assessments. Results suggested that responsibility attributions moderated the association between husband violence and wives' marital dissatisfaction but exerted a direct effect on wives' disposition toward divorce. Husband problem drinking moderated the impact of husband violence only on wives' disposition toward divorce. As would be expected from an "excuse" model of the associations between violence and marital outcomes, violence had less of an impact on marital satisfaction and divorce ideation when wives attributed responsibility for negative spouse behavior as external to their husbands and when husbands were problem drinkers, respectively.

Adult↗
PubMed1990

Marital therapy: a viable treatment for depression and marital discord.

Thirty-six maritally discordant couples with depressed wives were randomly assigned to marital therapy, cognitive therapy, or a waiting-list control condition. The women given marital or cognitive therapy showed significant and clinically meaningful reductions in their depression. The women given marital therapy showed greater increases in marital satisfaction than did those given cognitive therapy or no therapy; these differences were maintained at 1-year follow-up. These findings suggest that marital therapy may be the most effective and appropriate treatment for clinically significant marital discord with coexisting clinically significant depression.

Adult↗