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Biomedical subjects

S T Hauser

Publications and source records attributed to S T Hauser.

At least 19 recordsLinked to original sources
PubMed1999

Choice of feeding method of adolescent mothers: does ego development play a role?

STUDY OBJECTIVES: The purpose of this study was to determine whether, among childbearing adolescents, ego development was associated with intention to breast-feed and with actual breast-feeding behavior at birth and at 2 weeks postpartum. In addition, we sought to determine whether positive attitudes toward breast-feeding influenced pregnant adolescents' intentions to breast-feed and actual breast-feeding at the hospital and at 2 weeks postpartum. We hypothesized that adolescents with higher levels of ego development and positive attitudes toward breast-feeding would be more likely to intend to breast-feed and to actually breast-feed. DESIGN: Prospective cohort study of pregnant adolescents who completed questionnaires, Loevinger's Sentence Completion Tests, and attitudes toward breast-feeding scales before delivery and a follow-up questionnaire at 2 weeks postpartum assessing feeding practice in the hospital and at 2 weeks postpartum. SETTING: Two adolescents' clinics and two "teen-and-tot" clinics in urban teaching hospitals. PARTICIPANTS: Fourteen- to 22-year-old pregnant adolescents who had never given birth and who planned to carry their pregnancy to term and parent their children. MAIN OUTCOME MEASURES: 1) Intended feeding practice during pregnancy, 2) feeding method in the hospital, and 3) feeding method at 2 weeks postpartum. RESULTS: Of the 125 subjects enrolled in the study, 106 were at 2 weeks postpartum or more. Of these 106 participants, 75% (n = 78) completed more than 75% of the attitudes toward breast-feeding scale and Loevinger's Sentence Completion Test and are included in these analyses. Mean age at entry was 17.8 +/- 1.5 years (range, 14.3 to 21.8 years). Mean gestational age at enrollment was 21.2 +/- 11.6 weeks (range, 4 to 41 weeks). Of the 78 participants, 12% (n = 9) were at the preconformist, 85% (n = 66) at the conformist, and 4% (n = 3) at the postconformist level of ego development as determined by the Sentence Completion Test. Attitudes toward breast-feeding, intention to breast-feed, breast-feeding in the hospital, and breast-feeding at 2 weeks postpartum were not significantly associated with adolescents' stages of ego development. Almost three fourths of the adolescents intended to breast-feed, and 85% tried breast-feeding in the hospital. A total of 97% (56 of 58) of those who intended to breast-feed tried breast-feeding in the hospital compared with 40% (4 of 10) of those who did not intend to breast-feed (P < .0001). At 2 weeks postpartum, 58% of the participants were still breast-feeding. Of those participants who intended to breast-feed, 67% (39 of 58) were breast-feeding at 2 weeks postpartum compared with 10% (1 of 10) who did not intend to breast-feed (P = .001). The mean breast-feeding attitude score was 53.7 +/- 11.6 (range, 25 to 72). The mean breast-feeding attitude score was higher for those who intended to breast-feed than for those who intended to formula-feed (P = .009), but the score was not associated with breast-feeding in the hospital or at 2 weeks postpartum. CONCLUSION: Adolescent mothers were predominantly in ego stages 4 and 5, the conformist level. Because ego development was not associated with outcome measures in this study, ego development may not be a crucial factor when designing interventions to facilitate breast-feeding among adolescents. Attitudes toward breast-feeding were associated with the intention to breast-feed but not behaviors; the intention to breast-feed was significantly associated with breast-feeding behaviors.

Adolescent↗
PubMed1997

Social relationships among young adults with insulin-dependent diabetes mellitus: ten-year follow-up of an onset cohort.

Past cross-sectional studies have suggested that young adults with insulin-dependent (Type 1) diabetes mellitus (IDDM) may experience problems in their close peer relationships. For 10 years, we have followed an onset cohort of children and adolescents with IDDM (n = 57) and an age-matched group who were originally recruited after an acute illness, accident, or injury (n = 54). Now aged 19-26 years, these two groups were compared in terms of their friendship patterns, dating and love experiences, and sense of loneliness. All subjects in both groups had at least one friend. However, the IDDM group reported fewer friendships overall. The difference was accounted for by the number of less intimate friends. The two groups had similar frequencies of current romantic partners (IDDM = 63%; comparison group = 64%). While dating attitude and dating assertiveness did not differ between groups, some differences were found in terms of experiences of a primary love relationship. IDDM patients experienced less trust and sense of intimate friendship in these love relationships. No differences in loneliness were found. The preponderance of our findings indicate that the two groups had similar patterns and experiences of close peer relationships. Thus, the study does not suggest that IDDM leads to serious problems in forming social relationships for these patients during the transition to young adulthood. On the other hand, the IDDM patients' lower level of trust and intimacy within love relationships are consistent with other findings from this study suggesting specific areas of lowered self-worth that appear in social relationships.

Adolescent↗
PubMed1997

Consequences of irregular versus continuous medical follow-up in children and adolescents with insulin-dependent diabetes mellitus.

OBJECTIVES: To study the social and family characteristics of patients with insulin-dependent diabetes mellitus with irregular versus continuous clinical follow-up and to study the medical outcomes of patients with these follow-up patterns. METHODS: An onset cohort of 61 children and adolescents with insulin-dependent diabetes mellitus and their parents were studied. Aspects of their social and family environment were assessed at study inception and examined in relation to frequency of follow-up early in the course of the illness. Follow-up was dichotomized so that patients with continuous follow-up were compared with patients with irregular follow-up, who were defined as those missing 1 full year of planned medical appointments during the second through fourth years after diagnosis. Patients with irregular and continuous follow-up were compared in terms of acute metabolic complications, glycemic control, and retinopathy status during a 10-year period. RESULTS: Compared with individuals with continuous follow-up, patients with irregular clinical visits were more likely to be from families of lower socioeconomic class levels, have a parental history of separation and divorce, and were members of families that reported being least openly expressive of positive emotions. Poor glycemic control in year 1 was associated with irregular follow-up in years 2 through 4. Patients with irregular follow-up continued to have worse glycemic control in years 2 through 4 than patients with continuous follow-up. However, in years 7 and 10 their glycemic control no longer differed from patients with continuous follow-up. More episodes of diabetic ketoacidosis occurred in the irregular follow-up group. Finally, retinopathy occurred more frequently among those in the irregular follow-up group. CONCLUSION: Early irregular clinical follow-up should be considered a risk factor for complications of insulin-dependent diabetes mellitus.

Adolescent↗
PubMed1997

Psychological adjustment to IDDM: 10-year follow-up of an onset cohort of child and adolescent patients.

OBJECTIVE: To evaluate the psychological adjustment of young adults with IDDM in comparison with similarly aged individuals without chronic illness. RESEARCH DESIGN AND METHODS: An onset cohort of young adults (n = 57), ages 19-26 years, who have been followed over a 10-year period since diagnosis, was compared with a similarly aged group of young adults identified at the time of a moderately severe, acute illness (n = 54) and followed over the same 10-year period. The groups were assessed at 10-year follow-up in terms of 1) sociodemographic indices (e.g., schooling, employment, delinquent activities, drug use), 2) psychiatric symptoms, and 3) perceived competence. In addition, IDDM patients were examined for longitudinal change in adjustment to diabetes. RESULTS: The groups differed only minimally in terms of sociodemographic indices, with similar rates of high school graduation, post-high school education, employment, and drug use. The IDDM group reported fewer criminal convictions and fewer non-diabetes-related illness episodes than the comparison group. There were no differences in psychiatric symptoms. However, IDDM patients reported lower perceived competence, with specific differences found on the global self-worth, sociability, physical appearance, being an adequate provider, and humor subscales. The IDDM patients reported improving adjustment to their diabetes over the course of the 10-year follow-up. CONCLUSIONS: Overall, the young adults with IDDM appeared to be as psychologically well adjusted as the young adults without a chronic illness. There were, however, indications of lower self-esteem in the IDDM patients that could either portend or predispose them to risk for future depression or other difficulties in adaptation.

Acute Disease↗
PubMed1996

Attachment theory as a framework for understanding sequelae of severe adolescent psychopathology: an 11-year follow-up study.

This study examined long-term sequelae of severe adolescent psychopathology from the perspective of adult attachment theory. The study compared 66 upper-middle-class adolescents who were psychiatrically hospitalized at age 14 for problems other than thought or organic disorders, to 76 sociodemographically similar high school students. When reinterviewed at age 25, virtually all of the previously hospitalized adolescents displayed insecure attachment organizations, in contrast to a more typical mixture of security and insecurity in the former high school sample. Lack of resolution of previous trauma with attachment figures accounted for much of this insecurity. Insecurity in adult attachment organization at age 25 was also linked to self-reported criminal behavior and use of hard drugs in young adulthood. These findings are discussed as reflecting a substantial and enduring connection between attachment organization and severe adolescent psychopathology and a possible role of attachment organization in mediating some of the long-term sequelae of such psychopathology.

Adolescent↗
PubMed1995

Psychosocial predictors of acute complications of diabetes in youth.

In this paper we determine whether individual and family psychosocial functioning predicts the risk for recurrent acute diabetic complications. An onset-cohort of 61 children and adolescents with Type 1 diabetes received conventional diabetes care. Episodes of ketoacidosis and of severe hypoglycemia were recorded for 8 years, and glycaemic control was measured by glycohaemoglobin. Measures of psychosocial functioning of the patient and parents were obtained during the first year. Over 8 years, 28% of subjects had at least one episode of ketoacidosis, and 21% had at least one episode of hypoglycaemia. The odds of observing recurrent hypoglycaemia versus recurrent ketoacidosis was 14 times greater in boys than in girls (Fisher's exact test p < 0.05). Girls with recurrent ketoacidosis had more behaviour problems and lower social competence, they reported higher levels of family conflict, and their parents reported lower levels of family cohesion, expressiveness and organization in year one. These relationships were independent of any association with poor glycaemic control. Recurrent hypoglycaemia in boys was generally unrelated to individual and family functioning or glycohaemoglobin. Despite our small sample size, our findings are suggestive of relationships that may lead to early identification of patients who are prone to recurrent ketoacidosis, and to the development of early intervention strategies.

Adolescent↗
PubMed1994

Longitudinal assessment of autonomy and relatedness in adolescent-family interactions as predictors of adolescent ego development and self-esteem.

This study examined links between processes of establishing autonomy and relatedness in adolescent-family interactions and adolescents' psychosocial development. Adolescents in 2-parent families and their parents were observed in a revealed-differences interaction task when adolescents were 14, and adolescents' ego development and self-esteem were assessed at both 14 and 16. Developmental indices were strongly related to autonomy and relatedness displayed by both parents and adolescents. Significant variance was explained even after accounting for the number and quality of speeches of each family member as rated by a different, well-validated family coding system. Increases in adolescents' ego development and self-esteem over time were predicted by fathers' behaviors challenging adolescents' autonomy and relatedness, but only when these occurred in the context of fathers' overall display of autonomous-relatedness with the adolescent. The importance of the mutually negotiated process of adolescents' exploration from the secure base of parental relationships is discussed.

Adolescent↗
PubMed1992

Learned helplessness and urinary MHPG levels in unipolar depression.

OBJECTIVE: Studies of the learned helplessness paradigm in laboratory animals show increased central noradrenergic activity following exposure to uncontrollable stressors. In clinical studies, depressed patients as a group report higher perceptions of helplessness and powerlessness. The authors examined the relationship between perceptions of powerlessness and noradrenergic activity in depressed patients. METHOD: Twenty drug-free patients (12 women and 8 men) meeting DSM-III criteria for major depressive disorder were given the Kobasa Hardiness Questionnaire, which contains subscales measuring feelings of powerlessness, security, and alientation. Concurrently, 24-hour urine samples were collected for measurement of urinary MHPG. RESULTS: Significant correlations were found between MHPG levels and total hardiness scores as well as between MHPG levels and total powerlessness scores but not between MHPG levels and total security or total alientation scores. CONCLUSIONS: These results suggest that depressed patients with high urinary output of MHPG are more likely to show the cognitive features of learned helplessness.

Adolescent↗
PubMed1990

Adherence among children and adolescents with insulin-dependent diabetes mellitus over a four-year longitudinal follow-up: I. The influence of patient coping and adjustment.

An onset cohort of adolescents and children with insulin-dependent diabetes mellitus was studied over a 4-year period. Individual patient psychosocial and demographic factors were assessed at study inception and used to examine aspects of adherence over the follow-up. We found that initial assessment of patient coping (defense level, adaptive strength, and locus of control) and adjustment at study inception were predictive of the level of patient adherence to diabetic regimen over the 4 years of study. Psychosocial variables predicted adherence outcomes independent of patient age. This was found for three domains of adherence, i.e., diet, insulin adjustment, and metabolic monitoring, and for the composite index derived from the separate adherence scales. Preadolescents (ages 9-12) at study entry were more adherent than patients who were already adolescent (ages 13-16) when diagnosed. Using multiple regression, three factors (age, adjustment, ego defense level) accounted for 47% of the variance in adherence. No factors were predictive of change in adherence during the follow-up. Thus, psychosocial characteristics of diabetic children assessed shortly after diagnosis predicted typical or average adherence over a 4-year period. Identification of such characteristics may be useful in developing strategies for intervention early in the course of illness.

Adaptation, Psychological↗
PubMed1990

Adherence among children and adolescents with insulin-dependent diabetes mellitus over a four-year longitudinal follow-up: II. Immediate and long-term linkages with the family milieu.

Cross-sectional and longitudinal findings drawn from a 4-year longitudinal study of an onset cohort of preadolescents and early adolescents with insulin-dependent diabetes and their families are presented. Patient and parent perceptions of the family environment near the time of diagnosis are used to examine patterns of adherence in the first year of illness as well as over the four follow-up years. We found that family conflict, cohesion, and organization were strongly associated with independently rated first-year adherence levels. The strongest predictor of longer term adherence was family conflict, as experienced by the patients. In addition, parents' and youngsters' perceptions of family cohesion predicted improved adherence as well as overall higher levels of patient adherence. The findings are discussed with respect to the clinical implications of discovering those family characteristics that can, shortly after diagnosis, predict short- and long-term adherence. In addition, we present planned investigations intended to further clarify paths from family perceptions to individual diabetes behaviors.

Adaptation, Psychological↗
PubMed1990

Adaptation in adolescence: the influence of time and severe psychiatric disorder.

This study reports the development of adaptive processes in two groups of adolescents assessed initially and 2 years later with clinical research interviews. Students from a public high school (N = 44) and inpatients on an adolescent psychiatric ward (N = 51) formed the two subject groups. The psychiatrically hospitalized group had significantly improved scores after a 2-year interval on four of six adaptive process Summary Scales: Task Orientation, Relatedness, Self Knowledge, and Inner Synthetic Functions. However, these higher scores did not reach the levels of the high school group at either point of assessment. The scores in the high school group remained stable over time except for an increase in the area of Self Knowledge. The value of this interview-derived assessment, in comparison to other forms of measurement, is discussed, and consideration is given to factors which contribute to the differences between groups.

Adaptation, Psychological↗
PubMed1990

Paths of adolescent ego development: links with family life and individual adjustment.

In broad strokes, we have reviewed family contexts and adjustment of adolescent ego development. We concluded with group portraits, the salient family and individual characteristics of adolescents who followed six paths of ego development. There are strong differences in development--the profound arrests and the dramatic progressions. Although these composite pictures provide us with clearer ideas about each of the paths, we do not yet have a detailed understanding of how adolescents following the varied paths experience the world and relate in their families. Certain questions can only be pursued with this information. For instance, are there ways that parents of the steady conformist adolescents speak and behave that restrain their sons' and daughters' separation from the family? Or do the profoundly arrested teenagers provoke their parents to be less encouraging of their differences from other family members? These questions, touching on complex interactions flowing between parents and adolescents, require a closer look inside the families of teenagers following these paths of arrest and advance. In a work soon to be published, we listen closely to the voices of 13 adolescents and their parents, in solo and while together as a family. These narratives convey the message that paths of individual development are embedded within the intricate matrix of family relationships. The teenagers and their families closely and often poignantly illustrate the ways in which adolescents and parents handle the central dilemma posed during this phase of the life cycle: how to separate from the family and reaffirm one's place within it.

Adaptation, Psychological↗
PubMed1989

Adolescent mental health.

Definitions and descriptions of adolescent mental health are beginning to be grounded in psychologists' empirical studies of a wide variety of patterns of adaptation to adolescence. Three major themes guiding current research relevant to mental health in adolescence are discussed in this article: (a) a focus on analysis of interindividual differences to describe variety in adaptation; (b) the integration of biological, psychological, social, and cultural variables in models of adolescence; and (c) an emphasis on the developmental aspects of adolescent mental health. Empirical investigations of adolescent mental health and development within the social context of the family are reviewed.

Adolescent↗
PubMed1988

How families cope with diabetes in adolescence. An approach and case analyses.

In this paper we describe our newly constructed Family Coping Coding System. This scheme was constructed to identify family coping strategies that involve appraisal, problem solving, and emotion management dimensions. We discuss the theoretical rationale, meanings and reliability of the coping codes, and illustrate them through excerpts drawn from family discussions of a recent stressful situation (the onset of a chronic or acute illness in an adolescent member). Finally, we consider the clinical research relevance of this new assessment technique, exemplifying this potential with respect to medical compliance. We present analyses of two families with diabetic adolescents who strikingly differ with respect to compliance, and explore which family coping strategies may be predictive of an adolescent's favorable or problematic compliance to diabetes management.

Adaptation, Psychological↗