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PubMed2000

Psychosocial considerations in elderly patients with heart failure.

Neuropsychiatric conditions, such as Alzheimer's dementia, and complications, such as delirium, are common in elderly patients with heart failure. Persistent alcohol abuse and cigarette smoking sometimes contribute to the onset and progression of heart failure. Major depression and other depressive disorders are common in this population and have adverse effects on functional status, quality of life, and prognosis. Anxiety and social isolation are clinically significant problems in many cases. These problems often are treatable and deserve more clinical attention than they typically receive.

Activities of Daily Living↗

PubMed1988

Alcohol use and depression symptoms among female nursing students.

A sample of 286 female nursing students responded to questions concerning drinking practices and symptoms of depression. After controlling for the possibly confounding effects of nursing student experiences (aspects of burnout such as depersonalization and social isolation) and the sociodemographic characteristics of the students, increased quantity of alcohol consumed per drinking occasion was found to be associated with increased symptoms of depression in the sober state.

Adult↗

PubMed1990

Availability of knowledgeable informants for a psychological autopsy study of suicides committed by elderly people.

Psychological autopsy methodology has not been applied in studies of elderly suicides, despite the fact that the elderly are associated with a higher rate of suicide than any other age group. One school of thought argues that older adults who die by suicide are socially isolated and/or estranged for a long period of time before death, so that knowledgeable informants are difficult or impossible to obtain. In the present retrospective study we examine the number and availability of knowledgeable informants for 145 older people who committed suicide. We believe that the ability to access several motivated informants per case is essential to any psychological autopsy study by modern standards. The stereotype of the "average expectable" elderly suicide victim as socially isolated and living alone or in an institutional setting was not supported by our findings; an unexpectedly high percentage of subjects were married at the time of their death. There was at least one knowledgeable informant in 90% of cases and two or more in almost 50%. In 46%, the subject had expressed despondency over illness. In a prospective study involving interviews with informants for eight subjects, all eight had at least two knowledgeable and willing informants. Two cases of the eight are presented to illustrate the role of delirium and an ominous diagnosis (cancer) as causes of suicide. We conclude that it is feasible to do a psychological autopsy study of elderly suicides.

Aged↗

PubMed2000

Developmental outcomes and cognitive functioning in infant and child heart transplant recipients.

Pediatric heart transplantation has become a mainstay in the treatment of end-stage heart disease in infants and children. There is, however, sparse information on post-transplant developmental and cognitive functioning. At Loma Linda University Children's Hospital 223 infants have undergone heart transplantation surgery with a survival rate of 73% (n=165). This article reports on four areas of investigation of this cohort of infants. Infant development: Two studies were done utilizing the Bayley Scales of Infant Development (mean 100, S.D.+/-15). The first study (n=48) showed mean values within the normal range [Mental Development Index (MDI) 87; Psychomotor Developmental Index (PDI) 90]. The second study (n=23) showed developmental scores within normal limits in 4-8 month olds with a tendency for decline in development at 12-24 months (MDI 83, PDI 77). Child development: Ninty-one infant recipients were greater than 5 years old. Forty-five children were excluded because of long distances from the hospital, second transplantation, abnormal karyotype, primary language non-English, or invalid testing. The Wechsler Preschool and Primary Scale of Intelligence-Revised testing of 5-6-year-olds (n=23) showed a Full Scale IQ of 74, Performance IQ of 76, and Verbal IQ of 77. The Wechsler Intelligence Scale for Children-III testing of 7-10-year-olds (n=23) showed a Full Scale IQ of 86, Performance IQ of 89, and Verbal IQ of 86. The Wechsler Individual Achievement Test (mean 100, S.D.+/-15) yielded a Total Composite of 91, Mathematics Composite of 86, Language Composite of 98, and a Reading Composite of 94. Visual spatial skills: Visual motor integration (mean 100, S.D.+/-15) was evaluated in 5-10-year-olds with a mean of 87; however, 52% of the children had scores below 1 S.D. Subtests from the Wechsler scales that assess visual motor and visual spatial skills indicated significant deficits. Behavior: Younger children (n=33) demonstrated behaviors indicative of social isolation. Older children (n=36) showed behavior that was within the normal limits, but depression was noted in a significant number of them. Conclusions: Infant heart transplant recipients demonstrate IQ and achievement levels within the normal range, but there is a significant amount of variability with more children than would be expected scoring in the lower ranges. Children with heart transplantation are at risk for visual spatial skill deficits. Young children are at risk for social isolation while symptoms of depression are noted in older children.

Journal Article↗

PubMed1995

Psychotic states arising in late life (late paraphrenia). The role of risk factors.

BACKGROUND: This study explored the association between 'late paraphrenia' and various risk factors such as female gender, sensory impairment, marital status, positive family history of psychoses, and the presence of abnormal neurological signs. It was hypothesised that patients would show significantly more abnormal neurological signs than controls. METHOD: Inclusion criteria for the diagnosis of late paraphrenia were fulfilled by 47 patients, including in-patients, out-patients, day-patients, and those living in the community. Thirty-three age-, sex-, education-, and premorbid IQ-matched elderly controls were recruited from luncheon clubs in Southwark and Lambeth (London, UK). A scale for the assessment of neurological soft and hard signs was developed for this study. The Abnormal Involuntary Movement Scale (AIMS) and the Tardive Dyskinesia Rating Scale (TDRS) were also used. RESULTS: There was a high female-to-male ratio (42:5), and a fourfold increase in the risk of patients having hearing impairment (odds ratio = 4.15, Clodds = 1.36 to 12.63). There was no difference between the two groups in visual difficulties nor in marital status. Patients were approximately ten times more likely to be living on their own (odds ratio = 10.61; Clodds = 3.59 to 31.33) and 16 times more likely to be considered socially isolated (odds ratio = 16.65; Clodds = 5.39 to 51.40). There was no difference between patients and controls in frequency of schizophrenia-like family history. Patients were more likely than controls to exhibit neurological soft signs (z = 4.70; P < 0.001; Cld = 4.61 to 9.63). The presence of abnormal involuntary and tardive dyskinesia movements was associated with the use of antipsychotic medication. CONCLUSION: Women appear to run a greater risk of developing late paraphrenia, especially those who are socially isolated and present with associated hearing impairment. The increased presence of neurological soft signs among patients indicates that brain disease may be a critical factor in the development of psychotic symptoms in late life.

Aged↗

PubMed2005

Social support and depressive symptomatology among HIV-positive women: the mediating role of self-esteem and mastery.

Women constitute an increasing proportion of individuals contracting HIV in the United States and, once diagnosed, are living longer lives since the advent of combination antiretroviral therapies. HIV-positive women, who are disproportionately ethnic minority, face unique challenges to their psychosocial adaptation. Findings from a survey of 373 mainly indigent African-American and Puerto Rican women living with HIV/AIDS in the New York City area indicated high levels of depressive symptomatology, which were inversely related to HIV-related social support from friends, relatives, partner, and groups/ organizations. In line with the Cognitive Adaptation Model, structural equation modeling indicated that psychological resourcefulness (i.e., self-esteem and mastery) mediated the effects of social support on depressive symptomatology. Findings suggest the need to assess HIV-positive women for social isolation and depression and to provide them with interventions such as support groups that capitalize on their existing strengths, including their psychological resourcefulness.

Acquired Immunodeficiency Syndrome↗

PubMed2006

Social capital, age and religiosity in people who are lonely.

AIMS AND OBJECTIVES: The aims of the study were to (i) investigate age and loneliness, (ii) investigate the association between religiosity and loneliness, and (iii) and explore the relationship between social capital and loneliness. BACKGROUND: Loneliness is the subjective experience of social isolation and is a risk factor for a wide range of health problems including heart disease and depression. Poor self-rated health, domestic violence and poor economic conditions are associated with greater loneliness. DESIGN: The study was a cross-sectional survey of a random sample of adults aged 18 years and over. METHODS: A random sample of 1289 subjects was interviewed by computer-assisted telephone interviewing. This interview included the Loneliness Scale and items from the Social Capital Module of the General Household Survey. FINDINGS: Loneliness is more common in men and people without strong religious beliefs. An income-loneliness gradient is evident. Little support was found for the association between social capital and loneliness. CONCLUSION: The prevalence of loneliness is relatively stable in this population. Loneliness is linked to income and unemployment and as such pathways between socio-economic factors, loneliness and health need to guide interventions and future research. RELEVANCE TO CLINICAL PRACTICE: Loneliness is linked to a range of social and economic factors. Current Health Visiting practice recognizes the importance of tackling the effects of poverty and social deprivation and places community building at the core of much Health Visiting practice. This broad community level approach can usefully transfer into all community nursing and health promotion activity.

Adolescent↗

PubMed1994

Effects of testosterone exposure and fighting experience on the aggressive behavior of female and male mice selectively bred for intermale aggression.

Exposure of female mice to testosterone resulted in aggressive behavior as a function of breeding line in two lines of mice selectively bred for high (Turku Aggressive, TA) and low (Turku Nonaggressive, TNA) levels of aggressiveness. Female TA mice that received a single injection of testosterone propionate (TP) (1 mg in 0.05 ml peanut oil) on the second day of life, and starting at 120 days of age received daily injections for seven consecutive days, displayed aggressive behavior on a level comparable to that of socially isolated males of the same line, whereas control TA females (injected with 0.05 ml peanut oil) and TP-exposed TNA females were totally nonaggressive. The level of aggressiveness was assessed by means of dyadic tests against intact male opponents. Early and adult exposure to TP did not lead to increased aggressiveness in male TNA mice. Fighting experience in combination with prolonged TP treatment changed the aggressiveness of the TP-exposed TA females, leading to decreased aggressiveness in defeated animals. The genetically correlated low level of aggressiveness of TNA male and female mice was unaffected by any combination of TP exposure, learning and social isolation. It is concluded that differences in testosterone reactivity of target organs, other than those which are Y chromosome determined, i.e., the testes, are responsible for the aggressiveness in the strains studied.

Aggression↗

PubMed2002

Religious differentials in infant and child mortality in Holland, 1855-1912.

At least three kinds of hypothesis may be invoked to interpret religious differentials in mortality. They are (i) hypotheses that refer to characteristics, (ii) those that refer to lifestyle, and (iii) those that refer to the social isolation of minorities. This paper tests all three kinds of hypothesis using data on urban child mortality from the Hague just before and during the demographic transition. A hazard analysis suggests that economic and demographic characteristics do not account for much of the variation by religion. An analysis of seasonal mortality suggests that some of the variation may be explained by differences in lifestyle. The third kind of hypothesis is presented here for the first time. We suggest that the social isolation of small religious groups lowered their exposure to certain kinds of infectious disease. We use a simulation study to show that this hypothesis could account for part of the variation.

Child↗

PubMed1995

Nottingham health profile measurement in the assessment of clinical outcome after prostatectomy. Northern Regional Prostate Audit Group.

OBJECTIVE: To compare the changes in pre- and post-operative symptom scores with changes in Nottingham health profile (NHP) scoring, and thus determine whether NHP scoring offers a reliable assessment of outcome after transurethral resection of the prostate (TURP), and whether NHP scoring could usefully supplement the more traditional method of symptom scoring in this assessment. PATIENTS AND METHODS: An 8-month audit of 1396 TURPs, involving 12 hospital sites, was performed in the Northern region between April 1 and November 31, 1991. A cohort of 371 of these patients, for whom pre- and post-operative NHPs and irritative and obstructive voiding symptoms had been recorded, were investigated. RESULTS: There was a significant decrease in both obstructive and irritative voiding symptom scores 3 months after TURP and a significant fall in the NHP scores for all stations except social isolation. There were significantly higher irritative symptom scores both before and after operation in men with prostate cancer compared with those with benign prostatic hypertrophy, and significantly higher post-operative obstructive symptom scores in men with prostate cancer. However, there were no significant differences in the pre- and post-operative NHP scores for these two subgroups of patients. In patients who had a good outcome on symptom scoring, there was a significant reduction in NHP scores for all stations except social isolation. However, in those patients who had a poor outcome on symptom score, there was no correlation with changes in the NHP scores, with some NHP stations showing a significant reduction after operation. CONCLUSION: NHP quality-of-life scoring cannot replace symptom scoring in the assessment of outcome after TURP and when used alone, added little further information. However, for a comprehensive assessment of outcome, symptom scores and quality-of-life assessments should be used together.

Cohort Studies↗

PubMed2006

Trauma, post-migration living difficulties, and social support as predictors of psychological adjustment in resettled Sudanese refugees.

OBJECTIVE: This paper explores the impact of pre-migration trauma, post-migration living difficulties and social support on the current mental health of 63 resettled Sudanese refugees. METHOD: A semistructured interview including questionnaires assessing sociodemographic information, pre-migration trauma, anxiety, depression and posttraumatic stress, post-migration living difficulties and perceived social support were administered assisted by a bilingual community worker. RESULTS: Resettled refugees from Sudan evidenced a history of trauma. Less than 5% met criteria for posttraumatic stress but 25% reported clinically high levels of psychological distress. The results indicate that social support--particularly perceived social support from the migrant's ethnic community--play a significant role in predicting mental health outcomes. Pre-migration trauma, family status and gender were also associated with mental health outcomes. CONCLUSIONS: Refugees in Australia may constitute a particularly vulnerable group in terms of mental health outcomes. Culturally specific sequelae in terms of social isolation and acculturation may be particularly problematic for these migrants.

Adaptation, Psychological↗

PubMed1993

Cultural and linguistic factors in worker notification to blue collar and no-collar African-Americans.

This presentation offers historical and sociolinguistic perspectives regarding the origins of the language used by African-Americans. U.S. descendants of slaves of West and Niger Congo African origin should not be thought of as native speakers of English. To the extent that they have lived in de jure or de facto social isolation from Euro-American English-speaking persons, they have retained a West and Niger Congo African thought process or substratum in the phonology and morphosyntax of their speech. Their mother tongue has been described by several African-American linguists, psychologists, and ethnologists as Ebonics. In a sense, Ebonics refers to the paralinguistic verbal and non-verbal sounds, cues, and gestures that are systematically used in the process of communication by many African-Americans. As one consequence of historical social isolation, African-Americans invariably score poorly on nationally standardized scales of "Standard American" English competence. Therefore, worker notification intended for African-Americans, especially among the blue- and no-collar levels, that does not contain an Afro-centric perspective will likely not prove successful. The linguistic factors, which can severely impede or tremendously enhance the effectiveness of worker notification to these groups, are therefore vital and should not be ignored. Worker notification targeted for limited English-speaking or unlettered populations should include the development of materials and presentations in the language or primary medium best understood by the audience. Based upon research findings on the psycholinguistics of learning modal preference, the development of notification materials that target a learning channel that is audio oral or aural-oral is promoted.

Black or African American↗

PubMedDate not supplied

Living with chronic illness: social support and the well spouse perspective.

Progressive neurologic disease has a significant impact on family members, particularly those living with and caring for a homebound adult. Focus groups were conducted with women who were the primary caregiver for their disabled husband. The women described themselves as being restricted to the home by caregiving requirements. Multiple sclerosis was a critical personal hardship for them, involving persistent struggle that often resulted in anger and frustration. Because of the social isolation created by their caregiving responsibilities, these women depended on their disabled husband for support. Yet, never having time away from the husband strained the marital relationship and threatened the supportive nature of the relationship. The women in this study found it necessary to have personal time and space away from their husband. They created space for themselves by setting apart a place in the home that was theirs or by declaring time out for themselves. These strategies helped them avoid or reduce negative outcomes of the social support received from their husband.

Adaptation, Psychological↗

PubMed2001

Trust and the acceptance of and adherence to antiretroviral therapy.

BACKGROUND: Antiretroviral therapy (ART) has resulted in reduced AIDS incidence and mortality. Socially marginalized individuals with HIV infection, particularly injection drug users (IDUs), have received less ART and derived less benefit than others. Little is known about the therapeutic process necessary to promote acceptance of and adherence to ART among marginalized HIV-infected populations. We report on the correlates of both acceptance of and adherence to ART among HIV infected prisoners, most of whom are IDUs. DESIGN: Using a cross-sectional survey design within four ambulatory prison HIV clinics, 205 HIV-infected prisoners eligible for ART were recruited between March and October 1996. MEASUREMENTS: Detailed interviews were conducted that included personal characteristics, health status and beliefs, and validated standardized scales measuring depression, health locus of control, social desirability and trust in physician, medical institutions and society. Acceptance and adherence were documented by self-report and validated for a subset by pharmacy review. Clinical information was obtained from standardized chart review. Adherence was defined as having taken > or = 80% of ART. RESULTS: The acceptance of (80%) and adherence to (84%) ART among this group of prisoners was high. Multiple regression models demonstrated that correlates of acceptance of and adherence to ART differed. Acceptance was associated with trust in physician (8% increase for each unit increase with trust in physician scale) and trust in HIV medications (threefold reduction for those mistrustful of medication). Side effects (OR = 0.09), social isolation (OR = 0.08), and complexity of the antiretroviral regimen (OR = 0.33) were associated with decreased adherence. The prevalence of health beliefs suggesting an adverse relationship between ART and drugs of abuse was high (range 59 to 77%). Adherence did not differ among those receiving directly observed therapy (82%) or self-administration (85%). CONCLUSIONS: ART can be successfully administered within a correctional setting. Trust and the therapeutic relationship between patient and physician remain central in the ART initiation process. Characteristics of the therapeutic agents and the degree of social isolation predict adherence. These results may inform the design of interventions to improve both acceptance of and adherence to ART particularly among marginalized populations who have not derived full benefit from these potent new therapies.

Adult↗

PubMed1977

The attitudes of psychiatrists toward etiological theories of schizophrenia.

This study is an analysis of psychiatrists' opinions on the etiology of schizophrenia. A random sample of members of the American Psychiatric Association uncovers a general hesitation on their part to subscribe to any particular etiological theory. Only four theories are viewed as causally related to schizophrenia: social isolation, cognitive breakdown, biochemical imbalance, and maternal deprivation. Attitudes toward etiological theories are significantly different among psychoanalysts, behaviorists, and eclectics. Attitudes also are related to the setting in which the psychiatrist practices.

Attitude of Health Personnel↗

PubMed1987

A comparison of black and white women entering alcoholism treatment.

Similarities and differences between Black and White women in the early stages of alcoholism treatment were investigated. Characteristics relevant to treatment and to the risk of early treatment discontinuance were examined including health-related attitudes and beliefs, personality characteristics, alcoholism history, and social and situational factors. Data were obtained through interviews with 25 Black and 67 White women who had recently entered an alcoholism treatment facility. Black women had a significantly lower income and were on average 5 years younger than White women. After controlling for income and age, discriminant function coefficients indicated that ethnic differences also existed in women's perceptions about the role of health professionals in the maintenance of health, consequences of drinking, social isolation, self-esteem, access to alcoholism insurance, contact with important others and degree of opposition to treatment from others. Implications of the results for treatment continuance and service delivery are discussed.

Adult↗

PubMed1996

The moderating influence of service use on negative caregiving consequences.

This investigation adapts the social support conceptual framework to examine the moderating influence of community service use by impaired older persons on the negative consequences of caregiving for informal helpers. The model is modified by defining services as a type of social support that can counteract the stress associated with various care recipient impairments. Results from multivariate analyses of data from 401 caregivers suggest that certain services for care recipients can reduce the adverse effects of certain impairments on informal caregivers. The use of health care service by care recipients who are more disabled is related to lower levels of caregiver depression, health deterioration, and social isolation. Personal care service use consistently offsets the negative effects of care recipients' behavioral problems. Additionally, the use of household service when care recipients exhibit behavioral problems is associated with lower levels of caregiver depression.

Aged↗

PubMed2005

Acceptance, avoidance, and ambiguity: conflicting social values about childhood disability.

Advances in medical technology now permit children who need ventilator assistance to live at home rather than in hospitals or institutions. What does this ventilator-dependent life mean to children and their families? The impetus for this essay comes from a study of the moral experience of 12 Canadian families--parents, ventilator-dependent child, and well siblings. These families express great love for their children, take on enormous responsibilities for care, live with uncertainty, and attempt to create "normal" home environments. Nevertheless, they experience social isolation, sometimes even from their extended families and health care providers. Their lives are constrained in many ways. The challenges faced by parents of technology-dependent children raise questions of justice within society and within families.

Adolescent↗