Allan H. McFarlane

Adolescent depression in a school-based community sample: Preliminary findings on contributing social factors

A two wave survey carried out on a large community sample of adolescents with increased risk for problems with social functioning is described. In this paper we report the prevalence of depression in this population and social factors that contribute to it. The prevalence of depression is twice that in other studies. Stress is both a risk and causal factor in depression while relatively low social self-efficacy moderately increases risk. Being female is a risk factor for depression. The perception of parents and siblings as a source of support appears to be a key factor in protection from the onset of depression.

Health Diaries: Strategies for Compliance and Relation to Other Measures

This article describes experience with the use of health diaries in a two-year prospective study of the influence of the psychosocial environment on the health status of 500 subjects in the Hamilton area. Three strategies were used to maintain compliance: 1) random sampling of three days within each two-week interval; 2) a lottery ticket incentive; and 3) telephone follow-up. The results of an initial telephone and lottery ticket study demonstrated a significant effect on compliance. The data from the two-year study were analyzed to characterize health change based on diary reports over successive six-month intervals and to determine the relationship of reported health to medical utilization data. The results indicated that subjects reported symptoms on about one third of the days surveyed but took no action on about one third of these symptom days. Only one quarter of the symptom days resulted in a change in usual activity, and fewer than one tenth of the symptom days resulted in time off from work or physician visits. The diary variables showed a low, positive correlation with health utilization.

Characteristics and correlates of effective and ineffective social supports

The paper examines cohorts of individuals with helpful and unhelpful social supports identified in a longitudinal study of stressful events, social supports and health. Specific features of the quantity and quality of social relationships leading to help and support are examined. Individuals with helpful social supports describe their social networks as smaller and appear to derive support primarily from spouse and close family relationships. No significant differences in the number of multiplex and reciprocal relationships were found. Subjects reporting the least helpful social supports also reported significantly more stressful events in the past five years and significantly more childhood events.

Patterns of illness among individuals reporting high and low stress.

This paper reports the results of a prospective study of 428 adults, which was designed to explore the relationship between social stress and health. Individuals in the study were grouped into cohorts based on the number of stressful events experienced in a 12 month period, and the differences in the quantity and quality of health measures among the cohorts in the same time period explored. Individuals under stress experienced considerably more illness (assessed by symptoms reported on a health diary and physician visits) than those not under stress. However the quality of these illness episodes were similar in both groups, as measured by the distribution of problems in organ system/body region and diagnostic categories. A second analysis, examining a subgroup of individuals who went from periods of low to high stress came to similar conclusions. The results suggest that the onset of stressful events is associated with a deterioration of health of a general nature, not associated with particular diseases of body systems.