Aloen L. Townsend

Centrality of women's multiple roles: beneficial and detrimental consequences for psychological well-being.

Theorists have proposed that greater centrality (personal importance) of a social role is associated with better psychological well-being but that role centrality exacerbates the negative effects of stress in that same social role on well-being. The present study found evidence to support both hypotheses in a sample of 296 women who simultaneously occupied the roles of parent care provider, mother, wife, and employee. Greater centrality of all four roles was related to better psychological well-being. As predicted, wife centrality exacerbated the effects of wife stress on life satisfaction, and employee centrality exacerbated the effects of employee stress on depressive symptoms. Contrary to prediction, centrality of the mother role buffered women from the negative effects of mother stress on depressive symptoms. These findings point to an aspect of role identity that can benefit well-being but that has complex effects in the context of role stress.

Respite for Dementia Caregivers: The Effects of Adult Day Service Use on Caregiving Hours and Care Demands

The objective of this study was to determine whether adult day service use was related to decreases in primary caregiving hours (i.e., the time caregivers spent on activities of daily living/instrumental activities of daily living and behavior problems for care recipients) and care recipient function for these domains. Three-month longitudinal data from the Adult Day Care Collaborative Study (N = 400) were used. Adult day service users reported greater decreases in hours spent on behavior problems when compared to nonusers, even after controlling for baseline differences between the two groups. In addition, adult day service users reported decreased frequency of behavior problems in their relatives who attended adult day programs. The findings suggest that adult day services, if used over time, are effective in restructuring caregiving time and may offer potential benefits not only to family caregivers but to community-residing older adults who have dementia as well.

Stress of parent care: positive and negative effects of women's other roles.

The present study focused on 296 women who were primary caregivers to an ill or disabled parent or parent-in-law and who simultaneously occupied 3 other roles as mother, wife, and employee. All women lived in separate households from their impaired parent and had at least 1 child 25 years of age or younger living at home. It was predicted that stress in the roles of mother, wife, and employee would exacerbate the effects of stress in the parent care role on psychological well-being (depression and life satisfaction) and that rewards in these 3 additional roles would buffer the effects of parent care stress. For all 3 additional roles, findings supported the stress exacerbation hypothesis. In contrast, only the employee role supported the stress-buffering hypothesis. These findings underscore the complex relationships that often exist between womens multiple role experiences and their psychological well-being.

Employed family caregivers of cognitively impaired elderly: An examination of role strain and depressive symptoms

This paper compares employed and non-employed caregivers of cognitively impaired elderly family members. Using two competing positions derived from role theory, role conflict and role expansion, we explored whether holding the positions of both caregiver and worker led to greater role overload and psychological role conflict, or provided an outlet that helps caregivers better manage the demands placed on them. We found no differences between employed and non-employed caregivers on measures of role overload, worry and strain, and depression. For working caregivers, however, greater conflict on the job was associated with higher role overload and worry and strain while beneficial work experiences were only weakly associated with lower role overload and worry and strain. There was an interaction effect between positive work experiences and role overload when predicting depressive symptoms. These results provide some support for role conflict, but also suggest that caregivers may vary considerably in how they adapt to multiple roles.

Elderly Outpatients Respond Favorably To A Physician-Initiated Advance Directive Discussion

Background: Little is known about the emotional impact of physician-initiated advance directive discussions. Methods: One hundred ambulatory patients aged 65 years and older were randomly assigned to receive either a physician-initiated discussion of advance directive choices or a discussion of health promotion issues. Prediscussion, Immediate postdiscussion, and 1-week postdiscussion measures of positive and negative affect were measured for both groups. Results: Neither discussion topic resulted in adverse emotional or attitudinal responses. Only the advance directive participants showed positive affective and attitudinal responses to the discussion, including an increase in positive affect, an increased sense of physician-patient understanding, and increased thought and discussion about life-support issues in the week following the discussion. For those participants receiving the advance directive discussion, longer physician-patient relationships and higher educational levels significantly predicted a more positive affective response. Lower scores on indices of mental and physical health and a stronger belief that physicians should discuss advance directive issues signiftcantly predicted a more negative affective response to the advance directive discussion. Conclusions: Physicians should anticipate positive emotional responses when they initiate advance directive discussions with their elderly outpatients. Advance directive discussions will be received most positively by patients who enjoy good psychological and physical health and when initiated in the context of an established physician-patient relationship.

Colorectal cancer screening disparities in Asian Americans and Pacific Islanders: which groups are most vulnerable?

Background. Colorectal cancer (CRC) is a significant cause of mortality among Asian Americans and Pacific Islanders (AAPIs), yet studies have consistently reported lower CRC screening rates among AAPIs than among non-Latino Whites and African Americans. Moreover, existing research tends to aggregate AAPIs as one group when reporting CRC screening, masking the disproportionate burden in cancer screening that exists across AAPI groups. Methods. This study examines differences in CRC screening rates in both aggregated and disaggregated AAPI groups as compared with non-Latino Whites in order to identify the most vulnerable AAPI subgroups in terms of obtaining CRC screening. This study utilizes merged data from the 2001, 2003, and 2005 California Health Interview Survey (CHIS), specifically the data pertaining to adults aged 50 and older (n=52,491) from seven AAPI groups (Chinese, Japanese, Korean, Filipino, South Asian, Vietnamese, and Pacific Islander) and non-Latino Whites. Andersens Behavioral Model of Health Services Use was utilized to select potential confounders to racial/ethnic differences in CRC screening. Results. When AAPI groups were considered as an aggregate, their CRC screening rate (46.8%) was lower than that of non-Latino Whites (57.7%). When AAPI groups were disaggregated, further disparity was noted: Koreans (32.7%) showed the lowest CRC screening rate, whereas Japanese (59.8%) had the highest. When the influence of potential predisposing, enabling, and need confounders was adjusted, Koreans, Filipinos, and South Asians were found to have a lower likelihood than non-Latino Whites to undergo CRC screening. Comparisons among AAPI subgroups further revealed that Filipinos, Koreans, Pacific Islanders, and South Asians were less likely than Chinese, Japanese, and Vietnamese to receive CRC screening. Conclusion. These results highlight the importance of identifying differences in CRC screening behavior among disaggregated AAPI subgroups in order to help health professionals and policy-makers prioritize which AAPI subgroups need the most urgent interventions in terms of CRC screening promotion.

Patterns of adult day service use by family caregivers: A comparison of brief versus sustained use.

Low service use by family caregivers of dementia patients was examined by comparing brief and sustained users of Adult Day Services (ADS). Caregivers whose relative used ADS briefly were more likely to be spouses, had less education, and were caring for more severely impaired relatives than sustained users. They also were experiencing more role captivity, but fewer depressive symptoms. These results suggest that brief users have often waited until their relatives problem is severe before trying ADS.

Mastery in women's multiple roles and well-being: adult daughters providing care to impaired parents.

The current study focused on 296 adult daughter caregivers who were simultaneously providing care to an impaired parent, mothers to children living at home, wives, and employees. How mastery (perceived competence and control) in each of these 4 roles was related to well-being was examined. Women experienced higher levels of mastery in the employee role than in any other role. After controlling for household income and dispositional optimism, only employee mastery contributed unique variance to physical health, but mastery in each of the 4 roles contributed unique variance to either depression or life satisfaction. Results also suggest that womens satisfaction with life was related to an accumulation of mastery across roles. The study expands previous research by revealing that mastery in womens additional roles can supplement the benefits of mastery stemming from parent care.

Emotional support and well-being of midlife women : Role-specific mastery as a mediational mechanism

This study examined the relationships among emotional support, mastery, and well-being for 258 women who simultaneously occupied the roles of wife, mother, parent care provider, and employee. Its primary aim was to determine if a greater sense of mastery in each of these 4 roles could explain the relationship between emotional support from the partner or partners in the same role (the husband, children, impaired parent, or work supervisor) and better psychological well-being (less depressive symptomatology and more life satisfaction). Findings revealed that more emotional support from each of the 4 role partners was related to a greater sense of mastery in that same role. Furthermore, for each of the roles of wife, mother, and employee, role-specific mastery was a mediating mechanism in the relationship between support from the role partner or partners and better well-being.

Review of Multidisciplinary Measures of Cultural Competence for Use in Social Work Education.

This study reviews extant measures of cultural competence from many disciplines and evaluates their suitability for social work education based on 8 criteria: validity, reliability, relevance to social justice, item clarity, definition of diversity, coherence, social desirability, and appropriateness for social work. Nineteen instruments met inclusion criteria. Of these, 4 are recommended for social work education. Points of discussion include the ability of scales to transcend disciplinary boundaries, scales as cultural artifacts, and emerging tensions in scale construction. This study calls for interdisciplinary collaboration to develop instruments, pool knowledge, and work toward a socially just world.