Andrew Futterman

Effects of Parent Training on Infant Sleeping Patterns, Parents' Stress, and Perceived Parental Competence.

First-time parent couples from childbirth classes were randomly assigned to a four-session training group (n = 29) or a control group (n = 31). Members of the training group were taught behavioral strategies to promote healthy, self-sufficient sleep patterns in their infants, whereas the control group received the same amount of personal contact without the behavioral training. Six sleep variables were derived from a daily infant sleep diary completed by parents at two time points. Results show that at age 6-9 weeks, infants in the training group displayed significantly better sleeping patterns than did control infants. Training group parents awakened and responded less often to infant signaling and reported greater parental competence. By contrast, control group parents indicated increased stress over time.

The effects of late-life spousal bereavement over a 30-month interval.

Self-report measures of grief, depression, and general psychopathology were studied in widows and widowers over a 2.5-year period following death of their partner. A comparison sample of men and women was also followed for the same period. Differences in severity of depression and psychopathology previously reported at 2 months postloss (Gallagher, Breckenridge, Thompson, & Peterson, 1983) diminished to nonsignificant levels at 12 and 30 months. However, significant differences between bereaved and comparison subjects on measures of grief were still apparent 30 months after spousal loss. A main effect of gender for depression and psychopathology (but not for grief) was found at 2 and 12 months: Women reported more distress than men regardless of bereavement status. Results indicate that the experience of grief persists for at least 30 months in both older men and women who have lost their spouse.

Handbook of bereavement: The impact of spousal bereavement on older widows and widowers

The purpose of this chapter is twofold: to summarize basic results from two longitudinal studies of how elders adapt to death of their spouse, depending on whether the death was due to natural causes or to suicide; and to review what these studies have found regarding the possible correlates of good versus poor outcome. A final objective is to present some thoughts about unanswered questions and to suggest further research to shed light on these issues. The University of Southern California (USC) spousal bereavement study Although spousal loss occurs predominantly late in life (U.S. Bureau of Census, 1988), few studies have systematically assessed the response to this loss in older adults. The primary objective of the USC study was to assess longitudinally the impact of spousal loss on the mental and physical health of older widows and widowers. In addition, we also evaluated specific predictors of bereavement outcome in light of existing theory and previous research (e.g., Freud, 1917b; Parkes & Brown, 1972). Of particular interest in the USC study were the following factors, each of which alone, and in combination, was thought to be causally related to bereavement outcome: personality and ego strength, social support, religiosity, marital quality, anticipation of loss, and cumulative losses/stressors. Sample characteristics and research design Two samples of older adults were compared in the USC study. One sample comprised 212 recently widowed elders (99 males and 113 females) who had lost their spouse as a result of natural causes.

Retrospective assessment of marital adjustment and depression during the first 2 years of spousal bereavement.

Two hundred twelve bereaved elders rated marital adjustment using items drawn from the Locke and Wallace (1959) Marital Adjustment Test and completed the Beck Depression Inventory 2 months, 12 months, and 30 months after the loss of their spouses. Their responses were compared with those of 162 nonbereaved individuals of comparable age who were tested at the same times. More positive ratings of marital adjustment were made by bereaved subjects than by nonbereaved subjects. Among nonbereaved elders, more severe ratings of depression were associated with lower ratings of marital adjustment. In the bereaved sample, however, the opposite was found: More severe ratings of depression were associated with higher ratings of marital adjustment. This pattern of results changed only slightly over the 2.5-year course of bereavement and was not influenced by gender. These results are discussed in terms of cognitive processes (e.g., idealization) that influence retrospective assessments of marital adjustment during bereavement.

Atenolol Compared with Nifedipine: Effect on Cognitive Function and Mood in Elderly Hypertensive Patients

OBJECTIVE To compare the effects of atenolol and nifedipine on mood and cognitive function in elderly hypertensive patients. DESIGN Randomized, double-blind, crossover trial. PATIENTS Thirty-one elderly volunteers (7 women and 4 men) 60 to 81 years of age with mild to moderate hypertension were recruited from the general community and a Veterans Affairs hospital hypertension clinic. Six volunteers withdrew at early phases of the study for reasons unrelated to adverse drug effects. INTERVENTIONS Participants had 2 weeks of placebo, to 6 weeks of titration with atenolol or nifedipine, and weeks of treatment followed by similar periods with the other drug. MEASUREMENTS Psychometric tests designed to assess mood and cognitive function. RESULTS In the group first treated with nifedipine, the summed recall score on the Buschke selective reminding test (a test of verbal learning and memory) decreased by 9.3 words (95% CI, 2.8 to 15.6 words), or 0%, during nifedipine treatment compared with placebo (P = 0.031). The group first treated with atenolol showed no improvement in summed recall scores when results seen during atenolol therapy and placebo administration were compared (P = 0.10); however, this group had an improvement of 16.1 words (CI, 5.6 to 26.5 words), or of 16%, when the atenolol score was compared with the nifedipine score (P = 0.026). In the group first treated with nifedipine, 6 of 11 patients 55%) showed a decrease of 5 words or more during nifedipine therapy compared with placebo, whereas only 1 of the 14 patients (7%) in the group first treated with atenolol showed a similar decrease (P less than 0.01). On the digit symbol test (a psychomotor test), patients treated first with atenolol tended to improve, whereas patients treated first with nifedipine tended to decline. The difference between nifedipine and atenolol, in terms of the change from the score seen during placebo, was 4.3 codings (CI, 0.7 to 7.9 codings) or 10% (P = 0.043). No statistically significant differences were seen between nifedipine and atenolol therapy regarding the other measures of psychomotor ability, sustained attention, motor performance, verbal fluency, or abstract reasoning, and no effects of either drug on mood or psychopathologic symptoms were noted. CONCLUSIONS Although atenolol and nifedipine are generally free of gross effects on cognition or mood, nifedipine may subtly impair learning and memory in some elderly hypertensive patients.

Dimensions of perceived social support in clinically depressed and nondepressed female caregivers.

The relationship between social support and depression was studied in 165 women caring for frail family members. The Arizona Social Support Interview Schedule (Barrera, Sandler, & Ramsay, 1981), which includes 4 dimensions of availability and use of resources and satisfaction with and need for support, was used to examine 7 categories of supportive activity. Depression was assessed according to Research Diagnostic Criteria (Spitzer, Endicott, & Robins, 1978) with the Schedule of Affective Disorders and Schizophrenia (Endicott & Spitzer, 1978). There were no differences in overall satisfaction with received support in comparisons of depressed and nondepressed caregivers. However, depressed caregivers (n = 87) reported a higher incidence of negative interactions with others. Both groups appeared to have equal access to social support, with nondepressed caregivers (n = 78) reporting significantly greater use of those resources.

Factorial Validity of the Texas Revised Inventory of Grief-Present Scale among Bereaved Older Adults

The Texas Revised Inventory of Grief-Present scale (TRIG-Present) is one of the most widely used grief measures; however, researchers have only empirically examined the validity and underlying factor structure of TRIG-Present scores in a few studies. Hence, in the present investigation, we sought to examine the factorial validity of the TRIG-Present (those scores that index current grief) among 2 samples of bereaved older adults--a community-dwelling sample of 162 individuals who experienced a diverse set of losses in terms of relationship to the deceased and time since loss, and a recently widowed sample of 212 individuals who were assessed at 2-months and 12-months postloss. Across both samples, we found support for a 3-factor model, composed of clusters of items representing Emotional Response, Thoughts, and Nonacceptance regarding a loss. Additionally, this 3-factor model exhibited significant invariance from 2-months to 12-months postloss in the recently widowed sample. Analyses examining the convergent validity of these 3 factors also suggest that this conceptualization of the TRIG-Present could have practical advantages and potentially influence the way in which clinicians and/or researchers assess grief and evaluate bereavement interventions.

Difficulties Accepting the Loss of a Spouse: A Precursor for Intensified Grieving Among Widowed Older Adults

Previous research has identified three distinct factors that make up the Texas Revised Inventory of Grief—Present (TRIG-Present) scale, which tap into grief-related thoughts, emotional response, and nonacceptance regarding a loss. In the present study, the authors sought to identify which of these core grief experiences in the early aftermath of loss are predictive of subsequent intensified grieving. Information was collected from 169 conjugally bereaved older adults at 2- and 12-months following the loss of their spouse. Using a cross-lagged panel design, early experiences of nonacceptance were found to significantly predict more intense grief experiences later on; whereas grief-related thoughts and emotional response were not strongly related to grief at 12-months postloss, after accounting for synchronous (cross-sectional) and autoregressive (stability in the same factor over time) associations. These findings suggest that practitioners working with bereaved clients should pay close attention to early expressions of nonacceptance.

Endogenous Depression in the Elderly: Prevalence and Agreement Among Measures

This article describes agreement among diagnoses made according to five definitions of endogenous depression in a sample of 99 depressed elders and discusses the relationship among these systems and selected demographic and clinical characteristics. Poor to fair agreement was generally demonstrated, except for Research Diagnostic Criteria (Spitzer, Endicott, & Robins, 1978) and Diagnostic and Statistical Manual of Mental Disorders, 3rd ed., rev. (American Psychiatric Association, 1987), which demonstrated excellent agreement. Mostly, demographic and clinical variables (e.g., severity of depression) were unrelated to endogeneity diagnoses. The conclusion was reached that these criteria are not all measuring the same construct in older adults and that the relationship between depression severity and endogeneity should be discussed in terms of specific definitions rather than general terms.