Andrew G. Billings

The role of coping responses and social resources in attenuating the stress of life events

The nature of individual coping responses to stressful life events was explored in a representative adult community sample. Two approaches to the classification of coping strategies were operationalized. Using these measures, small but significant gender and contextual differences in coping were identified. Mood and symptom levels were related to coping responses and to quantitative and qualitative measures of social resources. Measures of coping and social resources attenuated the relationship between undesirable life events and personal functioning.

Children of alcoholics during the recovery process: Alcoholic and matched control families

Children of relapsed and recovered alcoholic patients were compared with children from sociodemographically matched control families on a set of indices of emotional and physical status. The children of relapsed alcoholics evidenced more symptoms of emotional disturbance than did the control children. In contrast, the children of recovered alcoholics were functioning as well as the control children. Additional analyses showed that the emotional status of children was related to the emotional, physical, and occupational functioning shown by their alcoholic and their nonalcoholic parent, as well as to family life stressors.

Social support and well-being: Implications for prevention programs.

A variety of prevention programs have assumed that social support has health-promotive and health-protective effects. Although numerous studies have examined the relationship between social support and well-being, the result has been a heterogeneous and complex set of findings. We seek to review and summarize this research as a data base for planning and evaluating prevention programs. To organize our review, we present a model of stress, support, and well-being which distinguishes among several mechanisms through which support may affect well-being. We consider research on each of these mechanisms: thedirect effects of support upon functioning; theindirect effects of support upon functioning through its influence on exposure to environmental stressors; and theinteractive effects of social support in buffering the individual from the maladaptive effects of stress. We then address several implications of this research that need to be considered in the process of designing and evaluating prevention programs: (a) the need to consider the varying mechanisms through which social support has its effects; (b) the need for specificity in developing preventive interventions; and (c) the need to examine relationships among stress, support, and functioning within a broader social context.

Psychosocial adaptation in juvenile rheumatic disease: a controlled evaluation.

Juvenile rheumatic diseases are serious chronic illnesses potentially capable of disrupting a childs development and functioning. This study examined the psychosocial functioning of 43 children with severe rheumatic disease as compared to that of 52 children with a milder or inactive form of rheumatic disease. Both patient groups also were compared to 93 healthy children from demographically matched families. Data were obtained from parent reports, from physician evaluation, and, for children who were old enough, from self-reports. The severe patient group showed more parent-reported psychological and physical problems than both the mild patient group and the healthy controls. Compared to the mild group, the severe group also missed more days of school due to illness. Older children in the severe group were more likely to miss school due to illness and to participate in fewer social activities with their families and friends than the controls; however, the older children reported comparable mood and functioning in other areas. An expanded model is proposed to examine risk and resistance factors predictive of psychological and social dysfunction among children with severe chronic disease.

Social support and functioning among community and clinical groups: A panel model

This study examined the relationship between social support and personal functioning in a longitudinal assessment of a representative sample of community men and women. Although there was considerable temporal stability in several indices of support and personal functioning, changes in levels of support during the follow-up period were associated with changes in functioning. These relationships varied according to the individuals gender and the source of support. Family support was more strongly related to functioning among women, while work support was more strongly related to functioning among men. In comparable analyses on patients recovering from alcoholism, levels of support and functioning were more variable over time, and changes in family support were somewhat more strongly related to changes in functioning. The findings are discussed in light of a perspective that considers the role of environmental stressors and resources in adaptation.

Assessing life stressors and social resources: Applications to alcoholic patients*

A growing body of evidence points to the importance of life stressors and social resources in the development and course of alcoholism and other substance abuse disorders. This article describes the Life Stressors and Social Resources Inventory (LISRES), which provides an integrated assessment of life stressors and social resources in eight domains: physical health, home/neighborhood, financial, work, spouse/partner, children, extended family, and friends. The indices were developed on data obtained at two points in time 18 months apart from four demographically comparable groups: alcoholic patients, depressed patients, arthritic patients, and non-problem-drinking adults. As expected, alcoholic patients reported more acute and chronic stressors and fewer social resources than did non-problem-drinking adults. More important, the indices were predictively related to changes in alcohol consumption, drinking problems, depression, and self-confidence. Procedures such as the LISRES have some potential clinical and research applications and may be helpful in examining the process of recovery and relapse in substance abuse disorders.

Psychosocial functioning of siblings of children with rheumatic disease

The potential impact of an ill child on other siblings in the family was examined by comparing 72 siblings of children with rheumatic disease with 60 siblings of healthy children from demographically matched families. Psychosomatic, behavioral, emotional, and social problems, as reported by both the parents and the siblings, were investigated. Although siblings of patients with rheumatic disease generally were functioning as well as siblings of healthy children, they reported having more allergies and asthma. A set of vulnerability and protective factors was tested as predictors of sibling functioning. Cohesive and expressive family environments in which mothers and patients with rheumatic disease were functioning adequately promoted better adaptation among the siblings.

Social-environmental factors among light and heavy cigarette smokers: A controlled comparison with nonsmokers

Support for the importance of psychosocial influences on smoking is limited because the evidence is primarily based on intervention studies which deal with self-selected and thus unrepresentative samples of smokers. There have been few comparisons with nonsmokers on these factors. In this study, we examine the role of psychosocial factors among a representative community sample of smokers and nonsmokers. Heavy smokers were distinguished from nonsmokers by only slightly higher levels of environmental stressors, less supportive social resources, and poorer psychological functioning. Light smokers did not differ from nonsmokers on these factors. Although stressors and resources were correlated with psychological functioning across all respondents, such relationships were not significantly stronger for either heavy or light smokers. These results suggest that psychosocial influences may have differential relevance during the different phases of smoking behavior such as initiation, maintenance, and cessation.

Chronic and nonchronic unipolar depression. The differential role of environmental stressors and resources.

There appear to be strong variations in the association between psychosocial factors and the onset and course of depressive disorders. To explore a possible correlate of such variation, we consider whether the role of social-environmental factors may differ between patients with a recurrence of unipolar depression and a recent history of prior treatment (termed chronic patients), patients with unipolar depression but without a recent prior treatment episode (termed nonchronic patients), and a demographically matched group of nondepressed controls. Both chronic and nonchronic patients experienced more stressors and reported fewer social resources than nondepressed controls, but the two patient groups did not differ on these factors. However, correlational analyses indicated that stressors and social resources were significantly related to functioning among nondepressed controls and nonchronic patients, but not among chronic patients. These findings support the value of specifying subgroups of individuals for whom depression is most strongly related to psychosocial factors.

Difficulty of follow-up and posttreatment functioning among depressed patients

Evaluations of treatment outcome may obtain positively biased findings by failing to reassess patients who are difficult to follow and who may also be functioning more poorly than those who are successfully followed. We consider whether difficulty of follow-up is related to pre- and posttreatment functioning by reassessing 95% of a sample of 424 depressed patients after a 12-month interval. In contrast to earlier findings with other patient populations (e.g., alcoholic patients), there was no strong or consistent tendency for depressed patients who were more difficult to follow to be functioning more poorly after treatment. Moreover, poor functioning at treatment intake was not predictive of later difficulty of follow-up. However, patients who were younger, single, and of lower occupational level were somewhat more difficult to follow.