Donald H. Sykes

Very Low Birthweight: A Long-term Developmental Impairment?

Research with very low birthweight (VLBW) infants (≤isoog) may be broadly categorised into product and process studies. Recent product-oriented outcome studies are reviewed from the perspective of whether VLBW infants born since 1975 (when intensive care methods became relatively stabilised in effectiveness) show behavioural problems, intellectual impairment, linguistic or social deficits. Process studies examining cognitive, social and contextual variables, differentiating VLBW and normal birthweight infants, and thought to compromise long-term outcome are then discussed. It is argued, in the light of the conflicting evidence, that future studies need to: (1) exert greater control over the medical and psychological variables confounded with low birthweight, including the variable of social class; (2) study outcome from a life-span perspective, examining the possibility of an intergenerational cycle for at least some families; and; (3) incorporate both systems-oriented and transactional models into their designs, for the purpose not only of predicting outcome, but also ultimately for providing the most appropriate types of support for these infants.

The social competence of very-low-birthweight children: Teacher, peer, and self-perceptions

Whether very-low birthweight (VLBW ≤1500 gm) children differ from normal birthweight (NBW > 2500gm) children with respect to social (as opposed to intellectual) competence has been a relatively neglected issue. The social competence at school age of 183 VLBW children was therefore compared with that of 183 NBW children born at the same hospital matched for age, gender, social class, parity, and maternal age. A multi-informant, multidefinilional approach to social competence was adopted involving teacher, (same-gender) peer, and self-ratings of the 366 childrens levels of social maladjustment, social skill, and peer acceptance. VLBW children from the upper, middle, and lower social classes received significantly higher mean sadness/unhappiness scores (even with IQ covaried) than their NEW counterparts. Mean scores for the VLBW group were also higher for social withdrawal, and lower for both social skill and peer acceptance. Possible antecedents and consequences of such group differences in affect and sociability are suggested.

In vitro fertilization: a long-term follow-up after treatment failure.

There is a considerable body of psychological research on women presenting for in vitro fertilization (IVF), but relatively little on the long-term adjustment of such women after unsuccessful treatment. This study examined the adjustment (4–9 years after treatment) of a sample (n = 76) of women whose treatment had failed. At follow-up, it was found that eight (10.53%) of the women had conceived naturally and 16 (21.05%) had become adoptive parents. In comparison with population norms, the women who had not subsequently conceived or adopted (n = 52) were found to rate themselves as more highly stressed (P < 0.001), but rated themselves as higher in self-esteem (P < 0.001). However, when women who remained childless after unsuccessful IVF were compared with those who subsequently conceived or adopted, the former group rated themselves as more stressed (P < 0.05), more depressed (P < 0.001) and with a lower satisfaction with life (P < 0.005) and lower self-esteem (P < 0.05). Women who wished to adopt but were unable to do so made a major contribution to this negative pattern. The study indicates that infertility long after failed IVF treatment contributes to psychological dysfunction. It highlights the need to prepare women better for treatment failure and to ensure appropriate counselling is available when further IVF treatment is no longer appropriate.

DISCHARGE FROM A CORONARY CARE UNIT: PSYCHOLOGICAL FACTORS

Anxiety is commonly experienced by patients following myocardial infarction. The role of anxiety in the recovery/rehabilitation process is not well understood, but anxiety is thought to be one of the factors determining outcome. It is important, therefore, to understand the possible effects on anxiety of changing discharge policies in coronary care units. Anxiety was assessed in a sample of MI patients, with good or poor prognoses, assigned to either early or late discharge from a coronary care unit. Although the overall level of anxiety of the total sample was not unduly high, it was clear that there was a subgroup of individuals, high in trait anxiety and with a poor prognosis, for whom early discharge was contra-indicated. Irrespective of prognosis, it was clear that early discharge did not produce a uniform response, indicating the need to differentiate between patients when determining the optimal date for discharge.

Socioeconomic status, social environment, depression and postdischarge adjustment of the cardiac patient

In this study, we assess the adjustment achieved by patients following discharge from coronary care and the role of socioeconomic status (SES), social environment (SE), and depression in achieving that adjustment. Two hundred eighty-seven patients were enrolled. The SE into which the patients were to be discharged was rated significantly poorer for patients of lower SES, who also scored higher on depression. At 1, 6, and 12 months postdischarge, lower SES patients recorded significantly poorer levels of adjustment across a range of functioning. Predischarge depression, together with measures of SE and SES, determined 10% to 28% of the variance in 12-month postdischarge adjustment. These data suggest the importance of identifying patients at greater risk for less than optimal outcome (those lower in SES and higher in depression), and the need to address the nature of the SE in which the patient has to effect his/her recovery.

Work strain and the post-discharge adjustment of patients following a heart attack

Abstract The role of work characteristics in determining return to work after an acute coronary event was examined. One hundred and forty nine patients were enrolled. One year post-discharge, 74 had returned to work. Work characteristics (decision latitude, and opportunity for social interaction at work), together with age, depression, and medical prognosis, correctly classified work status in 78% of cases. At 12 months post-discharge, patients who had not returned to work recorded significantly poorer levels of adjustment compared to those who had returned to work. A better quality of life is associated with a lower level of depression pre-hospitalization, ownership of a larger home, being male, and having a more positive work environment. The findings suggest that the pre-illness work environment of the patient is a factor influencing return to work, which needs to be considered in rehabilitation programmes.

Coping with a heart attack: Psychological processes

In a substantial proportion of patients surviving a heart attack, their quality of life following discharge from the coronary care unit is less than optimal. For the greater part this less than optimal adjustment is not a function of illness severity. Rather, it would appear to reflect the operation of psychological and inter-personal factors involved in the adjustment process. Anxiety and depression are most clearly implicated in the rehabilitation process, with the affective responses being modulated by cognitive and relationship variables. However, not all cardiac patients are equally vulnerable, nor are they vulnerable in the same ways. Important issues that therefore need to be addressed by rehabilitation programmes are the early identification of individuals at particular risk for poor outcome, and the design of interventions that target specific risk factors.

The Effects of Being Born of Very-Low-Birthweight

Whether very-low-birthweight (VLBW ≤1,500 g) children differ from normal birthweight (NBW ≥2,500 g) children with respect to long-term outcome continues to be a controversial issue. Preliminary findings are reported from the interdisciplinary Northern Ireland Very-Low-Birlhweight Project, which compared medical, cognitive, behavioural and social outcomes at school age in samples of VLBW and NBW infants (n=221 per group) matched for age, gender, social class, maternal age and parity. All infants were born in or treated in the Royal Maternity Hospital, Blfast during the years 1978–1981. As compared to the NBW group, the VLBW children from all social classes were found to score more poorly across all areas investigated. These differences, although not representing gross abnormalities, nonetheless were statistically significant and represented considerable dysfunctioning across a range of abilities relevant to later adult adjustment. Possible mechanisms common to all outcome areas and to all social classes wh...