Donna P. Funch

The role of support in relation to recovery from breast surgery

The relationship between support and short-term recovery from breast surgery was examined retrospectively in 151 female breast cancer patients who were 3-12 months postoperative. Subjects were interviewed regarding the extent to which 3 forms of support (social, professional, financial) were available. Two indices, representing physical recovery and psychological adjustment, were generated. Patient characteristics (age, education, prior health status, and life stress following surgery) and clinical indicators of disease severity (stage, type of mastectomy, adjunct therapy, and time elapsed since surgery) were controlled. Social and professional support were significantly positively related to psychological adjustment. Financial support was significantly positively related to physical recovery. Implications of these findings for future research are discussed.

Measuring life stress: factors affecting fall-off in the reporting of life events

Although the use of life events inventories continues, concern persists regarding their reliability. A major problem is respondent failure to recall events which have occurred in the past. Based on information gathered from a large national probability sample, this paper concludes the following: (I) fall-off in reporting event occurrence is rapid during the first twelve months (approximately five percent per month) then begins to level off; (2) the rate offall-off varies by the type of event, such that some highly salient events (death of spouse, marriage, birth of child) show essentially no fall-off, while other events (death of friend, illness in family) have immediate and severe fall-off; and (3) the rate of fall-off varies according to respondent characteristics. These findings are discussed in terms of their implications for future measurement of life stress. With the growing interest in the area of life events research has come an attendant concern over the reliability of data collected with techniques based on the retrospective cataloging of the life experiences of individual subjects over varying time periods. A major concern is respondent failure to recall events which have occurred in the past. It has been widely assumed that respondents would be less likely to remember events that are more remote in time; however, there is little evidence documenting the extent to which, as a result of time, this forgetting actually takes place.

Factors associated with nocturnal bruxism and its treatment

Using a single-subject design, two methods of treating nocturnal bruxism were evaluated. Neither technique was successful; both resulted in a rebound effect when treatment was stopped. In addition, the role of anxiety in bruxing behavior was evaluated. Contrary to most theoretical beliefs, bruxing resulting from anxiety was not as important as “anticipatory” anxiety resulting in bruxing.

Mental illness and the economy: a critique and partial replication

Two problematic aspects of a landmark study in psychiatric epidemiology (Brenner, 1973) are considered in this research note. First, one of the processes used in transforming the data of the study, Mental Illness and the Economy, is critically examined. Second, the difficulties inherent in drawing epidemiological inferences from the mental hospitalfirst-admission rate are emphasized. It is suggested that mental hospital capacity should be explicitly controlled in any attempt to base a study of mental illness incidence upon the rate of admission to mental hospitals. An alternative to the statisticalformulations utilized by Brenner is proposed and utilized in a partial replication of one of the central chapters of Mental Illness and the Economy. The results of this replication confirm that the effect of the state of the economy upon mental hospital admissions is generally confined to working-age populations of men and women. We found that mental hospital capacity is generally an important predictor of the hospitalfirst-admission rate and that, for the young andfor the aged, hospital capacity is a better predictor of the admission rate than is the state of the economy.

Assessment of a short scale to measure social support

A wide variety of measures have been used to assess the effects of social support on both physical and psychological status. Information on the reliability and validity of many of these instruments is unavailable; other instruments appear to be reasonably valid but involve large numbers of questions and require considerable time for completion. This study examines the properties of a short, self-administered social support scale (SSS). Data are available from 3 samples: HMO clients in a weight loss program (N = 268); chronic facial pain patients (N = 92); and colorectal cancer patients (N = 318). Three scoring strategies measuring two dimensions (structural and perceptual) of social support are compared with respect to internal consistency and criterion and construct validity. One of these strategies results in a measure that behaves in a way consistent with other, longer instruments and appears to possess acceptable reliability and validity. Scores can be broken down by source (e.g. spouse, friends), and wording can be modified to measure either general support or support for a specific situation.

Social environment and breast cancer. A Cohort analysis of patient survival

Several crude indicators of social stress and social involvement were used to explain survival among 283 women with breast cancer. The relationships of some stress and involvement indicators to survival are apparent; the data provide evidence that social stress decreases and social involvement increases the length of time breast cancer patients survive.

Diagnostic delay in symptomatic colorectal cancer.

Previous research on colorectal cancer patients has suggested that considerable delay can occur once the patient has sought medical care. However, little information has been available on the possible components of this delay. In this study, detailed information on diagnostic delays was collected from 294 symptomatic patients. Of these patients, 46% reported experiencing at least one delay. Three types of diagnostic delay were identified and were associated with different lengths of delay. Of all the delays, 31% were due to difficulties in scheduling initial or subsequent office visits or laboratory tests; these were associated with an average delay of 3 weeks. Physician‐related delays (e.g., misdiagnosis or observation of symptoms without specific action) comprised 46% of all diagnostic delays and resulted in an average delay of 18 weeks. The remainder of the delays were patient‐related and resulted in an average delay of 12 weeks. There was no association between any of these three delay types, suggesting that attempts to reduce diagnostic delay should encompass all three types in order to be maximally effective. Cancer 56: 2120‐2124, 1985.

Self-reliance as a modifier of the effects of life stress and social support ☆

A variable was introduced which classified 151 women with breast cancer into those with perceived self- or other-reliance regarding their recovery from breast surgery. While this factor played no direct role in psychological adjustment, it did serve as a modifier of the relationships between stress, social support, and adjustment. Life stress assumed more and support assumed less importance for those who were self-reliant. It is suggested that self-reliance is related to locus of control. The implications of this suggestion are applied to these findings.

Factors associated with successful outcome from behavioral therapy for chronic temporomandibular joint (TMJ) pain.

A total of 42 chronic temporomandibular joint pain patients completed behavioral therapy for their pain. The role of clinical, sociodemographic, and psychosocial factors was examined in relation to treatment outcome (immediately following treatment and at 2-yr follow-up). Psychosocial factors were better predictors of treatment outcome than clinical and demographic factors. Patients who had the most successful outcomes (both short- and long-term) were more motivated and less depressed than other patients and were internal with respect to their health locus of control.