Gail M. Williamson

STRESS AND INFECTIOUS DISEASE IN HUMANS

This article reviews research on the role of stress in infectious disease as measured either by illness behaviors (symptoms and use of health services) or by verified pathology. Substantial evidence was found for an association between stress and increased illness behavior, and less convincing but provocative evidence was found for a similar association between stress and infectious pathology. Introverts, isolates, and persons lacking social skills may also be at increased risk for both illness behaviors and pathology. Psychobiological models of how stress could influence the onset and progression of infectious disease and a psychological model of how stress could influence illness behaviors are proposed.

A 2-year longitudinal study of depression among Alzheimer's caregivers.

Results from a 2-year (4 waves) longitudinal study show strong evidence for patient decline and high levels of depressive symptomatology among caregivers. Female caregivers reported high, stable rates of depressive symptomatology throughout the study, whereas male caregivers exhibited significant increases in depression over time. Cross-sectional multivariate analyses revealed significant positive relationships between depression and number of patient problem behaviors, negative social support, and concern about financial resources; negative relationships were found between depression and social support, quality of prior relationship, and satisfaction with social contacts. Three significant independent predictors of change in depression were found: Lower depression scores at Time 1 were related to increases in depression over time; men were more likely than women to experience increases; and a decline in social support resulted in increased depression.

Risk factors for potentially harmful informal caregiver behavior.

Objectives: Caring for a sick or disabled relative has been linked to compromised caregiver health, and risk factors for negative caregiver outcomes have been studied extensively, but little attention has been given to care recipient and caregiver health as risk factors for potentially harmful behavior by informal caregivers. This article explores such risk factors.

Pessimism, age, and cancer mortality.

Cancer patients (N = 238) receiving palliative radiation treatment were followed for 8 months; 70 patients had died by the 8-month follow-up. Controlling for site of cancer and level of symptomatology at baseline, the authors studied the independent effects on mortality of pessimism, optimism, and depression. The findings show that the endorsement of a pessimistic life orientation is an important risk factor for mortality, but only among younger patients (ages 30-59). Attempts to replicate this finding with conceptually related constructs such as depression or optimism did not yield significant associations for either younger or older patients, suggesting that negative expectations about the future may contribute to mortality in unique ways. The authors conclude that attempts to link psychosocial factors to mortality should focus on specific psychological constructs instead of diffuse, global measures that cover many psychological phenomena and that the role of psychological processes in mortality may vary dramatically depending on age.

Activity restriction mediates the association between pain and depressed affect: A study of younger and older adult cancer patients.

Associations are reported frequently among pain, functional disability, and symptoms of depression. The purpose of this longitudinal study was to further clarify relations among these variables. In 268 younger (ages 30-64) and older (ages 65-90) cancer outpatients, cross-sectional analyses replicated previous findings showing that effects of pain on symptoms of depression are mediated by functional disability. Longitudinal analyses revealed that as pain increased over time, so did activity restriction, which in turn predicted increases in depressed affect. Comparative analyses indicate that restriction of routine activities that are due to illness and pain may be more distressing to individuals less than 65 years of age than to those 65 years of age or older. The results suggest that older persons are less distressed by restricted activities because of lower expectations about functional status and more experience with illness and disability.

ACTIVITY RESTRICTION AND PRIOR RELATIONSHIP HISTORY AS CONTRIBUTORS TO MENTAL HEALTH OUTCOMES AMONG MIDDLE-AGED AND OLDER SPOUSAL CAREGIVERS

In a sample of cancer patients (n = 75) and spousal caregivers (24 men and 51 women), restriction in caregiver routine activities mediated associations between caregiving stress (patient symptom severity) and caregiver depressed affect and resentment. Moreover, the antecedents and affective consequences of caregiver activity restriction were consistent with the theory of communal relationships (e.g., M. S. Clark & J. Mills, 1979, 1993). If a relationship had been communal in the past (i.e., characterized by mutual concern for and responsiveness to one anothers needs), activity restriction was predicted by intimacy and affectional loss (rather than by the severity of patient symptoms) and in turn predicted caregiver depressed affect. Among caregivers in less communal relationships, activity restriction was predicted by severity of patient symptoms (rather than by intimacy and affectional loss) and in turn predicted resentment of care recipients and the caregiving role.

Depression and Quality of Informal Care: A Longitudinal Investigation of Caregiving Stressors

This research examined longitudinal associations between caregiving stressors, caregiver depression, and quality of care. Informal caregivers of elderly care recipients were interviewed at baseline (N = 310) and again one year later (N = 213). Hierarchical regression analyses indicated that increases in caregiving stressors (i.e., caregiver physical health symptoms, caregiver activity restriction, and care recipient controlling and manipulative behavior) were related to increased caregiver depression. In turn, increased caregiver depression and decreased caregiver respectful behavior predicted increases in potentially harmful behavior. These results extend previous cross-sectional findings and indicate that changes in caregiving stressors, caregiver depression, and caregiver respect over time may signal that intervention is warranted in order to forestall or prevent poor quality of care.

Caregiver models of self and others, coping, and depression: predictors of depression in children with chronic pain.

In a sample of 59 chronically ill pediatric patients and their maternal caregivers, both child-reported pain and caregiver-reported depression predicted child-reported depression. Results further suggested that the association between pain and depression in children is ameliorated by caregiver coping strategies and that how caregivers cope is a function of their attachment-related representations of the self and others. Caregivers with a negative model of the self were more depressed. and those with a negative model of others were more prone to use avoidant coping strategies, and, in turn, to be more depressed. However, the extent to which caregivers with negative models of self used more avoidant and less approach coping appeared to depend on whether they perceived that others were likely to respond to their needs.

Affective Consequences of Refusing to Help in Communal and Exchange Relationships

Two studies illustrate the importance of a distinction between communal and exchange relationships in understanding reactions to helping and refusing to help. In Study 1, refusing to help caused declines in positive affect when a communal (but not an exchange) relationship with the help seeker was desired. In Study 2, recalling a refusal to help a communal (but not an exchange) partner caused declines in positive affect. Recalling when some-one else helped or refused to help did not produce analogous changes. Results demonstrate that there are differential reactions to refusing to help in communal and exchange relationships, differential reactions apply to naturally occurring relationships as well as desired relationships created by laboratory manipulations, and affective reactions in communal relationships are not due to merely knowing the other has (or has not) been helped. The authors suggest that they reflect the impact that helping or failing to help may have on communal relationships.

Sexual Satisfaction Predicts Quality of Life: A Study of Adult Amputees

Research provides ample evidence that limb amputation poses serious threats to psychological and psychosocial adjustment. However, very little is known about the effect of amputation on sexual activity. In this study, 77 amputees completed measures assessing a variety of amputation-related, functional status, and psychological variables. Satisfaction with ones sexual relationships with others predicted overall quality of life. Results are discussed in terms of implications for interventions aimed at improving adjustment to limb amputation.