Jason T. Newsom

Health effects of caregiving: The caregiver health effects study: An ancillary study of the cardiovascular health study

We propose that two related sources of variability in studies of caregiving health effects contribute to an inconsistent pattern of findings: the sampling strategy used, and the definition of what constitutes caregiving. Samples are often recruited through selfreferral and are typically comprised of caregivers experiencing considerable distress. In this study, we examine the health effects of caregiving in large population-based samples of spousal caregivers and controls using a wide array of objective and self-report physical and mental health outcome measures. By applying different definitions of caregiving, we show that the magnitude of health effects attributable to caregiving can vary substantially, with the largest negative health effects observed among caregivers who characterize themselves as being strained. From an epidemiological perspective, our data show that approximately 80% of persons living with a spouse with a disability provide care to their spouse, but only half of care providers report mental or physical strain associated with caregiving.

Suicide among male veterans: a prospective population-based study

Objectives: To assess the risk of mortality from suicide among male veteran participants in a large population-based health survey. Design and setting: A prospective follow-up study in the US. Data were obtained from the US National Health Interview Surveys 1986–94 and linked to the Multiple Cause of Death file (1986–97) through the National Death Index. Participants: The sample comprised 320 890 men, aged ≥18 years at baseline. The participants were followed up with respect to mortality for 12 years. Results: Cox proportional hazards analysis showed that veterans who were white, those with ≥12 years of education and those with activity limitations (after adjusting for medical and psychiatric morbidity) were at a greater risk for completing suicide. Veterans were twice as likely (adjusted hazard ratio 2.04, 95% CI 1.10 to 3.80) to die of suicide compared with non-veterans in the general population. The risk of death from “natural” causes (diseases) and the risk of death from “external” causes did not differ between the veterans and the non-veterans. Interestingly, male veterans who were overweight had a significantly lower risk of completing suicide than those who were of normal weight. Conclusions: Veterans in the general US population, whether or not they are affiliated with the Department of Veterans Affairs (VA), are at an increased risk of suicide. With a projected rise in the incidence of functional impairment and psychiatric morbidity among veterans of the conflicts in Afghanistan and Iraq, clinical and community interventions that are directed towards patients in both VA and non-VA healthcare facilities are needed.

State and trait negative affect as predictors of objective and subjective symptoms of respiratory viral infections

State and trait negative affect (NA) were measured in healthy people immediately before an illness was induced through exposure to a respiratory virus. State NA, disease-specific health complaints (e.g., runny nose, congestion, and sneezing), and an associated objective marker of disease severity (mucus secretion weights) were assessed daily during the illness. Baseline trait and state NA were both associated with increased numbers of subsequent complaints. Although greater numbers of complaints among people high in state NA were explicable in terms of greater disease severity, the association of trait NA and symptoms was independent of objective disease. The trait NA complaint association was also independent of state NA and hence not attributable to trait-elicited state affect. Greater trait NA was associated with biases in complaining during but not before illness. This suggested failure to discriminate between symptoms rather than increased sensitivity or hypochondriacal response.

The Relative Importance of Three Domains of Positive and Negative Social Exchanges: A Longitudinal Model With Comparable Measures

Researchers have expressed considerable interest in the question of whether positive or negative social exchanges more strongly affect psychological health, but previous studies have been limited by using nonparallel measures of positive and negative social exchanges, by measuring negative affect only, and by relying largely on cross-sectional designs. The independent effects of positive and negative exchanges on both positive and negative affect were examined in a short-term longitudinal study of 277 older adults, using social exchange measures with parallel content and equivalent reliability and validity. In cross-sectional analyses, positive exchanges predicted positive affect, and negative exchanges predicted negative affect. In longitudinal analyses, however, negative exchanges predicted both positive and negative affect, whereas positive exchanges were unrelated to either outcome. The more potent and longer-lasting effects of negative exchanges have important implications for theory and interventions.

Caregiving from the recipient's perspective: negative reactions to being helped.

This study investigated predictors of negative reactions to assistance provided to a physically disabled spouse (n = 276, M age: 76.6 years) and the consequences that negative reactions may have for the mental health of the care recipient. Nearly 40% of recipients reported some emotional distress in response to help they received. Fatalistic attitudes, perceived control, and lower self-esteem predicted greater helping distress, whereas lower self-esteem, fatalistic beliefs, and marital conflict were especially likely to lead to helping distress for those who received higher levels of assistance. Helping distress was also found to predict depression as much as 1 year later, suggesting that there may be long-term consequences of negative reactions to assistance. These findings have important implications for the study of caregiving and the relationship between physical impairment and depression.

Complementary and Alternative Medicine Use in Canada and the United States

Use of complementary and alternative medicine (CAM) has stimulated discussion in both Canada1–4 and the United States5–12 on topics such as who might benefit from CAM insurance coverage and the role of CAM as a substitute for use of conventional medical treatment vs a supplement to such treatment. In the United States, members of racial or ethnic minority groups are less likely to use CAM than are White people, and elevated income is a strong predictor of CAM use.5,6,8 In the United States (unlike in Canada), race and ethnicity are related closely to health insurance status.13 In both Canada4 and the United States,5,6,8 CAM use appears higher in western regions than in other areas. In Canada, western provinces are much more likely than those in the east to cover CAM in their health programs.1 In the United States, some 42 states mandate coverage of chiropractic care in private insurance,9 whereas federal legislation mandates coverage for all people older than 65 years (in the Medicare program) as well as for individuals whose health insurance is provided by large employers regulated under the Employee Retirement Income Security Act.14 This study examined relationships between race, geography, and conventional medical care and the use of acupuncture, chiropractic, homeopathy/naturopathy, and massage therapy.

Correlates and Prevalence of Benzodiazepine Use in Community-Dwelling Elderly

OBJECTIVE: To describe the prevalence of benzodiazepine use, sociodemographic and physical health factors associated with use, dosages taken, and directions for use among individuals aged 65 years and older.DESIGN: Cross-sectional analysis of baseline data from the community-based, prospective observational Cardiovascular Health Study.PATIENTS/PARTICIPANTS: Medicare eligibility lists from four U.S. communities were used to recruit a representative sample of 5,201 community-dwelling elderly, of which 5,181 participants met all study criteria.MEASUREMENTS AND MAIN RESULTS: Among participants, 511 (9.9%) were taking at least one benzodiazepine, primarily anxiolytics (73%). Benzodiazepines were often prescribed to be taken pro re nata (PRN “as needed”), and 36.5% of prescriptions with instructions to be taken regularly were taken at a dose lower than prescribed. Reported over-the-counter (OTC) sleep aid medication use was 39.2% in benzodiazepine users and 3.3% in nonusers. In a multivariate logistic model, the significant independent correlates of benzodiazepine use were being white (odds ratio [OR] 1.9; 95% confidence interval [CI] 1.0, 3.4), female (OR 1.7; CI 1.4, 2.2), and living in Forsyth County, North Carolina, or Washington County, Maryland, compared with living in Sacramento County, California, or Allegheny County, Pennsylvania (OR 2.3; CI 1.4, 2.2); having coronary heart disease (OR 1.6; CI 1.2, 2.1), health status reported as poor or fair (OR 1.8; CI 1.4, 2.3), self-reported diagnosis of nervous or emotional disorder (OR 6.7; CI 5.1, 8.7), and reporting use of an OTC sleep aid medication (OR 18.7; CI 14.1, 24.7).CONCLUSIONS: One in 10 participants reported taking a benzodiazepine, most frequently an anxiolytic, often at a lower dose than prescribed and usually PRN. The high prevalence of OTC sleep aid medication and benzodiazepine use may place the patient at increased risk of psychomotor impairment. Physicians should assess OTC sleep aid medication use when prescribing benzodiazepines.

Stable negative social exchanges and health.

Negative social exchanges with family, friends, and neighbors are known to be an important source of stress in daily life, and chronic stress is theorized to have especially potent impacts on health. Little is known about the health effects of stably high levels of negative social exchanges, however. In a national, longitudinal study of older adults (N = 666), we examined the association between stable negative social exchanges and health over a 2-year period. Trait-state-error models indicated that higher levels of stable negative social exchanges were significantly predictive of lower self-rated health, greater functional limitations, and a higher number of health conditions over 2 years after controlling for initial levels of health and sociodemographic variables. These results highlight the importance of examining continual and recurring interpersonal problems in efforts to understand the health effects of social relationships.

Health behavior change following chronic illness in middle and later life

OBJECTIVES Understanding lifestyle improvements among individuals with chronic illness is vital for targeting interventions that can increase longevity and improve quality of life. METHODS Data from the U.S. Health and Retirement Study were used to examine changes in smoking, alcohol use, and exercise 2-14 years after a diagnosis of heart disease, diabetes, cancer, stroke, or lung disease. RESULTS Patterns of behavior change following diagnosis indicated that the vast majority of individuals diagnosed with a new chronic condition did not adopt healthier behaviors. Smoking cessation among those with heart disease was the largest observed change, but only 40% of smokers quit. There were no significant increases in exercise for any health condition. Changes in alcohol consumption were small, with significant declines in excessive drinking and increases in abstention for a few health conditions. Over the long term, individuals who made changes appeared to maintain those changes. Latent growth curve analyses up to 14 years after diagnosis showed no average long-term improvement in health behaviors. DISCUSSION Results provide important new information on health behavior changes among those with chronic disease and suggest that intensive efforts are required to help initiate and maintain lifestyle improvements among this population.

Physical Illness, Functional Limitations, and Suicide Risk: A Population‐Based Study

The purpose of this study was to assess the independent association of physical illness and functional limitations with suicide mortality risk. The Cox proportional hazards model was used with data from the 1986-1994 National Health Interview Survey linked to the 1986-1997 National Death Index to analyze the effects of chronic physical illness and functional limitations on suicide deaths (ICD-9 E950-959). After controlling for potential confounders at baseline, functional limitations were shown to be a significant predictor of suicide. Also, psychiatric comorbidity increased the risk of completing suicide. Interestingly, chronic conditions alone were not predictive of suicide completion when functional limitation was added to the model. Implications for the clinical management of suicidal behavior among patients with chronic conditions are discussed.