Jennifer Ann Druley

Fates Worse Than Death: The Role of Valued Life Activities in Health-State Evaluations

One hundred eight college students (Study 1) and 109 elderly adults (Study 2) rated 28 health impairments for the quality of life perceived to be possible in that state, the extent to which the state was perceived as a fate better or worse than death, and the extent to which the state was perceived to interfere with the ability to engage in the activities each individual valued most in life. States perceived most negatively were those perceived to interfere most with valued life activities. For any given health state, evaluations were more negative the more the state was perceived by individuals as likely to interfere with engagement in their valued life activities. Implications of these results for end-of-life medical decision making in general and the use of advance medical directives in particular are discussed.

Elderly Outpatients Respond Favorably To A Physician-Initiated Advance Directive Discussion

Background: Little is known about the emotional impact of physician-initiated advance directive discussions. Methods: One hundred ambulatory patients aged 65 years and older were randomly assigned to receive either a physician-initiated discussion of advance directive choices or a discussion of health promotion issues. Prediscussion, Immediate postdiscussion, and 1-week postdiscussion measures of positive and negative affect were measured for both groups. Results: Neither discussion topic resulted in adverse emotional or attitudinal responses. Only the advance directive participants showed positive affective and attitudinal responses to the discussion, including an increase in positive affect, an increased sense of physician-patient understanding, and increased thought and discussion about life-support issues in the week following the discussion. For those participants receiving the advance directive discussion, longer physician-patient relationships and higher educational levels significantly predicted a more positive affective response. Lower scores on indices of mental and physical health and a stronger belief that physicians should discuss advance directive issues signiftcantly predicted a more negative affective response to the advance directive discussion. Conclusions: Physicians should anticipate positive emotional responses when they initiate advance directive discussions with their elderly outpatients. Advance directive discussions will be received most positively by patients who enjoy good psychological and physical health and when initiated in the context of an established physician-patient relationship.

Older Adults' Recovery From Surgery for Osteoarthritis of the Knee: Psychosocial Resources and Constraints as Predictors of Outcomes

The authors investigated psychosocial resources (positive support, active coping) and psychosocial constraints (negative support, avoidant coping) as predictors of improvement in the health of 63 older adults undergoing surgery for osteoarthritis of the knee. Following surgery, patients and social partners are motivated both to strive for the appetitive goal of recovery (approach), and to protect themselves from pain and impairment (avoidance). The authors assessed resources and constraints 6 weeks after surgery as predictors of outcomes (improvement in knee pain, knee functioning, and psychological well-being) 6 months after surgery. The constraints patients encountered early in recovery were strong predictors of poor recovery. Although resources were associated with some improvement, these effects were largely accounted for by constraints.

Couples' Support Provision During Illness: The Role of Perceived Emotional Responsiveness

DThe authors investigated emotional (empa-thy) and problematic (minimizing) supportexchanges between 243 women experiencinga lupus sare-up and their husbands. Hus-bands and wives reported the amount ofsupport they provided to each other and theextent to which they felt the support theyreceived from partners was emotionally re-sponsive (validating). The authors expectedindividualsO perceptions of spousesO emo-tional responsiveness to mediate the rela-tionship between support and psychosocialwell-being. As predicted, more spousal emo-tional support was interpreted as beingmore emotionally responsive, which in turnwas associated with better well-being. Incontrast, more problematic support was in-terpreted as being less emotionally respon-sive, which in turn was associated withpoorer well-being. Couples who are able tomeet each othersO emotional needs may ex-perience better adjustment when copingwith chronic illness.Keywords: emotional support, emotionalresponsiveness, depression, marital satis-faction, chronic illness

How Shared Are Age-Related Influences on Cognitive and Noncognitive Variables?

Several theories have suggested that age-related declines in cognitive processing are due to a pervasive unitary mechanism, such as a decline in processing speed. Structural equation model tests have shown some support for such common factor explanations. These results, however, may not be as conclusive as previously claimed. A further analysis of 4 cross-sectional data sets described in Salthouse, Hambrick, and McGuthry (1998) and Salthouse and Czaja (2000) found that although the best fitting model included a common factor in 3 of the data sets, additional direct age paths were significant, indicating the presence of specific age effects. For the remaining data set, a factor-specific model fit at least as well as the best fitting common factor model. Three simulated data sets with known structure were then tested with a sequence of structural equation models. Common factor models could not always be falsified--even when they were false. In contrast, factor-specific models were more easily falsified when the true model included a unitary common factor. These results suggest that it is premature to conclude that all age-related cognitive declines are due to a single mechanism. Common factor models may be particularly difficult to falsify with current analytic procedures.

Emotional and physical intimacy in coping with lupus: women's dilemmas of disclosure and approach.

This study examined whether self-rated physical and emotional intimacy of 74 women with their heterosexual partner, during an illness episode of lupus, was related to their affect and relationship satisfaction. It was predicted that greater intimacy would be related to better psychosocial adjustment. Women who engaged in physically intimate behavior with their partner more often reported greater relationship satisfaction. Women who frequently avoided or who were often the initiators of physical intimacy, however, reported greater negative affect. Concerning emotional intimacy, women who disclosed more information about illness symptoms and women who concealed more information about their symptoms and feelings experienced the highest levels of negative affect. Results identify dilemmas that women with recurrent illness may face when trying to maintain intimacy during illness periods.

Emotional Support and Affect: Associations with Health Behaviors and Active Coping Efforts in Men Living with HIV

The present study represents a cross-sectional examination of the relationship between affect, social support and illness adjustment in men diagnosed with HIV/AIDS. Positive and negative affect were examined as separate mediators of the relationship between emotional support received from a primary support provider and illness adjustment in 105 men living with HIV. Results suggested that depressive symptoms emerged as a mediator between emotional support and engaging in healthy lifestyle behaviors (assessed by summary index). In contrast, positive affect emerged as the primary mediator between emotional support and greater amounts of active coping. Overall, findings suggested that emotional support from close others was indirectly associated with health behaviors and coping through recipients’ affective states, and that these positive and negative affective states had differential relationships with multiple aspects of illness adjustment in men living with HIV.

Affective and behavioural reactions to positive and negative health-related social control in HIV+men

We examined associations between the receipt of positive and negative health-related social control (i.e. influence) from a primary network member, affective and behavioural reactions (i.e. behaviour change) to social control, and psychosocial well-being in a cross-sectional study of 91 HIV+ men living with HIV (MLWH). Receiving positive control was associated with more self-care behaviours, more active coping efforts, and fewer depressive symptoms. In contrast, receiving negative control was associated with fewer self-care behaviours and more depressive symptoms. Negative affective reactions to control mediated the associations between positive and negative control and depressive symptoms, and between positive control and active coping efforts. Behaviour change only mediated the association between positive control and self-care behaviours. Post-hoc analyses further revealed that men who were not at risk for clinical depression engaged in more behaviour change as a result of receiving negative control. Social control that elicits behaviour change and does not arouse negative affect is effective in promoting better self-care behaviours and psychosocial well-being in MLWH.

Long-term effects of HIV counseling and testing for women: Behavioral and psychological consequences are limited at 18 months posttest.

Behavioral and psychological consequences of HIV counseling and testing (HIV C&T) for women were examined in a longitudinal, prospective study. Women who received HIV C&T at community health clinics (n = 106) and a comparison group of never-tested women (n = 54) were interviewed five times over 18 months. There was no change in risk behaviors as a consequence of testing: tested and untested women engaged in high-risk sexual behavior at baseline and 18 months later. Tested women reported more anxiety, depression, and intrusive thoughts about AIDS than did untested women. Although tested women were more concerned about AIDS, their potential risk factors over the study period generally were equivalent to those for untested women. HIV counseling and testing should be considered one aspect of a broader program of HIV prevention. Identification of alternative interventions must be a public health priority.