Sheila Feld

Americans view their mental health

BOOK REVIEWS Americans View Their Mental Health. By Gerald Gurin, Joseph Veroff, and Sheila Feld. Price,

Social Support Coverage and the Well-Being of Elderly Widows and Married Women

7.50. Pp. 444. Basic Books, Inc., 59 Fourth Ave., New York 3, 1960. This is the fourth in the series of ten monographs sponsored by the Joint Commission on Mental Illness and Health and designed to assess the nations mental health resources and needs from a variety of perspectives. Its focus is the subjective dimension of mental health. Although not all of the monographs have been published so far, the findings and the recommendations of each have been already summed up and interpreted in the Commissions final report which, because of the publicity it has received, may be familiar to many readers. The present volume is based on an interview survey conducted in 1957 with nearly twenty-five hundred individuals selected to provide a probability sample of the countrys adult population. It is a product of three social psychologists, all of whom are on the staff of the Survey Research Center at the University of Michigan, one of the few widely recognized and influential organizations of its kind in social sciences. Besides being impressive for sheer magnitude and the consistent clarity in the presentation and evaluation of the data, the study gives further testimony of the methodological sophistication and the technical know-how typical of the work produced by the Center. Without committing themselves to a definition of mental health, the investigators explore it through a number of measures of adjustment. The measures, however, all derive from the self-appraised, experiential realm of the respondent. In the area of general life adjustment, such measures are obtained from the information about the extent of worrying, evaluation of personal happiness, whether the respondent ever felt close to a nervous breakdown, and if he ever experienced a problem relevant for professional help. In the more specific areas of functioning, namely, marriage, parenthood, and work, adjustment is studied via consideration of such variables as satisfaction with the particular role, feelings of adequacy in performing it, degree of involvement, expectations about future, and the type of problems and their prevalence encountered in each role. It is worth pointing out that in taking a multiple-criterion approach to mental health, the investigators are implicitly in agreement with the current view (e.g., Jahoda, 1958; Smith, 1961) that the search for a conceptual formulation of mental health which could meet with a general consensus is futile because of the unavoidable valuative assumptions in all such formulations. The organization of the book is as follows : The first part deals mainly with the distribution and the interrelations of the indices of adjustment in different demographic groups, most often specified in terms of such variables as sex, education, and age. (Religion, in-

Race/Ethnicity and Marital Status in IADL Caregiver Networks

The relationship between social support coverage and well-being was examined in four subgroups from a national sample of women ages 50 and older: first married (N = 151), widows (N = 144), widows within the last five years (n = 60), and widows for longer than five years (n = 84). The index of support coverage represented how many of six functions were carried out by at least one supporter. Two hypotheses were tested: (1) that support coverage is associated with well-being in all subgroups, and (2) that social support is more strongly associated with well-being in the subgroups experiencing higher stress, that is, widows more than married women and recent widows more than long-term ones. The hypotheses were not supported. Instead, the relationships between social support and well-being were positive in some groups and negative in others. The importance of considering the causal directions of links between social support and well-being and the possible negative consequences of receiving social support are discussed.

Does Gender Moderate Factors Associated With Whether Spouses Are the Sole Providers of IADL Care to Their Partners

Racial/ethnic variations in instrumental activities of daily living (IADL) caregiver network composition were examined in a nationally representative sample of elders, using task specificity and hierarchical compensatory theoretical perspectives. Logistic regressions tested network differences among White, Black, and Mexican American elders (n = 531 married, n = 800 unmarried). Findings concerning racial/ethnic differences were partially dependent on marital status, differentiation of spouses from other informal helpers among married elders, and which racial/ethnic groups were compared. Networks including formal caregivers did not differentiate married or unmarried Black from White elders but were more common among unmarried Mexican American elders than for comparable White and Black elders. Married Black elders with solely informal networks were more likely than comparable White elders to have informal helpers other than the spouse. Racial/ethnic similarities and differences in caregiver networks are discussed relative to their sociocultural context, including marital status, elder’s and spouse’s health, and financial resources

The Academic Marketplace in Social Work

The authors explored whether gender moderated the influence of other factors on solo spousal caregiving. The subsample (n = 452) from the Asset and Health Dynamics Among the Oldest Old study included elderly care recipients (CRs) receiving assistance with instrumental activities of daily living (IADLs) and their spouses. Logistic regression was used to model the likelihood of solo spousal IADL care. Gender moderation was tested by product terms between CRs’ gender and measures of partners’ health, potential helpers, and sociodemographic characteristics. As numbers of CRs’ IADLs and couples’ proximate daughters increased, wives less often received care solely from their husbands, but husbands’ receipt of care from their wives was unaffected. Age differences between spouses and CRs affected solo spousal caregiving to wives and husbands in opposite ways. Regardless of gender, CRs’ numbers of limitations in activities of daily living and spouses with limitations in IADLs or activities of daily living reduced the likelihood of solo spouse care. Identifying circumstances influencing solo spouse caregiving differently among couples with frail wives and husbands facilitates gender-sensitive services.

Does Becoming an ADL Spousal Caregiver Increase the Caregiver’s Depressive Symptoms?

Abstract Deans and directors of graduate and undergraduate programs in social work were surveyed to ascertain the number of academic jobs available during 1984–86. They were also questioned about characteristics desired in new faculty. Results showed a stable or increasing overall demand for social work faculty. Demand varied in relation to whether the highest degree offered by the hiring unit was the baccalaureate, masters, or doctorate. The quantity of recent hiring and the desirability of research skills and publications was higher in programs offering higher degrees, but teaching credentials were of equal importance for all three types of units. Implications for the educational system and for job seekers are discussed.

When Do Couples Expand Their ADL Caregiver Network Beyond the Marital Dyad

This study investigated whether transitioning into the role of activities of daily living (ADL) spousal caregiver is associated with increased depressive symptoms for older husbands and wives among a sample of coresiding community-dwelling older couples. Using data from the Health and Retirement Study, we estimated a two-level linear model to examine the association between change in caregiver status and respondents’ depressive symptoms at follow-up, controlling for other factors identified in Pearlin’s stress process model (PSPM). Results indicate that both husbands and wives who become ADL caregivers have more follow-up depressive symptoms than noncaregivers. Furthermore, wives continuing as caregivers have more follow-up depressive symptoms than wives who do not provide care. Finally, the physical health of the spousal caregiver is related to depressive symptoms at follow-up. We conclude with policy and practice implications of these three main findings.

Likelihood of African American Primary Caregivers and Care Recipients Receiving Assistance From Secondary Caregivers A Rural–Urban Comparison

Abstract Composition of caregiver networks (spouse only vs. others) for assistance with personal care limitations (ADLs) was examined in the AHEAD nationally representative sample of 215 elderly couples, using logistic regression. Findings showed network expansion beyond the spouse was influenced by a poor fit between solo spousal caregivers and caregiving tasks: Expanded networks were more likely when help recipients had numerous health problems (p< .01) and ADL limitations (p= .063), and when spouses had any ADL limitations (p< .01). Expanded networks were also likely when couples included the wife as help recipient (p< .05), were Black (p= .075), and were in lengthy marriages (p< .05). Implications for theory, research, and family policy and practice are discussed.

Moderating Effects of Prior Social Resources on the Hospitalizations of Elders who Become Widowed

We examine rural–urban differences in reliance on secondary caregivers for African American female primary caregivers (250 rural, 242 urban) and their care recipients. Logistic regression was used to identify caregiver and care recipient characteristics significantly associated with the likelihood of having a secondary caregiver within rural and urban samples. Post hoc Wald chi-square tests were used to identify significant between-sample differences in regression coefficients. Secondary caregivers were more common in urban than rural contexts. Having a secondary caregiver was more strongly related to primary caregivers’ poorer physical health and nonresidence with care recipients in rural than urban contexts. Findings suggest that policy initiatives, such as the National Family Caregivers Support Act and the cash and counseling model, may benefit rural and urban residents, particularly rural residents as the majority of them lacked secondary caregiver assistance.

The Prevalence of Older Couples With ADL Limitations and Factors Associated With ADL Help Receipt

In a prospective design, the effects of social resources before widowhood on changes in subsequent hospitalizations were compared for 86 married elders who became widowed over a 2-year period and 86 matched elders who remained married. Subjects were from the Established Populations for Epidemiologic Studies of the Elderly (Duke). Hospitalizations were used as an indicator of a serious health outcome whose report was unlikely to be biased by a widowed persons emotional state. The hypothesis that perceptions of inadequate social support from persons other than the spouse would exacerbate the effects of bereavement on hospitalizations was supported for elders who lacked close friends with whom to talk about private matters while still married; believing that no relative would provide such support and dissatisfaction with support tended to have the same effect. Inadequacies in social embeddedness (few contacts with friends, relatives, or children and being childless) had no significant moderating or main effects on change in hospitalizations.