Susan M. Heidrich

Physical and mental health in later life: The self-system as mediator.

The purpose of this research was to investigate how the self-system mediates the relationship between physical health and mental health in elderly women. Three theoretical perspectives were examined: social integration (self in relationship to the social structure), social comparisons (self in relationship to others), and self-discrepancies (internal self-evaluations). Community-dwelling elderly women (N = 243) completed self-report instruments measuring the various self-assessments, physical health, and 3 mental health outcomes: psychological distress, well-being, and developmental outcomes. Social integration and social comparisons mediated the effects of physical health on all 3 outcomes.

Factors women take into account when deciding upon type of surgery for breast cancer

For women with stage I or II breast cancer, randomized trials have demonstrated no significant difference in survival rates between women receiving modified radical mastectomy (MRM) and women receiving breast conserving (BC) surgery. Therefore, many women are now in a position of having a choice between these two options. Twenty-two women who met the surgical criteria for having this choice were interviewed 1 to 2 weeks postsurgery to determine factors they had considered when deciding between MRM and BC, how much they wished to participate in decision-making, and the sources of information they used. The sample was purposefully limited to women attending one clinic in order to insure control over variables such as the information to which patients are exposed. When asked why they had chosen a given surgery, two factors, concerns about radiotherapy (p = 0.003) and body integrity (p = 0.04), emerged as significantly different for women choosing BC vs. MRM. Furthermore, women reported that participation in decision-making was important to them and that they had had sufficient participation in the decision-making process. Finally, they rated “people” sources of information as more important than written or visual materials, suggesting that nurses and other care providers are important in supporting women through the decision-making process.

African American Women’s Beliefs, Coping Behaviors, and Barriers to Seeking Mental Health Services

Little is known about African American women’s beliefs about mental illness. In this qualitative study we employed the Common Sense Model (CSM) to examine African American women’s beliefs about mental illness, coping behaviors, barriers to treatment seeking, and variations in beliefs, coping, and barriers associated with aging. Fifteen community-dwelling African American women participated in individual interviews. Dimensional analysis, guided by the CSM, showed that participants believed general, culturally specific, and age-related factors can cause mental illness. They believed mental illness is chronic, with negative health outcomes. Participants endorsed the use of prayer and counseling as coping strategies, but were ambivalent about the use of medications. Treatment-seeking barriers included poor access to care, stigma, and lack of awareness of mental illness. Few age differences were found in beliefs, coping behaviors, and barriers. Practice and research implications are discussed.

Sense of coherence and illness appraisal in older women's quality of life

The purpose of this descriptive, correlational study was to test a conceptual model of proposed relationships between physical health limitation, the sense of coherence, illness appraisal, and quality of life in a sample of 137 older women. The typical respondent was 76, widowed, with an income less than

Experience and Well-being: Explorations on Domains of Life and How they Matter

12,000, and several health problems. Hierarchical multiple regression analysis indicated that physical health limitation, particularly symptom bother and functional health, had a significant negative influence on quality of life. However this effect was mediated by sense of coherence and illness appraisal. Regardless of the level of symptoms or functional health, women with higher sense of coherence and more positive illness appraisals had higher levels of quality of life. The findings support the proposed model and further our understandings regarding the protective role of personality resources in perceived quality of life in older women with chronic illnesses.

Psychological adjustment in adults with cancer: The self as mediator.

The guiding question was how past life experiences are linked with adults’ assessments of their present and future well-being. Typical events and transitions (normative experiences) were contrasted with atypical stresses (non-normative experiences). A sample of 308 men and women, divided between young, midlife, and older adults, completed past life event inventories and rated themselves on multiple dimensions of well-being (concurrently and prospectively). Hierarchical regression analyses revealed that normative events were significant predictors of multiple aspects of present and future wellness, but there were marked age differences in which domains were key influences: For young adults, life activities were primary; for midlife adults, greatest variance was explained by the family and friends domain; in late life, prior work and educational experiences were strongest predictors of well-being. Non-normative events were significant positive predictors of only personal growth in young adults.

Effects of urinary incontinence: psychological well-being and distress in older community-dwelling women.

The role of the self in adjustment to cancer has been noted but is not well understood. Research and theory on the self suggest that discrepancies between actual and ideal self-conceptions influence adjustment and mediate the effects of disease-related health problems on psychological well-being. This relationship was investigated in a cross-sectional study of 108 persons with cancer. Cancer patients who had more symptoms and worse functional health and perceived their cancer as a chronic rather than an acute disease had higher levels of self-discrepancies and poorer adjustment. Self-discrepancy was a significant mediator of the effects of perceived health status on purpose in life, positive relations with others, and depression.

Mechanisms related to psychological well-being in older women with chronic illnesses: Age and disease comparisons

Urinary incontinence (UI) has been related to lower quality of life. However, the research has generally been cross-sectional, and causal relationships have not been determined. This research was a secondary analysis of a 6-year longitudinal study of chronic illness and psychological well-being in older (mean age = 73 at Time 1), community-dwelling women (n = 103). Over time, women with UI reported significantly lower subjective health, purpose in life, affect balance, personal growth, positive relations with others, and self-esteem and higher scores for depression, compared to women without UI. Incontinence had broad effects on multiple domains of psychological well-being that persisted over time and need to be addressed by clinicians.

Does social problem solving differ from other types of problem solving during the adult years

The influence of type of illness (breast cancer versus osteoarthritis) and age on physical health and functioning, self-system interpretive mechanisms, and womens psychological well-being were examined. Self-system interpretive mechanisms are considered mediators of the effects of physical health on psychological well-being and include social comparisons, social integration, and illness perceptions. Young-old (aged 60-74) and old-old (75 +) women, diagnosed with osteoarthritis (N = 102) or breast cancer (N = 86), who volunteered for the study were interviewed using structured self-report scales. Young-old and old-old women did not differ in terms of health status, interpretive mechanisms, or on three of five indices of psychological well-being. On the other hand, women with arthritis, regardless of age, reported more functional health problems, more symptoms, and perceived their illness as more severe, more chronic, and less controllable than women with breast cancer. Although women with arthritis and breast cancer differed significantly in terms of physical health, they did not differ on multiple measures of psychological well-being. For both groups, women who made more positive social comparisons and who had more extensive social networks had higher levels of psychological well-being, regardless of physical health problems.

Health promotion in old age.

One hundred thirteen individuals, ages 18-81, were presented with a test of social problem solving, a test of practical problem solving, the Twenty Questions task (a test of traditional problem solving), the Wechsler Adult Intelligence Scale--Revised Vocabulary subtest (a measure of crystallized intelligence), and Ravens Progressive Matrices (a measure of fluid intelligence). The effects of age, sex, education, and intellectual abilities on problem-solving performance were examined. Social problem solving was positively related to higher education and higher Vocabulary scores, but it was not related to age. Social problem solving and practical problem solving were significantly related to each other and to scores on the Vocabulary subtest, whereas traditional problem solving was significantly related to scores on Ravens Progressive Matrices. These results suggest that different types of problem solving are differentially related to other intellectual abilities and to age.