Sydney H. Croog

Spouse caregivers of Alzheimer patients: problem responses to caregiver burden.

This paper reports on comparisons of patterns of responses by 199 spouses of Alzheimer disease patients to stresses of functioning as caregivers. Focusing on gender and age of spouses, we examine effects of the total burden of caregiving and perceived patient problems on a set of emotional and social responses of caregivers. We also examine ways in which depressive symptoms and anxiety of spouse caregivers were associated with patterns of their responses to caregiving stresses. Total patient problem burden was most strongly associated positively with caregiver anger-resentment toward the patient, followed by caregiver concerns about personal time restriction and limitation of social life. Among individual areas of patient problems, emotional lability of the patient rather than cognitive impairment appeared strongest by far in affecting caregiver response measures. Negative impact of caregiving on their social life and associations appeared to have particularly marked effects on effects on caregiver depressive symptoms and anxiety scores. Spouse caregivers did not differ by age in clinically significant ways in their patterns of reaction to stresses of caregiving. The study suggests the importance of considering potential spouse caregiver reactions in such areas as anger and aggressive response to patients, the impact of feelings of social deprivation and personal sacrifice, as well as the implications of caregiving stresses for patient care and maintenance of family cohesion and quality of life.

Help Patterns in Severe Illness: The Roles of Kin Network, Non-Family Resources, and Institutions

Findings are reported concerning differential perception of help patterns and use of kin, nonkin, and institutional resources by men during a time of recuperation from illness crisis. The study population consisted of previously well males who experienced a first myocardial infarction. Members of the kin group as well as friends and neighbors ranked similarly in degree of assistance reported. Minimal use was made of institutional and professional services, aside from contact with the physician. Type of aid given varied according to source, with nonkin such as neighbors providing services in higher proportion than kin, while parents and siblings were more prominent as sources of financial aid. Among the possible correlates of aid examined, only age of the patient was associated with types of help from various sources. Data on configurations of aid and on visiting patterns, it is suggested, may be interpreted through reference to level of social integration of individuals.

Denial among male heart patients. An empirical study.

&NA; Among 345 men under treatment for approximately 3 weeks after a first myocardial infarction, 20% were classified as denying that they had had a heart attack. Deniers and nondeniers of the heart attack were compared with regard to (a) whether there were social and psychologic correlates of the denial response, and (b) other areas to which denial was generalized. A third area examined was the temporal aspect‐‐ie, the manifestation of denial over time. Findings obtained from three interviews over a period of a year suggest an association between denial and ethnic background. Generalization of denial of the heart attack appeared in such findings as a tendency to disavow negative traits, minimizing of symptoms, minimizing the effects of the attack on life in general and on work in particular. One association of relevance to physicians was the tendency for deniers to resist medical advice related to work, rest and smoking. Differences in response between the deniers and nondeniers were noted 1 month after discharge from the hospital and 1 year after the infarct, suggesting persistence of the denial.

The psychosocial impact of dental diseases on individuals and communities.

Among the diseases and chronic conditions afflicting populations throughout the world, dental caries and periodontal disease are among the foremost in prevalence (Dunning, 1979). The many consequences of dental disease and dental conditions involve not only physical health but also economic, social, and psychological well-being of individuals. But their true impact on individuals has never been adequately assessed, and their complex implications for society have rarely been examined. In recent years the level of technology and innovative treatment in dentistry has considerably advanced. But it has not been matched by a comparable growth in systematic knowledge concerning the social, psychological, and economic sequellae of dental disease and impairments. Yet such information can have great importance for adequate understanding of the problems of dental conditions and for rational planning of programs of care at the level of both the individual and the community. In this paper we draw together some selected materials bearing on the impact of dental disease and dental conditions on individuals and on societies. We consider a series of selected problems of dental health and disease in the context of their social, psychological, and economic implications. Our purposes are (1) to bring together examples of data from empirical studies and (2) to point up some of the areas and themes which may deserve new research effort in the future.

Vulnerability of husband and wife caregivers of Alzheimer disease patients to caregiving stressors

This study assessed relationships between problem behaviors in 199 Alzheimer Disease patients and vulnerability factors in the well being and emotional health of their spouse caregivers. Among caregiver wives and the younger caregiver husbands (64 years old and under) the volume of patient problem behavior was significantly negatively associated with total scores on a summary well being measure. The association was not found within the older husband caregiver group. Considering five subdimensions of the summary well being scale (Anxiety, Depressive Symptoms, Positive Well Being, Vitality and General Health), correlational analyses showed that the total patient problems measure appeared to have impact primarily among wife caregivers, particularly those 64 years old and under. Multiple regression analyses showed that one patient problem behavior category, Emotional Lability, was the single strongest predictor of impaired well being of the caregiver among all five subdimensions of the caregiver well being measure. Although Destructive Behavior of the patient was not significant by itself, an Age by Destructive Behavior interaction showed that high levels of patient Destructive Behavior predicted high levels of Depression, Anxiety, and low levels of Positive Well Being more among younger caregivers. Husband caregivers had significantly higher Anxiety scores than wife caregivers. These findings document how particular patient problem behaviors can affect caregivers. They point up as well how both gender and age may help target which caregivers are most vulnerable to the stress of specific Alzheimer patient behavior problems. They also suggest the utility of examining specific dimensions of well being rather than a total score alone for purposes of understanding the relationship of particular patient behavior problems to caregiver emotional and physical health.

Religious identity and response to serious illness: A report on heart patients ☆

Abstract This paper reports on aspects of the role of religion in providing support and meaning for 324 men recovering from a life-threatening crisis, a heart attack. Over the course of a year following the crisis event, no significant changes were indicated in level of religiosity, in pattern of attendance at religious services, or in secular orientations to life and the illness experience. The men reported little contact with clergy and few plans for such contact in the future. The data reveal that, on the whole, conceptions of the etiology of the disease were strongly secular in orientation. A general implication is that this crisis experience did not fundamentally alter religious or secular attitudes among Catholic, Protestant and Jewish patients, nor did it lead to change in degree of reliance on the religious institution and its agents.

Pre-surgery psychological characteristics, pain response, and activities impairment in female patients with repeated periodontal surgery.

This study assessed relationships between pre-surgery psychological characteristics and post-surgery pain response and impairment of life activities following each of two sessions of periodontal surgery. Forty-two female periodontal patients between the ages 26 and 67 participated. None had experienced previous peridontal surgery. Pre-surgery scores on dental anxiety, fatigue, and depression were positively associated with measures of post-surgery pain after the first surgery, and were negatively associated with positive well-being scores. A similar, though weaker pattern of associations was evident after the second surgery. Younger women reported significantly greater impairment of life activities during recovery than did the older women after both surgery episodes. The study points to the relevance of pre-surgery well-being and psychological stability as predictors of post-surgery pain and degree of impairment of life activities, as seen in the time sequence of repeated surgeries.

Perception of the etiology of illness: causal attributions in a heart patient population.

This study examined perceived causes of myocardial infarction in a patient population of 345 men previously free from significant medical problems. Investigation of their perceptions following the life-threatening illness crisis indicated that stress and tension factors were the causes most commonly cited. Possible social and psychological correlates are analyzed using an attribution theory framework, and their implications are discussed.

Personality Self-Perceptions of Male Heart Patients and Their Wives: Issues of Congruence and “Coronary Personality”

This study examines personality self-ratings of 283 married men who had recently experienced a first myocardial infarction and who previously had been free from major disease. Similar data were collected from their “non-cardiac” wives. Results indicated that several traits often identified as descriptive of “coronary-prone” personality had high mean ratings in both husband and wife populations. In addition, factor analysis revealed a similar pattern of factors in each group. However, inspection of correlations showed for individual items, men with so-called “coronary-prone” personality traits did not generally have wives with these traits. Husbands and wives tended to agree regarding each others personality self-ratings. Implications of these husband-wife data are discussed in regard to questions on the role of “coronary-prone” personality in heart disease.