Youthful precursors of midlife social support.

Measures of family stability, sociocultural background, and emotional ties to parents in medical students (N = 589, mean age = 22 years) predicted their social support measures, assessed 23 to 39 years later (mean age = 56 years). Father's education and family's involvement in church were positively associated with group participation (number of group memberships), whereas parental loss between the ages of 11 and 20 was negatively associated with group participation; perceived emotional closeness to parents was positively associated with social closeness (number of close contacts providing emotional and instrumental support). Thus, group participation and social closeness were influenced by distinctly different childhood factors.

Psychological precursors of disorders: a thought-provoking observation.

While still in medical school at The Johns Hopkins University, participants in the Precursors Study, a longitudinal study of the precursors of coronary artery disease and other disorders, were given the Rorschach test along with other psychological and physical tests. In the present study, we looked at a cohort of 41 participants who, 8 to 24 years after having finished medical school, could be classified into five disorder groups: coronary, hypertension, mental illness, suicide, or malignant tumor. Using stepwise discriminant analysis, we found that participants' Rorschach test scores differed significantly among disorder groups. Since the Rorschach scores considerably predated the appearance of the disorders, this finding implies that the Rorschach scores were predictive of the subsequent development of the various disorders. The Rorschach scores were especially good at predicting mental illness. If this finding is not spurious, it suggests that a given Rorschach profile would be predictive long before mental illness became apparent. Consequently, it offers the possibility that some intervention might be undertaken which could either result in mental illness not occurring or, at perhaps a minimum, lessen its severity. Since the Precursors Study results discussed in this paper are some years old, it is likely that another cohort of participants have developed the various disorders. Therefore, the authors recommend that the discriminant functions derived from this effort be validated with another cohort from that study who had not yet exhibited one of the five disorders when the current analysis was undertaken. Were that not possible, we would recommend that this study simply be replicated with another cohort.

Temperament as a potential predictor of mortality: evidence from a 41-year prospective study.

Psychological factors were hypothesized to influence mortality, in particular, early versus later mortality. To explore the relationship between temperament, a psychological factor, and mortality in a prospective study of 1337 medical students, we constructed a measure portraying three temperament types, using latent class analysis. Death occurred in 113 subjects over 25-41 years of follow-up. In univariate survival analysis, subjects tending to direct tension "inward" when under stress ("Tension-In") had a higher risk of mortality than "Tension-Out" or "Stable" types. These associations persisted after adjustment for age, smoking, cholesterol level, and Quetelet Index. The relative risk (RR) of mortality for Tension-In was 1.56 (95% confidence interval, 1.00-2.44) compared with the Stable group. The risk was due entirely to the excess risk in persons under 55 years of age (RR, 2.59; 95% confidence interval, 1.46-4.62); the corresponding risk of death in older persons was 0.66 (0.30-1.48). Thus temperament is a significant risk factor for mortality, in particular, premature death.

Familial and psychological predictors of cancer.

The hypothesis that the quality of human relationships is a component in the development of cancer was investigated in a prospective study of former medical students. Findings from two psychological measures are presented: the Closeness to Parents Scale, which showed that students who subsequently developed cancer were more likely to describe a lack of closeness with their parents than their healthy classmates; and the Rorschach Interaction Scale, which demonstrated less satisfactory relationships among male cancer victims as contrasted with the rest of the cohort. The findings suggest that internal self-other representations, as measured by these two tests, are involved as regulators of biologic systems and manifestations of illness, such as cancer.

Habits of nervous tension and suicide.

In a prospective study of 1,046 male medical students, those who later committed suicide showed a heightened sensitivity in stressful situations as assessed by the Habits of Nervous Tension Questionnaire (HNT). Survival analyses specified 2 of the 25 HNT items as the strongest suicide predictors: Irritability (relative risk 5.5; 95% confidence interval 1.76-17.17) and Urinary Frequency (3.3; 1.07-10.32). No other risk factors for suicide emerged from family background measures or individual medical school measures. It appears that types of sensitivity reflect psychological characteristics that are long-term precursors of suicide.

Psychological correlates in the development of cancer: a review.

This review describes the research literature relating the possible psychological precursors to cancer, published between 1978-1987. The studies are grouped, according to their methodological design, to cross-sectional case-control studies, cross-sectional studies using pre-biopsy assessment, and prospective longitudinal studies. A theoretical framework, based on recent psychosomatic investigations, is proposed to integrate the seemingly discrepant findings.

Clustering of personality traits in youth and the subsequent development of cancer among physicians.

Using 14 personality measures obtained while the subjects were in medical school, the resulting profiles of 972 physicians were clustered into five groups using a two-stage cluster analysis procedure. Subjects were followed over a 30-year period to determine the cumulative survival rate (proportion of subjects remaining free of cancer) in each group. Statistically significant group differences in survival rate were found, with the group characterized by acting out and emotional expression having the most favorable curve (less than 1% developing cancer). The group characterized as "loners," who may well have suppressed their emotions, had the most unfavorable survival curve and was 16 times more likely to develop cancer than was the group characterized by acting out and emotional expression.

The Rorschach Interaction Scale as a potential predictor of cancer.

In a long-term prospective study, medical students who later developed cancer, in contrast to the rest of the cohort, gave Rorschach test responses indicating less satisfactory interpersonal relationships as assessed by the Rorschach Interaction Scale (RIS). The scale remained as a predictor of cancer after adjusting for smoking, serum cholesterol level, and age in medical school, and after taking into account the date of diagnosis and length of follow-up time. An exploration of the relationship between the RIS and specific types of cancer suggested that cancers of the lung may be less influenced by this psychologic factor than are other cancers. The findings were interpreted to suggest that internal self-other representations as measured by the RIS are involved as regulators of biologic systems and manifestations of illness, such as cancer.

Correlates of midlife career achievement among women physicians.

In the context of a longitudinal study, we explored factors contributing to midlife career achievement among 108 women physicians. Three groups were formed, based on medical specialty, specialty board certification, and professorial appointment. Using analysis of variance procedures, the career groups were compared on measures obtained during medical school and on marital status, family size, and three health measures in midlife. Of the youthful measures, academic standing, father's socioeconomic status, and early family (specifically father-daughter) relationships were found to be associated with midlife achievement. Furthermore, a clear association was observed between success and good health in midlife. Married women formed the majority in all groups; no differences in family size were found. We conclude that career achievement among women physicians is influenced less by marriage and family size than by motivational and personality factors shaped in early life.

Themes of interaction in medical students' Rorschach responses as predictors of midlife health or disease.

The purpose of this study was to examine variations in individual approaches to human relationships among members of a cohort of healthy medical students as revealed by their Rorschach Tests, and to explore the association between the assessed youthful relationship potential and midlife health or illness. In particular, the relationship potential among future cancer victims was found to differ significantly form that of their fellow students who remained healthy or who developed a cardiovascular disorder, but resembled that of those men who later became mentally ill or committed suicide. These prospective findings appear to fit with several retrospective reports stressing the role of human relationships as a psychological factor in the development of cancer.

Nutrition and infant behavior: a replication study in the Katmandu Valley, Nepal.

As a cross cultural comparison with an earlier study done in West Bengal, behavioral observations were made in the Katmandu Valley of 36 well-nourished and 38 undernourished children, 7 to 18 months of age, and their mothers. Undernourished children showed lowered levels of exploratory activity and attachment behavior, especially distance interaction, and a heightened need for physical closeness to the mother. Moreover, among the undernourished children the level of intellectual performance and the overall time spent in play were decreased, while time spent sucking at the breast was increased. In contrast to the West Bengali study, maternal behavior showed no differences between the two nutritional groups, and the intercorrelations between maternal and child scores showed similar or parallel patterns of reciprocity for the well-nourished and the undernourished children. No sex or age differences were found. The findings were interpreted to support Levitsky and Barnes' hypothesis of "functional isolation" as a mechanism between undernutrition and environmental stimulation to produce long-term behavioral changes. In addition, hunger as a motivational state, expressed as increased sucking, may interfere with other motivational determinants that might lead to exploration and/or increased social contacts.

Nutrition, infant behavior, and maternal characteristics: a pilot study in West Bengal, India.

Free activities and mother-child interaction in a standard setting were observed among undernourished and well-nourished children between the ages of 7 and 18 months in West Bengal. The undernourished boys showed less vigor in play activity, less attachment behavior toward the mother, especially in interaction across a distance, and maintained close physical contact with her more frequently than did the well-nourished boys. The mothers of the undernourished boys had lower scores in four of six measures of maternal behavior. Correlations between child and maternal scores revealed a high reciprocity in mother-child interaction for the well-nourished boys, but a lack of reciprocity for the undernourished boys. The developmental quotient and activity scores of the well- and undernourished boys were not different. However, the correlations between these and the maternal scores showed a divergent pattern of relationships for the two nutritional groups.