Social support and treatment response in older depressed primary care patients.

A previously tested theoretical model that specifies relationships among depression, activities of daily living (ADL) impairment, and social support components was validated with 307 patients aged 60 and older from a multisite effectiveness trial of 3 treatments (antidepressant, placebo, Problem-Solving Treatment) for dysthymia or minor depression in primary care. Participants completed interviews and self-reports at baseline and at 6 and 12 weeks. The short-term, longitudinal data were analyzed with covariance structure modeling techniques. Consistent with the previous model, impairment in ADLs was associated with subsequent increases in depression, a larger emotionally close network that made frequent visits was associated with subsequent increases in perceived support, and perceived support was associated with subsequent decreases in depression. This last effect was significant only among participants randomly assigned to receive placebo with clinical management. The similar results in 2 different studies are a substantial validation of the theoretical model. The effect of perceived support primarily in the placebo group suggests that those with greater perceived social support and subsyndromal depression may be more likely to have a positive response to nonspecific clinical treatment components.

Social support, depression, and activities of daily living in older heart surgery patients.

A theoretical model that specifies relationships among depression, ADL impairment, and social support components was tested using 147 patients age 55 and older undergoing open heart surgery for angina pectoris or aortic stenosis. Patients completed interviews and self-reports before surgery and one and 6 months after surgery. The longitudinal data were analyzed using covariance structure modeling techniques. Consistent with an initially theorized structural model, the number of close network members seen regularly before surgery was associated with perceived adequacy of support one month after surgery. In turn, perceived adequacy of support one month after surgery predicted less depression and less ADL impairment at 6 months. The number of close network members seen regularly was also directly associated with less ADL at one month and less depression at 6 months after surgery.

Neonatal pain: a comprehensive survey of attitudes and practices.

We surveyed 352 physicians board certified in neonatal-perinatal medicine on their attitudes and practices in the area of pain and pain management in neonates and infants. In contrast to earlier surveys of this type, almost all respondents indicated that even the youngest and most premature infants are able to perceive pain, and most reported that they always advocated anesthesia during the intraoperative period. The use of analgesic agents in the postoperative period, however, was more variable. Respondents who indicated that neonates perceived less pain than adults reported seeing fewer signs of pain and using less analgesia in the postoperative period. They were also more likely to believe that analgesics are too dangerous to use in neonates and that physiologic factors such as incomplete myelination of the pain pathways and neural/physical immaturity (factors now known not to play a role) contribute to diminished pain sensitivity. Conversely, respondents who indicated that neonates do not perceive less pain than adults, the majority of respondents, reported seeing more signs of pain and using more medication in the postoperative period. These physicians also believed that the physiologic stress associated with pain can be more dangerous than the analgesics. We conclude that attitudes and reported practices have changed in the area of neonatal pain and pain management. Furthermore, our data indicate that these attitudes significantly predict reported postoperative medicating practices.

A general approach to testing multifaceted personality constructs.

Some personality characteristics are composed of multiple, distinct subcomponents (e.g., Type A, hardiness, attributional style, self-monitoring). The advantages and disadvantages of 3 typical approaches to testing these constructs are reviewed. An alternative approach based on structural equation modeling is then offered. This approach has many advantages over its alternatives, including the provision of an explicit test of the structure of the multifaceted construct, the simultaneous test of the effects of this general construct and the unique aspects of its subcomponents, and the explicit consideration of measurement error. Although the modeling approach does have limitations, these limitations are equally applicable to all of its alternatives. Indeed, the principal disadvantages of the modeling approach seem to be its statistical complexity and the lack of education regarding its proper use.

Modeling the relations of attributional style, expectancies, and depression.

Structural modeling techniques were used to assess relations of attributional style, expectancies, and depression. According to an initial theoretical model, attributions are directly related to expectancies, and expectancies are directly related to depression, but attributions are only indirectly related to depression by means of their relation to expectancies. The results of Study 1 indicated that this model was flawed in 2 respects: (a) Attributions for positive and negative events did not form a single latent variable, and (b) attributions for negative events both were indirectly related to depression by means of expectancies and were directly related to depression. Attributions for positive events only were indirectly related to depression by means of expectancies. The model derived in Study 1 was replicated in Study 2. Discussion centers on the interpretation of this modified model and on issues in the measurement of attributional style.

Hardiness and health: a critique and alternative approach.

Recent research has suggested that individual differences in the personality variable of hardiness are related to health and illness. Despite some success at predicting health outcomes, there are several theoretical and empirical problems that must be addressed before research on this topic can proceed. Most critical are (a) how hardiness is to be measured; (b) whether hardiness should be treated as a unitary phenomenon or as three separate phenomena associated with commitment, control, and challenge; and (c) whether hardiness has direct effects on health or indirect effects by virtue of buffering the impact of stressful life events. After reviewing the literature and presenting our own study of the psychometric properties of the Hardiness Scale and its subcomponents, we draw the following conclusions: (a) Hardiness is not a unitary phenomenon, but should be treated as involving three separate phenomena; (b) of the three subcomponents of hardiness, only commitment and control have adequate psychometric properties and are systematically related to health outcomes; (c) lack of control and lack of commitment have direct effects on health because they are psychologically stressful; and (d) if there are buffering effects of commitment and control, they are in addition to these direct effects and are situation specific. Such a systematic consideration of the problems and prospects of the hardiness literature should facilitate research on this important topic.

Emotional reactions to dramatic film stimuli: the influence of cognitive and emotional empathy.

The idea that empathy may best be considered a multidimensional construct, consisting of both cognitive and emotional facets, has recently been gaining in popularity. To date, however, little research explicitly based on such a view has been carried out. We conducted the present experiment to explore the different influences of cognitive and emotional empathy on two types of responses to dramatic stimuli: positive and negative emotional reactions. Consistent with a multidimensional view of empathy, the two types of empathy exhibited different effects; positive emotional reactions were affected primarily by cognitive empathy, and negative emotional reactions were most heavily influenced by emotional empathy. The results are discussed in terms of their relevance to a multidimensional approach to the study of empathic responding.

Applications of the self-awareness model of alcohol consumption: predicting patterns of use and abuse.

We conducted two studies to test the applicability of a recently proposed self-awareness model of alcohol consumption to patterns of alcohol use outside of the laboratory. In both studies, we predicted that alcohol use would be a joint function of private self-consciousness and personal success or failure. High self-conscious individuals were predicted to drink following personal failure and avoid drinking following personal success in an attempt to control their sensitivity to the self-relevant implications of such events. Consumption by low self-conscious individuals was predicted to be relatively independent of self-relevant events. These predictions were supported in a longitudinal study of relapse following alcoholic detoxification. They were then replicated in a study of adolescent alcohol use and shown to be relatively independent of other significant environmental and behavioral predictors of consumption. Results are discussed in terms of their implications for theories of self-awareness and alcohol use.

Self-consciousness, self-esteem, and success-failure as determinants of alcohol consumption in male social drinkers.

An experiment was conducted to test the proposition that alcohol is consumed as a function of the quality of past performances and the individual's level of private self-consciousness. One hundred and twenty male subjects were randomly given success or failure feedback on an intellectual task. They then participated in a separate "wine-tasting" experiment in which they were allowed to regulate alcohol consumption. As predicted, high self-conscious subjects who had received failure feedback drank significantly more wine than did high self-conscious subjects who received success feedback. Consumption by low self-conscious subjects fell between these extremes and did not vary as a function of success and failure. Additional data indicated that these results were mediated by differential sensitivity to the positive or negative implications of success/failure by high and low self-conscious subjects. The results are discussed in terms of their implications for theoretical accounts of the psychological antecedents of alcohol consumption.