Labeling effects of a controversial psychiatric diagnosis: a vignette experiment of late luteal phase dysphoric disorder.

During the 1990s debate arose about the inclusion of Late Luteal Phase Dysphoric Disorder in the fourth edition of the American Psychiatric Association's Diagnostic and Statistical Manual. Opponents argued that the inclusion of this category would increase stigma and be used as a legal defense for child abuse and other violent crimes. Proponents argued that it would decrease stigma and enhance treatment seeking. Using an experimental vignette design, we tested these propositions in a study of 307 men and women living in Putnam County, New York. In general, the results do not indicate a pervasive negative impact of this label. On the other hand, labeling the disorder a "psychiatric condition" did increase recommendations for psychiatric help.

The examination of myofascial face pain and its relationship to psychological distress among women.

In this study, 110 female myofascial face pain patients were assessed monthly for 10 months on measures of pain, distress, and stressful life events. D. A. Kenny and A. J. Zautra's (1995) structural equation model for examining the separate trait, state, and error components of the variables was used to analyze the data. Both pain and distress had sizable trait variance, and the trait components were correlated. The 2 variables also showed sizable state variance, and the states of pain covaried with states of distress. A significant time-lagged relationship between the 2 variables was found: Increases in distress led to elevations in pain 1 month later. Stressful life events arising from major social roles were also associated with greater distress, but not pain. Illness events unrelated to the pain syndrome were associated with both pain and distress.

Relationship between lifetime occupation and parietal flow: implications for a reserve against Alzheimer's disease pathology.

We previously reported an inverse relation between parietal cerebral blood flow and years of education in Alzheimer's disease (AD) patients matched for clinical severity. This suggested that the clinical manifestation of advancing AD pathology is delayed in patients with higher educational attainment. Other aspects of life experience may also provide a reserve against the clinical expression of AD. To test this hypothesis, we classified the primary life-time occupations of 51 AD patients using the Dictionary of Occupational Titles, published by the US Department of Labor, and derived six factor scores describing intellectual, interpersonal, and physical job demands. Regional cerebral blood flow was measured using the xenon-133 inhalation method. After controlling for age, clinical dementia severity, and education, there was less relative perfusion in the parietal region in subjects whose occupations were associated with higher interpersonal skills and physical demands factor scores. We conclude that independent of education, aspects of occupational experience may provide a reserve that delays the clinical manifestation of AD.

Depressive symptomatology in single women heads of households in Puerto Rico: a comparative analysis.

The present study examines depressive symptomatology among women in Puerto Rico, using data from an island wide population-based sample. We focus on single women heads of households (SWHH) defined as divorced, separated, widowed and never married women with no permanent mate who have the main economic responsibility for their households. The study aims to identify social factors such as family responsibilities, stressful life events, and reduced levels of social support, that may contribute to the risk for depressive symptoms in these women. This is a growing population: the 1990 Census reported that 23% of all households in Puerto Rico were headed by women, an increase from 14% in 1970. The present study was based on a probability sample of adults (17-68 years), interviewed using a structured schedule, from which we analyzed the female subjects. Women were classified in three mutually exclusive groups: single women heads of households (SWHH, n = 138), single women not heads of households (SWNHH, n = 104), and married women not heads of households (MW, n = 275). Our finding that single women heads of households were especially vulnerable to depressive symptomatology is consistent with that of other studies in the United States. Also consistent with previous research, SWHH were found to be older, poorer, have less education and more often lived in urban areas, as compared to other women. Having children at home was associated with more depressive symptoms among both groups of single women, but not among married women. And the availability of emotional supporters had a weaker effect for SWHH. Furthermore, quality of support was found to be more important for these women than number of persons available for emotional support. The study has several implications for family policy and mental health prevention. Since SWHH are vulnerable for depressive symptomatology and their number is increasing, programs should be developed to attend the special needs of these women. These programs could include the provision of child care and the creation of self-help groups to build on their strengths and to combat isolation and loneliness.

Women, work, and well-being: the importance of work conditions.

This study investigates the role of work conditions in mediating the effect of employment status on married women's psychological well-being. Employed wives and full-time homemakers are compared on characteristics of their daily work activities and the consequences of these work conditions for psychological well-being. Using data from a national survey of employed wives and homemakers, I find that full-time housework involves more autonomy, more interruptions, greater physical effort, more routine, fewer time pressures, and less responsibility for matters outside one's control than paid work. Differences in work activities between employed wives and homemakers also have direct implications for well-being. Two of the dimensions examined--the extent to which the worker is responsible for things outside her control, and the amount of routine entailed--are associated with greater depressive symptoms among women, regardless of work status. It appears that, as compared to employed wives, full-time homemakers benefit from having less responsibility for things outside their control. Employed wives appear to benefit from having less routinized work than homemakers. As a result of the different configurations of their work characteristics, employed wives and homemakers experience on average similar levels of depressive symptoms.

Women and mental health: the interaction of job and family conditions.

Current research on the effects of wives' employment on their well-being focuses on the determinants of those effects. Most studies have used a gender model that concentrates on family conditions as mediators. In contrast, studies of the effects of employment on men typically use a job model and focus on work rather than family conditions as determinants. To understand fully the impact of employment on women, these models should be combined. We predict that certain work and family conditions interact, specifically, that the degree of control at work moderates the effects of demands in the family. Using two data sets on community mental health, we have found some support for this hypothesis.

Infant care and wives' depressive symptoms.

Although some investigators show that division of child care between spouses is related to the psychological well-being of wives, little attention has been given to the relevance of specific dimensions of child care or to nonemployed as well as employed wives. In this study we differentiate basic child care tasks, i.e., those that are essential for the family's physical well-being from other, more supplemental, or auxiliary tasks. We hypothesize that husbands' failure to perform auxiliary child care will be distressing for wives, regardless of employment status because it contributes to perceptions of marital inequity. On the other hand, husbands' lack of participation in the more time-consuming, basic, tasks will be most distressing for employed wives because it results in an increased overall work load. We also hypothesize that when employed mothers are responsible for arranging child care, and when such care entails financial strains, they are more likely to experience psychological distress. To evaluate these hypotheses we use data drawn from a mail survey of a sample of mothers of infants. Using multiple regression analysis, we find that husbands' involvement in child care and housework, especially in the time-consuming tasks, is relatively low and that the most consistent predictor of husbands' involvement is wives' relative income. In terms of the impact of husbands' involvement on wives' well-being, lower levels of husbands' participation in auxiliary, but not basic, child care are associated with increases in reported symptoms, regardless of wives' employment status. When child care is relatively more costly, employed wives report increased symptoms of depression. We discuss these results in terms of the role played by expectations of husbands and wives about parental responsibility for child care.

Losing face: sources of stigma as perceived by chronic facial pain patients.

The purpose of this paper is to identify potential sources of estrangement and feeling psychologically flawed as perceived by temporomandibular pain and dysfunction syndrome (TMPDS) patients. It is our hypothesis that a primary source of patients' perceived stigma results from pejorative labeling by clinicians. The data come from a study of 151 women TMPDS patients. The results show that the lack of a known etiology or pathogenesis for the condition allows the possibility of pejorative labeling by influential others such as physicians and dentists that in turn causes TMPDS sufferers to feel stigmatized. Stigmatization is not the result of clinical factors per se or personality problems. Perceived stigma associated with TMPDS leads to the same sorts of strained interactions and feeling estranged that have been shown to be typical of people with other stigmatized conditions. These strains and feelings in turn may contribute to ill health.

Coping and adaptation to facial pain in contrast to other stressful life events.

This article investigates whether coping with chronic pain influences adaptation to other negative life events using data on Temporomandibular Pain and Dysfunction Syndrome (TMPDS) patients (N = 99) and nonpatient controls (N = 98). It is found that cases cope very differently with pain than with other stressful events and that cases and controls do not differ on coping with nonpain events, with 2 exceptions. Cases view nonfateful events as more outside their control and they have more negative changes in usual activities following negative events. This excess of negative change is associated with greater demoralization and physical exhaustion. It is concluded that coping with repeated pain episodes leaves cases vulnerable to stressful events. Alternative interpretations, especially those involving the role of preexisting personality differences, are discussed.

The validity of tooth grinding measures: etiology of pain dysfunction syndrome revisited.

The current study explores the proposition that a treating clinician's etiologic model influences patients' reports of tooth grinding, the validity of, and subsequent research findings relying on these measures. The investigation compares self-reports of tooth grinding and related clinical variables for 151 cases of temporomandibular pain and dysfunction syndrome (TMPDS) treated by a clinician who does not explicitly support the grinding theory of the etiology of TMPDS, and 139 healthy controls. Cases were no more likely than well controls to report ever-grinding, but were actually significantly less likely than well controls to report current grinding. They were also significantly more likely to report that a dentist had told them they ground. Findings suggest that studies using self-report, clinician-report of tooth grinding (or both) are methodologically inadequate for addressing the relationship between tooth grinding and TMPDS.

The influence of social support on AIDS-related grief reaction among gay men.

This paper examines the relationships between instrumental and emotional social support and the experience of grief reaction in a sample of 180 gay men who had lost a lover or close friend to AIDS during the first 5 years of the epidemic. Structured, face-to-face interviews were conducted in mid-1985. Grief reaction was assessed through a newly developed 12-item scale (alpha = 0.85). Availability and adequacy of instrumental and emotional support were assessed with reference to the tasks of caretaking and emotional pain experienced during the lover's or close friend's illness with AIDS. The findings indicate that gay men who lost a lover or close friend to AIDS experienced symptoms of grief similar to those reported in studies of bereaved spouses and parents. The intensity of these grief reactions appears to be influenced by a number of factors. First, more intense grief reactions were observed among those who had taken care of their lover or close friend during his illness compared with those who did not act as caretakers. Second, while the simple availability of instrumental and emotional support was unrelated to grief reactions, the perceived adequacy of both types of support was strongly related to the level of grief. Respondents who had received inadequate help with caretaking responsibilities experienced more intense symptoms of grief subsequent to the death compared with those who reported receiving adequate caretaking support. Similarly, respondents who did not obtain adequate emotional support for the pain they experienced during the course of the illness reported more intense symptoms of grief compared with those who felt they had received adequate support.(ABSTRACT TRUNCATED AT 250 WORDS)