Sociocultural factors in MI recovery: an exploratory study

Psychometric Comparability of the English-and Spanish-Language Versions of the State-Trait Anxiety Inventory

The psychometric adequacy of the English-and Spanish-language versions of the State-Trait Anxiety Inventory (STAI) was compared across English-speaking Latino American women (n = 17) and men (n = 18) and Spanish-speaking Latino American women (n = 10) and men (n = 14) who were experiencing stressful and potentially anxiety-producing situations associated with physical pain. Subjects were administered the STAI as well as the Minnesota Multiphasic Personality Inventory (MMPI) in their preferred language. Psychometric comparisons of language group and gender revealed nonsignificant differences in (a) mean scores on the STAIscales, (b) internal consistency for the STAI scales, and (c) correlations between the STAI scales and MMPI scales. Item analyses identified several salient screening itemsfor the Spanish-speaking men; several items with low item-remainder correlations were revealedfor the English-and Spanish-speaking women. Overall, results attest to the psychometric strengths of the English-and Spanish-language versions of the STAI.

Rehabilitation after coronary heart disease: spouses' views of support

BACKGROUND

Family presence decreases mortality and improves psychosocial recovery after a coronary heart disease event. In this situation, spousal support seems important for the recovering partner's self-esteem and mastery. There is inadequate knowledge of how spouses view their supportive roles.

AIM

The aim of this paper is to report a study investigating spouses' experiences of the rehabilitation phase of their partners' coronary heart disease and to gain their views about supporting them in lifestyle changes.

METHOD

Eight male (mean age 61) and 17 female spouses (mean age 53), were interviewed 1 year after their partner's cardiac event. Of the partners, 18 had experienced myocardial infarction and 19 were revascularized. Interview transcripts were analysed qualitatively using a phenomenographic framework.

FINDINGS

The analysis yielded five different views of the spouse's role. The participative role involved taking a practical part in lifestyle changes, communicating empathetically, and being positive about changes. The regulative role was characterized by being either positive or negative about changes, giving practical or cognitive support in order to control the partner's behaviour, and communicating authoritatively. In the observational role the spouse was passive, complied with suggestions, and communicated empathetically. The incapacitated role involved a positive attitude to changes, communicating without making demands, but being unable to provide support because of personal problems. Assuming a dissociative role entailed being negative about changes and authoritatively declaring a reluctance to be involved in the partner's change of lifestyle. Spouses adopted different roles depending on the support situation.

CONCLUSION

Spouses' views of their roles in support varied considerably in terms of awareness of the benefits of behavioural changes, style of communication, pattern of co-operation and support situation. The findings favour the view that a family perspective is important in planning rehabilitation of patients following coronary heart disease.

En las manos de Dios [in God's hands]: Religious and other forms of coping among Latinos with arthritis

This study tested a theoretical model concerning religious, passive, and active coping; pain; and psychological adjustment among a sample of 200 Latinos with arthritis. Respondents reported using high levels of religious coping. A path analysis indicated that religious coping was correlated with active but not with passive coping. Religious coping was directly related to psychological well-being. Passive coping was associated with greater pain and worse adjustment. The effects of active coping on pain, depression, and psychological well-being were entirely indirect, mediated by acceptance of illness and self-efficacy. These findings warrant more research on the mechanisms that mediate the relationship between coping and health. This study contributes to a growing literature on religious coping among people with chronic illness, as well as contributing to a historically under-studied ethnic group.

Socioeconomic status, social environment, depression and postdischarge adjustment of the cardiac patient

In this study, we assess the adjustment achieved by patients following discharge from coronary care and the role of socioeconomic status (SES), social environment (SE), and depression in achieving that adjustment. Two hundred eighty-seven patients were enrolled. The SE into which the patients were to be discharged was rated significantly poorer for patients of lower SES, who also scored higher on depression. At 1, 6, and 12 months postdischarge, lower SES patients recorded significantly poorer levels of adjustment across a range of functioning. Predischarge depression, together with measures of SE and SES, determined 10% to 28% of the variance in 12-month postdischarge adjustment. These data suggest the importance of identifying patients at greater risk for less than optimal outcome (those lower in SES and higher in depression), and the need to address the nature of the SE in which the patient has to effect his/her recovery.

Coping with chronic pain: sources of intrinsic and contextual variability

Univariate and multivariate analyses were used to investigate intrinsic and contextual sources of coping variability among 90 patients with chronic pain. Pain coping strategies were assessed by the subscales of the Coping Strategies Questionnaire. Intrinsic variables included demographic characteristics and dispositional optimism. Contextual variables included pain-related variables and pain control appraisals. In univariate analyses, ethnicity was a statistically significant intrinsic source of variability for the praying and hoping coping subscale; however, comparisons between pairs of ethnic groups were not statistically significant. A multivariate perspective of the data found three independent and salient patterns of correlation between the intrinsic and contextual variables and coping subscales. These patterns of correlation accounted for 96% of the total variance and were conceptualized as optimistic active coping, educated rational coping, and optimistic restricted coping. The findings raise the prospect that there are intrinsic and contextual explanations of coping variability for patients with chronic pain.

Coping and social support resources among Latinas with arthritis

OBJECTIVE

To examine the coping strategies and social support resources of Latinas (Hispanic women with arthritis.

METHODS

A sample of 109 Latinas of low socioeconomic status with arthritis were interviewed. Most interviews were conducted in Spanish. In open-ended responses, participants described how they cope with their illness. Respondents also named the two individuals who help them most when they do not feel well because of their illness.

RESULTS

Engaging in activities was the most commonly reported coping strategy, followed by the use of religion or prayer. Respondents relied more on family members (especially daughters) than friends for support.

CONCLUSIONS

Coping responses to arthritis may reflect culture-based notions of "coping," as well as culturally valued norms, such as familism. The extent to which findings illustrate cultural, gender, or socioeconomic status factors requires further study.

Risk factors and mortality among black, Caucasian, and Latina women with acute myocardial infarction

The purpose of this study was to examine the clinical outcome of acute myocardial infarction among women of three ethnic/racial groups and to determine whether observed differences in outcome are explained by differences in associated risk factors. Nine hundred seventeen (917) consecutive admissions occurred among 810 women, of whom 347 (42.8%) were Caucasian, 258 (31.9%) were black, and 205 (25.3%) were Latina. The overall mortality rate was 13%; the Caucasian rate was significantly higher than the Latina rate (16.9% vs 7%, p < 0.01), as was the black rate (13.8% vs 7%, p < 0.05). Comparing survivors with nonsurvivors among the three groups, hypertension was more common for survivors among blacks, as was a history of angina; in-hospital congestive failure was associated with a higher mortality for blacks and Caucasians, as was in-hospital angina for Caucasians. Univariate and multivariate logistic regression for the outcome variables of congestive failure, in-hospital angina, and mortality, showed race to be a significant factor in the lower mortality rate for Latinas in the univariate analysis. In the multivariate analysis, only in-hospital angina and congestive failure significantly influenced mortality. In this study of myocardial infarction among women of lower socioeconomic status, factors other than race were the primary influences on outcome.

Causal attributions and coronary heart disease in women

The relationship between coronary heart-disease endpoints and attributional style in women has been previously unexamined. This study examined the attributions of 73 postmyocardial infarction (MI) women about their heart disease and explored the relationship between attributions and nonfatal coronary recurrence. Women's primary causal attributions included personal behavior (9.6%), blaming others (19.3%), stress (28.8%), luck (12.3%), and family history (13.7%). The largest proportion of recurrences occurred in women attributing their infarcts to marital problems. Of the attributional ratings, ascriptions involving spouses were the only attributions that met entry criteria for logistic regression (p = .019) after controlling for severity of first infarction.

Psychiatric morbidity during the early phase of coronary care for myocardial infarction: association with cardiac diagnosis and outcome

We evaluated the association of psychiatric morbidity during the early phase of admission to a coronary care unit with cardiac diagnosis and subsequent morbidity. Ninety-two patients admitted for the first time for presumed myocardial infarction were evaluated within 48 hours of hospitalization. Anxiety and depressive symptoms and cognitive impairment were rated. Data were collected on cardiac diagnosis and morbidity. Three and 12 months after hospitalization, cardiac morbidity, psychiatric symptoms and psychosocial morbidity were assessed.

Hypertension in minority populations. Access to care

Data from multiple sources confirm the greater risk of morbidity and mortality from cardiovascular disease that is seen in some minority segments of the population of the United States, when those segments are compared with the population as a whole. In most studies, blacks are shown to have the highest overall mortality rate from cardiovascular disease--higher than the rate for Hispanics, and substantially higher than the rate for whites and Asians. In some of these studies, blacks also have higher rates of both hypertension-related stroke and coronary artery disease. In some of the major clinical trials, Hispanic patients have the next-highest death rate from high blood pressure and ischemic heart disease. In other, smaller studies, however, non-Hispanic whites have had comparable or higher age-adjusted death rates. Asians, by contrast, have significantly lower death rates from cardiovascular disease, irrespective of national origin, and they also have correspondingly lower mortality from stroke and other hypertension-related diseases. As in coronary artery disease, issues related to access to care may be implicated in the disproportionate morbidity and mortality rates noted in black and Hispanic patients, as well as among some lower-class segments of the non-Hispanic white population. Access to care may depend upon a number of factors, among them cultural isolation, public awareness, individual and group attitudes, perception of resource availability, actual resources, socioeconomic status, educational level, and peer behavior.

Coping with serious illness: on integrating constructs to enhance clinical research, assessment and intervention

Empirical research suggests that given relatively similar illness contingencies, patients who cope successfully with serious illness have access to and use effectively social network support, believe events are to some extent within their control, perceive themselves to be effective, and employ an array of flexible coping strategies. Based on a selective literature review, the argument is made that more integrative conceptual frameworks are needed to advance theory and to enhance the applied value of research data. Clinical implications for assessment, intervention, and evaluation are set forth.