Faculty Bibliography

The death of a parent in childhood represents a profound psychological insult. Although a number of studies have examined rates of depression and anxiety in bereaved children, less attention has been given to understanding predictors of children's adjustment to the loss. Data are presented from 83 families with schoolage children in which a parent had died of cancer in the preceding 18 months. The surviving parent and one randomly selected child completed individual interviews conducted by a clinician in the families' homes. Using multiple regression, potential predictors of children's psychosocial adjustment to parental death are examined and their relative importance is discussed. Among the predictors considered were child's age, child's gender deceased parent's gender; time since death, length of illness, presence of siblings, and parental communication patterns. The child's perception of the surviving parent's level of openness in parental communication was found to be significantly correlated with lower levels of depressive symptoms and state anxiety in bereaved children. Boys reported lower levels of depressive symptoms than did girls, and older children reported lower levels of state anxiety than did younger children.

As more elderly people experience a cancer diagnosis and live longer, the psychological sequelae of the disease and its treatment increasingly becomes a central concern. Cancer and its treatment are likely to present significant adaptive challenges to the elderly. Knowledge of the correlates of depressive symptoms in older patients may help to identify patients who are at increased risk for co-morbid depression and to inform the development of programs and services that can help reduce depressive symptoms. Data from 169 outpatients with cancer (aged 60 to 86 years) were included in-an analysis to estimate a model of patients' depressive symptoms using the Center for Epidemiologic Studies Depression Scale. The results of regression analyses indicated that a college degree and a lesser impact of the disease on patients' social functioning correlated with lower depression and that feeling separated or set apart from others and a wider range of negative interactions with one's support network correlated with greater depression.

Understanding the factors that increase adult caregiving daughters vulnerability to poor psychological functioning and thereby threaten their ability to provide adequate informal support and assistance is important to maintaining the chronically ill elderly in the community. On the basis of data obtained from 164 elderly outpatients (aged 60 to 90) and their adult caregiving daughters, the effect of potential predictors on the caregiving daughter's state anxiety (STAI-S) scores was estimated using hierarchical regression. The total model suggests that scores of a daughter having a health-limiting condition, a greater sense of filial obligation, and a greater caregiver burden were correlated with higher anxiety scores, whereas having a favorable attitude regarding her caregiving experience, providing care in a greater number of domains of care, and having a higher level of overall satisfaction with the help received in providing care were correlated with lower scores. These findings demonstrate the value of considering the situational factors that may constrain or facilitate caregiving when investigating emotional distress among familial caregivers.

The relationship of race and ethnicity with standardized measures of depressive symptomatology and mental health was examined in a sample of HN-infected African American (n = 48), Puerto Rican (n = 50), and White non-Hispanic (n = 48) women in New York City. Mean scores of women from all three racial and ethnic groups were higher than those reported for normative samples on measures of depressive symptomatology and psychological distress, and mean scores on measures of psychological well-being were lower Puerto Rican women reported significantly higher levels of depressive symptomatology than either African American or White women. Puerto Rican women also reported significantly higher levels of psychological distress and lower levels of psychological well-being than African American women. The findings suggest that while all HIV-infected women are at risk of poor adjustment, Puerto Rican women may be especially vulnerable. They also point to the need for future research to determine what factors in these women's lives are predictive of adjustment, especially those factors amenable to intervention. (C) 1998 John Wiley & Sons, Inc.

Semistructured interviews were conducted with 63 HIV-infected late middle-age and older adults (i.e., age 50 or older). An analysis of the narrative material revealed a variety of themes that reflected participants' beliefs about how their older age advantaged and/or disadvantaged them in living with this disease. Themes reflective of perceived advantages included (1) with age comes wisdom; (2) older people do not feel as cheated; (3) with age comes greater respect for health and life; (4) with age comes patience, contentment, and moderation; (5) older people are less psychologically threatened by disability and fatigue; and (6) older people can focus more on their own needs. Themes reflective of perceived disadvantages included (1) older people's bodies are more worn down and less resilient, (2) older people are more socially isolated, (3) older people get less sympathy and are judged more harshly, (4) doctors set higher goals when treating younger patients, and (5) older people are too compliant and conservative.

BACKGROUND: As a consequence of advances and changes in the detection and treatment of cancer, increasing demands are being placed on familial caregivers of elderly cancer patients. Understanding the factors that place familial caregivers at risk of poor psychological outcomes and threaten their ability to provide adequate care is important for maintaining chronically ill patients in the community. METHODS: Dyads comprised of 164 cancer outpatients (ages 60-90 years) and their adult caregiving daughter completed structured telephone interviews. Hierarchical regression was used to determine the individual and cumulative effect of five domains of potential predictors on the daughters' depressive symptomatology (Center for Epidemiologic Studies Depression Scale [CES-D]). RESULTS: The domains that were shown to be significantly predictive of a daughter's level of depressive symptomatology were daughter sociodemographics, constraints on/facilitators of caregiving, and caregiver burden. The domains of disease/patient characteristics and the daughter's appraisal of the caregiving situation were not found to be significant. The total model suggests that having a health-limiting condition, a greater sense of filial obligation, and greater caregiver burden were correlated with higher CES-D scores, whereas having graduated college, having other social roles, having favorable attitudes regarding her caregiving experience, and providing care in a greater number of domains of care were correlated with lower scores. CONCLUSIONS: These findings demonstrate the importance of focusing on situational factors that may function to constrain or facilitate caregiving when investigating caregiver depression.

Data from an investigation of HIV-infected African-American, Puerto Rican and non-Hispanic white women's treatment behaviour and decision-making are presented. Findings are based on a thematic analysis of the narrative accounts of 31 women who exhibited significant delay in seeing a physician about their HIV infection after testing positive for HIV antibodies. Analysis of the women's qualitative interview data indicated that a variety of barriers impeded them from actively pursuing treatment. The women's psychological responses to learning their serostatus were the most pervasive factors associated with delaying seeking care. Implications of the analysis for informing the design of secondary prevention efforts to move women into treatment earlier are discussed, such as the need to develop interventions or supportive services designed to assist women in coming to terms with their infected status.

Through in-depth interviews the testing experiences of HIV-infected women were examined. The barriers that impeded the women from recognizing their at-risk status and from seeking testing once their vulnerability was acknowledged are discussed. Also described are the pathways that led women into testing. The data reveal that lack of understanding about risk behaviors, ignorance of their partner's risk practices, lack of information about HIV-related symptoms, and perceived invulnerability to infection were the principal barriers to women recognizing their at-risk status. The women's accounts also indicate that psychological factors--fear and denial--are the principal barriers to seeking testing once one acknowledges vulnerability. Finally, the data show that few women made a thoughtful proactive decision to be tested but rather seemed to be led by circumstances to learn their status, sometimes unwittingly.

The findings from a qualitative investigation of HIV-infected African American and Puerto Rican gay and bisexual men's experiences obtaining HIV-related information; seeking HIV-related health care; as well as soliciting assistance from, and involvement with, HIV/AIDS service organizations are presented. Many men felt that their race or ethnicity-alone or together with their lower socioeconomic status-had been a factor in their experiences in seeking illness-related information, health care, advocacy, and social services. With respect to medical care, African American men held move critical and distrustful attitudes toward physicians than did Puerto Rican men. Both groups of men viewed the principal, high-profile, HIV-related advocacy and social service organizations as largely disinterested in non-White and non-middle-class clients. The men also viewed the minority-focused HIV/AIDS organizations as largely ineffectual.

Findings from a study of the testing and treatment behaviour and experiences of African-American (n = 31), Puerto Rican (n = 30) and non-Hispanic white (n = 23) HIV-infected women are reported. All women were 20-45 years of age and had not yet been diagnosed with AIDS. Data for the analyses presented were gathered through an interviewer-administered questionnaire completed before respondents participated in an unstructured interview. The analyses examine race/ethnic differences in women's delays in seeking testing and medical care, and in sources and types of HIV-treatment. Most significant for primary and secondary prevention efforts, the findings suggest that a significant proportion of women who suspect they are infected may delay being tested, and further, a substantial proportion who learn they are seropositive may delay seeking medical care. Thus important opportunities among HIV-infected women for secondary prevention through timely antiviral and prophylactic treatment, and for primary prevention through risk-reduction counselling may be being missed in many cases.