Explaining inconsistencies between patients and collaterals: validity in outcome studies of coercive alcoholism treatment

This study aims to assess the consistency of replies to questionnaires mailed to patients and two kinds of collaterals, i.e., social workers and significant others, at a public treatment center with socially unstable and compulsory committed patients. It compares the quantity and kind of discrepancies between replies by patients and collaterals on outcome data concerning social situation and drinking habits. It aims to measure the amount of systematic bias among factors that may explain inconsistencies between reports, especially the factors compulsory commitment, worse outcome, frequency of contact and type of collateral. The responders generally agreed. Variables in which there was less agreement were explored in logistic regressions using ten explanatory variables. Significant relations did not exceed those expected by chance. Discrepancies were not systematic in size and kind. On a six-rank ordinal scale of alcohol use or abuse, however, patients tended to underestimate the extent of their abuse. Inconsistencies here concerned the degree but not the presence of abuse. No difference in consistency due to type of collateral was found. In conclusion, the consistency of the questionnaires was high and independent of the social situation of the patient, of compulsory commitment and of other background or treatment factors, as well as of treatment outcome and type of collateral.     

The impact of sense of coherence and high-demand/low-control job environment on self-reported health,burnout and psychophysiological stress indicators

Sense of Coherence (SOC) is a new concept belonging to a salutogenic paradigm, proposing to explain health as contrasted to disease, a pathogenic paradigm. The Job Demand-Control (JDC) model of job stress suggests that the combination of high job demands and low job control, defined as job strain, is strongly associated with adverse health consequences. The aim of this study was to evaluate the relationship between SOC and the JDC model in assessment of negative job effects within three pathogenically defined contexts: self-reported health, burnout and psychophysiological stress indicators, assessing the explanatory value of SOC for such variables. The study was conducted with 103 employees of social-welfare and social-insurance agencies in Sweden. A questionnaire related to job conditions, health and burnout was administered, and blood samples were collected and analysed for serum concentrations of cortisol, prolactin and immunoglobulin G. Multiple-regression models were calculated including variables from all three contexts. In the analyses, a distinction was made between emotional job strain and quantitative job strain. The SOC interacted with emotional job strain, but the interaction also increased the independent effect of emotional job strain. The independent effect of SOC disappeared in most models when interaction was included. It is concluded that studies of job strain-effects according to the JDC model should include the SOC as an interaction factor.     

Prediction of outcome in coerced and voluntarily treated alcoholics

The study concerns multivariate prediction of the short-term outcome of alcoholism in a coercive treatment setting in Sweden. One hundred and twenty-one patients (87 men, 34 women) with a mean age of 41 (range 26–63) years attended a 5-week program. They were for the most part severely alcohol-dependent and socially unstable. Compulsorily committed patients ( n -32) were less socially stable but did not differ from the voluntary patients ( n =89) in the type of drugs abused. Nine months (mean) after treatment, a follow-up was performed by mailing questionnaires to the patients and to the referring social workers. The improvement data in the questionnaires were checked with other data. Data on alcohol abuse were available for 116 (96%) of the patients; 55% improved. Of these, 13% had remained entirely abstinent. Using multivariate logistic regression, participation in a self-help group and first-time admission were found to be significant factors for overall improvement, while having a family and more than primary education were significant for abstinence. Compulsory commitment to treatment was not related to the short-term drinking outcome. Undergoing voluntary treatment and having previous treatment experience were significant factors for participation in self-help groups.     

The impact of sense of coherence and high-demand/low-control job environment on self-reported health, burnout and psychophysiological stress indicators

Sense of Coherence (SOC) is a new concept belonging to a salutogenic paradigm, proposing to explain health as contrasted to disease, a pathogenic paradigm. The Job Demand-Control (JDC) model of job stress suggests that the combination of high job demands and low job control, defined as job strain, is strongly associated with adverse health consequences. The aim of this study was to evaluate the relationship between SOC and the JDC model in assessment of negative job effects within three pathogenically defined contexts: self-reported health, burnout and psychophysiological stress indicators, assessing the explanatory value of SOC for such variables. The study was conducted with 103 employees of social-welfare and social-insurance agencies in Sweden. A questionnaire related to job conditions, health and burnout was administered, and blood samples were collected and analysed for serum concentrations of cortisol, prolactin and immunoglobulin G. Multiple-regression models were calculated including variables from all three contexts. In the analyses, a distinction was made between emotional job strain and quantitative job strain. The SOC interacted with emotional job strain, but the interaction also increased the independent effect of emotional job strain. The independent effect of SOC disappeared in most models when interaction was included. It is concluded that studies of job strain-effects according to the JDC model should include the SOC as an interaction factor.