The Mental Health of the Childless Elderly

The substantial number of childless elderly in Canada and the United States raises important concerns about the nature of their family support, as well as their psychological well-being. Although the (mixed) effects of childlessness on the mental health of the elderly are well documented in the literature, little is known about the social distribution of psychological distress and depression within this population: how well the childless elderly live, the status of their mental health, and what factors affect their psychological well-being are all crucial questions that remain unanswered. This paper utilizes Pearlin et al.'s (1981) stress process model to examine psychological distress and depression among the childless elderly. Our empirical analysis uses a nationally representative sample of childless individuals aged 55 and over ( N = 2,311) from the 1996-1997 National Population Health Survey (NPHS), and generalized linear model (GLM) techniques. Generally, our results support the stress process model. We find that individual-level stressors exert a strong and consistently negative impact on psychological distress and depression. We also find significant buffering effects of (perceived) social support.     

The Case for Insurance Reimbursement of Couple Therapy

A case is made for why it may now be in the best interest of insurance companies to reimburse for marital therapy to treat marital distress. Relevant literature is reviewed with a considerable focus on the reasons that insurance companies would benefit from reimbursing marital therapy – the high costs of marital distress, the growing link between marital distress and a host of related physical and mental health problems, as well as the availability of empirically supported treatments for marital distress. This is followed by a focus on the major reasons insurance companies cite for not reimbursing marital therapy, along with a discussion of advances in several growing bodies of research to address these concerns. Main arguments include the direct medical offset costs of couple and family therapy (including for high utilizers of health insurance), and the fact that insurance companies already find it cost effective to reimburse for prevention of other health and psychological problems. This is followed by implications for practitioners and researchers.     

Psychological Distress as an Indicator of Co-Occurring Psychopathology among Treatment-Seeking Disordered Gamblers

Disordered gamblers frequently present with concurrent anxiety, depressive, personality, and substance use disorders, which may complicate treatment. Although there is a need for a thorough assessment, some questionnaires may prove lengthy for clients and clinicians. Thus, there is a need for brief screens for identifying co-occurring psychopathology. The present study sought to examine whether a brief, self-report measure of psychological distress could indicate the presence of co-occurring psychopathology among an outpatient sample of disordered gamblers. At intake, 69 participants completed self-report measures of distress and gambling symptomatology, a personality inventory, and a structured interview for the diagnostic criteria for disordered gambling. Gamblers with greater elevations of psychological distress evidenced greater severity of gambling pathology. Clinically significant elevations were present for symptoms of depression, deviancy, and anxiety, but not substance abuse. Greater scores of psychological distress significantly predicted elevations of depression, deviancy, and anxiety. Sensitivity and specificity were evaluated and the findings supported that an average psychological distress score of 16 corresponded with the presence of co-occurring psychopathology. Clinicians treating disordered gamblers should consider screening for co-occurring psychopathology with brief, self-report measures of psychological distress.     

The effectiveness of stigma coping orientations: can negative consequences of mental illness labeling be avoided?

Recent research has assigned a prominent role to labeling and stigma as factors that impair the social and psychological functioning of people officially labeled mentally ill. But can the effects of labeling and stigma be overcome by adopting a few simple approaches to coping with these problems? If so, the stigma-induced problems of social awkwardness, demoralization and unemployment emphasized by recent research may not be as severe as claimed. Using a sample of psychiatric patients, we examine this issue by assessing whether patients can ameliorate labeling effects by keeping their history of treatment a secret, educating others about their situation, or avoiding situations in which rejection might occur. None of these coping orientations were effective in diminishing negative labeling effects on unemployment or on psychological distress/demoralization. In fact, the three coping strategies show consistent effects in the direction of producing more harm than good, and with respect to withdrawal-avoidance this effect is significant. Based on these results we argue that stigma is powerfully reinforced by culture and that its effects are not easily overcome by the coping actions of individuals. Using C. Wright Mills's (1967) distinction we conclude that labeling and stigma are "social problems" not "individual troubles."     

Marital Status and Depressive Symptoms

Marital status differences in depressive symptoms are examined in a random sample of 559 Anglos, 403 Blacks, and 822 Mexican American adults. Findings were generally consistent with a "crisis" model, with highest levels of depression observed among the separated, with lower distress levels among the divorced, although, marital differences remained significant after controls only among Anglo males. Differences were negligible among Blacks and Mexican Americans and lower levels of distress were found among never married than married Black females. Further analyses indicated that observed racial/ethnic differences can be partially explained by differences between groups in length of time since separation/divorce and likelihood of previous marriage, though significantly higher levels of depression and marital strain among married Black females relative to Anglo and Mexican American females-even among those in their first marriage-suggests differences between groups in the relative rewards or costs of marriage. These preliminary analyses underscore the need to examine alternative explanations of racial/ethnic and marital status differences in distress in a larger, prospective data base.     

An Evaluation of the "Recovery of Hope" Program

The Recovery of Hope program was initiated in 1981 to address the problem of couples entering marriage enrichment events whose distress levels indicated a need for therapy rather than enrichment. An ex post facto evaluation was conducted for this divorce prevention program, surveying 190 spouses who had been involved in the program prior to October 1984. Returns were obtained from 34 wives and 27 husbands on post-test and retrospective pre-test marital satisfaction measures, along with a variety of other items and demographic data. Program completion appeared to assist couples in either improving their rclationship or in deciding to divorce, as opposed to continuing with an unsatisfactory marital relationship.     

Developmental changes in self-perception: The role of gender in a preadolescent clinical population

Research indicates that gender and psychopathology are interrelated and that the nature of this relationship changes over the course of development. Rates of incidence for psychological distress reflect both gender and age differences. Furthermore, the expression of emotional problems is also related to gender. Some symptom patterns, for example, are more likely experienced by females than males. This study examines how psychological disturbance, operationalized as magnitude of symptomatology, interacts with development, or chronological age, in order to predict a child's self-perception. Forty-eight children involved in psychotherapy and their mothers were sampled for this research. It was found that for girls and not boys self-perception diminished with age. Results were interpreted in light of recent feminist theory on female development.     

IS BOWEN THEORY VALID? A REVIEW OF BASIC RESEARCH

In the last 15 years, a substantial number of studies have tested the theoretical validity of Bowen family systems theory. A review of this basic research provided empirical support for the relationship between differentiation and chronic anxiety, marital satisfaction, and psychological distress. Bowen's assumption that couples with the same level of differentiation marry was not supported. His specific theories of sibling position and triangulation also received little empirical support. Research on multigenerational transmission has generally ignored Bowen's theoretical perspective, and more research needs to test Bowen's claim that his theory is universal. In addition, researchers still need to examine the effect of differentiation on child functioning, physical health problems, and adaptability.     

Developmental Processes in African American Families: An Application of McLoyd’s Theoretical Model

In accordance with McLoyd’s model of African American children’s development, we examined the linkages among family income, maternal psychological distress, marital conflict, parenting, and children’s outcomes in early and middle childhood, using a sample of 591 African American children from the National Longitudinal Survey of Youth. Income during early childhood had a direct effect on behavior problems and reading recognition in middle childhood. Income also had an indirect effect on the child outcomes via maternal psychological distress and parenting. In a comparison of African American and White families, marital conflict predicted children behavior problems only in White families. Findings suggest that family psychological and material resources influence parenting as well as behavioral and cognitive outcomes for African American children.     

Pathways Among Marital Distress,Parental Symptomatology,and Child Adjustment

A community sample of 295 mothers, fathers, and children (M age = 11.14 years, SD = 2.32 years) rated marital distress, maternal and paternal psychological symptoms, and child adjustment. The predicted direct relations between these family and child variables were demonstrated for both fathers and mothers. Tests of pathways among these variables were conducted for separate but complementary mediation models. Maternal and paternal symptoms mediated the association between marital distress and child adjustment. Marital distress mediated the link between fathers’ symptoms and child adjustment, but the direct pathway between mothers’ symptoms and child adjustment remained. Pubertal status was modestly related to higher levels of family stressors. Joint implications of marital distress and parental symptoms for child adjustment are discussed.     

Linking Financial Strain to Marital Instability: Examining the Roles of Emotional Distress and Marital Interaction

Using a sample consisting of 4,997 married couples from the National Survey of Families and Households, individual emotional distress, the occurrence of couple disagreements, couple fighting, and couple quality time together mediated the relationship between financial strain and personal assessments of marital instability. The overall results suggest that financial strain influences both positive and negative forms of couple interaction which are stronger mediators than personal emotional distress of the relationship between financial strain and marital instability. The results further suggest that there were no gender differences among these linkages.     

Pathological Gambling and Posttraumatic Stress Disorder: A Study of the Co-Morbidity versus Each Alone

This report is the first empirical study to compare pathological gambling (PG), posttraumatic stress disorder (PTSD), and their co-occurrence. The sample was 106 adults recruited from the community (35 with current PG; 36 with current PTSD, and 35 with BOTH). Using a cross-sectional design, the three groups were rigorously diagnosed and compared on various measures including sociodemographics, psychopathology (e.g., dissociation, suicidality, comorbid Axis I and II disorders), functioning, cognition, life history, and severity of gambling and PTSD. Overall, the PG group reported better psychological health and higher functioning than PTSD or BOTH; and there were virtually no differences between PTSD and BOTH. This suggests that it is the impact of PTSD, rather than comorbidity per se, that appears to drive a substantial increase in symptoms. We also found high rates of additional co-occurring disorders and suicidality in PTSD and BOTH, which warrants further clinical attention. Across the total sample, many reported a family history of substance use disorder (59%) and gambling problems (34%), highlighting the intergenerational impact of these. We also found notable subthreshold PTSD and gambling symptoms even among those not diagnosed with the disorders, suggesting a need for preventive care. Dissociation measures had mixed results. Discussion includes methodology considerations and future research areas.     

Economic Crisis and Marital Problems in Turkey: Testing the Family Stress Model

This paper applied the family stress model to the case of Turkey in the wake of the 2001 economic crisis. Using structural equation modeling and a nationally representative urban sample of 711 married women and 490 married men, we tested whether economic hardship and the associated family economic strain on families resulted in greater marital problems. Our results showed a modified family stress model applies to Turkey. In contrast to most previous research, economic strain had a direct effect on marital problems, and the indirect effect of strain, via emotional distress, was only significant for women. The results were interpreted in light of social and cultural factors that condition how economic distress affects marital relations.     

Psychological distress among black and white Americans: differential effects of social support, negative interaction and personal control

This study examines the relationships among social support, negative interaction, financial strain, traumatic events, personal control, personality, and psychological distress among African American and white adults. These analyses: (1) test the overall adequacy of various models (i.e., main, mediator, and artifactual effects) of these effects, (2) examine the role of social support and negative interaction within the context of financial strain and traumatic events, and (3) verify possible indirect effects of social interaction on distress by assessing their impact on personal control. Data from The National Comorbidity Survey were used to examine these relationships using structural equation modeling techniques. Findings indicated different models of these relationships for African Americans and whites. Overall, personal control mediated the relationship between negative interaction and psychological distress. For whites, negative interaction was an overall stronger predictor of distress and contributed to the impact of financial strain and traumatic events on psychological distress. Among African Americans, social support was a stronger predictor of distress. The findings suggest that the underlying models of these relationships are different for African Americans and whites.     

Economic Hardship and Psychological Distress in Custodial Mothers

The present research examined the relationship between economic hardship and post-divorce psychological distress of custodial mothers. Economic hardship was measured in terms of: (1)current income level; (2) drop in income; and (3) negative economic events. Drop in income was further subdivided into (a) actual amount of drop; (b) ratio of income post-to pre-separation; (c) per person ration of income; and (d) ratio of income per person corrected for reduced financial needs. The HSCL (Derogatis, 1974) measured psychological distress, while four items from the Divorce Events Schedule for Adults (Braver et al., 1987) measured negative economic events. The subjects were 77 custodial mothers, recently separated and either divorced or seeking a divorce. Results documented both an increase in psychological suffering relative to a random sampleand substantial economic declines (about 30%). Further, there were significant unique relationships between the HSCL and both drop in income and the experience of negative economic events (but not current income).     

Resilience in Non-Offending Mothers of Children Who Have Reported Experiencing Sexual Abuse

Growing evidence shows that non-offending mothers experience significant loss and trauma following their child reporting experiencing sexual abuse. Maternal support offered to sexually abused children following disclosure can be a crucial factor in children’s recovery. Although mothers are often seen as playing a central role in facilitating the recovery of their sexually abused child, there has been little focus on their own needs and profiles. This present study aimed to increase our understanding of the diversity of profiles of non-offending mothers of sexually abused children by exploring the differences in psychosocial traits of non-offending mothers (N = 68; age range 28–67 years) reporting higher and lower resilience.

The mediating role of these psychosocial factors on the relationship between resilience and psychological distress will also be explored. Results found that non-offending mothers in the higher resilience group reported higher levels of positive reappraisal, self-compassion, social support, and significantly lower levels of psychological distress compared to non-offending mothers in the lower resilience group. Additionally, multiple mediation analysis indicated positive reappraisal, self-compassion, and social support to be significant mediators of the relationship between resilience and psychological distress. Increased levels of self-compassion and social support were found to be predictive of lowered psychological distress, while increased positive reappraisal predicted increased psychological distress. The findings of the present study provide support for the targeting of the psychosocial factors such as self-compassion, social support, and positive reappraisal in interventions for non-offending mothers in an effort to promote resilience.     

Bringing Work Home or Bringing Family to Work: Personal and Relational Consequences for Working Parents

This study examined the impact of work–family and family–work role blurring on personal and, consequently, relational well-being among parents. A sample of 402 working parents of children between the ages of 2–12 completed measures of role blurring, well-being, and marital satisfaction. Both directions of role blurring were indirectly associated with lower marital satisfaction in mothers through a decreased psychological well-being. For fathers, family–work role blurring was also indirectly associated with poorer marital satisfaction through decreased psychological well-being, whereas work–family role blurring was directly associated with higher marital satisfaction. However, for both parents, the effects of work–family role blurring on well-being and marital satisfaction became non-significant when levels of family–work role blurring were held constant.     

Antecedents and consequences of negative marital stressors

Many couples seeking therapy report the occurrence of severe, negative marital stressors (e.g., infidelity, threats of marital dissolution). In addition, existing research has demonstrated that these marital stressors precipitate Major Depressive Episodes and psychological symptoms. This longitudinal study examines the antecedents and consequences of negative marital stressors to help clinicians and researchers develop interventions that might prevent these stressors and their outcomes. Forty-one women completed a semistructured interview and measures of marital discord and depressive symptoms within one month after experiencing a marital stressor (baseline) and at a 16-month follow up. The results indicate that baseline marital discorded contributes to the occurrence of additional marital stressors during the follow-up period. Although baseline depressive symptoms do not predict additional marital stressors, depressive symptoms along with marital discord predict future depressive symptoms. Finally, baseline marital discord and additional marital stressors contribute to future marital dissolution. Clinical and research implications are discussed.     

Systemic alliance in individual therapy: factor analysis of the ITAS-SF and the relationship with therapy outcomes and termination status

Clients providing systematic feedback to therapists via self-report measures of psychological distress and working alliance have been shown to increase therapy outcomes. However, there are few systemic-based measures that are feasible for therapists to use. Recently, Pinsof et al. (Family Process, 2008, 47, 281) developed a brief systemic alliance measure (ITAS-SF) for individual therapy. The current study tested the factor structure of this measure and examined whether the subscales related to clients' therapy outcomes and termination status (N = 570). The results demonstrated supported a 3-factor model for the ITAS-SF (as compared to the seven factors proposed by Pinsof et al.). In the first factor, content combined the goals for therapy, the tasks or methods to reach those goals and bond between the client and therapist. The second factor reflected how clients perceive the relationship with the therapist (i.e., interpersonal dimension-self/therapist), and the third factor reflected how clients perceive the alliance between their social network and the therapist (i.e., interpersonal dimension others/therapist). The two interpersonal factors were related to therapy outcome and termination status.     

Marital Conflict and Children's Emotional Security in the Context of Parental Depression

Evidence has emerged for emotional security as an explanatory variable linking marital conflict to children's adjustment. Further evidence suggests parental psychopathology is a key factor in child development. To advance understanding of the pathways by which these family risk factors impact children's development, the mediational role of emotional security for children with parents who have potentially clinical levels of depression compared to children whose parents have lower levels of symptomatology was examined (i.e., moderated mediation). Participants included 297 families assessed annually for 3 years. Paternal depression moderated pathways, such that marital conflict was associated with greater child emotional insecurity 2 years later in the context of paternal depression. Testing alternative pathways, emotional insecurity mediated relations between maternal depression and externalizing problems.