Mental Illness as a Barrier to Marriage Among Unmarried Mothers

This study explores how mental illness shapes transitions to marriage among unwed mothers using augmented data from the Fragile Families and Child Wellbeing study (N= 2,351). We estimate proportional hazard models to assess the effects of mental illness on the likelihood of marriage over a 5‐year period following a nonmarital birth. Diagnosed mental illness was obtained from the survey respondents’ prenatal medical records. We find that mothers with mental illness are about two thirds as likely as mothers without mental illness to marry, even after controlling for demographic characteristics, and that human capital, relationship quality, partner selection, and substance abuse appear to explain only a small proportion of the effect of mental illness on marriage.     

I've Got You Under My Skin: Marital Biography and Biological Risk

Social relationships shape adult health in profound ways. This study informs our understanding of this association by investigating how the transitions, timing, and exposures to marriage are associated with types of biological risk presumed to serve as pathways to disease and disability. Drawing on the 2005–2006 National Social Health and Aging Project (N = 1,062), the authors evaluated how marital biography was associated with cardiovascular, metabolic, and chronic inflammation risk. The results showed that the effects of marital biography were highly sensitive to gender, the dimension of marital biography, and type of biological risk. For example, marital exposure was protective of cardiovascular risk for women, but not men, whereas an earlier age at first marriage had a pernicious effect on chronic inflammation among men, but not women. Health behaviors did not explain these associations. The implications of these findings are discussed as they pertain to under‐the‐skin risk processes and chronic morbidity.     

Perceived Marital Support and Incident Mental Illness: Evidence from the National Comorbidity Survey

Social support in marriage may be associated with reduced risk for mental illness. Past studies are limited by short follow up and a focus on depression. A two‐wave nationally representative survey in the United States (n = 2,503) is used to examine whether social support in marriage is associated with the onset of each of four clusters of disorders—internalizing, externalizing, phobic, and bipolar—10 years later. Results indicate that higher levels of perceived marital support were protective against internalizing, fear, and bipolar disorders, and against incident externalizing disorders for women. Protective effects of social support in marriage against mental illness are long‐lasting, and sometimes differ by gender. Findings suggest the importance of mental health assessment in clinical practice.     

Marital Interaction and Depressed Women**

Most people diagnosed as depressed are currently married. The interaction of depressed patients with their spouses can contribute to the understanding of depressive syndromes. Questionnaires show promise of being a useful method of assessing marital interaction. From a questionnaire and interview study involving 75 psychiatric patients and 46 non-patients, a group of 22 married women inpatients with a depressive illness was matched by age to a group of 22 married women attending a family planning clinic. The depressed women were more likely to perceive their marriage as having less emotional involvement, fewer positive expressions of affection and more negative feelings and to perceive their husbands as dominating. These results broadly confirm previous studies. Hafner's spouse-aided therapy may be the most useful type of family therapy approach for depressed women.     

Revisiting the relationships among gender,marital status,and mental health

Three decades ago, Grove introduced his sex-role theory of mental illness, which attributes women's higher rates of psychological distress to their roles in society. Central to his hypothesis is that marriage is emotionally advantageous for men and disadvantageous for women. This article revisits this topic with data from the National Survey of Families and Households. The analyses indicate that the emotional benefits of marriage apply equally to men and women, but that men and women respond to marital transitions with different types of emotional problems. The implications of these findings for future research on gender and mental health are discussed.     

Adult cardiac stem cells--where do we go from here?

A potential treatment for cardiovascular disease involves the transplantation of a patient's bone marrow stem cells into the heart of that same patient. In order to maximize the potential benefits to select patient populations, the continued clinical development of this technology will require a comprehensive understanding of the role(s) of the transplanted cells in the repair of damaged heart tissue as well as an understanding of which types of cardiac injury can be repaired by this approach. The widespread application of cardiovascular stem cell therapies, however, will likely be based on pharmacological approaches to enhance the capacity of endogenous bone marrow stem cells to provide for the replacement of cardiac muscle and vascular cells after myocardial injury.     

Spouse-aided Therapy and Psychiatric Nursing: A Preliminary Report

The training of psychiatric nurses as behavioural nurse therapists has been successfully established in the U.K. by Marks et al. However, their approach has a number of theoretical and practical limitations, such as a rigid adherence to an illness model of psychiatric disorder. This paper describes and evaluates an approach to the training of psychiatric nurses based on systems theory. Four nurses were trained in the use of Spouse-aided Therapy, a time-limited, goal-orientated outpatient approach to the treatment of married psychiatric patients with persisting psychological disorders. Patients' spouses are involved throughout therapy, with the aim of making full use of resources within marriage which may facilitate patients' recovery. Questionnaire and anecdotal data from 12 patients showed a mean fall of 30% in patients' symptoms and a mean fall of 20% in marital dissatisfaction after therapy. The pattern of results supported a systems theory interpretation of outcome.     

Circadian rhythm of hot flashes and activity levels among prostate cancer patients on androgen deprivation therapy

Abstract

Background: Modifiable risk factors contribute to the pathogenesis of cardiovascular disease (CVD) and erectile dysfunction (ED). We aimed to compare the knowledge about the contribution of modifiable risk factors to the pathogenesis of CVD and ED. The impact of patients’ having modifiable risk factors on the awareness of their negative influence on the development of CVD and ED was examined.

Methods: To this multicenter cohort study, we included 417 patients with CHD who had been hospitalized in the cardiology or cardiac surgery department during the previous six weeks and underwent cardiac rehabilitation in one of the five centers. Knowledge about modifiable risk factors was collected. ED was assessed by an abridged IIEF-5 questionnaire. Comparisons between groups were conducted using the Student’s t-test, Mann–Whitney U test, and Kruskal–Wallis test. Relationships were analyzed with Spearman's rank correlation coefficient.

Results: The mean number of correctly identified risk factors for CVD was significantly higher than those for ED (3.71?±?1.87 vs. 2.00?±?1.94; p?<?.0001). Smoking was the most recognized risk factor both for CVD and ED. Dyslipidemia was least frequently identified as a risk factor for CVD. Sedentary lifestyle was the only risk factor whose incidence did not affect the level of patient knowledge.

Conclusions: Cardiac patients with ED know more about risk factors for CVD than ED. It is necessary to include information about the negative impact of modifiable risk factors on sexual health into education programs promoting healthy lifestyles in men with cardiovascular diseases.     

Assessment of Cardiovascular Risk in Collegiate Football Players and Nonathletes

Abstract

Collegiate American football players may be at risk for cardiovascular disease. Objective: To compare cardiovascular disease risk factors and cardiovascular structure and function parameters of football players, stratified by position, to a group of sedentary, nonathletes. Participants: Twenty-six collegiate football players and 13 nonathletes participated in this study. Methods: Blood pressures, anthropometrics, and blood chemistries were obtained and analyzed using standardized procedures. Resting echocardiography was used to evaluate cardiac morphology and function. Brachial artery flow-mediated dilation was assessed using high-resolution ultrasonography. Results: The prevalence of the metabolic syndrome was significantly higher amongst the linemen compared to the skill-position players (46% versus 0%, p < .05). Mildly abnormal wall thickness was noted in 20% of the football players. No significant differences in vascular function were observed between the groups. Conclusions: The increased prevalence of the metabolic syndrome and its components in the collegiate linemen may increase cardiovascular disease risk.     

In Gesundheit und Krankheit?

This Study examines the relationship between health status and the risk of marital separation. The data base is the German Socio-Economic Panel, a representative longitudinal study of private households in Germany. Controlling for marital duration and other covariates, both poor health of one partner and poor health of both partners are associated with a higher risk of dissolution. The results suggest that the higher risk of dissolution is partly caused by financial burdens which are associated with illness. Further possible explanations??social expectations addressed to the healthy partner, an increasing dependence of the sick partner on his spouse, a reduction of alternatives and a deterioration of the marriage match??are of minor importance for the risk of separation. The results are also relevant for explaining health inequalities. They suggest that better health of married people compared to unmarried people not only depends on a protective effect of marriage on health, but is also due to the fact that healthier people are more likely to stay married.     

The Economic Impact of Progressive Neurological Illness on Quality of Life in Australia

The current study examined the impact of financial costs and self-reported economic pressure on the quality of life of patients with progressive neurological illness. Participants were 423 people from four illness groups in Australia. Participants completed measures of (a) quality of life, (b) income, (c) expenses, (d) economic pressure, (e) social support, (f) relationship satisfaction, and (g) severity of illness. There was a strong negative association between quality of life and economic pressure (but not income or expenses) for all groups. Subjective assessment of economic pressure was strongly associated with quality of life for people with motor neurone disease and multiple sclerosis. Implications of these results for assisting people with progressive neurological illnesses to cope with the financial changes that occur due to their illness are discussed.     

Effects of Premarital Medical Examination on Engaged Endogamous Couples in Rural Lebanon

Abstract

This article discusses the findings of a survey of Shiite Muslim engaged couples to assess their knowledge of the risks of congenital disease in endogamous marriage and the importance of the premarital medical examination. The engaged couples live in the Chmistar and Tarayya villages, located west of Baalbeck, in Lebanon. In-depth interviews were conducted with a group of mothers and key informants (religious leaders, general practitioners, geneticists, biologists and social workers) who are charged with providing information on the risks of marriage between first cousins. The qualitative analysis of their discourse revealed that: (i) endogamous marriage is preferred and fulfills the normative social tradition, and (ii) premarital medical examination, as practiced, seems to give the engaged couple a false sense of security. Results of this research emphasized that a health promotion program aiming at responding to a 1000-year-old tradition, such as endogamous marriage, should take into account the potential conflicts it introduces concerning the anthropological and sociological bases typical of this practice.     

Taming predators through photography

In this article we examine an innovative application of visual communication and social science methods, moving the study of indigenous media from the purely academic realm into pediatric health research. Through Video Intervention/Prevention Assessment (VIA), children and adolescents who share a medical condition create visual narratives of their lives with chronic disease to show and tell their illness experiences to health care providers. Clinicians routinely plan medical management with limited knowledge of how patients interact with disease in their “real life” physical, psychological, and social environments. VIA asks young patients to teach clinicians the realities of day‐to‐day life with illness, yielding unique insights that can guide the development of more realistic, more humane, and ultimately more effective medical care. We describe the VIA methodology, a pilot study of asthma, and the illness experiences shown and told by VIA Asthma participants. Not only did VIA generate useful research findings, it also produced visual documents of the child's illness experience that can serve as tools for influencing policy, advocating for patients, and educating health care providers, patients, and their families.     

The Health Belief Model and the Contraceptive Behavior of College Women: Implications for Health Education

Abstract

“The Incidence of Primary Cardiac Arrest During Vigorous Exercise,” David S. Siscovick, et al. To examine the risk of primary cardiac arrest during vigorous exercise, we interviewed the wives of 133 men without known prior heart disease who had had primary cardiac arrest. Cases were classified according to their activity at the time of cardiac arrest and the amount of their habitual vigorous activity. From interviews with wives of a random sample of healthy men, we estimated the amount of time members of the community spent in vigorous activity.

Among men with low levels of habitual activity, the relative risk of cardiac arrest during exercise compared with that of other times was 56 (95% confidence limits, 23 to 131). The risk during exercise among men at the highest level of habitual activity was also elevated, but only by a factor of 5 (95% confidence limits, 2 to 14). However, among the habitually vigorous men, the overall risk of cardiac arrest—i.e., during and not during vigorous activity—was only 40% that of the sedentary men (95% confidence limits, 0.23 to 0.67).

Although the risk of primary cardiac arrest is transiently increased during vigorous exercise, habitual vigorous exercise is associated with an overall decreased risk of primary cardiac arrest. (New England Journal of Medicine 1984;311:874-7.)

“Osteoporosis in Women with Anorexia Nervosa,” Nancy A. Rigotti, et al. Because estrogen deficiency predisposes to osteoporosis, we assessed the skeletal mass of women with anorexia nervosa, using direct photon absorptiometry to measure radial bone density in 18 anorectic women and 28 normal controls. The patients with anorexia had significantly reduced mean bone density as compared with the controls (0.64 ±0.06 vs. 0.72 ±0.04 g per square centimeter, P < 0.001). Vertebral compression fractures developed in two patients, and bone biopsy in one of them demonstrated osteoporosis. Bone density in the patients was not related to the estradiol level (r = 0.02). Levels of parathyroid hormone, 25-hydroxyvitamin D, and 1,25-dihydroxyvitamin D were normal despite low calcium intakes.

The patients with anorexia who reported a high physical activity level had a greater bone density than the patients who were less active (P < 0.001); this difference could not be accounted for by differences in age, relative weight, duration of illness, or serum estradiol levels. The bone density of physically active patients did not differ from that of active or sedentary controls.

We conclude that women with anorexia nervosa have a reduced bone mass due to osteoporosis, but that a high level of physical activity may protect their skeletons. (New England Journal of Medicine 1984;311:1601-6.)     

Gender,the Marital Life Course,and Cardiovascular Disease in Late Midlife

Drawing on 5 waves of the Health and Retirement Study, we examine the influence of the marital life course on the prevalence and incidence of cardiovascular disease among 9,434 middle‐aged individuals. Results show that compared to continuously married persons, both men and women with a marital loss have significantly higher prevalence of cardiovascular disease at baseline. Men and women, however, differ in the effects of marital loss on the incidence of cardiovascular disease over the course of the study. Women with a marital loss have a higher risk of cardiovascular disease in late midlife compared to continuously married women, whereas marital loss is not associated with men’s risk of cardiovascular disease. Emotional distress and socioeconomic status account for the higher risk of cardiovascular disease among divorced women.     

Helping HIV-positive persons to negotiate the disclosure process to partners, family members, and friends

For people who have been diagnosed with a chronic illness, one inevitable issue to be addressed is whether and how to share this information with others. For persons who are HIV positive, disclosure presents an especially arduous task. The purpose of this article is to offer a strategy to assist marriage and family therapists in facilitating client disclosure of an HIV-positive status to partners, family members, and friends. In addition, suggestions for setting the stage for disclosure to occur and recommendations for client follow-up are proposed.     

The mental health recovery movement and family therapy, part I: consumer-led reform of services to persons diagnosed with severe mental illness

In 2004, the U.S. Department of Health and Human Services issued a consensus statement on mental health recovery based on the New Freedom Commission's recommendation that public mental health organizations adopt a "recovery" approach to severe and persistent mental illness, including services to those dually diagnosed with mental health and substance abuse issues. By formally adopting and promoting a recovery orientation to severe mental illness, the United States followed suit with other first-world nations that have also adopted this approach based on two decades of research by the World Health Organization. This movement represents a significant paradigm shift in the treatment of severe mental health, a shift that is more closely aligned with the nonpathologizing and strength-based traditions in marriage and family therapy. Furthermore, the recovery movement is the first consumer-led movement to have a transformational effect on professional practice, thus a watershed moment for the field. Part I of this article introduces family therapists to the concept of mental health recovery, providing an overview of its history, key concepts, and practice implications. Part II of this article outlines a collaborative, appreciative approach for working in recovery-oriented contexts.     

Family Therapy and Lithium Deficiency*

Lithium carbonate's usefulness in relieving the more dramatic symptoms of bipolar-affective disorder can obscure the family systems components of this illness. A compromised form of family therapy results which may stabilize the marriage but cause troubles for the larger family system. This paper offers a partial modus operandi for keeping family therapy systems oriented and avoiding the infantilization of the identified patient which occurs when the importance of purely medical treatment is overplayed.     

Researching Chinese Cultural Understandings of Marriage via Similes and Metaphors on the World Wide Web

In an attempt to understand how changes in the societal context of Chinese marriage are reflected in Chinese cultural understandings of marriage, we explore Chinese similes and metaphors for marriage posted on the World Wide Web. Seven themes were found: You will have to decide whether a marriage will work for you, marriage is not about romantic love, marriage is bitter and sweet at the same time, marriage is strong and real, you must work at a marriage, marriage is risky, and marriage is not always taken seriously. The themes give a picture of cultural meanings for marriage in China that reflect more traditional ideas and such recent changes as the move to greater freedom of choice of spouse and greater ease of divorce. The themes provide cultural understandings both by characterizing contemporary marriage and by capturing advice about how to find a partner and make a marriage work.     

It Won't Change a Thing: The Meanings of Marriage in the Netherlands

The vast body of literature that highlights the increasing fragility of marriage fails to explore the effect of this fragility on the meanings people attach to marriage. During the last twenty-five to thirty years the instrumental and normative reasons for marriage—legal protection, societal support and enforcement, the social rejection of alternatives to marriage—have largely disappeared in the Netherlands. This study focuses on how young adults, raised after the most dramatic changes in marital practices took place, talk about the meanings of marriage in the context of building intimate relationships. In-depth interviews with fifteen heterosexual young adults (aged twenty-one to thirty) who were in a committed relationship showed that they talked about marriage in four different ways. They (1) minimized the meaning of marriage, (2) talked about the idea of marriage to ascertain commitment, (3) defined marriage as the ideal relationship, and/or (4) saw marriage as a jinx. Contradictions between these modes of talk revealed feelings of ambivalence and anxiety associated with a desire for commitment. The emotionally charged meanings associated with marriage anchored marriage in interviewees' imaginations, enabling the institution to retain its hold even though social pressures to marry are limited and legal substitutes to marriage exist.