Arthritis Impact on U.S. Life Quality: Morbidity and Mortality Effects From National Health Interview Survey Data 1986–1988 and 1994 Using QWBX1 Estimates of Well-Being

Objective: To estimate the impact ofarthritis using a general health index andNational Health Interview Survey (NHIS) data.Methods: Morbidity data came from NHISPublic Use data, from the years 1986–1988 and1994. The data are 423 400 cases, representing975 421 153 person-years. Quality ofWell-being Scale (QWB) morbidity scores wereimputed from NHIS questions about healthconditions and limitations in functioning. Both the QWB and multiple linear regressionwere used to estimate the effects of arthritiswith and without adjustments for co-morbidity. Mortality data for NHIS-sampled adults weredrawn from the National Death Index by staff ofthe National Center for Health Statistics.Results: The mean QWB for those withself-reported arthritis was 0.608 on a scaleranging from 0.0 (for death) to 1.0 (for fullyfunctional without symptoms or problems). Thisobserved mean for arthritis is 39.2% below the1.000 comparison standard. QWB morbidityscores for self-reported arthritis appear(0.701 – 0.608=) 9.3% more severe than meaneffects of all other health conditions. Mortality adds an average 13.8% to themorbidity burden. Persons with arthritisconstitute 4.7% of the population, but accountfor 9.6% of Quality-Adjusted Life Years(QALYs) lost to morbidity.Conclusions: Self-reported arthritis isassociated with very significant losses inQuality-Adjusted Life in the US population.     

The “Good Enough” Fit: Psychoanalytic Psychotherapy and Psychoanalysis as Culturally Sensitive Practice

This paper examines the impact of the gender, race, class, and culture of the three participants in the patient-therapist dyad and the patient-therapist-supervisor triad, and how these similarities and differences reflect the unconscious cultivation of transferences and internalizations. The analyst's skills, art, experience, and relative freedom from conventional assumptions are important, and the main problem for analyst and supervisor is to meet the challenge to our analytic selves posed by conventional assumptions, which are compromises regarding culturally sensitive issues that derive from the ever-present dominant culture and its ideologies.     

Affect and cognition in the context of home: The quest for intangibles

The three papers in this special issue represent an important advance in the effort to understand people's attachment to place. Economic factors do not provide an adequate explanation; it is necessary to seek less tangible influences. There are grounds for looking to the physical setting, and especially the natural environment available to residents. Access to other resources may also be important. And group affiliation can impact both cognitive and affective aspects of the attachment process. In terms of future research to better understand these intangibles, it may help to focus on the sense of place, the factors that make an environment psychologically comfortable. Three variables are proposed as researchable facets of the sense of place: (1) legibility, (2) the perception of and preference for the visual environment, and (3) the compatibility of the setting with human purposes.Requests for reprints should be mailed to Dr. Stephen Kaplan, Department of Psychology, Psychological Laboratories, Mason Hall, University of Michigan, Ann Arbor, MI 48109     

A bidimensional view of distancing: Reciprocity versus compensation,intimacy versus social control

The present paper is devoted to placing two theoretical contrasts emerging in the interpersonal distancing literature into a metatheoretical framework. The first of these contrasts is that between reciprocity and compensation; the second is that between intimacy and social control. The point of departure for this placement is a bidimensional approach to interpersonal distancing.Reciprocity is defined as an individuated and attached mode of functioning,compensation as a deindividuated and detached mode.Intimacy is defined as a deindividuated and attached style andsocial control as one that is individuated and detached. Interpersonal and situational constraints are discussed in an attempt to understand better the workings of this typology in relationships.     

Treatment of an acting-out adolescent girl: An interpersonal experience

The current emphasis on psychotherapy as an interpersonal or intersubjective experience is highly relevant to clinical work with adolescents. This paper presentes and discusses the treatment of an acting out adolescent girl from the perspective of the two-person relationship, emphasizing the interaction between the patient's dynamics and the therapist's responses.     

Stability of psychological symptoms: drug use consequences and intervening processes

We integrate aspects of coping response, impaired ability, and motivational explanations for the causes and consequences of drug abuse, all which were cast previously as competing or alternative paradigms. We projected a model of 1) continual daily drug use as a consequence of early adolescent psychological symptoms and 2) continual daily drug use as an influential variable in maintaining or exacerbating these symptoms over the young adult life-course. Gender, race, and education also were modeled explicitly according to their presumed theoretical importance. Finally, we modeled contemporaneous factors such as physical health and employment status as the common consequences of the shared independent variables in order to reduce bias in the estimated structural relationships. We found that continual daily drug use is significantly dependent on early psychopathology and increases psychological symptoms significantly. Daily proximate drug use has direct negative effects on education. Education, in turn, improves both mental and physical symptoms significantly. During young adulthood, psychological symptoms are related significantly to contemporaneous unemployment and physical health limitations; thus modeling these symptoms as common consequences reduces potentially biased estimates of the effect of shared independent variables.     

Perspectives on early adolescence

Processes of separation-individuation and mourning are examined in detail for their applicability to the early adolescent phase of development. Similarities and differences are noted, with emphasis placed on the differences in an attempt to achieve greater theoretical precision. Through a series of songs written by a relatively well functioning adolescent girl between the ages of eleven and fifteen, a view of early adolescent development related to affect states is offered for consideration.     

Estimating the costs of preventive interventions

The goal of this article is to improve the practice and reporting of cost estimates of prevention programs. It reviews the steps in estimating the costs of an intervention and the principles that should guide estimation. The authors then review prior efforts to estimate intervention costs using a sample of well-known but diverse studies. Finally, the authors illustrate the principles with an example, the Family Bereavement Program. They conclude that example by discussing whether and how the costs of the intervention might differ when implemented in a real-world setting.