Joirnal Articles on Mental Ilnesses and Family Support

Prim Care Companion J Clin Psychiatry. 2003; 5(iii): 111–117.

Family Support, Self-Rated Wellness, and Psychological Distress

Annmarie Cano, Ph.D., Douglas J. Scaturo, Ph.D., Robert P. Sprafkin, Ph.D., Larry J. Lantinga, Ph.D., Barbara H. Fiese, Ph.D., and Frank Make, G.D.

Received 2003 Apr iv; Accepted 2003 May 20.

Abstract

Groundwork: Comprehensive health care is becoming an important upshot; however, footling is known about the complex relationships between perceived family support, self-rated health, and psychological distress in mixed centre-anile/older primary intendance patient samples.

Method: In this cantankerous-sectional and predominantly male sample of 137 patients attending their appointments at a master care clinic in a Department of Veterans Affairs Medical Center, participants completed several questionnaires including the Family Accommodation, Partnership, Growth, Affection, and Resolve; the Full general Health Questionnaire-12; the Symptom Checklist-x; and the Chief Care Evaluation of Mental Disorders (PRIME-MD) screening questionnaire and interview. Data were collected in 1998. 18 per centum of the participants were diagnosed with a mood disorder, and 15% were diagnosed with an anxiety disorder (PRIME-Doctor diagnoses).

Results: Perceived family support and self-rated health were negatively associated with psychological symptoms and sure psychological disorders, while perceived family back up and self-rated health were positively rated. In improver, the interaction between perceived family unit back up and self-rated health was meaning (p < .01) in relating to psychological symptoms such that psychological symptoms were well-nigh elevated in participants reporting dissatisfying family back up combined with poor self-rated health. However, the cross-exclusive nature of the written report prevents causal conclusions from being made.

Conclusions: Physicians and other health care professionals are encouraged to assess both the perceived family back up and self-rated health in an endeavor to anticipate their patients' problems in a more than comprehensive manner.

Family support is an important factor in conceptualizing primary care patient bug. Numerous examples of how the family system determines the course of chronic illness have been influential in the development of collaborative medical intendance.^{1–half dozen} Family unit factors such as perceived family unit support and illnesses, either physical or psychological, may influence each other in a bidirectional fashion.^{4, 7} Similarly, negative marital perceptions (due east.g., spousal back up) have been related to clinical low.^{8, ix} Thus, the assessment of family support might be used to further assess the take chances of psychological distress in main intendance. Gathering these data may enhance working relationships with patients, ease patients' acceptance of referrals to mental health services, and help physicians and residents become more skilled in conceptualizing patient bug in a comprehensive manner.

Notwithstanding, before potent recommendations can be made for the assessment of family back up in older primary care patients, several issues must be examined. First, it is unclear whether family support relates to some measures of psychological distress just not to others. Some measures only assess psychological distress whereas others include an assessment of somatic symptoms. Measures also differ on the response format (eastward.g., presence of symptoms vs. severity of symptoms) and timeframe (e.thousand., last calendar week vs. terminal month). If a distress measure is not correlated with family unit support, it is possible for wellness care professionals to incorrectly presume that patients are at risk for psychological distress considering they report that they are unhappy or dissatisfied with the support their family provides to them (i.e., dissatisfying family support). Second, little is known about the relationship between dissatisfying family back up and distress in samples consisting of a big proportion of older patients. Perhaps this is a phenomenon that is limited to more than youthful samples. Third, the upshot of family back up on emotional distress may vary depending on patients' self-rated health. Perceptions of proficient wellness may buffer the effects of dissatisfying family support, and measures of self-rated health may help physicians brand comprehensive judgments of risk.

Research on Family Back up and Psychological Distress

A number of studies provide some back up for the theoretical relationship between perceived family support and mental wellness. The quantity and quality of family back up are inversely related to psychological symptoms.^{10, 11} Some studies have indicated that persons with psychiatric disorders also report more than dissatisfying family support than those without diagnoses.^{12, 13} Other enquiry has shown that family back up is non related to psychological symptoms or diagnoses.^xiv Diverse psychological symptom measures were used beyond these studies, thereby calling into question whether family support is related to only some types of psychological symptoms. To examine this upshot, we used iii dissimilar measures of psychological distress that inquire well-nigh unlike kinds of symptoms with different response formats as well as a diagnostic interview designed to assess clinically pregnant psychological disorders. Previous findings with these measures have shown that all 3 measures can exist used with some degree of accurateness in screening for mental disorders.¹⁵

Cocky-Rated Health

In the present written report, we also examined a more complex human relationship between perceived family back up and psychological distress by including an assessment of self-rated health. Self-rated wellness is a dynamic representation of overall health that includes the patient's knowledge of electric current and by medical issues, electric current frailty, and wellness changes over time.^16–18 Because self-rated health is oft measured with a single item, it is an hands administered assessment tool in clinic settings. Poor self-rated wellness is related to an increased risk of mortality, even when a diversity of health indicators are controlled for.^{19, 20} Cocky-rated health is besides an important correlate of mental disorders,^21–23 elevated psychological symptoms,²⁴ and dissatisfying family back up.^xvi–25

Although cocky-rated health, family unit support, and psychological distress have been found to correlate with each other, more complex associations betwixt these variables have not been explored. The chance for psychological distress may increase as i makes negative appraisals about more than than one surface area of life²⁶; in this case, health and family. Still, no published studies have tested the hypothesis that family unit back up and self-rated health might interact in relating to psychological distress. Patients with poor self-rated health and dissatisfying family unit back up might report more psychological distress than individuals who are protected by either good self-rated wellness or satisfying family support.²⁶ Support for this hypothesis would provide wellness care professionals with an extension of the theoretical and empirical literature, a more comprehensive view of patients, and another way of identifying at-hazard patients.

Hypotheses

Following the existing theory and research, we hypothesized that dissatisfying family back up would exist related to elevated psychological distress and psychiatric diagnoses using several different measures of distress. Nosotros likewise expected that self-ratings of wellness interact with family support in correlating with psychological symptoms such that dissatisfying family support in the presence of poor cocky-rated health would be associated with elevated psychological symptoms and diagnoses. Whereas the research on the univariate association between self-rated health and distress in older samples has been extensive,¹⁸ only a few studies have shown that family and other social supports are associated with less severe depression, regardless of age.^{27, 28} To date, no studies have been conducted on the interaction betwixt family support and self-rated wellness in older master intendance patients. For this reason, we examine our hypotheses in a cantankerous-exclusive, mixed sample of heart-anile and older patients visiting a Veterans Affairs clinic.

METHOD

Participants

Participants were 137 patients attention primary care appointments at a large upstate New York Department of Veterans Affairs Medical Center (Syracuse, North.Y.). The study was approved by an institutional review board. Information were collected in 1998. The mean age of patient participants was 63.71 years (SD = 12.98). The sample was predominantly male person (97.08%; N = 133). In terms of marital condition, 58.eight% (Northward = lxxx) were married at the time of the report, 18.four% (Northward = 25) were separated or divorced, 12.5% (North = 17) were widowed, and 9.6% (Northward = 13) were never married. One participant did non disclose marital status. Thirty participants (22.i%) had combat experience, while 2.2% (N = 3) were one-time prisoners of war (POWs). Ane paticipant did not give information on gainsay feel. Combat and Pow status were not associated with psychological distress, perceived family support, or self-rated health. One hundred twenty-two participants (89.1%) reported attending at to the lowest degree i medical appointment in the year prior to participation, whereas only 14.vi% (N = twenty) of participants utilized outpatient mental health services in the twelvemonth prior to participation. Participants' medical diagnoses are shown in Table one. These medical diagnoses were not necessarily addressed at each of the medical appointments that were attended in the past year.

Tabular array 1.

Medical Problems Recorded in Participants' Charts

Procedure

A full description of the process and the measures used tin can exist found in Cano et al.¹⁵ A mental wellness technician approached potential participants while they were awaiting their main intendance appointments. Patients who agreed to participate completed a consent form, the Family Adaptation, Partnership, Growth, Amore, and Resolve (APGAR),^{29, 30} the Primary Intendance Evaluation of Mental Disorders (Prime-Doctor) questionnaire,³¹ the Full general Health Questionnaire-12 (GHQ-12),³² and the Symptom Checklist-10 (SCL-10).^{33, 34} Patients were administered the PRIME-Doc interview by a mental health technician on the ground of their responses on the PRIME-Dr. questionnaire. Data on wellness intendance apply and medical diagnoses were obtained from participants' charts. Since no information were collected on the patients who declined to participate in the study, no comparisons could be fabricated betwixt participants and patients who declined to participate.

Measures

Family Adaptation, Partnership, Growth, Amore, and Resolve.

The APGAR is a 5-detail measure of perceived family support that was designed equally an cess tool for physicians.^{29, thirty} The APGAR was called for this study because it measures a theoretically important construct in a brief and easily administered format. Family physicians trained in lengthier methods of assessment (due east.chiliad., the McMaster Model of Family unit Functioning³⁵) are unlikely to use them in actual exercise³⁶ and reported that they were simply too busy to use such a protracted and plush arroyo.³⁷ Even more than recent approaches that rely on patient self-report, such as the Family Contour,³⁸ tin be time-consuming and therefore less probable to be used than a brief measure such equally the APGAR.

The APGAR has distinguished betwixt patients with and without family distress,³⁹ with lower scores indicating less satisfying perceived family support. A sample item of the scale includes the statement "I am satisfied that I can plow to my family for aid when something is troubling me." In this article, nosotros refer to lower scores on this scale as indicating "dissatisfying family support." "Unsatisfying support" implies that the individual perceives the support in a categorical manner (i.due east., unsatisfying vs. satisfying), which is incorrect because of the Likert-type response format. Participants responded to each detail using a five-signal rating scale ranging from 0 (never) to 4 (e'er), as detailed in the research version of the scale.³⁰ The current sample reported a mean APGAR score of 15.28 (SD = five.09; range, 0–22). The inter-item reliability for the electric current study was .93, indicating excellent reliability.

General Health Questionnaire-12.

The GHQ-12 was developed to assess psychological symptoms.³² Participants noted the presence or absence of 12 symptoms within the past few weeks. This mensurate has been used in large cross-cultural studies and is correlated with psychiatric disorders in master health care settings.^{32, 40} Participants reported a mean of ii.07 (SD = three.04) symptoms. The current interitem reliability was .90.

Symptom Checklist-10.

The SCL-10 is a 10-item instrument that Nguyen et al.³³ derived from the SCL-90.³⁴ Each item describes the psychological distress experienced within the past calendar week using a 0 (not at all) to v (extremely distressed) scale. A single global score may be used every bit an index of psychopathology or psychological distress.³³ The interitem reliability of the SCL-x was first-class in the current study (α = .92), and the hateful SCL-x score was v.50 (SD = vii.84).

Primary Care Evaluation of Mental Disorders.

The PRIME-MD is a two-step psychiatric diagnostic musical instrument designed for use in primary care settings.³¹ The get-go step consists of a 26-item screening questionnaire that measures psychological (10 items) and somatic (15 items) symptoms that may be signs of psychological disorders also equally self-rated wellness (i item) within the past calendar month. The second step consists of a diagnostic interview conducted by a trained interviewer just if specific clusters of symptoms are endorsed on the questionnaire. The PRIME-Physician has been validated in a sample of m patients.³¹

The mean number of Prime-Dr. symptoms reported by participants was v.24 (SD = 4.31; range, 0–17). The interitem reliability for cocky-report Prime-Doc symptoms was excellent at .85. Approximately fourteen.3% (N = xix) of patients were diagnosed with more than 1 psychiatric disorder. Diagnoses were as follows: 18.0% (N = 24) were diagnosed with a mood disorder, fifteen.0% (Due north = 20) were diagnosed with an anxiety disorder, 7.five% (Northward = ten) were diagnosed with a somatoform disorder, and 1.5% (North = 2) were diagnosed with an eating disorder. For ease of interpretation, the terms Prime number-Md symptoms and PRIME-Md questionnaire are used when referring to the continuous measure of symptoms, whereas Prime number-Dr. diagnosis is used when describing the categorical diagnoses.

Self-rated health was assessed on the PRIME-Md by one item asking participants to rate their overall health from 1 (poor) to 5 (splendid) (mean = ii.99, SD = 1.00; range, one–5). Unmarried item scales of cocky-rated wellness are commonly used in the literature with powerful results.^{16, 18, 41} The modest correlation between self-rated health and the number of medical diagnoses reported in participants' charts (r = −0.28, p < .001) supports the notion that cocky-rated wellness is not solely a reflection of electric current medical problems.

Assay Plan

Four participants did not consummate every measure used in the study; therefore, N = 133 for all analyses. To test the first hypothesis that family back up would exist related positively to psychological distress, Pearson product moment correlations were conducted betwixt family support and the iii psychological distress measures. In add-on, analyses of variance were conducted to determine whether patients with PRIME-MD diagnoses perceived less satisfying family support as compared with patients without these diagnoses.

Multiple regression was used in analyses involving the 3 symptom measures (i.e., continuous dependent variables), and logistic regression was used in analyses involving diagnoses (i.e., dichotomous dependent variables). The first pace of the regression consisted of the covariate of age, which was correlated with the GHQ-12, SCL-10, and PRIME-Medico questionnaire (p < .001 for each comparison). Participants with a PRIME-MD diagnosis were significantly younger than participants without a diagnosis (p < .0001). The 2d step included the APGAR and self-rated health. The third step included the interaction term between these ii variables (i.e., APGAR multiplied by self-rated health). Hierarchical regression was used to test whether the interaction term contributed significantly to the variance in psychological distress beyond the main effects of family support and self-rated health. The standard mistake (SE) was used to summate a confidence interval around b. Comparisons (t tests) were also run to make up one's mind the nature of significant interactions. A more stringent significance level (p < .01) was used to control for type I error in the comparisons. Because the analyses were similar when conducted separately for men and for women, men and women are combined in the following analyses. Information technology should be noted that the analyses cannot prove a causal human relationship because the data are cross-exclusive.

RESULTS

Family Support and Psychological Distress

Starting time, nosotros tested the hypothesis that perceptions of dissatisfying family unit support would be related to elevated psychological symptoms and psychiatric disorders. As expected, correlations showed that dissatisfying family unit back up was associated with elevated psychological symptoms on all 3 symptom measures (Table two). These results suggest that this human relationship is not specific to the measure used. These correlations were non significantly different from one another. Furthermore, poorer cocky-rated health was related to dissatisfying family unit support and elevated psychological symptoms (come across Table 2).

Table two.

Pearson Product Moment Correlations Between the GHQ-12, SCL-10, Prime number-Medico Questionnaire, APGAR, and Cocky-Rated Health (SRH)

Analyses of variance showed that patients diagnosed with anxiety disorders reported less family support satisfaction (APGAR; hateful = 11.fifty, SD = 6.45) than patients without feet disorders (mean = 16.08, SD = 5.46; F = xv.08, df = ane,131; p < .001). Similarly, patients with mood disorders reported lower APGAR scores (mean = 10.88, SD = half dozen.82) than patients without mood disorders, (mean = 16.39, SD = 4.06; F = 27.41, df = i,131; p < .0001). Somatoform disorder was not related to family support (p > .35), possibly due to the low frequency of somatoform disorders. More PRIME-MD diagnoses were besides correlated with lower APGAR scores (r = −0.46, p < .0001).

Family Support, Cocky-Rated Wellness, and Psychological Distress

A series of hierarchical regressions were conducted to test the second hypothesis that family support would interact with self-rated wellness in relating to psychological distress. An examination of the unstandardized coefficients (b) shows how many units of change tin be observed in the dependent variable for each unit modify in the independent variable. For instance, if age and family support are accounted for, a ane-point decrease in self-rated wellness will event in a 0.79-bespeak increase in GHQ-12 score (Table 3).

Table three.

Hierarchical Regression Analyses: Full general Wellness Questionnaire-12

Analyses showed a pregnant interaction between family support and cocky-rated health on the GHQ-12 and the SCL-10 psychological distress measures (Tables 3 and ​ 4). T tests showed that participants with dissatisfying family support (i.e., APGAR score lower than the median score of 17) and poor self-rated health (i.east., cocky-rated health score less than the median score of 3) reported significantly more than psychological distress on the GHQ-12 and SCL-10 than participants with (1) satisfying family support and poor self-rated health and (two) satisfying family support and splendid self-rated health (p < .01 for both comparisons).

Tabular array four.

Hierarchical Regression Analyses: Symptom Checklist-10

In addition, participants who reported poor cocky-rated health and dissatisfying family support reported significantly more than SCL-10 symptoms than participants with dissatisfying family unit support and excellent cocky-rated health (p < .01). At that place was a trend for a similar relationship on the GHQ-12 (p < .03). Amid the participants with satisfying family back up, self-rated health did not relate to psychological symptoms on the SCL-10 or GHQ-12 (p > .20 for both comparisons). Although the interaction was not meaning for Prime number-Doc symptoms (p > .20), the principal effect of self-rated wellness was meaning (b = −ii.23, SE = 0.xxx, β = −0.52, t = −7.43, p < .001), whereas the main effect of family back up approached significance (b = −0.12, SE = 0.06, β = −0.14, t = −1.86, p < .07). These results bespeak that poorer self-rated health statistically contributed independently to Prime number-MD symptoms after decision-making for historic period.

With regard to diagnoses, dissatisfying family support and poor self-rated health were related to mood disorders (family support, B = −0.14, SE = 0.05, Wald statistic = seven.38, Exp [B] = 0.87 [CI = 0.79 to 0.96], p < .01; and self-rated wellness, B = −i.07, SE = 0.34, Wald statistic = 10.14, Exp [B] = 0.35 [CI = 0.18 to 0.66], p < .001), after controlling for age. The Wald statistic is a measure of effect size, and Exp (B) is the odds ratio. Only the main event for self-rated health was meaning for anxiety disorders (b = −0.94, SE = 0.33, Wald statistic = 7.95, Exp [B] = 0.39 [CI = 0.20 to 0.75], p < .01). In other words, dissatisfying family support was positively correlated with mood disorders, and poor self-rated health was positively correlated with mood equally well as feet disorders. The interaction betwixt APGAR score and cocky-rated wellness was not associated with mood or anxiety disorders, indicating that family support did not buffer the effects of poor cocky-rated health on distress. For mood disorders, the Wald statistic for the interaction was 0.22 (Exp [B] = 0.97 [CI = 0.87 to one.09], p > .63). For anxiety disorders, the Wald statistic for the interaction was 0.25 (Exp [B] = 1.03 [CI = 0.92 to 1.16], p > .61). Neither main effects nor interactions were significant for somatoform disorders.

DISCUSSION

This report investigated satisfaction with family back up as ane aspect of family operation that may be particularly important in conceptualizing patients' bug. Equally expected, patients' perceptions of dissatisfying family unit back up were significantly related to elevated psychological distress regardless of the symptom measure used. In add-on, dissatisfying family support was significantly related to mood and anxiety disorders. These were of import findings for 2 reasons. First, the results replicated the findings of previous studies that relied on younger, not-military veteran samples,^10–13 suggesting that the link betwixt family unit support and psychological distress is not dependent on the age or civilian condition of the sample. Second, the current findings also prove that the relationships between family support and distress are not limited to ane specific self-report questionnaire or to questionnaires in general. By using 3 psychological distress measures and a diagnostic interview, we were able to testify that family unit support relates to the presence and the severity of psychological and somatic symptoms experienced in a recent fourth dimension period (due east.thousand., past month vs. past week) as well as clinically meaning mood and anxiety disorders. Determining the causal nature of these associations was non a goal of this study; however, it may evidence useful to acquit longitudinal inquiry on family back up and psychological distress in primary intendance settings to more fully understand the reciprocal relationships between these variables over time.

We extended existing inquiry that demonstrated the independent statistical contributions of family support and cocky-rated health to psychological symptoms.^{x–thirteen, 22, 23, 25} Some might argue that cocky-rated wellness is just another measure of psychological distress or concrete wellness. All the same, our findings that self-rated health merely moderately correlated with medical diagnoses and psychological distress support claims that self-rated wellness is a cerebral representation or perception of health.^16–18

Nosotros also found that patients who perceived dissatisfying family back up and who rated their health status as poor reported the near psychological distress on the SCL-10 and GHQ-12. Even so, participants with satisfying family support, regardless of their self-rated health, reported fiddling psychological distress. These results make sense from family office perspectives,^{4, seven} cerebral-behavioral and interpersonal models of depression,^{8, 9} and behavioral medicine perspectives.²⁶ The perception that family members are reliable helpers might minimize the effect of physical illness on psychological distress. Conversely, perceiving deficiencies in health and family support may atomic number 82 to hopelessness, decreased family interaction, and decreased pleasant activities. These cognitions and behaviors may and so lead to distress.

As noted in the Method, there were differences in response time frames (eastward.g., by month vs. past calendar week), response choices (e.g., presence or absence vs. severity), and types of symptoms (psychological vs. psychological and somatic). Findings with the GHQ-12 and SCL-10 were essentially similar; however, analyses with the more somatic Prime number-MD questionnaire sometimes resulted in dissimilar findings. For instance, satisfying family unit support did not protect participants with poor self-rated health from experiencing elevated somatic complaints. If symptoms on the Prime-Medico reflect physical rather than psychological distress, and so the protection offered past family unit support may be limited to psychological distress.

In sum, we believe that the current study has contributed to the existing knowledge past providing an in-depth analysis of the part of family support and self-rated health in psychological distress. Our results suggest that both perceived family back up and health status (i.e., a total of six patient-rated items) can be used to assess patients' risk for psychological distress to identify primary care patients for appropriate referrals and provide comprehensive health care. Patients with dissatisfying family unit support (i.e., enquiry APGAR scores < 17) and poor cocky-rated health (i.e., self-rated health scores < 3) are particularly at risk. Loftier-risk patients could, and then, exist administered cursory measures of psychological distress (due east.g., GHQ-12 or SCL-ten) in a stepwise style. Alternatively, physicians interested in assessing the context in which older patients' problems occur may administrate the APGAR along with psychological distress measures. As shown in one written report, nearly one-half of elderly primary care patients with moderate or astringent low reported no depressive symptoms to their full general practitioner, presumably considering they felt uncomfortable discussing symptoms with their physicians.⁴² Collaborative care between medical and mental wellness service providers in master care settings may ameliorate older patients' access to psychological assistance.⁴³ Understanding the context in which health problems occur in this population, including patient perceptions of back up from family unit members and perceptions of their own health, can possibly heighten these collaborative partnerships by providing physicians the unique opportunity to engage in fruitful discussions with patients almost their overall health and well-being.

Footnotes

Corresponding author and reprints: Annmarie Cano, Ph.D., Department of Psychology, Wayne State University, Detroit, MI 48202 (e-mail service: ude.enyaw@onaca).

This research was supported in part by grant R03-MH61569-01from the National Institute of Mental Health, Bethesda, Md. (Dr. Cano).

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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC406377/