Discussion: Impact of Illness on Families and Patients

Discussion: Impact of Illness on Families and Patients ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Discussion: Impact of Illness on Families and Patients Illness can lead to emotional instability and permanent or temporary physical disability. Patients might also experience reduced levels of independence and/or modifications of their roles in family and society. These changes may also have significant effects on family members and caregivers’ lifestyles and quality of life. Chronic exposure to stressors, such as medical treatments, side effects, complications, or hospital admissions, can deplete the internal and external coping resources of a patient and his or her family system. Walden University SOCW 8205 Week 1 Impact of Illness on Families and Patients Medical social workers confront the challenges posed by illness every day. In addressing these concerns, medical social workers focus attention on the impact of illness on patients and families. Through ongoing assessment, they consider how and if this impact might change with the progression of illness, whether positive or negative. Discussion: Impact of Illness on Families and Patients To prepare for this Discussion: Discussion: Impact of Illness on Families and Patients Review this week’s resources. Consider the experience of illness by patients and families. Think about emotional or psychological factors associated with illness and the impact of illness on patients and families. By Day 3 Post a description of three major emotional or psychological factors that influence both patients and their families. Then, explain patients’ and their families’ experiences in dealing with illness and associated disability. Explain one of these factors that might be challenging for a medical social worker to address. Then, explain strategies that a medical social worker might employ to address the factor. Discussion: Impact of Illness on Families and Patients Be sure to support your postings and responses with specific references to the resources and the current literature using appropriate APA format and style. Discussion: Impact of Illness on Families and Patients .pdf .pdf .pdf .pdf .pdf THIS ARTICLE HAS BEEN CORRECTED. SEE LAST PAGE Health Psychology 2018, Vol. 37, No. 2, 170 –178 © 2017 American Psychological Association 0278-6133/18/$12.00 http://dx.doi.org/10.1037/hea0000567 Affective Reactivity to Daily Stress and 20-Year Mortality Risk in Adults With Chronic Illness: Findings From the National Study of Daily Experiences Jessica J. Chiang Nicholas A. Turiano Northwestern University West Virginia University This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly. Daniel K. Mroczek and Gregory E. Miller Northwestern University Objective: Daily stress processes have been previously linked to health-related outcomes, but implications for longevity remain unclear. The present study examined whether daily stress exposure and/or affective responses to daily stressors predicted mortality risk over a 20-year period. Based on the hypothesis that chronic illness confers vulnerability to deleterious effects of stress, we also examined whether its presence accentuated the association between daily stress processes and later mortality risk. Method: Participants were 1,346 middle-aged adults from the survey of Midlife Development in the United States who also completed the National Study of Daily Experiences. Participants reported on their experiences of stress and affect for 8 consecutive evenings, and mortality data were collected over the next 20 years, using the National Death Index and other methods. Results: There was a positive association between total number of stressors experienced across days and mortality risk. There was also a positive association between increases in negative affect on stressor days relative to nonstressor days and risk for mortality. The presence of a chronic illness moderated this association such that negative affective reactivity predicted mortality risk among individuals with at least one chronic illness but not among otherwise healthy individuals. This association was independent of sociodemographic characteristics, typical levels of negative affect on nonstressor days, and total number of endorsed stressors. Conclusion: These results suggest that greater increases in negative affect in response to stress in everyday life may have long-term consequences for longevity, particularly for individuals with chronic illness. Keywords: daily experience, stress reactivity, negative affect, chronic disease, longevity alterations in biological processes thought to contribute to the development and worsening of diseases, including elevated blood pressure, stress hormones, and inflammatory biomarkers (Chiang, Eisenberger, Seeman, & Taylor, 2012; Stawski, Cichy, Piazza, & Almeida, 2013; Uchino, Berg, Smith, Pearce, & Skinner, 2006). Among individuals with existing chronic diseases, such as asthma, rheumatoid arthritis, irritable bowel syndrome, and diabetes, higher daily stress is associated with more severe illness-related symptoms (Halford, Cuddihy, & Mortimer, 1990; Levy, Cain, Jarrett, & Heitkemper, 1997; Stone, Broderick, Porter, & Kaell, 1997). Of importance is that not all individuals confronting stress develop poor health, which has been attributed, in part, to variability in people’s affective responses to stress (Almeida, Piazza, Stawski, & Klein, 2011; Lovallo & Gerin, 2003). Perceptions of threat elicit increases in negative affect and decreases in positive affect, which, in turn, can modify patterns of cardiac, vascular, endocrine, metabolic, and immune functioning (Holmes, Krantz, Rogers, Gottdiener, & Contrada, 2006; Kiecolt-Glaser, McGuire, Robles, & Glaser, 2002; Lovallo & Gerin, 2003; Pressman & Cohen, 2005). Repeated and/or heightened activation of these systems over time may exact a toll, ultimately altering the function of tissues and organs in ways that contribute to morbidity and Acute stressful experiences, such as interpersonal conflict and work deadlines, are ubiquitous in everyday life. Walden University SOCW 8205 Week 1 Impact of Illness on Families and Patients Research suggests that these everyday experiences with stress are consequential for physical health. For instance, individuals who report more stress in their daily lives endorse more somatic and infectious illness symptoms and have smaller antibody responses to ingested antigens (DeLongis, Folkman, & Lazarus, 1988; Stone et al., 1994; Stone, Reed, & Neale, 1987). More daily stress is also associated with This article was published Online First November 20, 2017. Jessica J. Chiang, Institute for Policy Research, Northwestern University; Nicholas A. Turiano, Department of Psychology, West Virginia University; Daniel K. Mroczek, Department of Psychology and Department of Medical Social Sciences, Northwestern University; Gregory E. Miller, Institute for Policy Research and Department of Psychology, Northwestern University. The present study was supported by the National Institute on Aging (P01-AG020166; R01-AG018436) and the National Heart, Lung, and Blood Institute (R01-HL122328; F32-HL134276). Correspondence concerning this article should be addressed to Jessica J. Chiang, Institute for Policy Research, Northwestern University, 1801 Maple Avenue, Suite 2450, Evanston, IL 60201. E-mail: jessica.chiang@ northwestern.edu 170 This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly. DAILY AFFECTIVE REACTIVITY AND MORTALITY RISK mortality (McEwen & Seeman, 1999). Thus, individuals who react strongly (i.e., greater increases in negative affect or decreases in positive affect) to stress repeatedly day after day may be more vulnerable to health problems associated with exposure to stress. Indeed, greater stress-related increases in negative affect in daily life have been linked to smaller antibody responses to ingested antigens (Stone, Marco, Cruise, Cox, & Neale, 1996), higher cortisol levels (Jacobs et al., 2007), lower heart rate variability (Sin, Sloan, McKinley, & Almeida, 2016), and self-reports of mood problems and chronic illness (Charles, Piazza, Mogle, Sliwinski, & Almeida, 2013; Piazza, Charles, Sliwinski, Mogle, & Almeida, 2013). Moreover, larger reductions in positive affect in response to daily stress have been associated with higher levels of inflammatory biomarkers (Sin, Graham-Engeland, Ong, & Almeida, 2015), lower sleep efficiency and quality (Ong et al., 2013), and more depressive symptoms (O’Neill, Cohen, Tolpin, & Gunthert, 2004). Of particular interest, more positive affect reactivity has been linked to increased mortality risk in the VA Normative Aging Study (Mroczek et al., 2015). In this study of 181 men, larger decreases in positive affect on stressor days compared with nonstressor days were associated with greater risk for mortality 10 years later. This association was independent of men’s frequency of stress exposure and typical experiences of negative and positive affect in daily life. Interestingly, greater increases in negative affect in response to stress did not predict mortality risk. To our knowledge, the study conducted by Mroczek et al. (2015) is the only study to date that has explored how daily stress and affective processes relate to longevity. Although provocative, findings from this initial study were based on a small, all-male sample, raising concerns regarding generalizability. Furthermore, although this study used daily reports of physical symptoms and bodily pain to adjust for preexisting health problems, it did not explicitly consider the role of chronic diseases. Walden University SOCW 8205 Week 1 Impact of Illness on Families and Patients The most prevalent chronic illnesses in America, like cardiovascular disease and various cancers, can alter people’s affective and biological responses to stress (e.g., Costanzo, Stawski, Ryff, Coe, & Almeida, 2012; Kop et al., 2008; van Der Pompe, Antoni, & Heijnen, 1996), and forecast shorter lifespans even among those who are successfully treated (Hudson et al., 1998; Ronkainen et al., 2001). These observations raise the possibility that chronic diseases contributed to the mortality risks associated with greater positive affective reactivity (i.e., daily stress-related decreases in positive affect) in the Mroczek et al. study. Alternatively, chronic disease may function as a moderator of this association, creating an underlying vulnerability that accentuates the mortality risks associated with stressor exposure and/or affective reactivity. Indeed, there is evidence to suggest that stress-evoked changes in the cardiovascular and inflammatory systems are magnified in patients with a history of coronary artery disease (Huikuri et al., 1994; Kop et al., 2008; Nijm, Kristenson, Olsson, & Jonasson, 2007). With these issues in mind, the overarching goal of the present study was to clarify how daily stress processes relate to overall mortality patterns, using a national sample of midlife Americans who were followed over an average of 20 years in the study of Midlife Development in the United States (MIDUS). Specifically, we examined (a) whether daily stress exposure predicted mortality risk 20 years later, (b) whether negative affective responses to daily stress predicted mortality risk, and (c) whether chronic illness operated as a confounder and/or moderator of these associations. 171 We focused primarily on negative affective responses because the study’s assessment of positive affective responses to daily stress was quite limited in scope. Nevertheless, we used the available data to evaluate parallel hypotheses for positive affect, keeping in mind that these findings are subject to interpretive limitations. Method Participants and Procedures Data for the present study came from the first waves of MIDUS and the National Study of Daily Experiences (NSDE). MIDUS is a national survey study investigating the development of health and well-being from midlife to older adulthood. A national sample of adults was recruited via random-digit dialing and completed telephone interviews and self-administered survey measures. The NSDE is one of the in-depth projects within MIDUS that examines daily stress processes. Each night for eight consecutive evenings, participants were interviewed via telephone about stressful events they encountered, and their activities, behaviors, and emotions in the last 24 hr. Participants from MIDUS I (1995–1996) were 7,108 noninstitutionalized, English-speaking adults ages 25 to 74 years. Of these, a random subsample of 1,843 was selected to participate in NSDE I (1996 –1997). The majority of selected participants (n ? 1,499) agreed to participate— 8% declined participation and 11% were difficult to contact. Mortality data were obtained through October 2015. Fifty-nine individuals were excluded from analyses because they had missing information on demographic variables and chronic conditions collected in MIDUS I. An additional 94 individuals were excluded because the computation of affective reactivity requires having both stressor and nonstressor days, and these participants reported experiencing stress either every day or none of the days. Walden University SOCW 8205 Week 1 Impact of Illness on Families and Patients Thus, the final analytic sample was 1,346. All study procedures were approved by the institutional review boards at University of Wisconsin and Harvard Medical School. Compared with the broader MIDUS I sample, participants in the analytic sample had slightly higher educational attainment, t(7093) ? ?3.08, p ? .002, d ? ?.09, and were more likely to be female (?2 ? 24.31, p ? .001). They did not differ in age, t(7047) ? 1.57, p ? .12, d ? .05, race, t(6174) ? .84, p ? .40, d ? .03, or total number of chronic illnesses, t(7105) ? ?1.41, p ? .16, d ? ?.04. Participants in the present study were marginally more likely to be of decedent status relative to those in the original MIDUS I cohort (?2 ? 3.58; p ? .06). Among participants who died, those in the present study had longer survival times, t(6313) ? ?3.83, p ? .001, d ? ?.12. Measures Daily stress exposure. The Daily Inventory of Stressful Events (Almeida, Wethington, & Kessler, 2002) was used to assess daily stressful experiences. Participants reported on whether they experienced seven different stressors in the past 24 hr. Stressors included had an argument, avoided an argument, had a stressor at work or school, had a stressor at home, faced discrimination, had a network stressor, or experienced any other stressor. Stress exposure was operationalized in two ways. First, the total number of stressors reported across the 8-day period was summed across all CHIANG, TURIANO, MROCZEK, AND MILLER This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly. 172 days to index cumulative stressor exposure. Second, for each day of reporting, a dichotomous variable was computed such that participants who reported no stressors were assigned a value of zero, whereas those who endorsed any of the stressors were assigned a value of one. This variable indexed stressor versus nonstressor days. Recoded scores were then averaged across the 8-day period to index the proportion of stressor days. Both cumulative stressor exposure and proportion of stressor days were used in analyses focusing on mortality risk associated with daily stress exposure. Affective reactivity to stress. Scales developed for NSDE were used to assess affect each day on a 5-point scale (0 ? none of the time, 4 ? all of the time). Negative affect items included “so sad nothing could cheer you up,” “restless or fidgety,” “nervous,” “worthless,” “everything was an effort,” “hopeless,” and “angry or irritable.” Items were averaged to compute a summary negative affect score for each day. Cronbach’s alpha ranged from .69 to .76 for during the 8-day study period. Assessment of positive affect in NSDE was limited and included only a single item: “in good spirits.” In line with previous research (Mroczek et al., 2015; Piazza et al., 2013; Sin et al., 2015), affect reactivity was operationalized as the difference in affect levels on stressor days compared with nonstressor days. Multilevel modeling was used to estimate reactivity coefficients for each individual: Level 1 (day level): Affectij ? ?0i ? ?1i(Stressor Day)ij ? eij Level 2 (person level): ?0i ? ?00 ? u0i ?1i ? ?10 ? u1i These models used the computed dichotomous variable representing exposure to any one of the stressors on a given day (stressor vs. nonstressor day). Accordingly, at the day level, the intercept ?0i represents levels of negative or positive affect on days when no stress was experienced. The slope ?1i reflects the link between stress and affect at the day level, or, more technically, the difference in affect between days when a stressor was and was not endorsed. The residual parameter eij indexes the day-to-day variability in affect for each individual. The person level of the model includes parameters representing the sample’s average levels of affect (?00) and of affective reactivity (?10) across the 8-day period. It also contains the variance parameters u0i and u1i, reflecting the extent of each individual’s deviation from these samplewide averages.Walden University SOCW 8205 Week 1 Impact of Illness on Families and Patients Affective reactivity for each participant was indexed by summing his or her estimated u1i value and the sample fixed effect for affective reactivity (?10). Separate negative and positive reactivity scores were estimated; they were scored such that higher values signify greater increases in negative affect and smaller decreases in positive affect, on stressor days compared with nonstressor days. Chronic conditions. In MIDUS I, participants reported whether they had experienced any of 26 chronic and acute physical health conditions in the past year. They also indicated whether they had ever been diagnosed with heart disease or cancer. For the purposes of this article, we restricted analyses to chronic life- threatening health problems, and for which patients could be expected to provide accurate self-reports of its presence. These conditions included HIV/AIDS, cancer, heart disease (stroke, heart attack, valve disease, hole in heart, blocked artery, heart failure), diabetes or high blood sugar, neurological disorders, and arthritis or bone disease. To reflect total disease burden, the number of chronic conditions was summed for each individual. Mortality. Mortality data were gathered using several methods, namely, National Death Index reports, tracing that included mortality closeout interviews, and longitudinal sample maintenance. Survival times for decedents were computed as the interval from the date of the MIDUS 1 interview to the date of death. Because only month and year of death were documented in order to protect confidentiality, the day for all deaths was set to the 15th day of each month. Survival times for participants who were still living reflected the length of follow-up censored at October 31, 2015. Covariates. Demographic data on age, gender, race, and education level were assessed during the parent study (MIDUS I) and included as covariates. Participants reported their gender (0 ? male, 1 ? female) and their date of birth, from which age was computed. Education was coded as less than high school, high school diploma, some college, or 4-year college degree or higher. Race was coded as European American, African American, or Other, due to small numbers of other racial minorities. From this variable, two dummy variables were created, with European Americans as the reference group. Daily stress exposure and affect on nonstressor days were also included as covariates in some analyses to ensure that any observed associations were not due to greater stress exposure and to discern between the effects of affective reactivity to stress and typical experiences of affect. In these analyses, the total number of stressors experienced across the 8-day study period was used to index cumulative stress exposure, and the average level of negative and positive affect across all nonstressor days was used to index typical levels of affect. Analyses Primary analyses consisted of estimating a series of Cox proportional hazard models in Stata 14 to test whether daily stress exposure and negative affective reactivity to daily stress predicted mortality risk. Unadjusted models were examined in the first step. Demographic covariates (i.e., age, gender, race, and educational attainment) and main effects of daily stress exposure or negative affective reactivity were entered in the second step. To probe the role of chronic conditions, total number of chronic conditions was added as a covariate in the third step, followed by the interaction between stress exposure or negative affective reactivity and number of chronic conditions in the final step. In subsequent models, we stratified the sample by presence of at least one chronic condition. We estimated models in each group and included additional covariates, namely, negative affect on nonstressor days and total number of stressors. Separate models were estimated for each daily stress exposure variable (i.e., total number of stressors and proportion of stressor days) and negative affective reactivity. In exploratory analyses, parallel models were tested to examine whether results extended to positive affective reactivity. DAILY AFFECTIVE REACTIVITY AND MORTALITY RISK This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly. Results Sample characteristics from NSDE are …Discussion: Impact of Illness on Families and Patients Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

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