Distressing aspects of women's roles, vicarious stress, and health consequences

Determinants of health-related quality of life among patients with systemic lupus erythematosus in Hanoi, Vietnam

BACKGROUND

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease which impacts patients' lives. Many studies in high-income countries have focused on their health-related quality of life (HRQoL). However, evidence of awareness of SLE and HRQoL in low- and middle-income countries is lacking. Therefore, this study aimed to identify the determinants of HRQoL of SLE patients in Vietnam, a lower-middle income country.

METHODS

This cross-sectional study was conducted at the National Hospital of Dermatology and Venereology in 2019. A pre-tested structured questionnaire was used to collect data. It consisted of Short Form-36 to assess HRQoL which comprised physical and mental component summaries, Multidimensional Scale of Perceived Social Support, Satisfaction with Life Scale, and Mental Adjustment to SLE. Multiple linear regression was used to identify the determinants of HRQoL.

RESULTS

One hundred thirty four patients with SLE participated in this study. The majority of the patients were women (n = 126, 94.0%). The mean age of all participants was 37.9 years old (standard deviation [SD] 12.5). Of 134 participants, 104 (77.6%) were married. Older patients were more likely to have a lower score of mental component summary (B=-0.45, 95% CI -0.73, -0.17). Patients with more children were more likely to have a lower score of physical component summary (B=-5.14, 95% CI -9.27, -1.00). Patients who felt more helplessness or hopelessness were more likely to have lower scores of physical and mental component summaries (B=-1.85, 95% CI -2.80, -0.90; B=-1.69, 95% CI -2.57, -0.81). Also, patients who felt more anxious were more likely to have a lower score of mental component summary (B=-1.04, 95% CI -1.77, -0.32). Patients who were more satisfied with their lives were more likely to have higher scores of physical and mental component summaries (B = 1.07, 95% CI 0.50, 1.64; B = 1.08, 95% CI 0.55, 1.61).

CONCLUSION

Factors associated with lower HRQoL in Vietnam were feelings of helplessness or hopelessness, and burdens of parenting roles. However, social support can contribute to a higher HRQoL, such as information support, self-support groups, and daycare services provided at the community level.

Health risks and outcomes that disproportionately affect women during the Covid-19 pandemic: A review

BACKGROUND

The Covid-19 pandemic is straining healthcare systems in the US and globally, which has wide-reaching implications for health. Women experience unique health risks and outcomes influenced by their gender, and this narrative review aims to outline how these differences are exacerbated in the Covid-19 pandemic.

OBSERVATIONS

It has been well described that men suffer from greater morbidity and mortality once infected with SARS-CoV-2. This review analyzed the health, economic, and social systems that result in gender-based differences in the areas healthcare workforce, reproductive health, drug development, gender-based violence, and mental health during the Covid-19 pandemic. The increased risk of certain negative health outcomes and reduced healthcare access experienced by many women are typically exacerbated during pandemics. We assess data from previous disease outbreaks coupled with literature from the Covid-19 pandemic to examine the impact of gender on women's SARS-CoV-2 exposure and disease risks and overall health status during the Covid-19 pandemic.

CONCLUSIONS

Gender differences in health risks and implications are likely to be expanded during the Covid-19 pandemic. Efforts to foster equity in health, social, and economic systems during and in the aftermath of Covid-19 may mitigate the inequitable risks posed by pandemics and other times of healthcare stress.

The mediating effect of effort-reward imbalance in household and family work on the relationship between education and women's health

Occupational stress as a key determinant for explaining health inequalities has been well established while the impact of stress related to family work has rarely been considered. This study investigates whether stress in household and family work may contribute to health inequalities in women. We used a population-based sample of German mothers (n = 3129) to determine the total, direct and indirect effects of education on somatic complaints by means of OLS regression-based mediation models. Inference about indirect effects was determined by 95% bias corrected bootstrap confidence intervals. Education was assessed by a measure combining school education and vocational training. Stress was measured using the adopted effort-reward-imbalance (ERI) questionnaire for household and family work. The von Zerssen list of somatic complaints was used as measure of subjective health. We found a significant total effect of education on somatic complaints (p ≤ 0.001) as well as significant indirect effects through 'effort' (p = 0.006) and 'reward' in household and family work (p ≤ 0.001). However, the subscales of ERI pointed into different directions: while levels of 'effort' increased with women's educational attainment, levels of distress related to low 'reward' decreased with higher levels of education. Our findings suggest that the effect of women's education on somatic complaints is mediated through stress related to low reward for household and family work. In particular, lack of 'societal esteem' for household and family work contributed to health disadvantages in lower educated mothers. We conclude that research on health inequality would benefit from taking stressful experiences in household and family work greater into account.

Mothers with chronic disease: a comparison of parenting in mothers with systemic sclerosis and systemic lupus erythematosus

This study compared parenting ability in mothers with systemic sclerosis (SSc) and systemic lupus erythematosus (SLE), two chronic, autoimmune, connective tissue diseases that primarily affect women. Seventy-four mothers with SSc and 68 mothers with SLE completed self-report questionnaires on demographic characteristics, pain, fatigue, occupational performance, and parenting. Results showed that mothers with SSc were slightly older, were more educated, and had decreased occupational performance. Mothers with SLE had more pain and fatigue. There were no significant differences between mothers with SSc and SLE who had children 5 years of age and younger. However, there were significant differences between the mothers with SSc and SLE who had children aged 6 to 18 years on four items on the Parenting Disability Index: playing games with child, getting up with child during the night, keeping child out of unsafe situations, and helping child solve personal/social problems. These differences may be due to differences in the levels of pain, fatigue, and occupational performance, possibly stemming from differences in disease manifestations.

Parenting: the forgotten role of women living with systemic lupus erythematosus

This study investigates parenting and the impact of symptoms, such as pain and fatigue, on the parenting abilities of mothers with systemic lupus erythematosus (SLE). Participants were 68 mothers with SLE who had children 18 years of age and younger. The mothers completed surveys consisting of a demographic questionnaire and self-report instruments such as the Parenting Disability Index (PDI), Health Assessment Questionnaire, Pain Visual Analog Scale, and Multidimensional Assessment of Fatigue Scale. Analysis of variance was used to compare parenting abilities for women with younger children (birth -5 years) and women with older children (6-18 years) and women with children in both age groups. There were no significant differences between the three groups. However, having more fatigue, functional disability, and less education resulted in higher PDI scores in all groups. Mothers with children younger than age 5 reported that having energy to talk/listen to a child was the most difficult parenting task. Mothers with children between 6 and 18 years of age reported the most difficulties with maintaining discipline, playing games, shopping, and doing household chores. Symptoms of lupus have a significant influence on mothering roles. In daily practice, health care providers may want to consider inquiring about the impact SLE may be having on their patients' parenting roles.

Anger, stress and blood pressure in overweight children

Among adults, trait anger, patterns of anger expression, and stress have been associated with blood pressure (BP). Less apparent is the effect of these variables on BP in overweight and obese children. To characterize the relationships between these psychological variables and BP, the authors conducted a secondary analysis of data from 73 overweight and obese 9- to 11-year-old children. Findings indicate a positive correlation between trait anger and systolic BP (SBP). Regression results indicate that the overall model significantly predicted SBP by explaining 15.4% of the variance and that trait anger was a significant predictor of SBP.

Perceived parenting ability and systemic sclerosis

OBJECTIVE

The purpose of this study was to compare perceived parenting abilities in mothers with systemic sclerosis (SSc) based on the subtype of SSc and age group of their children, and to examine how the degree of pain, fatigue and functional ability relates to parenting ability.

METHODS

In this cross-sectional survey, 74 mothers with SSc, who had children aged 18 years or younger living at home with them, completed a series of questionnaires online or on paper. The questionnaires included the Parent Disability Index (PDI) and surveys regarding demographic information, pain (visual analogue scale), fatigue (Multidimensional Assessment of Fatigue) and functional ability (Health Assessment Questionnaire).

RESULTS

An analysis of variance revealed that the mean age of the mother (F(2,71)  = 7.9; p < 0.01), mean PDI score (F(2,68)  = 5.4; p < 0.01) and mean pain score (F(2,71)  = 4.0; p = 0.02) were each associated with the age group of the children. The univariate analysis of variance results showed that dichotomized pain (F(1,69)  = 13.3; p < 0.01), fatigue (F(1,69)  = 18.9; p < 0.01) and disability (F(1,69)  = 9.8; p < 0.01) were each associated with the PDI score. The multivariate analysis of variance results showed that dichotomized pain (F(1,68)  = 7.5; p < 0.01) and fatigue (F(1,68)  = 12.7; p < 0.01) were associated with the PDI.

CONCLUSION

Mothers with SSc report difficulty with parenting, which can be related to the severity of the symptoms. The findings suggest that interventions to reduce pain and fatigue may improve perceived parenting ability.

The role of stress in the relationships between gender and health-promoting behaviours

Studies have shown that in Western societies, women live longer than men. Among other factors, this has been attributed to health behaviours; men engage in health-risking behaviours, while women perform health-promoting behaviours. These tendencies were argued to align with cultural notions of masculinity and femininity. There may be some evidence, however, that men and women engage in different types of health-promoting behaviours, and stress may play a role in these tendencies. This study attempts to examine the various types of health-promoting behaviours women engage in and compare them to the tendencies of men. Secondly, it examines the mediating role of stress in the relationships between gender and health-promoting behaviours. The sample was comprised of 402 young Israeli adults. Half were undergraduate university students majoring in social work. The remaining participants were sampled by 'snowball sampling'. Participants completed a questionnaire containing 63 closed-ended questions on various health issues. For the purpose of this study, gender, stress and health-promoting behaviours measures were used. Data were collected over three academic years by the teacher responsible for the course and were received by the author at the end of the data collection phase. The study was approved by the institution's internal review board. The results indicate that,-while women engage in 'type 2 behaviours'- refraining from smoking and drinking, eating breakfast regularly and sleeping 7-8 hours per night-men engage in 'type 1 behaviours'- physical exercise, refraining from snacking, and maintaining an appropriate body mass. We also found that, to some extent, women refrain from 'type 1 behaviours' because of their levels of general stress. Our study suggests that the social construction of masculinity and femininity which undermines individuals' health needs to be challenged and addressed. In particular, the enduring role of stress in women's health outcomes should be addressed.

Social support networks and maternal mental health and well-being

The link between social networks and mental health has increasingly been recognized by public health as an important topic of interest. In this paper, we explore this association among a specific group: mothers. Specifically, we discuss how maternal mental health can be understood in the context of social networks, the influence of specific social relationships, and how the type and quality of support can mediate maternal mental health outcomes. We review interventions that foster social networks to address maternal mental health as well as other related health outcomes. Findings suggest that interventions that combine multiple treatment approaches may be more effective in addressing mental health. Also, traditional measures of social networks may not be appropriate for vulnerable populations, with qualitative, rather than quantitative, indicators of social networks being more predictive of maternal health and well-being. The implications of these findings and future research directions are discussed.

[Oxytocin and maternal stress during the post-partum period]

Oxytocin is required for lactation by promoting milk expulsion. Oxytocin has also been reported to exert a positive role in social attachment. The postpartum period has been shown to be crucial for maternal behavior initiation, and required self-trust reinforcement. However, this period is also remarkable for the high risk exposure of either psychic or physical stress. A negative impact on young mother is suspected, both in the short, medium or long term, which can even be deleterious for child-mother relationships. During lactation in female rats and sheep, oxytocin production has been proved to decrease stress-induced hormonal changes and later consequences. In human beings, only the first hour after breast-feeding seems to protect against physical or psychic stress. Oxytocin improves the stress-induced response by reducing the ACTH and cortisol secretion thus representing a potential therapeutic pathway in post-partum pathologies such as depression. Thus, this review of recent literature about oxytocin and stress during post-partum period, leads to the assumption that oxytocin, at the moment of installation of breastfeeding, acts not only on the physiological condition, but also on the psychic condition of the mother.

Exercise: who needs it?

Nurses will be involved in delivering the UK Government's 'Choosing Activity: a physical activity action plan' (Department of Health, 2005), so it is important to ensure that nurses benefit from the implementation of this policy. It is accepted that in some areas of nursing, the daily routine can be physically and mentally demanding; all the more reason to examine lifestyle and the benefits of exercise. This article considers some factors that may affect nurses' physical and mental health. The potential value of the Healthy Workplace Award Scheme is discussed and some recommendations are made about future strategies that employers could adopt or develop to give nurses the opportunity to improve their physical and mental well-being within the workplace. These opportunities could improve nurses' health and impact on the care nurses provide.

Grandmothers' diaries: a glimpse at daily lives

Little information exists about the daily lives of women who are grandmothers, and the differences in daily stresses based on caregiving status to grandchildren. This content analysis examines the stresses of 64 grandmothers as grouped by caregiver status (grandmothers raising grandchildren, grandmothers living in multigeneration homes, non-caregivers to grandchildren) as recorded in three-week diaries. The nature of salient issues and stressful interactions differed by caregiver groups. Grandmothers raising grandchildren reported more stresses related to grandchildren's routines, activities, and school progress, more time pressure, and difficult interactions with grandchildren. The diary entries of grandmothers in multigenerational homes reflected their supplemental role in childcare, and sometimes stressful interactions with other family members. Grandmothers with no routine caregiving to grandchildren reported more involvement with those outside the immediate family. Many general concerns about the well-being of the family represent commonalities in grandmothers despite differences in current caregiving roles to grandchildren.

Stress discourse and Western biomedical ideology: rewriting stress

Popular psychosocial theories of stress and coping are based on an empiricist paradigm and a Western biomedical framework that reflect Western ideologies and values about health and illness. Problems associated with this discourse lie mainly in the ideologies that emphasize naturalism, individualism, rationalism, and objectivity. We suggest that stress and coping theory should be concerned with the ways in which power relations and social institutions produce the meaning of stress. The inclusion of alternative discourses that attend to the micro and macro social and historical factors is necessary for the further development of stress and coping theory and practice.

Relationship between psychosocial factors and health behaviours for women experiencing menopause

This study investigated the psychosocial factors related to the health behaviours of women at menopause. These health behaviours included choice of intervention by women for menopause, particularly consultation of health professionals, use of hormone replacement therapy and preferred information sources. A postal questionnaire was distributed to a structured random population-based sample of 400 women in the 45-54 years age group living in south-east Queensland, Australia. Explanatory variables were: attitudes to menopause, social functioning, mental health, vitality, preventive health practices and lifestyle factors. This study found that information, preventive health practices, attitudes towards menopause, exercise, number of children living at home, years of formal education and working in paid employment, were related to the health behaviours of women at menopause. The study concludes that a number of related psychosocial factors not associated with hormonal changes may influence the health behaviours of menopausal women. It will be important for nurses, other health professionals and counsellors to decide how best to respond to these findings in consultation with the women affected by their decisions.

Social network and role demands in women's Type 2 diabetes: a model

Type 2 diabetes is a common chronic disease in middle-aged and older women. The social network, although an important source of support, can place conflicting demands on women who cope with a chronic disorder. Because this paradoxical situation can be a burden for many women a model was constructed to systematically investigate social network demands in women's Type 2 diabetes. In developing the model, network theory provided the framework and an extensive literature review determined which network components should be included. Material from our individual and focus group interviews was used to clarify the model. Traditional gender roles in the home, obligation profiles at the workplace, cultural expectations on women's bodies, and prejudice about the psychological etiology of women's diseases in health care, could all contribute to women's experiencing role conflict in their daily diabetes management. To systematically investigate potential deterrents to women's self-care, questions that address the different components of women's social networks are proposed.

Postpartum stress: current concepts and the possible protective role of breastfeeding

OBJECTIVE

To review stress during the postpartum and the research supporting that a unique, protective biology exists in breastfeeding mothers that may reduce reactivity to stress.

DATA SOURCES

Publications from nursing and biomedical literature.

STUDY SELECTION

Studies reviewed were those that have contributed to concurrent conceptualizations of postpartum stress. Additionally, studies with sufficient participants were analyzed for common findings. Animal literature was reviewed for studies on the stress response in lactating and nonlactating animal models.

DATA EXTRACTION

Stress during the postpartum may be conceptualized as physical, intrapersonal, and interpersonal. Animal data and a few recent human studies suggest that the neuroendocrinology of the lactating mother may down-regulate the magnitude of the stress response.

DATA SYNTHESIS

A diminished stress response may serve to protect the breastfeeding maternal-infant dyad from environmental stimuli and to direct the physiology of the mother toward milk production, energy conservation, and nurturance.

CONCLUSION

Nurses understand the benefits of breastfeeding for optimal infant health, but new research suggests that maternal health may also be benefited in a biologic and as yet unexplored way.

Testing a theory of decision-making derived from King's systems framework in women eligible for a cancer clinical trial

The purpose of this study was to test an explanatory theory of decision-making in women eligible for a cancer clinical trial. The theory derived from King's framework proposed that the concepts of uncertainty, role functioning, and social support relate to emotional health (hope and mood state), which in turn relates to the treatment decision. A correlational study design was used to test the theory in a sample of 40 women. Findings provided empirical evidence of the adequacy of King's framework and supported, in part, theorized relationships among the critical factors. However, these factors did not illuminate the treatment decision.

Grandparent parents. Intergenerational surrogate parenting

There is an increasing prevalence in the United States of intergenerational surrogate parenting. In fact, grandmother-headed households that include grandchildren without their parents are the fastest growing intergenerational surrogate family combination. This article reviews the intergenerational surrogate family phenomenon relative to its impact on the grandmothers' health and offers resources and implications for nursing.

Vulnerability to health problems in female informal caregivers of persons with HIV/AIDS and age-related dementias

The health of informal caregivers is often studied from the perspective of caregivers' and care receivers' personal and interpersonal characteristics. This study offers an alternative explanation based on a vulnerable populations framework and considers the role of resource availability to the health status of informal caregivers (n=76). Caregivers in a convenience sample were females of diverse ethnicity and socioeconomic status, and care recipients were diagnosed with human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) or age-related dementias (ARD). Personal interviews using structured instruments were conducted with caregivers who were attending outpatient clinics at a public hospital and a VA hospital. Instruments included the Center for Epidemiologic Studies Depression-Scale (CES-D), the Global Health Assessment (GHA), the Activities of Daily Living Scale (ADL), the Memory and Behavior Problems Checklist (MBPC) and items from the Symptom Checklist-90 (SCL-90) measuring anger, anxiety and loneliness. Caregivers were experiencing both physical and mental health problems. Regression analyses were used to examine the relationships among resources available to caregivers, conditions that put caregivers at risk for poorer health, and health status itself. Analyses were conducted for each group of caregivers separately (HIV and ARD) and for the total group, using depressive symptoms and perception of physical health as dependent variables. In caregivers of people with HIV/AIDS (PWHIV), caregiver distress over care recipient symptoms, anxiety and education were related to depressive symptoms. Depressive symptoms, anger and functional status of the PWHIV were related to caregivers' perception of poorer physical health. In caregivers of people with ARD, there were no significant predictors for depressive symptoms or perception of physical health. In the total group of caregivers, lower income and more anger were related to depressive symptom score. When perception of physical health was the dependent variable, minority ethnicity and depressive mood were related to worse perception of physical health. These findings support the relationship of a lack of resources to health status. A community-based programme of resources and health care services for the caregiver-care receiver dyad is recommended.

Interactive model of women's stressors, personality traits and health problems

Theories have linked various stressors with health problems, and some studies have identified personality traits that enhance health. However, few studies have examined the interaction among women's stressors, personality traits and their health. This retrospective study (1996-1997) analysed the effects of women's major stressors and personality traits on symptoms of health problems, and developed a model of women's health based on the interaction among these factors. A convenience sample of 300 women aged between 18 and 66 years completed a questionnaire that measured three types of stressors, eight personality traits and 40 symptoms of health problems. Principle components and factor analyses identified the best items to measure the stressors, traits and problems. New reduced data subsets were constructed for classification tree analyses to identify the effects of stressors and personality traits on women's health. Women with medium or high stressors and low assertiveness, low hardiness, or the inability to express their feelings, were more likely to report physical symptoms than women who were stronger in these personality traits. Also, women with medium or high stressors and low to medium trust or love relationships were very likely to report high emotional symptoms, as were women with high trust or love, who did not express their feelings. An interactive model of women's health was supported. The amount of women's stressors and their personality traits may increase or diminish their stress response and affect their health. Nurses can identify women with high stressors and unhealthy personality traits that increase their risk for stress-related illnesses, and assist these women to modify their stressors or personality traits to enhance their health.

Women's 'inner-balance': a comparison of stressors, personality traits and health problems by age groups

Women's 'inner-balance': a comparison of stressors, personality traits and health problems by age groups The purposes of this descriptive study were to identify differences in women's stressors, personality mediating traits and symptoms of health problems by age groups, and to guide revisions for development of a shorter, reliable questionnaire to measure women's health and risks for stress-related illnesses. A convenience sample of 299 women aged between 18 and 66 years who resided in the south-western United States and could read English completed a lengthy questionnaire. ANOVAs were used to compare women by three age groups. Young women (18-29 years) reported high stressors, less healthy personality traits, and significantly more physical and emotional symptoms of health problems than middle-age and older women. Middle-age women (30-45 years) had significantly more stressors than other women, but their healthy personality traits may have contributed to fewer health problems. Older women (46-66 years) had the fewest stressors, highest healthy personality traits, and fewest symptoms of problems compared to other age groups. In their roles and relationships as wives, mothers and employees, women experienced multiple stressors such as inadequate physical and emotional support from their spouse/partner, along with parenting and employee difficulties that contributed to their health problems. Young and middle-aged women were more stressed, juggling the multiple responsibilities and demands of their spouse, children, ageing parents, and their occupation, while trying to maintain their own 'inner balance'.

Conceptualizing vulnerable populations health-related research

BACKGROUND

A conceptual model for vulnerable populations research relates resource availability and relative risk to health status. The model has a population-based focus that places responsibility for the collective health status of its citizens with the community. Vulnerable populations are social groups who experience limited resources and consequent high relative risk for morbidity and premature mortality. There is considerable research evidence to support the major relationships in the model. Conceptual links that need additional research are identified.

CONCLUSIONS

The implications for research include a variety of methodological problems related to recruiting and retaining participants, instrumentation, and data collection. Research designs are needed that move beyond descriptive and epidemiological approaches to interventional and outcome studies. Ethical considerations take on special significance with vulnerable populations.