This study examined the psychometric properties of the "original" seven factored scales derived by Aldwin et al. from Folkman and Lazarus' Ways of Coping Checklist (WCCL) versus a revised set of scales. Four psychometric properties were examined including the reproducibility of the factor structure of the original scales, the internal consistency reliabilities and intercorrelations of the original and the revised scales, the construct and concurrent validity of the scales, and their relationships to demographic factors. These properties were studied on three distressed samples: 83 psychiatric outpatients, 62 spouses of patients with Alzheimer's disease, and 425 medical students. The revised scales were consistently shown to be more reliable and to share substantially less variance than the original scales across all samples. In terms of construct validity, depression was positively related to the revised Wishful Thinking Scale and negatively related to the revised Problem-Focused Scale consistently across samples. Anxiety was also related to these scales, and in addition, it was positively related to the Seeks Social Support Scale across samples. The Mixed Scale was the only original scale that was consistently related to depression and anxiety across the three samples. Evidence for concurrent validity was provided by the fact that medical students in group therapy had significantly higher original and revised scale scores than students not participating in such groups. Both sets of scales were shown to be generally free of demographic biases.

Forty-four caregivers to spouses with a diagnosis of Alzheimer's disease provided a stressed subject population considered at high risk for depression. Unlike more typical unidirectional measures of perceived social support quality, subject ratings were elicited separately as to how helpful as well as how upsetting each network member was in five different support categories. Correlations between perceived network "upset" and depression (Beck Depression Inventory) were highly significant, while in no case did perceived "helpfulness" relate to depression. Using stepwise multiple regression, the set of five support category Upset ratings predicted depression better than did helpful/upset ratios, which in turn predicted depression better than the Helpfulness ratings as a group. The implications of these findings for the conceptualization of social support and its measurement are discussed.

Raw scores (frequency of efforts) versus relative scores (percentage of efforts) were compared on the five scales of the revised Ways of Coping Checklist. It was hypothesized that, conditional on the source of and appraisal of a stressor, problem-focused coping should be inversely related and Wishful Thinking should be positively related to depression when relative scores were used but that raw problem-focused scores would be less clearly related to depression in such a way. It was further hypothesized that these relationships would hold for very diverse samples: psychiatric outpatients (n = 145), spouses of patients with Alzheimer's disease (n = 66), and medical students (n = 185). Given the maladaptive status of the psychiatric outpatients, it was hypothesized that they would report more emotion-focused strategies and less problem-focused coping than the nonclinical samples and that these differences would be better observed using relative rather than raw scores. The hypotheses were generally supported.

Studies of social support networks have almost exclusively measured only their positive aspects. In this research, we investigated both the helpful or positive and the upsetting or negative aspects of social networks in a longitudinal study of spouses caring for a husband or wife with Alzheimer's disease, a progressive senile dementia. Measures of helpful and upsetting aspects of the care givers' networks, derived from interviews and daily interaction ratings, were studied for their relations with overall network satisfaction and depression at an initial interview period (n = 68) and at a follow-up period about 10 months later (n = 38). Results from hierarchical multiple regression analyses, in which care givers' age and sex and a measure of the spouses' health status were controlled, showed that the care givers' degree of upset with their networks was strongly associated with lower network satisfaction and increased depression at both time periods. Helpful aspects bore little or no direct relation to either depression or network satisfaction. Helpful aspects of the network did, however, interact with network upset in predicting network satisfaction, and depression (combined probabilities test, p less than .05). Longitudinal predictions of follow-up depression, after age, sex, care givers' health status, and initial depression levels were controlled, showed that changes in upsetting aspects of one's network were predictive of changes in depression over time. We interpreted these results within an attributional framework that emphasizes the salience of upsetting events within a social network.

Objective: To investigate the efficacy and safety of abatacept in combination with etanercept in patients with active rheumatoid arthritis during a 1-year, randomised, placebo-controlled, double-blind phase, followed by an open-label, long-term extension (LTE). Methods: Patients continued etanercept (25 mg twice weekly) and were randomised to receive abatacept 2 mg/kg (n = 85) or placebo (n = 36). As the effective dose of abatacept was established as 10 mg/kg in a separate trial, all patients received abatacept 10 mg/kg and etanercept during the LTE. Results: A total of 121 patients were randomised; 80 completed double-blind treatment and entered the LTE. During double-blind treatment, the difference in the percentage of patients achieving the primary end point (modified American College of Rheumatology (ACR) 20 response at 6 months) was not significant between groups (48.2% v 30.6%; p = 0.072). At 1 year, no notable changes in modified ACR responses were observed. Subsequent to the dosing change, similar modified ACR responses were seen during the LTE. Significant improvements in quality of life were observed with abatacept and etanercept versus placebo and etanercept in five of the eight short-form 36 subscales at 1 year. More abatacept and etanercept-treated patients experienced serious adverse events (SAEs) at 1 year than patients receiving placebo and etanercept (16.5% v 2.8%), with 3.5% v 0% experiencing serious infections. Conclusion: The combination of abatacept (at a dose of 2 mg/kg during the double-blind phase and 10 mg/ kg during the LTE) and etanercept was associated with an increase in SAEs, including serious infections, with limited clinical effect. On the basis of the limited efficacy findings and safety concerns, abatacept in combination with etanercept should not be used for rheumatoid arthritis treatment.