Objective This study sought to examine the relationship among the amount of stress, the perception that stress affects health, and health and mortality outcomes in a nationally-representative sample of U.S. adults. Methods Data from the 1998 National Health Interview Survey were linked to prospective National Death Index mortality data through 2006. Separate logistic regression models were used to examine the factors associated with current health status and psychological distress. Cox proportional hazard models were used to determine the impact of perceiving that stress affects health on all-cause mortality. Each model specifically examined the interaction between the amount of stress and the perception that stress affects health, controlling for sociodemographic, health behavior, and access to healthcare factors. Results 33.7% of nearly 186 million (n=28,753) U.S. adults perceived that stress affected their health a lot or to some extent. Both higher levels of reported stress and the perception that stress affects health were independently associated with an increased likelihood of worse health and mental health outcomes. The amount of stress and the perception that stress affects health interacted such that those who reported a lot of stress and that stress impacted their health a lot had a 43% increased risk of premature death (HR = 1.43, 95% CI [1.20, 1.71]). Conclusions High amounts of stress and the perception that stress impacts health are each associated with poor health and mental health. Individuals who perceived that stress affects their health and reported a large amount of stress had an increased risk of premature death.

1) the paucity of studies using the same or similar indicators, and (2) the consistent existence of social class gradients in characteristics related to subsequent health, particularly intake of nutritional foods and physical activity. The sparseness of existing data and the different aspects of health investigated in the relatively few studies underscore the need for (1) the development of conceptual models specifically focused on adolescent health and social class; (2) additional inquiry into the measurement of social class and adolescent perceptions of class; (3) inclusion of contextual variables in study design; and (4) longitudinal cohort studies to better understand the specific determinants of health during adolescence. S ocial gradients in health, wherein health is found to be better at each successive level of social position, are consistently found for the vast majority of health indicators in infancy, 1 2 early childhood, 3-5 and adulthood. 6 However, there is debate about the existence of social gradients in late childhood and adolescence, the time during which much of the foundation for subsequent health is being established. Several investigators, most notably from the United Kingdom, have reviewed much of the relevant literature through 1996 and have found little evidence that the health of adolescents varies with their parents' social class. Perhaps the greatest support for absence of a gradient effect was provided by West.1 8 In his extensive review of the literature up to the mid-1990s, West set the stage for viewing social differences in the context of past experiences as well as current ones. Attempting to delineate effects atributable to chronological age from those attributable to life contexts, he hypothesised that there might be social class gradients in adolescence for chronic illness, particularly severe or activity limiting chronic illness that might be a consequence of social disadvantage earlier in life and continuing. On the other hand, those aspects of illness that are newly occurring in the adolescent period might not show social class gradients because of the homogenising effects of experiences in school, with peers, and with pervasive youth culture. His review revealed relatively consistent social gradients for height and for severe chronic conditions, and only very inconsistent gradients for some other aspects of health in either males or females but not both. The studies derived largely from longitudinal datasets in the United Kingdom, and often grouped adolescent age groups with younger age groups, or only considered a very limited age range (often one year of age within adolescence).Furthermore, social status was overwhelmingly characterised by occupational status of the head of the household, with certain limitations noted on this method of classification. Also, the conclusions about the existence of gradients often were limited to differences between the lowest social group and higher ones, rather than a progressive increase (or decrease) across the social groupings.Like W...

Purpose-To determine if caring for a child with cancer or a brain tumor affects parental health and mental health and if and to what extent stress mediates the relationship between case status and parental quality of life.Methods-In person interviewer-assisted surveys were administered to 74 case dyads (children diagnosed with cancer or a brain tumor and their parents) and 129 control dyads (children without health problems and their parents from a community sample) to assess health-related quality of life and perceived levels of stress.Results-Parents of children with cancer or a brain tumor had significantly worse health-related quality of life, including worse overall mental health. Overall physical health was no different between cases and controls. Staged multivariate analysis revealed that worse health-related quality of life is completely mediated by perceived stress in these parents.Conclusions-The experience of caring for a child with cancer is not in itself related to poor quality of life, but is related to an increased level of stress that may adversely impact parental mental health and quality of life.

Objectives We sought to determine if and to what extent a woman’s exposure to stressful life events prior to conception (PSLEs) were associated with subsequent infant birth weight by using a nationally representative sample of US women. Methods We examined 9350 mothers and infants participating in the first wave of the Early Childhood Longitudinal Study-Birth Cohort in 2001. Weighted regressions estimated the effect of exposure on very low and low birth weight, adjusting for maternal sociodemographic and health factors and stress during pregnancy. Results Twenty percent of women experienced any PSLE. In adjusted analyses, exposed women were 38% more likely to have a very low birth weight infant than nonexposed women. Furthermore, the accumulation of PSLEs was associated with reduced infant birth weight. Conclusions This was the first nationally representative study to our knowledge to investigate the impact of PSLEs on very low and low birth weight in the United States. Interventions aimed to improve birth outcomes will need to shift the clinical practice paradigm upstream to the preconception period to reduce women’s exposure to stress over the life course and improve the long-term health of children.

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Pregnancy complications and poor birth outcomes can affect the survival and long-term health of children. The preconception period represents an opportunity to intervene and improve outcomes; however little is known about women’s mental health prior to pregnancy as a predictor of such outcomes. We sought to determine if and to what extent women’s preconception mental health status impacted subsequent pregnancy complications, non-live birth, and birth weight using a nationally representative, population-based sample. We used pooled 1996-2006 data from the nationally-representative Medical Expenditure Panel Survey (MEPS). Poor preconception mental health was defined as women’s global mental health rating of “fair” or “poor” before conception. Logistic regression was used to assess the association between preconception mental health and pregnancy complications, non-live birth, and having a low birth weight baby within the follow up period. Poor preconception mental health was associated with increased odds of experiencing any pregnancy complication (AOR 1.40, 95% CI: 1.02-1.92), having a non-live birth (AOR 1.48, 95% CI: 0.96-2.27), and having a low birth weight baby (AOR 1.99, 95% CI: 1.00-3.98), all controlling for maternal age, race/ethnicity, marital status, education, health insurance status, income, and number of children in the household. Significant racial and ethnic disparities exist for pregnancy complications and non-live births, but not for low birth weight. Women’s preconception mental health is a modifiable risk factor that stands to reduce the incidence of adverse pregnancy complications and birth outcomes.

Purpose Research suggests a relationship between caring for a child with cancer and psychological distress in caregivers. Less evident is the role which financial difficulties might play in this relationship. We sought to determine if caring for a child with cancer was related to clinically relevant depressive symptoms among parents, whether or not financial difficulties mediated this relationship, and if financial difficulties were independently associated with symptoms of depression among parents of children with cancer. Methods Data are from 215 parents of children diagnosed with cancer or brain tumors (n=75) and a comparison group of parents of healthy children (n=140). Multiple logistic regression analyses were used to assess the factors associated with reporting clinically relevant depressive symptoms. Results Caring for a child with cancer was associated with increased odds of clinically relevant depressive symptoms in parents (OR: 4.93; 95% CI: 1.97 – 12.30), controlling for covariates. The mediating effect of financial burden on this relationship was not statistically significant. However, among parents of children with cancer, negative financial life events increased the likelihood of reporting symptoms of depression (OR: 4.89; 95% CI: 1.26 – 18.96). Conclusions Caring for a child with cancer was associated with depressive symptoms for parents. Financial difficulties were the strongest correlate of these symptoms among parents of children with cancer. Our results suggest that it may not only be the burden of caring for the child with cancer, but also the associated financial difficulties that contribute to a higher likelihood of depressive symptoms in parents.

Objective: To explore factors that influence how informal caregivers manage medications as part of caring for hospice patients. Methods: Semistructured, open-ended interviews were conducted with 23 informal caregivers and 22 hospice providers from 4 hospice programs in the Chicago metropolitan areas. Qualitative analysis was conducted consistent with the grounded theory approach. Results: In general, informal caregivers and hospice providers identified similar key factors that facilitated or impeded caregivers' process in managing medications. Caregivers' life experience and self-confidence were considered assets that facilitated medication management. Limitations impeding the process included caregivers' negative emotional states, cognitive and physical impairments, low literacy, other competing responsibilities, as well as patients' negative emotional states and complex medication needs. Furthermore, the social context of medication management emerged as a salient theme: caregivers' good interpersonal relations with patients facilitated medication management, whereas poor communication/relations among caregivers within a support network impeded the process. While both study groups discussed the positive attributes of good caregiverpatient relations and support from multiple caregivers, hospice providers were cautious about the potential adverse influence of close relations with patients on caregivers' decision making about medications and discussed poor communication/relations among informal and privately hired caregivers that often resulted from family conflicts and/or a lack of long-standing leadership. Conclusion: Our findings suggest additional intervention points, beyond knowledge and skill building, that could be addressed to support caregivers in executing medication responsibilities at home for hospice patients.