Outcomes of Heart Surgery  Contrada, R., Goyal, T. M., Cather, C., Rafalson, L., Idler, E. L., & Krause, T. J. (2004). Psychosocial factors in outcomes of heart surgery: The impact of religious involvement and depressive symptoms, Health Psychology, 23 (3), 227-238. Richard Contrada and his colleagues reported on the relationship between religiousness and recovery from heart surgery. Their study was of a convenience sample of patients scheduled for heart surgery. The researchers assessed religiousness and other psychosocial factors among 142 patients about one week prior to surgery. Patients considered ineligible for the study were those who did not speak English or who had psychiatric conditions that would interfere with the interview. The majority of patients were male (81 percent or n = 115) and patients ranged in age from 32-88 (M = 64.9 years). Eighty-three percent of participants were white and 7.7 percent black, 4.9 percent Asian, 2.8 percent Hispanic. The majority of patients were married (76.8 percent), 6.3 percent divorced and 4.2 percent single (never married).

The majority (85.2 percent) underwent surgery on an elective basis. Length of stay ranged from three to 84 days (M = 7.47 days). Most patients identified themselves as Christian (83.8 percent). The majority of Christians were Catholic (52.8 percent of the entire sample); 28.2 percent identified themselves as Protestant and 2.8 percent identified as Eastern Orthodox. Other religions represented included Judaism (8.5 percent) and Hinduism (2.8 percent). Seven participants did not identify with a religion. Roman Catholic and Protestant Christians scored higher than the other participants on various measures of religious involvement. The researchers found evidence to support the hypothesis that religious involvement helps with adaptation to heart surgery. For example, in this study stronger religious beliefs were associated prospectively with shorter length of stay and fewer surgical complications. The effect on complications appeared to mediate the effect on length of stay. However, prayer frequency did not have an effect on length of recovery, and more frequent religious attendance was actually associated with increased length of stay. Age was associated with length of stay, with older patients staying longer, though this was mediated at least partially by risk of complications. Also, gender was an important variable, as the effects of religiosity (beliefs and attendance) on length of stay were stronger for women than men.

The varied findings are interpreted by the researchers as follows: religiousness can have a positive effect on health when religious beliefs and attendance reflect an “integrated pattern of religious involvement.” For others, strong religious beliefs may not be reflected in high attendance; still others may attend religious services regularly but not have strongly held religious beliefs. Post hoc analyses seem to support this interpretation of the data. The findings on prayer are also not consistent with extant literature on religious coping and may reflect on the question asked—about frequency of prayer—rather than use of prayer as a religious coping activity in general, or in relation to their surgery. Certainly, additional research is needed to shed light on the potential positive and negative effects of aspects of religiosity on various health outcomes. Timing of Puberty  Graber, J. A., Seeley, J. R., Brooks-Gunn, J., Lewinsohn, P. M. (2004). Is pubertal timing associated with psychopathology in young adulthood? Journal of the American Academy of Child and Adolescent Psychiatry, 43 (6), 718-726. Julia Graber and her colleagues studied the link between timing of puberty and onset of psychopathology in adolescence and young adulthood. Using data from the Oregon Adolescent Depression Project, Graber et al. report on Time 3 questionnaires. Of the 1,104 potential participants, 941 (85.5 percent) young adults participated, and 931 had information on timing of puberty that was relevant to the study.

The mean age was 24.2 years (SD = 0.6 years) and 57 percent were women (n = 539). The majority was white (89 percent), while three percent were Hispanic, 2.6 percent Native American, 2.6 percent Asian, and 1.1 percent black. Sixty-one percent of participants were single. Many experts assume that while timing of puberty may predict onset of pathology (that is, the earlier the onset of puberty, the greater the risk of pathology), the normal and late onset adolescents would simply “catch up” in rates of illness over time. This study did not find support for this assumption. For example, in this study younger women who reported going through puberty at an earlier age had higher rates of major depression, anxiety, disruptive behavior, and antisocial features. Perhaps not surprisingly, they also reported lower life satisfaction as young adults. Late maturing young women were more likely to complete college. Early maturation among males was not related to increased risk of pathology in adolescence or young adulthood. Early maturation did, however, place males at risk for poorer psychosocial functioning at mid-adolescence. Early maturers also reported higher rates of tobacco use.

This is certainly an important area for early intervention and prevention. As the researchers observe, the picture that forms for females is one of early maturing girls having greater conflict with parents, fewer social skills, and an overall decreased capacity to make good decisions and face the numerous social dilemmas of adolescence. Christian counselors will want to continue to be mindful that early maturers, especially females, are at greater risk for mental health concerns and may benefit from family therapy, social skills training, and interventions to improve problem-solving skills. Spinal Cord Injury Sherman, J. E., DeVinney, D. J., Sperling, K. B. (2004). Social support and adjustment after spinal cord injury: Influence of past peer-mentoring experiences and current live-in partner. Rehabilitation Psychology, 49 (2), 140-149. This is a cross-sectional survey study comparing the impact of two types of social support on adjustment after a spinal cord injury.

The two types of social support studied were past peer-mentoring and current live-in partner (spouse or significant other). Peer mentoring refers to a relationship with someone who has had a similar injury, responded successfully to his or her difficult circumstances, and serves as a mentor to the patient. Participants were recruited from a listing of those with spinal cord injuries through the rehabilitation department of a major university hospital. Forty-three percent of the potential participants (62 of 144) returned usable survey instruments. The measures included in the survey were the Craig Handicap Assessment and Reporting Technique, Brief Symptom Inventory, and Satisfaction with Life Scale. The average age at time of injury was 30.3 years (range = 10 to 85 years). Forty-two (67.7 percent) participants were male and 60 (96.8 percent) were white. Sixty-five percent reported that they were unemployed, and 47.5 percent reported living with a partner. About half (53.2 percent) of the participants reported having had a peer-mentor, and the majority (71.9 percent) of these had one mentor, typically making initial contact within six months of the injury. Interestingly, the majority (78.8 percent) of peer mentors was reported to be met informally rather than through an organized program.

The peermentoring experience typically concluded 10 years prior to the study. The researchers found that past peer-mentoring experience was associated with higher occupational activity and higher ratings on the measure of life satisfaction. Having a live-in partner was correlated with selfreport of greater mobility, economic independence and self-sufficiency. Sherman and colleagues conclude that peer-mentoring experiences are a helpful, complimentary intervention that provides much-needed social support to the person recovering from a spinal cord injury. Early intervention with a peer mentor appears to have a lasting and positive effect, and there may be benefit in developing more intentional contacts between mentors and those who sustain a recent injury. Depression and Back Pain  Larson, S. L., Clark, M. R., Eaton, W. W. (2004). Depressive disorder as a long-term antecedent risk factor for incident back pain: A 13-year follow-up study from the Baltimore Epidemiological Catchment area sample. Psychological Medicine, 34 (2), 211-219. This is a study of the relationship between lifetime depression and incident back pain as reported over a 13-year period of time.

Larson et al. report on findings from the Baltimore Epidemiologic Catchment Area Study, and specifically questions on depression and back pain taken from the Diagnostic Interview Schedule. For this study data was available from 3349 respondents at baseline, 2747 respondents at Time 2, and 1771 respondents at Time 3 (a 13-year period of time altogether). The researchers conclude that back pain is not related to subsequent onset of depression (beyond reactive distress); rather, depression appears to be a risk factor for incident back pain. Back pain was not a short-term result of depression but a condition that emerges over a rather lengthy period of time (longer than one year). There is certainly a need for additional research to help us come to a better understanding of the relationship between back pain and depression. What we do know from prior research is that depression can certainly lead to a worsening of other medical conditions and can lead to the onset of various medical illnesses.

What this study suggests, however, is that back pain can lead to the onset of depression over time, and this should be studied further. Perhaps, as the researchers suggest, this will lead to programs that include psychological interventions in the treatment of chronic pain. Pain,Well-Being,and Older Adulthood  Bookwala, J., Harralson, T. L., & Parmelee, P. A. (2003). Effects of pain on functioning and well-being in older adults with osteoarthritis of the knee. Psychology and Aging, 18 (4), 844-850.Jamilial Brookwala, Tina Harralson, and Patricia Parmelee reported on 367 participants suffering from osteoarthritis (OA). Patients were recruited through local newspapers, rheumatology clinics, and primary care practices. To be eligible for the study they had to be over 50 years old and been diagnosed with either OA or degenerative joint disease. Potential participants were also screened for significant cognitive impairment, a life-threatening condition (e.g., cancer), rheumatoid arthritis, and language/hearing problems that would keep them from completing an interview.

The mean age of the group was 67.9 years (SD = 9.7 years) and 64% were female (n = 234). Seventy-three percent were white (n = 268) and 25% black (n = 99). About 50% of the sample was married at the time of the study. Bookwala et al. reported that greater OA-related pain was associated with depression, poorer physical functioning, and lower social functioning. In terms of a model, poor physical functioning was related to lower social functioning, and both of these were related to an increase in symptoms of depression and physical illness. Concerning psychosocial impact of OA-related pain, OA pain is related to both psychological and physical wellbeing. In this study physical and social functioning functioned as mediators of the relationship between OA-related pain and well-being. Web counselor plays a vital role for the welfare of society.

Higher OA-related pain was correlated with poorer perceived health. As the researchers suggest, these associations may lead to further research on what directly and indirectly links to mortality through perceived health. The path to intervention may be through services that enhance well-being, increase social participation and physical activities, and lead to favorable evaluations of one’s own health. Mark A.Yarhouse,Psy.D., is associate professor of psychology at Regent University, Virginia Beach,Virginia. He is co-author (with Lori A. Burkett) of the book, Sexual Identity: A Guide to Living in the Time Between the Times (University Press of America).