Emotional Hardship Research Articles

Lost in transition

From a patient’s perspective, cancer is not only a physical illness. The emotional toll incurred upon diagnosis can be equally devastating but is often overlooked. As a cancer survivor, I know that for young adults this emotional hardship could not come at a worse time. Young adult’s lives are

Rural, Poverty-level Mothers: A Comparative Study of those with and without Children who have Special Needs

A study of low-income rural mothers in four states investigated the differences in demographics, school experience, social support, and school involvement for mothers with children with and without special needs. Forty percent of the mothers reported having at least one child with special needs. Twice as many mothers who did not complete the eighth grade had a child with a disability. Significant differences were found in marital status, mother's retention in school, mother reporting having special needs in school and receiving services, amount of homework, and writing notes to the teacher. Almost all mothers reported being somewhat involved in school. Results suggest that poverty may be a more salient factor in educational considerations than disability. Suggestions for educators include providing special programs for female students with disabilities, considering the material and emotional hardships of poor families when designing family involvement programs, and acting as an advocate for comprehensive anti-poverty programs.

Mental Health Burden Among Impoverished HIV-Positive Patients in Peru

HIV and poor mental health are intricately related. In settings of poverty, both are often rooted in structural factors related to material and social deprivation. We performed a qualitative analysis to understand factors contributing to poor emotional health and its impact among impoverished Peruvian HIV-infected individuals. We conducted focus group discussions with patients and providers consisting of semistructured, open-ended questions. Qualitative analysis provided insight into the profound impact of depression, isolation, stigma, and lack of social support among these patients. Living with HIV contributed significantly to mental health problems experienced by HIV-positive individuals; furthermore, long-standing stressors-such as economic hardship, fragmented family relationships, and substance use-shaped patients' outlooks, and may have contributed not only to current emotional hardship but to risk factors for contracting HIV as well. Once diagnosed with HIV/AIDS, many patients experienced hopelessness, stigma, and socioeconomic marginalization. Patients tended to rely on informal sources of support, including peers and community health workers, and rarely used formal mental health services. In resource-poor settings, the context of mental health problems among HIV-positive individuals must be framed within the larger structural context of poverty and social exclusion. Optimal strategies to address the mental health problems of these individuals should include integrating mental health services into HIV care, task shifting to utilize community health workers where human resources are scarce, and interventions aimed at poverty alleviation.

Idealisations of self and nation in the thought of diaspora intellectuals

ABSTRACT. Diaspora intellectuals have often played prominent roles in the formation of national revival and independence movements. This article explores the factors that may help to explain this phenomenon through a survey of the literary responses of intellectuals from Eastern Europe, colonial Africa and Asia to their experiences in the capital cities of Western Europe over the early modern and modern era. These reactions, expressed through the writings of influential figures such as Adamantios Koraes and Leopold Senghor, reveal, in their thematic convergence, aspects of such encounters that have remained consistent over time. Portrayed throughout are the emotional hardships of talented individuals who found their status suddenly conditioned by the ideas associated with their places of origin in the host society's imagination. Unwilling, for reasons explored below, to submit passively to these affronts, the individuals studied here threw their energies instead into ambitious projects of national re‐imagination and rehabilitation. The article makes use, finally, of the rather visceral quality of the literature surrounding the experience of diaspora intellectuals to account for the complex weave of modern and traditional elements often exhibited in the new idealisations of self and nation that appear throughout their works.

Role of glutamate in schizophrenia: integrating excitatory avenues of research

Schizophrenia is a debilitating lifelong disorder affecting up to 1% of the population worldwide, producing significant financial and emotional hardship for patients and their families. As yet, the causes of schizophrenia and the mechanism of action of antipsychotic drugs are unknown, and many patients do not respond well to currently available medications. Attempts to find risk factors for the disorder using epidemiological methods have shown that schizophrenia is highly heritable, and path analyses predict that the disorder is caused by several genes in combination with nongenetic factors. Therefore, intensive research efforts have been made to identify genes creating vulnerability to schizophrenia and also genes predicting response to treatment. Interactions of the glutamatergic system with dopaminergic and serotonergic circuitry are crucial for normal brain function, and their disruption may be a mechanism by which the pathophysiology of schizophrenia is manifest. Genes within the glutamatergic system are therefore strong candidates for investigation, and these include the glutamate receptor genes in addition to genes encoding neuregulin, dysbindin, D-amino acid oxidase and G72/G30. These genetic studies could eventually reveal new targets for antipsychotic drug treatment, which currently focuses on inhibition of the dopaminergic system. However, a recent breakthrough indicates clinical efficacy of a drug stimulating the metabotropic glutamate receptor II, LY2140023, which has improved efficacy for negative and cognitive symptoms of schizophrenia. Studies of larger patient samples are required to consolidate these data. Further investigation of glutamatergic targets is likely to reinvigorate antipsychotic drug development.

Home Meets Heimat

Home Meets Heimat

Locked Up, Then Locked Out

SUMMARY Women prisoners face tremendous psychological, emotional, and physical hardships inside prison. These include isolation, separation from their families and children, lack of medical care and general abuse of their basic human rights. When they are released from prison, women confront institutional as well as psychological barriers to a successful return to their communities

Feeling like a burden: Exploring the perspectives of patients at the end of life

The issue of caregiver burden within the context of end-of-life care has received considerable attention. Less focus has been directed at the corresponding issue of care recipients’ perceptions of being a burden to others, referred to as “self-perceived burden”. The purpose of this interpretative phenomenological study was to gain a better understanding of self-perceived burden from the patient's perspective. Fifteen patients (ten women, five men) from Ottawa, Canada, receiving palliative care for advanced cancer were interviewed. Participants’ experiences of self-perceived burden were reflected in two major interrelated categories. “Concern for Others” included the physical, social, and emotional hardships participants believed they were creating for others, as well as concerns about the future and likely effect of their death on those around them. “Implications for Self” reflected feelings of responsibility for causing hardships to others, resulting in distress and a diminished sense of self. A third category, “Minimizing Burden”, was also identified, which described coping strategies used by participants to alleviate the burden on others and to reduce the negative impact on themselves. These categories and themes are discussed from the perspective of social psychology theory pertaining to the maintenance of equity in relationships.

Requiem for international medical graduates

Requiem for international medical graduates

How Do Hired Workers Fare Under Consumer-Directed Personal Care?

This study describes the experiences of workers hired under consumer direction. Medicaid beneficiaries who volunteered for the Cash and Counseling demonstration were randomly assigned to the treatment group, which could participate in the consumer-directed program, or the control group, which was referred to agency care. Paid workers for both groups were surveyed about 10 months after demonstration enrollment. Directly hired workers for the treatment group were nearly always the consumers' friends or relatives. The two groups received similar wages and both were highly satisfied with their working conditions and the supervision they received. Compared with agency workers, directly hired workers who lived with or were related to the consumer were more likely to report emotional strain and a desire for more respect from the consumer's family; however, no such differences were observed for directly hired workers who were not relatives. Directly hired workers and agency workers providing comparable amounts of care reported similar levels of injury and physical strain, although directly hired workers received less formal training. The Cash and Counseling model does not appear to cause adverse consequences for the hired workers. Directly hired workers report high levels of job satisfaction and do not suffer physical or emotional hardship beyond what might be expected for individuals providing care to relatives. However, states might be able to reduce emotional strain and injuries by providing educational materials and referrals for consumers, their families, and workers, and by having counselors monitor workers' well-being.

Cow's milk-specific immunoglobulin E levels as predictors of clinical reactivity in the follow-up of the cow's milk allergy infants.

IgE-mediated cow's milk proteins (CMPs) allergy shows a tendency to disappear with age. The sooner tolerance is detected, the earlier the substitute diets can be suspended and the quicker family emotional hardship is alleviated. To analyse the specific IgE levels to cow's milk and its proteins, which help to separate tolerant from no tolerant children in the follow-up of infants with allergy to cow's milk. Sixty-six infants diagnosed with IgE-mediated allergy to CMPs were included in this prospective follow-up study. Periodic reassessments were carried out every 6 months until they were 2-years old and then, annually, until tolerance arose or until the last reassessment in which tolerance had not been achieved. Non-tolerant infants were followed, at least, for a period of 3 years. In each visit, the same skin tests and determination of specific IgE (CAP System FEIA) for milk and its proteins were carried out. The open challenge test was repeated unless a clear transgression to milk, which came to be positive, had taken place within the previous 3 months in each of the follow-up visits. Specific IgE levels to milk and its proteins, in different moments of the follow-up were analysed by means of the receiver-operating characteristic curve to predict clinical reactivity. Throughout the follow-up 45 (68%) infants became tolerant. The follow-up mean for tolerant infants was 21.2 months whereas for non-tolerant infants it was 58 months. The specific IgE levels which were predictors of the clinical reactivity (positive predictive value (PPV)> or =90%), grew as the age of the infants increased: 1.5, 6 and 14 kU(A)/L for milk in the age range 13-18 and 19-24 months and in the third year, respectively. Specific IgE levels to casein: 0.6, 3 and 5 kU(A)/L, respectively, predicted clinical reactivity (PPV> or =90%) in the different analysed moments of the follow-up. The cut-off points: 2.7, 9 and 24 kU(A)/L for milk and 2, 4.2 and 9 kU(A)/L for casein, respectively, predicted clinical reactivity with an accuracy > or =95% corresponding to a specificity of 90%. Monitorization of specific IgE concentration for milk and casein by means of the CAP system in allergic children to CMPs allows us to predict, to a high degree of probability, clinical reactivity. Age factor must be taken into account to evaluate the specific IgE levels which are predictors of tolerance or clinical reactivity.

Rural, Poverty-level Mothers: A Comparative Study of those with and without Children who have Special Needs

A study of low-income rural mothers in four states investigated the differences in demographics, school experience, social support, and school involvement for mothers with children with and without special needs. Forty percent of the mothers reported having at least one child with special needs. Twice as many mothers who did not complete the eighth grade had a child with a disability. Significant differences were found in marital status, mother's retention in school, mother reporting having special needs in school and receiving services, amount of homework, and writing notes to the teacher. Almost all mothers reported being somewhat involved in school. Results suggest that poverty may be a more salient factor in educational considerations than disability. Suggestions for educators include providing special programs for female students with disabilities, considering the material and emotional hardships of poor families when designing family involvement programs, and acting as an advocate for comprehensive anti-poverty programs.

Home and Career Development: A Life History of Elia Hill Swann, 1878-1961, with Implications for Counseling

This study is based on a life history of a woman born in 1878 who, at the age of eighteen, left her farm home in an isolated rural area to make a life in an urban career. Her life history parallels and extends our understanding of the experience of modern day women who leave home for careers in distant areas. It is also an example of the experience of women of a rural diaspora. The results identify ways that home and memories of home can support women's career development over the lifespan. The qualitative data analyzed in this study leads to recognition of how home can support the launching as well as reinventing of a career by providing a source of strength for women who are far from home. In addition, a woman's home and reminiscence of home can provide a source of comfort and support during times of emotional or financial hardship. Women who are from outside the mainstream American urban/suburban culture, such as women whose homes are in rural or non-European American areas, need to be prepared for difficulties that can arise while becoming acculturated in a commercial, consumer culture. Finally, implications for counseling are discussed.

Comment

Lorence, Dworkin, Toenjes, and Hill have correctly identified me and my colleagues as critics of retention policies based on the evidence. But in their concluding section, they seriously misrepresent our work. They say that "proponents of social promotion would argue that the emotional hardships experienced by retained children and their parents are unnecessary because such children will mature sufficiently in a few years and will then be able to learn the required curriculum." This sounds like our summary of research on kindergarten readiness, kindergarten retention, and within-grade age effects, whereby we showed that kindergarten retention for reasons of social immaturity was unwarranted because within-grade age effects disappear. However, we explicitly distinguished kindergarten retention for reasons of immaturity from retention used as a remedy for poor academic performance. To my knowledge, no one who criticizes the effectiveness of retention as a means to improve achievement would claim that poor achievement can be overcome by [End Page 57] ignoring it. Instead, the argument would be to use instructional interventions that are more effective than repeating a grade in school.

Suffering from water: social origins of bodily distress in a Mexican community.

This article is an ethnographic analysis of what it means to "suffer from water." Using a critical medical anthropology approach, the study examines how residents living in a foothill community of the Valley of Mexico experience bodily distress associated with water scarcity. Data for the study come from participant-observation of domestic water use and community drinking water management as well as interviews with local civil and religious officials who monitor the water distribution system. While the community discourse on suffering from water does not correspond to biomedical categories of illness, it does speak to the physical and emotional hardships and the social conditions that limit residents' access to an adequate supply of domestic water. By taking a broad view of water-related suffering, the study reveals some of the efforts made by people to address what they consider to be the social origins of their bodily distress.

Individual emotion in work organizations

We are predisposed to thinking of emotions as our own, perhaps the most intimate parts of ourselves. Yet, more often than not, our emotions are inextricably bound up with other people and social worlds, with one of the most powerful of those being the organizational work context. The central premise of this article is that much of our social and emotional life is organizational. We begin with a view to the past, describing how, because of a focus on control, both management and scholars attempted to tightly delineate the emotions that could legitimately be expressed and recognized in work settings. Such tight control could not hold emotions at bay, however. Managers and scholars have recognized that individual feelings are often expressions of or reactions to organizational realities. We review two waves of what we loosely call current organizational research that acknowledges emotion. The first wave attempts to explain individual emotion in organizational terms, while the second wave focuses on the idea of culture. Looking toward the future, we conclude that attempts to quell and ignore emotion in organizations are recognized as outdated. The emerging alternative appears to be to somehow “manage” the beast called emotion at work. We call for future research that recognizes employees', customers', shareholders', and suppliers' emotions in designing organizational features such as cultures, routines, structures, and patterns of leadership. Yet we note that as emotion is being more and more managed, people are feeling more and more alienated. The managed emotions of organized work can become very attractive to people as a place to escape to from the emotional hardships of home and community. We suggest future research and policy pay attention to a growing paradox in the future of emotion: that as emotion is more and more organizationally managed, the less it feels truly emotional.

Hardships and personal strategies of Vietnam War nurses.

This study describes hardships faced in Vietnam and personal strategies used to deal with these hardships as defined by 24 female military nurses who served during the war. Purposive sampling was used, and data were generated using four core questions and in-depth interviews. The research methodology was phenomenology, incorporating data analysis procedures of Colaizzi, Lincoln and Guba, and Van Manen. Eight hardship and nine personal strategy themes were identified. This study found that caring for young, severely injured, and disfigured soldiers was a significant hardship and that nurses struggled with the moral dilemmas inherent in mass casualty situations, triage policies, and the practice of returning recovered soldiers to combat. Most nurses relied on personally proven and familiar strategies to reduce or buffer the effects of emotional hardships, whereas some discovered and used new strategies.

Can stress cause disease? Revisiting the tuberculosis research of Thomas Holmes, 1949-1961.

The increasing emphasis in medicine on treating the whole patient has focused attention of the association between emotions and disease. However, physicians have long studied the connection between mind and body. One particularly interesting researcher in this area was Thomas Holmes, a charismatic and iconoclastic Seattle physician who studied the association between stress and tuberculosis in the 1950s. Although lacking the sophistication of modern biostatistics, several of Holmes' studies suggested that persons who had experienced stressful situations, such as divorce, death of a spouse, or loss of a job, were more likely to develop tuberculosis and less likely to recover from it. Holmes consciously used the same scientific methods as his peers, devising a numeric scale that quantified stressful events and doing prospective studies with control groups. Yet, he also emphasized the need to understand each patient's story and to view his or her tuberculosis as the culmination of a life of emotional hardship. Although Holmes' work was rudimentary, his basic supposition may have been correct. Recent research, benefiting from advances in both immunology and biostatistics, suggests that stress may lead to decreased immune function and thus to clinical disease. As studies of stress and disease become more statistically sophisticated, it will be important to retain Holmes' emphasis on understanding the lives of individual patients.

The Mistaken Diagnosis of Child Abuse: A Three-Year USAF Medical Center Analysis and Literature Review

Medical personnel who evaluate children for child abuse and neglect (CAN) must be familiar with the many pediatric conditions that resemble CAN in order to avoid over reporting. During a 3-year period, a total of 504 suspected child abuse patients were evaluated by our CAN team. After preliminary evaluation, 264 (52%) of these cases were unsubstantiated. Eighteen of these 264 (7%) were initially considered as cases of CAN but were later proven to be conditions that were misdiagnosed as CAN. Thirteen of the 18 (72%) were readily diagnosed after consultation with a pediatrician or other health care consultant. Investigation of the remaining 5 patients (29%) was more difficult and more extensive, requiring a period of separation from the parents with consequent emotional hardship to the family. These conditions included (1) a patient with osteogenesis imperfecta type IV, (2) a patient with Ehlers-Danlos syndrome, (3) two patients with benign external hydrocephaly of infancy, and (4) a patient with Crohn's disease, who was evaluated for sexual abuse because of chronic abdominal pain. A comprehensive literature review of pediatric conditions that may mimic CAN is presented by diagnostic categories to assist clinicians in differentiating medical conditions that may simulate CAN. Methods to support parents who have been incorrectly reported are discussed.

UNDERSTANDING DISTRESSED FATHERS' PERCEPTIONS OF LEGAL AND RELATIONAL INEQUITIES POSTDIVORCE

This study examines distressed fathers' perceptions of inequity about their experiences related to the divorce process, custody, visitation, and child support. A content analysis of men's subjective responses to an open‐ended survey question revealed dissatisfactions with the legal system and emotional hardships associated with divorce. Fathers expressed strong negative feelings about discrimination from the legal system. Relational inequities centered around the ex‐wife and her perceived responsibility for problems with the courts and relationships with children.