Family structure in relation to health and disease: A review of the literature

Marital status is related to morbidity and mortality, with married people healthier and at lower risk of death than those who are unmarried (especially among men). However, the relationship between marital status and obesity is not well established. Role theory suggests through a marital causation model that people in the marital role are more likely to be obese, and through a marital selection model that people in the marital role are less likely to be obese because of stigmatization. The marital causation model was examined using data from the National Survey of Personal Health Practices and Consequences, a cross-sectional national telephone survey of 3025 adults age 20–64 in the United States. Sequential regression analyses revealed that married men were significantly fatter and more likely to be obese than never married or previously married men, even when demographic, social, and physical variables were controlled. By contrast, marital status was not significantly associated with fatness or obesity among women when other variables were controlled. The marital role appears to influences fatness and obesity among men, but not women.

The relationship among recent life stress, social support, a patient's locus of control, and the control of blood glucose is evaluated in persons with diabetes mellitus, using objective measures of these psychosocial variables. Short-term [fasting blood sugar (FBS)] and long-term [glycosylated hemoglobin (Hgb A-1C)] control measures are taken at two points in time in order to evaluate the effects of the psychosocial variables on change in diabetes control. For life events, a significant positive association was found between the number of recent life events and blood glucose control. Decrease in social support predicted a worsening of longer-term (Hgb A-1C) control over time. An external locus of control within the patient was associated both with poor short-term control at time one and prediction of poorer long-term control over time. The implications of these findings are discussed in support of a biopsychosocial approach to the management of diabetes mellitus.

This study evaluated objectively the relationship between recent life events, social support systems, and blood glucose control in diabetic patients using both short-term [fasting blood sugar (FBS)] and long-term ([glycosylated hemoglobin (Hgb A-1C)] measures of control. We found that a higher number of life events was associated with a higher percentage of abnormal FBS and Hgb A-1C results, and that improved social support was associated with a smaller percentage of abnormal Hgb A-1C scores. These pilot findings are discussed in connection with a biopsychosocial approach to the understanding and management of diabetes mellitus.

Considerable attention has been paid to the role of the family as a system in its own right, rather than the individual patient, as the fundamental unit of health care delivery. Despite the apparent validity of this concept, many important questions remain unanswered. Among these are: (1) Is there sufficient understanding of family pathophysiology, of the sensitivity and specificity of diagnostic techniques and of the safety and efficacy of therapeutic modalities to make true family health care possible? (2) If this type of care is possible, how are the needs of the family and its individual members met, or value judgements made about their relative importance? and (3) What are the consequences for the health care delivery system of this type of care? An extensive literature review is used in an attempt to answer these queries, from which questions for further study are posed.

This article reviews a broad range of clinical and research material investigating the coping processes of individuals and families, particularly in response to a serious illness or handicapping condition in a child family member. The interactive effects of family and illness are established; then several theoretical, descriptive and empirical theories of coping are presented. Coping responses of family members and the family unit as a whole to minor illness, to chronic illness and handicapping conditions, to childhood cancer, and to death in childhood are all discussed. The article concludes with a discussion of the implications and benefits for the physician and other health care professionals in adopting a family-oriented treatment approach.

Social support may be defined as the social ties an individual has, and which lead the subject to believe that he is cared for. The present study describes research on the hypothesis that social support protects the person against the noxious effects of job stress and will keep the strain and health effects low. A short review of relevant literature is given and 6 hypotheses about the role of support are tested; 3 about the interactive effects and 3 about the main effects. The study resembles the work of LaRocco, House and French, although there are some differences. Like these authors, a moderated regression technique was used on data from a sample of 1246 employees of 13 different industrial organizations. The analysis shows that social support buffers the impact of work-related stressors on psychological and behavioral strains but that there is no such a buffering effect on health strains. A very striking result was the strong buffering effect against employee's high blood pressure (SBP andDBP), of the supervisor giving support in the case of psychological problems.