Depression, Disability & Coping in Midlife

描述(申请人提供)：NIH R03(PA-03-108)。这项拟议研究的主要目标是更好地了解中年慢性残疾的影响和后果。视力障碍是中老年人中第二常见的残疾(NCHS，1993年)，影响了930万年龄在45岁至之间的美国人(The LighTower，Inc.，1995年)。尽管人们对中年人如何处理这种残疾知之甚少，但最近由首席研究员(NIMH 1 R03 MH65382，K.Boerner，Pi)进行的一项研究表明，与老年人相比，中年人出现后续心理健康问题的风险往往更高，例如临床相关的抑郁症水平(Boerner，2004)。此外，残疾很可能会干扰对成年生活这一阶段常见目标的追求，这可能会导致日常生活和情绪困扰的显著中断(Wheeler&Munz，1990)。关于一生中适应过程的研究表明，在损失和衰退的情况下，适应性应对方法涉及到将一个人的目标和偏好调整为可行的能力，而不是试图追求受阻的目标(例如，Brandtstadter，1999)。PI先前的工作表明，这种应对倾向对报告视力相关残疾程度较高的中年人的心理健康特别有益(Boerner，2004)。一项关于老年人视力丧失的研究也有初步证据表明，除了性格应对倾向外，还应评估一个人具体的日常应对目标干扰的能力(Horowitz等人，2005年)。因此，这项拟议的研究试图通过评估他们的重要生活目标、他们的残疾对这些目标的干扰程度以及他们如何应对这种目标干扰来表征迄今未被研究的中年人群体的情况。具体目标是：1.确定对视障中年人重要的生活目标。2.探讨视力障碍和功能性残疾对特定生活目标的干扰程度，以及视力障碍个体如何应对这种干扰。3.考察视觉相关目标干预在一般应对倾向和特定情境应对中对心理健康的影响。4.探讨一般应对倾向与情境应对之间的联系，以及倾向性应对和情境应对对心理健康的不同影响。200名中年成年人将从一家社区视力康复机构招募。结构方程模型将被用来检验损害状态、目标干扰和应对方式对心理健康结果的直接和间接影响。

DESCRIPTION (provided by applicant): NIH R03 (PA-03-108). The primary goal of the proposed research is to better understand the implications and consequences of a chronic disability in middle adulthood. Vision impairment is the second most prevalent disability among middle-aged and older adults (NCHS, 1993), affecting 9.3 million Americans between the ages of 45 and 64 (The Lighthouse, Inc., 1995). Although little is known about how middle-aged adults deal with such a disability, recent evidence from a prior study conducted by the principal investigator (NIMH 1 R03 MH65382, K. Boerner, PI) shows that the risk for subsequent mental health problems such as clinically relevant levels of depression tends to be higher for middle-aged compared to older adults (Boerner, 2004). Also, the disability is likely to interfere with the pursuit of goals common during this point of adult life, which can result in a significant interruption of daily routines and emotional distress (Wheeler & Munz, 1990). Research addressing the process of adaptation over the life span has shown that, in the case of loss and decline, adaptive coping approaches involve the ability to adjust one's goals and preferences to what is feasible instead of trying to pursue blocked goals (e.g., Brandtstadter, 1999). Prior work by the PI demonstrated that such coping tendencies were particularly beneficial for the mental health of middle-aged adults who reported high levels of vision-related disability (Boerner, 2004). There is also preliminary evidence from a study of vision loss among older adults suggesting that a person's concrete day-to-day coping with goal interference should be assessed in addition to dispositional coping tendencies (Horowitz et al, 2005). Thus, the proposed research seeks to characterize the situation of a thus far understudied group, middle-aged adults with visual impairment, by assessing their important life goals, the extent to which their disability interferes with these goals, and how they cope with this goal interference. Specific aims are: 1.To identify the life goals that are important to middle-aged adults with a visual impairment. 2. To explore the extent to which visual impairment and functional disability interfere with particular life goals, and how individuals with visual impairment deal with this interference. 3. To examine the effect of vision-related goal interference on mental health, as mediated by both general coping tendencies as well as situation-specific coping. 4. To explore the links between general coping tendencies and situation-specific coping, as well as the differential effects of dispositional and situational coping on mental health. 200 middle-aged adults will be recruited from a community-based vision rehabilitation agency. Structural Equation Modeling (SEM) will be employed to test the direct and indirect effects of impairment status, goal interference, and coping on mental health outcome.