Depression, Disability & Coping in Midlife

描述（由申请人提供）：NIH R03 （PA-03-108）。这项研究的主要目的是为了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），影响了930万45至64岁的美国人（the Lighthouse, Inc., 1995）。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）进行的一项先前研究的证据表明，与老年人相比，中年人患临床相关抑郁水平等后续精神健康问题的风险往往更高（Boerner, 2004）。此外，残疾可能会干扰成年人在这个阶段对目标的追求，这可能会导致日常生活的严重中断和情绪困扰（Wheeler & Munz, 1990）。针对生命周期适应过程的研究表明，在丧失和衰退的情况下，适应性应对方法包括调整个人目标和偏好的能力，使其成为可行的，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年）。一项针对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，还应评估一个人应对目标干扰的具体日常应对能力（Horowitz et al, 2005）。因此，本研究旨在通过评估中年人的重要生活目标、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，来描述一个迄今未被充分研究的群体——有视力障碍的中年人的情况。具体目标是：1.；确定对有视力障碍的中年人来说重要的生活目标。2. 探讨视觉障碍和功能障碍对特定生活目标的干扰程度，以及视觉障碍患者如何处理这种干扰。3. 目的探讨视觉相关目标干扰对心理健康的影响，包括一般应对倾向和情境特定应对。4. 探讨一般应对倾向与情境应对的关系，以及性格应对和情境应对对心理健康的差异影响。将从社区视力康复机构招募200名中年人。采用结构方程模型（SEM）检验障碍状态、目标干扰和应对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.