Perceived family stress as a predictor of health-related outcomes
G. R. Parkerson Jr, W. E. Broadhead and C. K. Tse
Department of Community and Family Medicine, Duke University Medical Center, Durham, NC.
OBJECTIVE: To measure the predictive effect of patient-perceived family
stress for health-related outcomes. DESIGN: Prospective study of patients
whose social stress and support were measured by self-report at baseline
with the Duke Social Support and Stress Scale and used as predictors of
outcomes during an 18-month follow-up period. SETTING: Rural primary care
community health clinic. PATIENTS: Convenience sample of ambulatory adults.
INTERVENTION: None. MAIN OUTCOME MEASURES: Follow-up (one or more follow-up
visits), frequent follow-up (more than six visits), referral and/or
hospitalization (one or more), high follow-up severity of illness
(upper-tertile mean Duke Severity of Illness Checklist scores), and high
follow-up total charges (> or = $268). RESULTS: There were 413 patients
with a mean age of 40.4 years. Of these, 58.6% were women; 47.2%, African
American; 52.8%, white; 56.7%, married; 77.2%, wage earners or
housekeepers; and 52.3% had more than one health problem. At baseline,
patients with high self-reported family stress (upper-tertile Duke Social
Support and Stress Scale scores) had lower quality of life, functional
health, and social support scores and higher dysfunctional health and
social stress scores than other patients. High baseline family stress
scores (scale of 0 to 100) predicted follow-up (odds ratio [OR] = 1.014),
frequent follow-up (OR = 1.021), referral and/or hospitalization (OR =
1.018), high severity of illness at follow-up (OR = 1.016), and high
follow-up charges (OR = 1.018) after controlling for the effects of social
support, age, gender, and race. Family stress scores were stronger
predictors of these outcomes than the other social stress and support
variables. CONCLUSION: The finding of patient-perceived family stress as a
risk factor for unfavorable health-related outcomes suggests the need for
early detection and treatment of family stress by family physicians.
