Camille B. Wortman, Ph.D. - US grants

Physicians influence the well-being of many Americans, yet themselves face high risks of mental distress, alcoholism, drug abuse, and stress-related disorders. This research traces physicians from medical school through early career years to examine antecedents of mental health and distress. The major purposes of this project are threefold: (1) to identify the major strains that are encountered in both the professional and personal roles during early years of practice; (2) to examine the impact over time of several variables suggested by the literature to be important risk factors for this population, including role strains, as well as physicians' values; the fit between aspirations and achievement; and the fit between skills acquired during training and professional role demands; and (3) to examine the impact of social support and coping strategies in moderating the relationship between these risk factors and mental distress. Toward these ends, the investigators propose to conduct a rigorously designed longitudinal study. This study would utilize a unique longitudinal database from several cohorts of students enrolled in structurally diverse programs at The University of Michigan. The investigators plan to supplement this database by interviewing a subsample of 200 respondents during their first year of practice and again 18 months later. The research would provide information on antecedents of physician impairment, help identify individuals who are at risk, discover factors associated with mental health, and aid in the design of effective interventions to prevent or alleviate impairment.

This proposal seeks support for five years to continue a comprehensive, multidisciplinary investigation of conjugal bereavement. Ultimate goals of the project are to broaden our knowledge base regarding this life stressor, and to help clarify the theoretical mechanisms through which bereavement influences subsequent physical and mental health. During the past five years, we have had the opportunity to collaborate on a large-scale interdisciplinary study of stress, health and adaptation across the lifespan, in which a national probability sample of respondents (n = 3,617) was interviewed in 1986 and again in 1989. By including a component on widowhood, we have developed the first nationally representative study (n = 804 at Wave 1 and 616 at Wave 2) of conjugal loss. The project also includes two prospective components, one of which has already been completed, and involves those respondents who lost their spouse between waves of this large-scale survey (n = 92). The second prospective study is currently underway in the Detroit area, where older couples are interviewed prior to the loss of their spouse (n = 1,532). By monitoring state death records, bereaved respondents and matched controls are located and recruited to take part in follow-up interviews at regular intervals thereafter (6-8 months, 18 months, 37 months, and 61 months following the death). In addition, biomedical data are collected from a subsample of the baseline respondents and from all of those who become widowed. Funds are requested to continue analytic efforts on the large-scale, nationally representative study and the national prospective study, and to continue ongoing data collection, and analysis, in the Detroit study. The major aims of this study are to specify the impact of widowhood on mental and physical health, and to clarify the long-term consequences of conjugal loss; to clarify sex. age, and race differences in response to widowhood; to determine the role played by pre-crisis coping resources, such as social support, on the bereaved person's response to the loss and on the course of recovery; and to delineate the theoretical mechanisms through which particular coping resources may protect the bereaved from subsequent problems in mental and physical health.