title: Perceived family stress as a predictor of health-related outcomes.
abstract: OBJECTIVE
  To measure the predictive effect of patient-perceived family stress for health-related outcomes.
  
  
  METHODS
  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.
  
  
  METHODS
  Rural primary care community health clinic.
  
  
  METHODS
  Convenience sample of ambulatory adults.
  
  
  METHODS
  None.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Community and Family Medicine, Duke University Medical Center, Durham, NC.
authors.forename: G R
authors.initials: GR
authors.lastname: Parkerson
authors.forename: W E
authors.initials: WE
authors.lastname: Broadhead
authors.forename: C K
authors.initials: CK
authors.lastname: Tse
mesh_terms: D000328:Adult; D004194:Disease / Q000523:psychology*; D005190:Family / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D011320:Primary Health Care; D011446:Prospective Studies; D011788:Quality of Life; D012423:Rural Health; D012720:Severity of Illness Index; D012938:Social Perception; D012944:Social Support; D013315:Stress, Psychological; D011795:Surveys and Questionnaires