title: The association of optimism and perceived discrimination with health care utilization in adults with sickle cell disease.
abstract: OBJECTIVE
  We evaluated the effect of perceived discrimination, optimism, and their interaction on health care utilization among African American adults with sickle cell disease (SCD).
  
  
  METHODS
  Measures of optimism and perceived discrimination were obtained in 49 African American SCD patients. Multiple regression analyses controlling for sex and age tested effects of optimism and perceived discrimination on the number of emergency department visits (ED) and number and duration of hospitalizations over the past year.
  
  
  RESULTS
  A perceived discrimination-optimism interaction was associated with number of emergency departments visits (b = .29, p = .052), number of hospitalizations (b = .36, p = .019), and duration of hospitalizations (b = .30, p = .045) such that those with high perceived discrimination/high optimism had the greatest health care utilization.
  
  
  CONCLUSIONS
  African American SCD patients with high perceived discrimination/high optimism had greater health care utilization than patients who reported either low perceived discrimination or low optimism. This study suggests that patient personality and coping styles should be considered when evaluating the effects of stress on SCD-related outcomes.
authors.affiliation: Department of Psychology and Neuroscience, Duke University Medical Center, Durham, North Carolina, USA.
authors.forename: Michael V
authors.initials: MV
authors.lastname: Stanton
authors.forename: Charles R
authors.initials: CR
authors.lastname: Jonassaint
authors.forename: Frederick B
authors.initials: FB
authors.lastname: Bartholomew
authors.forename: Christopher
authors.initials: C
authors.lastname: Edwards
authors.forename: Laura
authors.initials: L
authors.lastname: Richman
authors.forename: Laura
authors.initials: L
authors.lastname: DeCastro
authors.forename: Redford
authors.initials: R
authors.lastname: Williams
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D001741:Black or African American / Q000523:psychology*; D000755:Anemia, Sickle Cell / Q000208:ethnology / Q000523:psychology*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D011287:Prejudice; D012044:Regression Analysis