title: Bifurcating effects of hope and support in short- and long-term health outcomes among primary care patients without mental illness.
abstract: BACKGROUND
  Adverse life events and stressors can lead to symptoms, increased alcohol intake, and impaired functional status, while hope and social support can mitigate such adverse effects. Yet, there is reason to question such simple, linear relationships among healthy adults. The purpose of this study was to assess whether short-term or long-term changes in alcohol intake, psychological symptoms or functional status were better modelled as cusp catastrophic or linear processes among primary care patients without mental illness.
  
  
  METHODS
  This secondary analysis of a study on the stability of psychological symptoms among primary care patients without mental disorders included 38 subjects who completed baseline, and 2-month and/or 6-month assessments of psychological symptoms, functional status and stressors as well as hope and social support. The analyses modelled short-term and long-term changes in alcohol intake, psychological symptoms and functional status using cusp catastrophe (CCM) and linear modelling.
  
  
  RESULTS
  Overall, four of the nine 2-month analyses found CCM superior to linear models; however, only one 6-month analysis (alcohol intake) found that CCM was superior. The 2-month cusp phenomena included both symptomatology and functional status. The asymmetry variables were often not significant in the CCM models; in fact, only distress was significant at all. While hope was a significant bifurcation variable at both the 2-month and 6-month levels, social support was a significant bifurcation variable for three of the four 2-month CCMs.
  
  
  CONCLUSIONS
  In conclusion, while 6-month outcomes were rarely explained through CCM, half of 2-month outcomes were. Hope and support demonstrated bifurcation effects.
authors.affiliation: Family & Community Medicine, University of Texas Health Science Center, San Antonio, Texas, USA.
authors.forename: David
authors.initials: D
authors.lastname: Katerndahl
mesh_terms: D000428:Alcohol Drinking; D005260:Female; D065026:Hope; D006801:Humans; D008297:Male; D008960:Models, Psychological; D010361:Patients / Q000523:psychology*; D011320:Primary Health Care; D036301:Qualitative Research; D011788:Quality of Life; D012944:Social Support; D016896:Treatment Outcome
keywords: alcohol use; hope; non-linear dynamics; quality of life; social support; symptomatology