Objective
To measure the predictive effect of patientperceived 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 (
$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.
