Konstruksi BerpikirKonstruksi Berpikir

Filsafat Ilmu KesmasFilsafat Ilmu Kesmas

Veni HadjuVeni Hadju

Marital Status, Marital Quality, Marital Status, Marital Quality, and Atherosclerotic Burden inand Atherosclerotic Burden in

Postmenopausal WomenPostmenopausal Women

LINDA C. GALLO, PHD, WENDY M. TROXEL, MS, LINDA C. GALLO, PHD, WENDY M. TROXEL, MS, LEWIS H. KULLER, MD, DRPH, KIM SUTTON-LEWIS H. KULLER, MD, DRPH, KIM SUTTON-

TYRRELL, DRPH,TYRRELL, DRPH,DANIEL EDMUNDOWICZ, MD, AND KAREN A. DANIEL EDMUNDOWICZ, MD, AND KAREN A.

MATTHEWS, PHDMATTHEWS, PHD

Psychosomatic Medicine 65:952–962 (2003)

by the American Psychosomatic Society

From SDSU/UCSD Joint Doctoral Program in Clinical Psychology, SanDiego State University (L.C.G.), the Department of Psychology

(W.M.T.), and the Graduate School of Public Health (L.H.K., K.S.T), University of Pittsburgh, and the Departments of Psychiatry (K.A.M.)

and Medicine (D.E.), University of Pittsburgh School of Medicine, Pittsburgh, PA.

Address correspondence and reprint requests to: Karen A. Matthews, Department of Psychiatry, University of Pittsburgh School of Medicine,

3811 O’Hara Street, Pittsburgh, PA 15213.

Received for publication January 22, 2003; revision received April 11, 2003. This research was supported by NHLBI grant HL28266, the

Pittsburgh Mind Body Center (HL65111 and HL65112), NIH training grant HL07560, and by NIMH grant MH6610101.

DOI: 10.1097/01.PSY.0000097350.95305.FE

Summary: Marriage confers health benefits for men, but the evidence for women is less consistent. Inconsistent findings may be attributed, in part, to the confounding of marital status and marital quality. Objectives: The authors examined whether women in satisfying marriages evidence lesser atherosclerosis relative to women in low-satisfying marriages and relative to unmarried women. Materials and Methods: Three hundred ninety-three women from the Healthy Women Study participated in this study. Marital status and quality were assessed at baseline when women were premenopausal. Cardiovascular risk factors were also assessed at baseline to determine potential mediators. Markers of atherosclerotic burden—B-Mode ultrasound measures of intima-media thickness and plaque in the carotid arteries and electron beam computed tomography assessments of calcification in the aorta and coronary arteries—were performed, on average, 11 years and 14 years later, respectively. A subset of women underwent a second ultrasound scan approximately 3 years after their first scan. Results: Women in satisfying marriages had theleast atherosclerosis in the carotid arteries and aorta, especially relative to those in low-satisfying marriages. Women in satisfying marriages also tended to show less rapid progression of carotid atherosclerosis relative to women in low-satisfying marriages. Women who did not have a partner had intermediate levels of atherosclerosis. Risk factors measured at baseline contributed to the differences between the satisfied and low-satisfied groups, but not those between the satisfied and unmarried groups. Conclusions: High-quality marriages may protect against cardiovascular disease for women. Studies concerning marriage and cardiovascularhealth in women should, therefore, concurrently examine marital quality and marital status. Key words: atherosclerosis, calcification, marriage, stress, ultrasound.

Paragraf 1.Paragraf 1.

Previous research suggests that being married exerts ahealth-protective effect for men; the evidence for womenhas been less consistent (1,2). However, several lines of researchsupport the idea that being married should conferhealth benefits for men and women. First, marriage mayprotect against the well-documented risks associated withsocial isolation (3). Second, the positive involvement andactive influence of a spouse may promote health-enhancingbehaviors and deter health-damaging behaviors (4,5). Finally,marriage may affect health indirectly, by increasing socioeconomicresources, particularly for women (6).

Paragraf 2.Paragraf 2.

Given these assertions, why have some previous studiesfailed to identify salutary effects of marriage for women (1,2)?We hypothesize that inconsistent findings may reflect theconvention of grouping together all marriages, irrespective ofquality. That is, in studies concerning marital status, the positiveeffects of “healthy” marriages may be obscured by themarked, negative influence of discordant marriages. This assertionmay be particularly relevant for women, who showgreater emotional and physiological stress responses to martialconflict when compared with men (7).

Paragraf 3.Paragraf 3.

To date, only limited research has pursued the effects ofmarital relationship quality on cardiovascular health. In arecent study, marital distress predicted poorer prognosis (ie,cardiac death, acute myocardial infarction [MI], revascularization)in women recovering from MI or unstable angina (8).In another recent study, marital quality predicted survival timein congestive heart failure patients, somewhat more stronglyin women than in men (9). Helgeson (10) found that men whoreported disclosing to their wives were less vulnerable toevent recurrence after MI, relative to men who did not discloseto their wives. The effect was nonsignificant in women, possiblyconsequential to low power. Hence, preliminary evidencesuggests that marital quality influences outcomes inmale and female coronary heart disease (CHD) patients.

Paragraf 4.Paragraf 4.

In contrast, marital quality did not predict incident CHD inan initially healthy community sample (11). However, theoutcome included angina, which is a poor predictor of

coronaryatherosclerosis in women (12). To our knowledge, thiswas the only previous study to examine marital relationshipquality as a predictor of CHD incidence, rather than

outcomesin patient populations.

Paragraf 5a.Paragraf 5a.

Despite the lack of evidence, marital relationship qualitywould in theory influence the development of atherosclerosisby altering exposure to stress. Acute and chronic stresses arebelieved to hasten atherosclerosis by influencing hemodynamicand neuroendocrine responses and clotting processes(13). Consistently, laboratory studies have shown that maritalconflict leads to increases in blood pressure and heart rate,stress hormones, and alterations in immune functioning (14–16), often with heightened and/or prolonged responses inwomen when compared with men (7). Over time, these physiologicalresponses could affect resting blood pressure levels (17–19) and metabolic risk factors, such as elevations inplasma lipids (20,21) and glucose (22–24).

Paragraf 5b.Paragraf 5b.

Marital distresscould also affect CHD risk indirectly, by increasing exposureto behavioral and psychosocial risk factors (7, 25). Conversely,being in a harmonious marriage could protect againstatherosclerosis by increasing material and social support resources,thereby buffering the pathogenic consequences ofstress (26). Happy marriages may also facilitate health-promotingbehaviors (27) and enhance psychological adjustment(28). These findings suggest that individuals in supportivemarriages should experience a health advantage relative tothose without a partner and relative to persons in distressedmarriages.

Paragraf 6.Paragraf 6.

In support of these assertions, previous analyses from theHealthy Women Study (HWS) showed that women in highlysatisfying marriages had lower levels of behavioral, biological,and psychosocial cardiovascular risk factors measured onmultiple occasions across approximately 13 years when comparedwith women in less satisfying relationships and whencompared with unmarried women (29). In specific cases,women in satisfying marriages also showed less atherogenicrisk factor trajectories (ie, within person changes) across time.These results demonstrate the usefulness of examining maritalstatus and quality concurrently to assess the salubrious effectsof supportive relationships in women.

Paragraf 7.Paragraf 7.THE CURRENT STUDYThe current study used indicators of marital status andquality to examine whether women in highly satisfying maritalrelationships exhibit lower atherosclerotic burden whencompared with unmarried women (ie, single, divorced, orwidowed) and women in less satisfying marital relationships.We explored this association during middle age and the climacteric,when women’s risk for CHD increases substantially.In addition, we used state-of-the art methods for assessingatherosclerotic burden at presymptomatic stages. Objective,presymptomatic indicators of atherosclerosis provide an advantageover clinical CHD outcomes in terms of specificityand sensitivity. Many asymptomatic individuals have significantatherosclerosis, (30) and many with clinically debilitatingangina, particularly women, have no underlying occlusion(12). By quantifying atherosclerosis before the appearance ofsymptoms, these measures also reduce the possible reverseimpact of poor cardiovascular health on marital quality.

Paragraf 8.Paragraf 8.We examined atherosclerotic burden in the carotid arteriesthrough carotid ultrasound and in the coronary arteries andaorta through electron beam computed tomography (EBCT).We also examined atherosclerotic progression in the carotidarteries, in a subset of women who underwent two ultrasoundscans. We hypothesized that women in satisfying marriageswould exhibit lower levels of atherosclerosis across sites anda slower progression of atherosclerosis in the carotid arteries,relative to married women with lower marital satisfaction andto unmarried women. Based on previous research concerningthe probable routes through which being unmarried or being ina distressed marriage would lead to worse health outcomes, relative to being in a supportive relationship, we also examinedwhether cardiovascular risk factors assessed at baseline,including blood pressure, metabolic risk factors, and behavioraland psychosocial risk factors, mediated the associationsbetween marital grouping and atherosclerotic burden.

ReferenceReference

1. Litwak E, Messeri P. Organizational theory, social supports, and mortality rates: A theoretical convergence. Am Sociol Rev 1989;54:49–66.

2. Ross CE, Mirowsky J, Goldsteen K. The impact of the family on health: The decade in review. J Marriage Fam 1990;52:1059–1078.

3. Berkman LF, & Glass T. Social integration, social networks, social support, and health. In: Berkman LF, Kawachi I, eds. Social Epidemiology, New York, Oxford; 2000.

4. Rook KS. Social networks as a source of social control in older adults’ lives. In: Giles H, Coupland N, Wiemann J, eds. Communication, health,and the elderly, Manchester, England: University of Manchester Press; 1990:45–63.

5. Umberson D. Gender, marital status and the social control of health behavior. Soc Sci Med 1992;34:907–917.

6. Johnson NJ, Backlund E, Sorlie PD, et al. Marital status and mortality: the national longitudinal mortality study, Ann Epidemiol 2000;10: 224–238.

ReferenceReference7. Kiecolt-Glaser J, Newton N. Marriage and health: His and hers. Psych Bull

2001;127:472–503.

8. Orth-Gomer K, Wamala SP, Horsten M, et al. Marital stress worsens prognosis in women with coronary heart disease. JAMA 2000;284: 3008–3014.

9. Coyne JC, Rohrbaugh MJ, Shoham V, et al. Prognostic importance of marital quality for survival of congestive heart failure. Am J Cardiol 2001;88:526–529.

10. Helgeson VS. The effects of masculinity and social support on recovery from myocardial infarction. Psychosom Med 1991;53:621–633.

11. Haynes SG, Feinleib M, Kannel WB. The relationship of psychosocial factors to coronary heart disease in the Framingham Study. III. Eight-year incidence of coronary heart disease. Am J Epidemiol 1980;111:37–58.

12. Wilcosky T, Harris R, Weissfeld L. The prevalence and correlates of Rose questionnaire angina among women and men in the Lipid Research Clinics Program Prevalence Study. Am J Epidemiol 1987;125:400 – 409.

ReferenceReference

13. Krantz D, McCeney MK. Effects of psychological and social factors on organic disease: A critical assessment of research on coronary heart disease. Annu Rev Psychol 2002;53:341–369.

14. Broadwell SD, Light KC. Family support and cardiovascular responses in married couples during conflict and other interactions. Int J Behav Med 1999;6:40–63.

15. Kiecolt-Glaser JK, Glaser R, Cacioppo JT, et al. Marital conflict in older adults: endocrinological and immunological correlates. Psychosom Med 1989;59:339–349.

16. Mayne TJ, O’Leary A, McCrady B, et al. The differential effects of acute marital distress on emotional, physiological and immune functions in maritally distressed men and women. Psychol and Health 1997;12:277–288.

17. Markovitz JH, Raczynski JM, Wallace D, et al. Cardiovascular reactivity to video game predicts subsequent blood pressure increases in young men: The CARDIA study. Psychosom Med 1998;60:186–191.

18. Matthews KA, Woodall KL, Allen MT. Cardiovascular reactivity to stress predicts future blood pressure status. Hypertension 1993;22:479–485.

ReferenceReference

19. Stewart JC, France CR. Cardiovascular recovery from stress predicts longitudinal changes in blood pressure. Biol Psychol 2001;58:105–120.

20. Burker EJ, Fredrikson M, Rifai N, et al. Serum lipids, neuroendocrine, and cardiovascular responses to stress in men and women with mild hypertension. Behav Med 1994;19:155–161.

21. Stoney CM, Bausserman L, Niaura R, et al. Lipid reactivity to stress:II. Biological and behavioral influences. Health Psychol 1999;18:251–261.

22. Alvarez MA, Portilla L, Gonzalez R, Ezcurra E. Insulin response to a short stress period, Psychoneuroendocrinology. 1989;14:241–244.

23. Cesana G, Panza G, Ferrario M, et al. Can lycosylated hemoglobin be a job stress parameter? J Occup Med 1985;27:357–360.

24. Vitaliano PP, Scanlan JM, Krenz C, et al. Insulin and glucose: relationships with hassles, anger, and hostility in nondiabetic older adults. Psychosom Med 1996;58:489–499.

ReferenceReference

25. Burman B, Margolin G. Analysis of the association between marital relationships and health problems: an interactional perspective. Psychol Bull 1992;112:39–63.

26. Uchino BN, Cacioppo JR, Kiecolt-Glaser JK. The relationship between social support and physiological processes: A review with emphasis on underlying mechanisms and implications for health. Psychol Bull 1996;119:488–531.

27. Wickrama KAS, Lorenz FO, Conger RD. Marital quality and physical illness: A latent growth curve analysis. J Marriage Fam 1997;59:143–155.

28. Zlotnick C, Kohn R, Keitner G, Grotta SAD. The relationship between quality of interpersonal relationships and major depressive disorder: findings from the National Comorobidity Survey. J Affect Disord 2000;59:205–215.

29. Gallo LC, Troxel WM, Matthews KM, et al. Marital role occupancy and quality in middle aged women: prediction of the levels and trajectories of cardiovascular risk factors. Health Psychol in press.

30. Kannel WB, Abbott RD. Incidence and prognosis of unrecognized myocardial infarction. An update on the Framingham study. N Engl J Med 1984;311:1144–1147.

RDSRDS

• Dimana para penulis bekerja?• Gambarkan konstruksi berpikir yang dilakukan

oleh peneliti• Berapa buah reference yang digunakan dalam

Bab Introduction, sebagai Reference Primer dan Reference Sekunder?

• Berapa Nama Jurnal yang digunakan oleh Peneliti dalam Bab ini?

• Apa pendapat Anda? Berikan komentar dalam 10 kalimat (1 halaman hand writing)

Konstruksi Berpikir (TUGAS)Konstruksi Berpikir (TUGAS)

• Buatlah konstruksi berpikir dari masalah penelitian yang telah Anda buat untuk Tugas yang lain

• Caranya:– Buatlah kalimat pertanyaan (research question)

tentang masalah yang ingin Anda teliti– Jawablah MENGAPA Anda ingin meneliti masalah

tersebut– Kembangkan jawaban tersebut dengan membuat

beberapa paragraf (minimal 5 paragraf)– Tulislah kalimat inti dari setiap paragraf sebelum

Anda mengembangkannya menjadi paragraf utuh.– Kalimat inti harus diserahkan dalam waktu 3 hari kerja

(lewat email vhadju@indosat.net.id

• Paragraf inti tersebut harus memperlihatkan kontruksi berpikir Anda terhadap masalah Anda

• Selanjutnya, dari kalimat inti tersebut Anda dapat melengkapi menjadi paragraf utuh dengan menggunakan minimal 10 references (minimal 80% adalah artikel jurnal)

• Tugas paragraf utuh ini diberikan melalui email: vhadju@indosat.net.id