CALIFORNIA STATE UNIVERSITY SAN MARCOS THESIS SIGNATURE PAGE THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE MASTER OF ARTS IN PSYCHOLOGY THESIS TITLE Optimism, Social Support and Coping with Miscarriage AUTHOR: Carolyn J. Parker DATE OF SUCCESSFUL DEFENSE: May 6, 2003 THE THESIS HAS BEEN ACCEPTED BY THE THESIS COMMITTEE IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF ARTS IN PSYCHOLOGY Dr. Heike I.M. Mahler 4~ J. mqv.)J4. _d~s THESIS COMMITTEE CHAIR (TYPED) SIGNATURE DATE Dr. Joanne Pedersen J'"'-C:- OJ THESIS COMMITTEE MEMBER (TYPED) DATE Dr. Gerardo M. Gonzalez .cJ,It,~_ THESIS COMMITTEE MEMBER (TYPED) ~ Coping with Miscarriage 1 ABSTRACT This project was designed to examine whether individual differences in perceived social support and dispositional optimism predict coping with miscarriage. In Study 1, approximately 20 couples who had recently experienced a miscarriage were interviewed and administered measures of social support, dispositional optimism, grief (coping), helpful and unhelpful support received, and perceived severity of miscarriage relative to other types of losses. The interviews and questionnaire administration took place at three time points (between 1 and 20 days after miscarriage, 6 weeks, and 12 weeks following miscarriage). Females who more frequently mentioned their spouse as a support person were coping better at intake than females who less frequently mentioned their spouse as a support person. Additionally, spouses who scored higher in optimism were coping better at intake than spouses who scored lower in optimism. Furthermore, there were significant differences in coping between women and their partners at intake and 12-weeks. Finally, grief at intake was significantly associated with grief at 6-weeks and 12- weeks for both males and females. In Study 2, a comparison group of 42 people who had never experienced a miscarriage were interviewed to determine their perceived severity of miscarriage relative to other types of losses and the frequency that they would perform specific behaviors in an effort to provide support to someone who had experienced miscarriage. These specific support behaviors were categorized using the comparison groups' frequency rating and then compared to the miscarriage groups' perceptions of helpfulness. As expected, those behaviors that the comparison group stated they would do with high frequency, moderate frequency, and low frequency were found to be very helpful, moderately helpful, and not too helpful (respectively) by miscarriage participants. Coping with Miscarriage 2 Social Support, Dispostional Optimism and Coping With Miscarriage It has been estimated that miscarriage (the unplanned spontaneous termination of a pregnancy prior to twenty weeks of gestation) occurs in 15-20% of known pregnancies (Layne, 1990; Pizer, & Palinski, 1980). Experiencing a miscarriage can be a very stressful event. In addition to the physical effects of miscarriage (e.g., pain, bleeding, hospitalization for evacuation of the uterus [D&C]) (Friedman, & Gath, 1989; Laferla, 1986), many women and their partners experience significant emotional effects, such as anxiety, uncontrollable crying, depression, and fears that they will never have a child (Laferla, 1986; Beutel, Deckardt, Von Rad, & Weiner, 1984; Kirkley-Best & VanDevere, 1986; Lasker & Toedter, 1994; Madden, 1988; Moscarello, 1989; Neugebauer, Kline, O'Connor, Shrout, Johnson, Skodol, Wicks, & Susser, 1992; Neugebauer, Kline, Shrout, Skodol, O'Connor, Geller, Stein, & Susser, 1997; Prettyman, Cordlel, & Cook, 1992;, Thapar & Thapar, 1992). Indeed, it has been documented that up to 33% of women develop severe psychological disturbances following miscarriage (Neugebauer, et al., 1992; Katz & Kuller, 1994; Neugebauer, et al., 1997) and that the emotional effects of miscarriage can last for months or even years (Kirkley-Best & VanDevere, 1986; Rajan, & Oakley, 1993). Such disturbances may lead to diminished work activity or absence, along with a generalized lower quality of life for each individual. Although most women who suffer a miscarriage and their partners experience some negative psychological effects, there are individual differences in the degree and time course of the effects (Black, 1991). That is, some individuals cope more effectively than others (James & Kristiansen, 1995) .. Two individual difference factors that have been linked with adjustment to or coping with various major Coping with Miscarriage 3 stressers are perceived social support and dispositional optimism (Collins, Dunkel­ Schetter, Lovel & Scrimshaw, 1993; Scheier, Weintraub, & Carver, 1986; VanderPlate, Aral, & Magder, 1988).' Positive and Negative Social Support Although consensual definitions remain elusive, social support is generally conceptualized as a multidimensional construct consisting of emotional support (feedback that one is valued, loved, and/or respected by others), information support (provision of information or advice), and instrumental or tangible support (provision of material aid or direct help) (House, 1981; Wills, 1991). Social support can be further discriminated into positive and negative support (also referred to as social conflict, social hindrance, or social undermining). Most previous research has examined the effects of positive social support. Some of the benefits of positive social support include lower rates of psychological distress (Billings & Moos, 1982; Kaplan, Robbins, & Martin, 1983; Jones, 1991; Felston, 1998), reduced risk of mortality (Berkman, 1985; House, Umberson, & Landis, 1988), higher compliance with doctors recommendations (Christensen, Smith, Turner, Holman, Gregory & Rich, 1992; Kulik & Mahler, 1993), and faster recovery following surgery (Mahler & Kulik, 1989). Additionally, positive social support is related to bereavement outcome after the loss of a child (Littlewood, Cramer, Hoekstra, & Humphrey, 1991; Brabant, Forsyth, & McFarlain, 1995; Hazzard, Westin & Gutierres, 1992). Specifically, higher levels of social support have been shown to be related to greater well being for both mothers and fathers (Hazzard, et al., 1992; Mcintosh, Silver, & Wortman, 1993). Not only are there physical and psychological benefits to having social support during stressful periods (Heitzman & Kaplan, 1984; Leana & Feldman, 1991; Kissane & MacKenzie, 1997), there are also physical and psychological costs when social Coping with Miscarriage 4 support is absent (Black, 1991; James & Kristianson, 1996), especially in individuals where the need for social support is high (Kaplan, et al., 1983). Thus, in general, the literature is consistent; positive social support is related to more effective coping with a wide variety of stressers. Negative social support has been conceptualized as behaviors directed toward an individual that convey negative affect (e. g. anger, irritation) or negative evaluation (e.g. criticism) and which hinder the attainment of instrumental goals (Vinokur & Van Ryn 1993). It is becoming increasingly apparent that positive and negative social support are not necessarily opposite poles of the same construct (Abbey, Abrarnis, & Caplan, 1985). In fact, recent work suggests that positive and negative social support may independently and uniquely contribute to well being. Among students, the more social conflict they received from any one person in their life, the greater was students' anxiety, depression, interpersonal sensitivity, and the less pleasant quality of life they experienced (Abbey, Abramis, & Caplan, 1985). Furthermore, Stephen, Kinney, Norris, and Ritchie (1987) investigated positive and negative aspects of social support between geriatric stroke victims and their family members after the patients' returned horne from a rehabilitation facility. Even though negative interactions (e.g. receiving unwanted advice) were reported less often than were positive ones, only negative ones were related to the patients' psychological adjustment. Due to the apparent importance of negative social support to an individual, it is necessary to better understand how this type of support affects coping with stressful events. Gender Differences and Received Social Support Although social support has generally been demonstrated to be beneficial for both genders, there is some evidence that men and women cope with stress Coping with Miscarriage 5 differently. An experimental study by Kirschbaum, Klaueer, Filipp, and Hellhammer (1995) found that males facing a threatening situation exhibited a reduced stress response if their female partners were present as compared to absent. In the same vein, a laboratory study by Glynn, Christenfeld, and Gerin (1999) indicated that support from females lowered physiological reactivity in males and females during impromptu speeches. They concluded that support from women may be more effective than support from a man, when it comes to dampening physical reactivity. In two separate studies, in a sample of college students (Felston, 1998) and the unemployed (Malen & Stroh, 1998) women more often sought social support than men. When coping with job loss, both men and women fared better when more as opposed to less social support was utilized, however, the effect may be stronger for women (Leana & Feldman, 1991). Furthermore, in diabetic patients, males who expressed more satisfaction with their social support had poorer metabolic control than did males with lower social support. Conversely, females exhibited the opposite pattern. Females