Waltz M
Soc Sci Med. 1986;22(8):791-805. doi: 10.1016/0277-9536(86)90233-9.
The development of a theory of quality of life following serious illness is currently an important field of endeavour in rehabilitation research. The interpersonal relationships of people and elements of the self-concept appear to be salient factors in causal models of subjective well-being. One such model developed to explain characteristic levels of well-being was used in a longitudinal study of adaptation to a first myocardial infarction. Data were collected from a national sample of male cardiac patients and their spouses on the illness and marital situation as predictors of long-term well-being or ill-being. Analyses of data from the first three waves of the study, which is to extend over 5 years after the onset of illness, are to be discussed in the paper. Marital status, the emotional quality of the spouse relationship and long-standing marital stressors were found to have direct and indirect effects on the two dimensions of the Bradburn Affect Balance Scale. The same is true of continuing problems associated with the heart attack relative to perceptions of having coped effectively with the after effects of illness. Differences in self-esteem and personal competence were suggested as mediators of socio-environmental and illness-related influences. The two-factor conception of well-being developed was found to be a useful framework for investigating positive and negative aspects of psychosocial rehabilitation. The same factors that explain differences between happy and unhappy people in social indicators research also appeared to be determinants of different trajectories of adaptation in the wake of a life-threatening illness. Previous research using theoretical models from stress research has overemphasized psychosocial morbidity and stress management and neglected positive processes of adaptation. The identification of love resources related to positive feeling states and life satisfaction has, therefore, not received the attention it deserves. This is especially the case regarding an overemphasis of the concept of social support as a buffer of stress. Instruments were developed to measure high and low marital intimacy, as well as chronic marital role strains, and these measures appeared to explain different trajectories of adjustment to cardiac disease. The two-factor model appears to be useful for future work on quality of life with chronic illness. The same is true of four marital contexts of rehabilitation that were identified in the study.
重病后生活质量理论的发展是目前康复研究中一个重要的努力领域。人际关系和自我概念的要素似乎是主观幸福感因果模型中的显著因素。在一项关于首次心肌梗死适应情况的纵向研究中，使用了一个为解释幸福感特征水平而构建的模型。从全国范围内选取男性心脏病患者及其配偶作为样本，收集关于疾病和婚姻状况的数据，将其作为长期幸福或不幸的预测因素。本文将讨论该研究前三轮的数据，该研究将在疾病发作后持续5年。研究发现，婚姻状况、配偶关系的情感质量以及长期存在的婚姻压力源对布拉德伯恩情感平衡量表的两个维度有直接和间接影响。与心脏病发作相关的持续问题相对于对有效应对疾病后遗症的认知也是如此。自尊和个人能力的差异被认为是社会环境和疾病相关影响的调节因素。所提出的幸福感双因素概念被发现是研究心理社会康复积极和消极方面的有用框架。在社会指标研究中解释快乐和不快乐人群差异的相同因素，似乎也是危及生命疾病后不同适应轨迹的决定因素。以往使用压力研究理论模型的研究过度强调心理社会发病率和压力管理，而忽视了积极的适应过程。因此，与积极情绪状态和生活满意度相关的爱的资源的识别没有得到应有的关注。尤其在过度强调社会支持概念作为压力缓冲方面更是如此。开发了测量高低婚姻亲密度以及慢性婚姻角色压力的工具，这些测量似乎可以解释对心脏病的不同调整轨迹。双因素模型似乎对未来慢性病生活质量的研究有用。该研究中确定的四种婚姻康复背景也是如此。
