Journal of Research in Personality 42 (2008) 1352–1357
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Optimism and pessimism as predictors of physical and psychological health among grandmothers raising their grandchildren Francine Conway a,*, Carol Magai b, Carolyn Springer a, Samuel C. Jones b a b
Derner Institute of Advanced Psychological Studies, Blodgett 212 C, Adelphi University, One South Avenue, Garden City, NY 11530-0701, USA Long Island University, Brooklyn Campus, NY 11201, USA
a r t i c l e
i n f o
Article history: Available online 11 April 2008 Keywords: Optimism Pessimism Grandparent caregivers Physical health Psychological health Life Orientation Test Aging Ethnicity African American Latino
a b s t r a c t This study examines the role of personality in predicting psychological and physical health among grandmothers who are coping with a non-normative non-traumatic stressor, i.e. serving as primary caregivers for their grandchildren. Using the Life Orientation TestRevised (LOT-R), a measure of personality disposition, we examine the contributions of both optimism and pessimism to health outcomes. ANOVAs and regression analyses of the LOT-R and self reports of health in 67 African American and Latino grandmothers revealed psychological (obsessive compulsive symptoms, depression, hostility) and physical (sleep disorder, hypertension) health outcomes are differentially predicted by optimism and pessimism among older and younger age-groups of grandmothers. Implications for grandmothers’ response to caregiving stress and for future studies of personality’s relation to health are discussed. Ó 2008 Elsevier Inc. All rights reserved.
1. Introduction The number of grandparent caregivers has risen dramatically over the past decades from 2.2 million in 1970 (Bryson & Casper, 1999) to 5.8 million (Simmons & Dye, 2003). The grandmothers’ assumption of the caregiving role stems from the inability of the child’s birth parent to parent due to their incarceration, substance abuse, and/or neglect and physical abuse of the child (Janicki, McCallion, Grant-Griffin, & Kolomer, 2000). The psychological cost of raising one’s grandchild has included coping with a developmentally out-of-stage parenting experience (Landry-Meyer & Newman, 2004), and increases in rates of depression and stress along with lowered life satisfaction (Fuller-Thompson, Minkler, & Driver, 2000; Kelley, Whitley, Sipe, & Yorker, 2000). Grandparent caregivers have also been found to have poor physical health (Kelley et al., 2000). Research on the adjustment of grandparents to the grandparenting role has focused largely on psychosocial contributors to psychological and physical health such as the perception of stress associated with the caregiving role (Sands, GoldbergGlen & Thornton, 2005) , a lack of financial resources (Bachman & Chase-Lansdale, 2005), problems exhibited by the grandchildren (Cooney & An, 2006), and a lack of social support (Gerard, Landry-Meyer, & Roe, 2006). However, there are no studies to date that incorporate the role of dispositional personality traits in grandparents’ physical and psychological adjustment to caregiving. This study’s focus on grandparent caregivers also addresses a gap in the literature about how dispositional personality traits influence coping with adverse life events that may be neither life-threatening nor normative. Most of the previous research on optimism and coping has focused on medical events and adjustments to normative life events (Carver et al., 1993;
* Corresponding author. Fax: +1 516 877 4754. E-mail address:
[email protected] (F. Conway). 0092-6566/$ - see front matter Ó 2008 Elsevier Inc. All rights reserved. doi:10.1016/j.jrp.2008.03.011
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Fitzgerald, Tennen, Affleck, & Pransky, 1993; Schulz, Bookwala, Knapp, Scheier, & Williamson, 1996). However, optimism and pessimism have been found to play a role in how individuals cope with situations that evolve slowly over time (Scheier, Weintraub, & Carver, 1986). Generally, caregiving situations develop slowly and are marked by chronic stress, particularly when caring for those with progressive debilitating diseases or permanent disabilities. For example, a few studies on caregiving have found that optimism has been significantly related to psychological well-being among caregivers of patients with cancer (Given et al., 1993) and Alzheimer’s’ disease (Robinson-Whelen, Kim, MacCallum, & Kiecolt-Glaser, 1997). The nature of the grandparent caregiver situation, i.e. adverse and stressful, but unrelated to serious medical events, provides a unique opportunity to consider their physical and psychological adaptation to adverse life situations. The discourse in the research literature on the relation between personality disposition and health informs us of two key considerations, age and linearity, which we address in this study. Researchers are reminded that the relation of health to dispositional traits is dependent on age—for example, physical health seems to be related to pessimism among older adults, but in younger adults optimism is a better predictor of physical health outcomes (Brenes, Rapp, Rejeski, & Miller, 2002; Lai, 1994; Robinson-Whelen et al., 1997; Schulz et al., 1996). The discrepancy between the predictive values of optimism may point to the limited utility of optimism to predict physical health outcomes. Friedman and colleagues’ (1993) exploration of longitudinal data from L.M. Terman’s 1921 study points to the limitation of optimism in predicting health outcomes. Their counterintuitive findings that optimism in childhood was negatively associated with longevity led them to call for a reexamination of the role of optimism in health. The second consideration, a largely unresolved issue, is whether or not the relationship between personality disposition and health is a linear or non-linear one. Although linear relationships are supported by Carver and Scheier (1998) self-regulation of behavior theory, seminal work by Milam and colleagues (2004) offer evidence for a non-linear relation between health and optimism where both low and high optimism scores increase health risks and moderate optimism scores predict good health outcomes. There is a paucity of evidence for a curvilinear relation between pessimism and health (Janis, 1958) and although this relation has been recently examined, the findings have not been replicated (Milam et al., 2004). This study examined the relation between personality disposition, when used as a two factor measure of optimism and pessimism, and physical and psychological health among older and younger grandmothers. We expected personality to contribute significantly to grandmothers’ health outcomes above and beyond demographic and parenting constraint variables. We also expected differential health outcomes based on grandmothers’ age. Non-linear models of the relationships between personality and health were examined. 2. Methods 2.1. Participants A convenience sample of 67 African-American (68.7%, n = 46) and Latino grandmothers (31.3%, n = 21) who are the primary caregivers for their grandchildren and reside in an urban environment in the United States were recruited for this study. Grandmothers’ age ranged from 26–79 years old. Because it was important to know if grandmothers received help with the caregiving from another adult in the home, marital status was defined as a dichotomous variable as ‘‘grandmothers who were married or living with a partner.” Grandmothers also responded yes or no to whether they were widowed. Education was assessed using a choice response format to the number of year of education ranging from 1–12 years (compulsory education), 13–14 years (Associate degree) and 14–16 years (Bachelor’s degree). Grandmothers were asked to respond yes or no to whether they were employed, at least part time, or retired. 2.2. Procedure The grandmothers were first screened to determine their eligibility for the study and grandmothers who were the primary caregivers for their grandchildren were selected for inclusion. Informed consent was obtained; grandmothers received a semi-structured interview about their caregiving experience and were assisted in completing the study’s measures during the interview. 2.3. Measures Optimism and pessimism personality disposition traits were measured using the Life Orientation Test-Revised (LOT-R: Scheier, Carver, & Bridges, 1994). The LOT-R has three positively phrased items reflecting optimism (e.g., ‘‘in uncertain times I expect the best”) and three negatively phrased items reflecting pessimism (e.g., ‘‘if something can go wrong... it will”) along with four filler items. Participants’ responded on a 5-point scale ranging from 0 (strongly disagree) to 4 (strongly agree). A single score was computed for each of the factors, i.e. optimism and pessimism, so that higher scores suggest higher levels of optimism and pessimism, respectively. Several researchers have confirmed the use of the LOT-R as a two-factor measure of optimism and pessimism that is superior to a one-dimensional approach and as having little shared variance (r = .16) (Herzberg, Glaesmer, & Hoyer, 2006; Robinson-Whelen et al., 1997; Scheier et al., 1994). Test-retest reliability (ranging from 0.68 at 4 months to 0.79 at 28 months), and convergent and discriminant validity of the LOT-R have been established as ade-
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quate (Scheier et al., 1994). Reliability analyses for grandmothers in this study showed the internal consistency for optimism (a = .53, p < .001) and pessimism (a = .63, p < .001) were significant. Psychological health was assessed using the Brief Symptom Inventory (Derogatis, 1992), a 53-item scale adapted from the SCL-90-R (Derogatis, 1997). The scale assesses psychological distress on nine clinical subscales including obsessive compulsive symptoms, paranoid ideation, hostility, phobic anxiety, psychoticism, somatization, interpersonal sensitivity, depression and anxiety. The BSI yields an index which is an overall indication of global distress: the Global Severity Index (GSI). Community standardized norms were used to convert raw scores to T-scores (M = 50, SD = 10). Participants responded on a 5-point scale ranging from 0 (not at all) to 4 (extremely) regarding symptoms experienced within the past week. The BSI has adequate internal consistency (0.71–0.85) and high test-retest reliability (0.68–0.90; Derogatis, 1993). Physical health was measured using the physical health scales of the Comprehensive Assessment and Referral Evaluation (CARE) instrument. This self-report measure offers a checklist of symptoms and was developed to assess health and social status of community-dwelling elderly residents. The 12 physical health subscales consist of 189 items assessing total impaired health and functional health (Teresi, Golden, & Gurland, 1984). The 12 health subscales includes somatic symptoms, heart disorder, stroke effects, cancer, respiratory symptoms, arthritis, leg problems, sleep disorder, hearing disorder, vision disorder, hypertension and ambulation problems. The CARE convergent validity coefficients range from .40 to .75. These coefficients are supported by convergent validity coefficients ratings from informant scales ranging from .30 to .70 (Teresi, Golden, Gurland, Wilder, & Bennett, 1984). 2.4. Analyses ANOVA and v2 tests for differences between the two age-groups of grandmothers were conducted for the study’s demographic, personality and health variables. Pessimism and optimism variables were converted to standardized scores. Regression analyses testing both linear and non-linear models of personality as predictor of psychological and physical health outcomes were conducted. 3. Results 3.1. Demographics A median split of age yielded two grandmother cohorts, ‘60 years and older’ (n = 34; M = 66.20, SD = 5.04) and ‘under 60 years old,’ (n = 33; M = 52.00, SD = 5.21). ANOVAs yielded group differences for grandmothers’ age (F = 128.82, p < 0.001) and the number of grandchildren being parented who were ‘five years old or younger’ (‘‘60 years and older” n = 34; M = 0.20, SD = 0.41vs. ‘‘under 60 years” n = 33; M = 0.75, SD = 0.43; F = 28.51, p < 0.001). Chi Squares tested dichotomous variables of marital status including whether grandmothers were ‘married or living with a partner,’ (‘‘60 years and older” n = 7; 10.4% vs. ‘‘under 60 years” n = 15; 22.4% vs.; v2 = 5.78, p < .05) or widowed (‘‘60 years and older” n = 11; 16.4% vs. ‘‘under 60 years” n = 4, 6%, v2 = 3.94, p < 0.05); employment status—whether or not grandmothers were employed at least part time—(‘‘60 years and older” n = 1, 1.5% vs. ‘‘under 60 years” n = 16, 23.9%, v2 = 18.34, p < 0.001) or retired (‘‘60 years and older” n = 23, 34.3% vs. ‘‘under 60 years” n = 4, 6%; v2 = 21.46, p < 0.001). The standardized residuals for the employment status variables were equal to or greater than 2.0; however, all significant v2 were included in further analyses for complete exploration of their contributions to health outcomes. Most grandmothers parented one child (M = 2.16, SD = 1.34; Mode = 1; Median = 2) and have received an average of 10.49 years of education (M = 10.49, SD = 4.22). Seventy percent of the grandmothers reported at least one adult living in the home. Grandmothers reported mean scores of 9.62 (SD = 2.14) and 4.23 (3.09) for optimism was and pessimism, respectively. Psychological and physical health outcomes significantly correlated with personality variables were discussed here and included in further analyses. Grandmothers’ standardized scores (T-scores, M = 50.00, SD = 10), ranged from 41.27 to 82.40 for obsessive compulsive symptoms, 42.10–83.68 for depression and 39.76–78.62 for hostility. For physical health variables, on average grandmothers reported 2.17 (SD = 2.77) sleep disorder and 2.00 (SD = 1.86) hypertension symptoms. The two age-groups of grandmothers were not significantly different on these demographic and health outcome variables. See Table 1 for significant correlations among personality and health variables. 3.2. Personality as a predictor of health Standardized scores of pessimism and optimism were used in regression analyses to predict psychological and physical health outcomes. Demographic variables were entered on the first step, pessimism on the second step and optimism on the third step. Pessimism predicted obsessive compulsive symptoms and hypertension in older grandmothers each contributing 18% of the variance over and above the contributions of demographic variables (obsessive compulsive: Step 1, R2 = .16, Step 2, R2 = .34, p < .05; hypertension: Step 1, R2 = .22, Step 2, R2 = .40, p < .01). Optimism predicted depression and hostility in older grandmothers and sleep disorder in younger grandmothers contributing 19%, 22% and 10% of the variance over and above the contributions of demographic variables, respectively (for depression: Step 1, R2 = .20, Step 2, R2 = .23, Step 3, R2 = .43, p < .05; for hostility: Step 1, R2 = .29, Step 2, R2 = .37, Step 3, R2 = .59, p < .05; for sleep disorder: Step 1, R2 = .38, Step 2, R2 = .39, Step 3, R2 = .50, p < .05) (See Table 2).
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F. Conway et al. / Journal of Research in Personality 42 (2008) 1352–1357 Table 1 Pearson correlations among personality disposition, psychological and physical health variables
1. 2. 3. 4. 5. 6. 7. 8.
Optimism Pessimism Obsessive compulsive Depression Hostility Global Severity Index Sleep disorder Hypertension
1
2
3
4
5
6
7
8
1 .43* .44* .59** .63** .41* .04 .25
.42* 1 .40* .22 .46* .23 .13 .46**
.11 .00 1 .47* .50** .69** .11 .20
.10 .02 .72** 1 .45* .68** .08 .35
.05 .09 .60** .68** 1 .46* .07 .15
.09 .11 .84** .82** .75** 1 .37* .17
.36* .23 .17 .15 .00 .40* 1 .12
.18 .02 .22 .28 .39* .29 .12 1
Note. Correlations above diagonal are for grandmothers under 65-years-old. Correlations below diagonal are for grandmothers 65-years and older, n = 67. * p < .05. ** p < .01.
Table 2 Hierarchical regressions of personality predicting physical and psychological health outcomes over and above the study’s demographic variables Predicted variable
Psychological health
Physical health
Obsessive compulsive (n = 30)
Depression
Hostility
Sleep disorder
Hypertension
(n = 28)
(n = 29)
(n = 31)
(n = 34)
60-years and older
60-years and older
60-years and older
under 60-yearsold
60-years and older
Step 1: Demographics
R2adj ¼ :05 Fchange (5, 23) = .75
R2adj ¼ :14 Fchange (5, 23) = 1.91
R2adj ¼ :12 Fchange (1, 22) = 5.76*
R2adj ¼ :19 Fchange (1, 21) = 2.64
R2adj ¼ :23 Fchange (6, 24) = 2.50 R2adj ¼ :21 Fchange (1, 23) = .01
R2adj ¼ :04 Fchange (6, 27) = 1.24
Step 2: Personality
R2adj ¼ :02 Fchange (5, 22) = 1.13 R2adj ¼ :02 Fchange (1, 21) = .95
Step 3: Personality
R2adj ¼ :13 Fchange (1, 21) = 1.17
R2adj ¼ :23 Fchange (1, 20) = 6.92*
R2adj ¼ :45 Fchange (1, 20) = 11.30**
R2adj ¼ :31 Fchange (1, 22) = 4.54*
.09
.14
.19
.13
.47*
.17 .13 .15 .12 .35 .40b .24
.13 .14 .24
.18 .04 .29
.08 .02 .55*
.01 .06 .59**
.36 .18 .02 .61** .32 .02 .36*
.10 .19 .01 .17 .00 .43* .13
Betas Number of grandchildren age 5 and younger Age Married or living with a partner Widowed Employeda Retired Pessimism Optimism
R2adj ¼ :24 Fchange (1, 26) = 8.11** R2adj ¼ :22 Fchange (1, 25) = .44
a
Variable deleted from the analysis for depression and hostility for older grandmothers since there were no older grandmothers employed. Betas for pessimism Step 2, b = .50, p < .05. (For obsessive compulsive: Step 1, R2 = .16; Step 2, R2 = .34, p < .05; Step 3, R2 = .37; for depression: Step 1, R = .20, Step 2, R2 = .23, Step 3, R2 = .43, p < .05; for hostility: Step 1, R2 = .29, Step 2, R2 = .37, Step 3, R2 = .59, p < .05; for sleep disorder: Step 1, R2 = .38, Step 2, R2 = .39, Step 3, R2 = .50, p < .05; for hypertension: Step 1, R2 = .22, Step 2, R2 = .40, p < .01, Step 3, R2 = .41). * p < .05. ** p < .01. b
2
3.3. Non-linear model Multiple regression analyses were conducted to estimate a non-linear model that best predicts physical and psychological health outcomes based on personality dispositions pessimism and optimism. Pessimism and optimism were converted to standardized scores and the quadratic model was tested using regression analyses. Non-linear relations were found for pessimism and health outcomes obsessive compulsive symptoms (F(2, 27) = 4.66, p < .05; R2 = .25) and hypertension (F(2, 31) = 4.8, p < .05; R2 = .23). Moderate levels of pessimism predicted lower levels of obsessive compulsive symptoms and hypertension. High and low levels of pessimism predicted poorer health outcomes. 4. Discussion In this study, we expected personality disposition would predict health outcomes differentially for older and younger grandmothers over and above demographic and parenting constraint variables. We also examined whether these relationships were linear or non-linear.
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Results show that optimistic older grandmothers were less likely to report psychological health problems of depression and hostility and optimistic younger grandmothers were less likely to report sleep disorder. Optimism was a significant predictor of these health outcomes and findings support a linear model. Given the long term commitment made by grandmothers in the grandparent caregiving situation, the findings that less optimistic grandmothers experience more hostility and depression is not surprising. These negative psychological states may be reflective of grandmothers’ lack of positive expectations for the future, i.e. the unlikelihood of changes occurring in their caregiving status. Most grandmothers are the only available caregivers for their grandchildren. The permanence of the caregiving situation coupled with little hope for relief from the caregiving burden may contribute to feelings of anger and hostility towards their plight. Optimism seems to insulate grandmothers from impingements on their sleep patterns which could be attributed to the sense of invulnerability that an optimistic outlook provides. In contrast, because low optimists lack positive expectations for the future, they may be more prone to worry which could lead to sleep problems. Actually, those reporting sleep disorders also reported high levels of global psychological distress. Another significant contributor to sleep interruptions among younger grandmothers was the fact that most of them were employed. In spite of the demands of the caregiving and employment faced by younger grandmothers, those who were more optimistic fared better. Age differences in optimism’s prediction of physical and psychological health suggest the benefit of optimism does not extend to the physical health of older grandmothers. Since mortality is more pronounced in older adults, it is possible that the sense of invulnerability from which highly optimistic individuals benefit is shattered by the reality of their aging experiences. These findings are reminiscent of the limits of optimism in benefiting physical health in breast cancer (Achat, Kawachi, Byrne, Hankinson, & Colditz, 2000) and in Friedman and colleagues’ (1993) longitudinal study of health outcomes. Although aging is not a disease, these results suggest that age is an alternative pathway that impacts physical health outcomes in addition to personality disposition. The results showed pessimistic grandmothers were more likely to report higher rates of hypertension and obsessive compulsive symptoms. Regarding obsessive compulsive symptoms, we cannot explain why obsessive compulsive symptoms would be more prevalent among older grandmothers; however, it is important to note that only four (12%) older grandmothers’ scores were considered clinically significant. The relations between pessimism and these health outcomes are non-linear with less adverse health outcomes among grandmothers with moderate levels of pessimism. Given the risks for hypertension identified among high stress groups, the pervasive stress associated with grandparent caregiving can play a role in exacerbating those grandmothers who may be at risk. Grandparent caregiving stressors due to developmentally out-of-stage parenting, the precursors of the caregiving situation, and the resulting absence of the birth parent have resulted in the instability of the family, a significant source of stress. The experience of heightened awareness to stressful situations among highly pessimistic individuals or inattention to stress among low pessimists increases the likelihood of poor health outcomes. The study’s finding that moderate levels of pessimism is protective was supported by a previous study (Janis, 1958 in Milam et al., 2004) and may need to be re-examined in future studies. In sum, results show that among older adults, both pessimism and optimism are predictive of psychological and physical health outcomes. In comparison, among the younger cohorts of grandmothers, only optimism was a significant predictor. It has been previously suggested that optimism and pessimism are separate constructs in older adults possibly due to differing cognitive approaches to the meanings of optimism and pessimism compared to cognitions of younger adults. These findings confirm those of Hertzberg and colleagues (2006) that the general expectancies of the world, i.e. optimistic or pessimistic outlooks, seems to be more diverse among older adults who are in a unique position to revise their beliefs and expectations compared to their younger counterparts (Herzberg et al., 2006). Given the stressors associated with caregiving, it is not surprising that depression, hostility, sleep disorders and hypertension pose the largest physical and psychological problems this group of adults encounter. The study has shown that older adults may bring their life experience to bear on their caregiving situation, i.e. expectancies that a situation can illicit both optimistic and pessimistic perspectives simultaneously. Future studies could incorporate other measures of personality and health, such as physiological indicators, that go beyond selfreport. Acknowledgments This research was supported by grant from the National Institute on Aging, Resource Center for Minority Aging Research/ Columbia Center for Active Life of Minority Elderly during residence in the Long Island University’s Intercultural Institute on Aging and Development, Brooklyn Campus. I would also like to thank my teaching assistants Francesca Bucarro and Blythe Wyatt for their assistance. References Achat, H., Kawachi, I., Byrne, C., Hankinson, S., & Colditz, G. (2000). A prospective study of job strain and risk of breast cancer. International Journal of Epidemiology, 29, 622–628. Bachman, H. J., & Chase-Lansdale, P. L. (2005). Custodial grandparents’ physical, mental, and economic well-being: Comparisons of primary caregivers from low-income neighborhoods. Family Relations, 54, 475–487. Brenes, G., Rapp, S., Rejeski, W. J., & Miller, M. (2002). Do optimism and pessimism predict physical functioning? Journal of Behavioral Medicine, 25, 219–231. Bryson, K., & Casper, L. M. (1999). Coresident grandparents and grandchildren. Current population reports. Washington, DC: US Bureau of the Census. pp.23– 198.
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Carver, C. S., Pozo, C., Harris, S. D., Noriega, V., Scheier, M. E., Robinson, D. S., et al (1993). How coping mediates the effects of optimism on distress: A study of women with early stage breast cancer. Journal of Personality and Social Psychology, 65, 375–390. Carver, C. S., & Scheier, M. F. (1998). On the self regulation of behavior. New York: Cambridge University Press. Cooney, T. M., & An, J. S. (2006). Psychological well-being in mid to late life: The role of generativity development and parent-child relationships across the lifespan. International Journal of Behavioral Development, 30, 410–421. Derogatis, L. R. (1992). The Brief Symptom Inventory (BSI): Administration, scoring & procedures manual-II. Towson, Md: Clinical Psychometric Research. Derogatis, L. R. (1993). BSI, Brief Symptom Inventory: Administration, scoring & procedures manual. Minneapolis, MN: National Computer Systems. Derogatis, L. (1997). The SCL-90 Scoring Manual. Johns Hopkins School of Medicine, Clinical Psychometrics Unit. Fitzgerald, T., Tennen, H., Affleck, G., & Pransky, G. (1993). The relative importance of dispositional optimism and control appraisals in quality of life after coronary artery bypass surgery. Journal of Behavioral Medicine, 16, 25–43. Friedman, H. S., Tucker, J. S., Tomlinson-Keasey, C., Schwartz, J. E., Wingard, D. L., & Criqui, M. H. (1993). Does childhood personality predict longevity? Journal of Personality & Social Psychology, 65(1), 176–185. Fuller-Thompson, E. F., Minkler, M., & Driver, D. (2000). African American grandparents raising grandchildren: A national profile of demographic and health characteristics. Health and Social Work, 25, 109–118. Gerard, J. M., Landry-Meyer, L., & Roe, J. G. (2006). Grandparents raising grandchildren: The role of social support in coping with caregiving challenges. The International Journal of Aging and Human Development, 62, 359–383. Given, C. W., Stommel, M., Given, B., Osuch, J., Kurtz, M. E., & Kurtz, J. C. (1993). The influence of cancer patients’ symptoms and functional states on patients’ depression and family caregivers’ reaction and depression. Health Psychology, 12, 277–285. Herzberg, P. Y., Glaesmer, H., & Hoyer, J. (2006). Separating optimism and pessimism: A robust psychometric analysis of the revised Life Orientation Test (LOT-R). Psychological Assessment, 18, 433–438. Janicki, M., McCallion, P., Grant-Griffin, L., & Kolomer, S. R. (2000). Grandparent caregiver I: Characteristic of the grandparents and children with disabilities for whom they care. Journal of Gerontological Social Work, 33, 35–55. Janis, I. L. (1958). Psychological stress. New York: Wiley. Kelley, S. J., Whitley, D., Sipe, T. A., & Yorker, B. C. (2000). Psychological distress in grandmother kinship care providers: The role of resources, social support, and physical health. Child Abuse and Neglect, 24, 311–321. Lai, J. C. L. (1994). Differential predictive power of the positively versus the negatively worded items of the Life Orientation test. Psychological Reports, 75, 1507–1515. Landry-Meyer, L., & Newman, B. M. (2004). An exploration of the grandparent caregiver role. Journal of Family Issues, 25, 1005–1025. Milam, J., Richardson, J., Marks, G., Kepmer, C., & McCutchan, A. (2004). The roles of dispositional optimism and pessimism in HIV disease progression. Psychology and Health, 19, 167–181. Robinson-Whelen, S., Kim, C., MacCallum, R. C., & Kiecolt-Glaser, J. K. (1997). Distinguishing optimism from pessimism in older adults: Is it more important to be optimistic or not to be pessimistic? Journal of Personality and Social Psychology, 73, 1345–1353. Sands, R. G., Goldberg-Glen, R., & Thornton, P. L. (2005). Factors associated with the positive well-being of grandparents caring for their grandchildren. Journal of Gerontological Social Work, 45(4), 65–82. Scheier, M. F., Carver, C. S., & Bridges, M. W. (1994). Distinguishing optimism from neuroticism (and trait anxiety, self-mastery, and self-esteem): A reevaluation of the Life Orientation Test. Journal of Personality and Social Psychology, 67, 1063–1078. Scheier, M. F., Weintraub, J. K., & Carver, C. S. (1986). Coping with stress: Divergent strategies of optimists and pessimists. Journal of Personality and Social Psychology, 51, 1257–1264. Schulz, R., Bookwala, J., Knapp, J. E., Scheier, M., & Williamson, G. M. (1996). Pessimism, age, and cancer mortality. Psychology and Aging, 11, 304–309. Simmons, T., & Dye, J.L. (2003). Grandparents living with grandchildren. Washington, DC: US Department of Commerce, Economics and Statistics Administration, US Census Bureau. Teresi, J. A., Golden, R. R., & Gurland, B. J. (1984). Concurrent and predictive validity of indicator scales developed for the Comprehensive Assessment and Referral Evaluation interview schedule. Journal of Gerontology, 39, 158–165. Teresi, J. A., Golden, R. R., Gurland, B. J., Wilder, D. E., & Bennett, R. G. (1984). Construct validity of indicator-scales developed from the Comprehensive Assessment and Referral Evaluation interview schedule. Journal of Gerontology, 39, 147–157.