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A growing body of evidence suggests that chronic medical illness is associated with an increased prevalence and incidence of psychiatric and psychological disturbances. The present literature review is based on two theses: first, that chronic illness is viewed as a stressor and is associated with increased psychological distress, and secondly, that interventions can minimize the distress. A review of the studies conducted with adult patients diagnosed either with coronary heart disease or cancer suggests that psychosocial interventions are, in general, efficacious in relieving self-reported psychological distress. The review also recommends psychosocial interventions for high-risk patients rather than all patients, and that researchers need to identify other outcomes such as health care costs, disability, days in hospital, morbidity, and mortality in order to convince policy makers that these interventions are worthwhile. Recommendations for future research are also discussed.

Health Quality of Life (HQL) assessment in clinical trial and epidemiological research is necessary to determine the efficacy of treatments and interventions. A definition of HQL is presented with the following dimensions of HQL identified: social, physical, and neuropsychological functioning; emotional stability; personal productivity; and intimacy. A strategy for selecting HQL dimensions and measures is discussed and includes consideration of the study population, the intervention(s), and the clinical trial design. Examples from NHLBI-sponsored clinical trials illustrate how HQL measures are selected as well as the goals that HQL assessment can address. That is, the authors discuss how HQL data can be used to characterize the study populations, determine the effects of HQL on critical outcomes, and assess how treatment affects overall HQL and specific dimensions of HQL.

A large body of prospective data has accumulated linking social support to health, and most social scientists agree that low levels of support are associated with poor physical and mental health. Unfortunately, most of the research has been limited to White men. When women and people of color are included in the designs, the relationships between social support and physical health are more complicated. Prospective population-based studies provide evidence that low support is associated with increased risk of mortality in women. However, in several studies, results indicated that, for specific age groups, women with high social support have increased risk of mortality. Factors that may contribute to the observed gender differences in the social support-physical health relationship are discussed. Future research should include adequate numbers of women and more sophisticated measures of social support to move the field forward.

Local crime rates are similar in several respects to natural hazards. The points of similarity include objective and subjective features and responses to both. These comparable characteristics may help explain a continuing conundrum in the responses to disorder literature: the loose coupling between crime and fear levels at the local level. The proposed analogy may also be relevant to the relationship between local crime and behavioral responses to disorder. The points of analogy between crime and natural hazards lead to theoretical expectations supported by results from recent studies on responses to disorder. The perspective developed here helps explain why instrumental responses to crime elevate fear over time. We discuss the policy implications of the analogy, and suggest future areas of research and theoretical development.