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various medical conditions and whether different modes of treatment produce changes in that time course In industry the same analysis is called failure analysis and is used to determine time until failure of a speci c part and whether parts manufactured differently have different rates of failure An advantage of survival analysis over traditional logistic regression is that the analysis can handle censored cases These are cases for which the time is not known at the conclusion of the study either because the case is still apparently well (or the part is still functioning) or the case has been lost to follow-up However, there are special assumptions related to such cases, as well as other assumptions particular to the analysis.



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Differences Between Withdrawn and Remaining Cases The rst assumption is that the cases that have been lost to follow-up do not differ from the cases with complete data at the conclusion of the study If there are systematic differences between the two types of cases, you have a missing data problem with nonrandom loss of cases If the study was initially an experiment with random assignment to treatment conditions, the advantages of random assignment have been lost due to nonrandom loss of cases Change in Survival Conditions Over Time Because these data are collected over time, it is assumed that the factors that in uence survival at the beginning of the study are the same as the factors that in uence survival at the end of the study Put another way, it is the assumption that the conditions have not changed from the beginning to the end of the study.

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In a maturing bio-behavioral science, these mechanisms are informed by basic research in medical physiology and closely tied to current research on the pathophysiology of speci c diseases In addition to human epidemiological and clinical research on psychosocial risk factors and human psychobiological research on the underlying mechanisms, research in this area often utilizes animal models that permit stronger experimental tests of psychosocial in uences on disease and more de nitive albeit invasive evaluations of underlying mechanisms Animal research permits tests that would be obviously unethical in humans, but the issue of generalizability to human disease is a central concern Ultimately, psychosomatic research in this area guides the development and evaluation of interventions (eg, stress management) intended to prevent or manage disease through the disruption of unhealthy psychobiological processes or through the promotion of stress-buffering resources.

If, for example, a new medical treatment is offered to patients during the course of the study and that treatment in uences survival, the assumption is violated Proportionality of Hazards If the Cox proportional-hazards model, one of the more popular models, is used to evaluate the effects of various predictors on survival, there is the assumption that the shape of the survival function over time is the same for all cases and for all groups That is, the time until failures begin to appear may differ from one group to another, but once failures begin to appear, they proceed at the same rate for all groups This assumption is violated when there is interaction between time and group To test the assumption, a time variable is constructed and its interaction with groups tested A test of the assumption through SAS PHREG is demonstrated in Tabachnick and Fidell (2001b)..

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This latter type of intervention research could also be considered an example of the third major topic in health psychology psychosocial aspects of physical illness and medical care Research in this area examines the psychosocial impact (eg, emotional functioning, functional activity levels, pain) of physical illness and other medical events on patients and their families Not all people with a given type and severity of disease experience the same psychosocial impact Hence, the determinants of individual differences in these impacts is an important topic in this area, as it identi es high risk groups in need of assistance and guides the development and evaluation of interventions designed to maximize functioning and well-being A related topic addresses the psychosocial impact of standard medical and surgical care, again with the ultimate goal of maximizing bene ts and minimizing the negative consequences and side effects of these regimens and procedures.

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