Comparison of two modes of stress measurement: Daily hassles and uplifts versus major life events

The standard life events methodology for the prediction of psychological symptoms was compared with one focusing on relatively minor events, namely, the hassles and uplifts of everyday life. Hassles and Uplifts Scales were constructed and administered once a month for 10 consecutive months to a community sample of middle-aged adults. It was found that the Hassles Scale was a better predictor of concurrent and subsequent psychological symptoms than were the life events scores, and that the scale shared most of the variance in symptoms accounted for by life events. When the effects of life events scores were removed, hassles and symptoms remained significantly correlated. Uplifts were positively related to symptoms for women but not for men. Hassles and uplifts were also shown to be related, although only modestly so, to positive and negative affect, thus providing discriminate validation for hassles and uplifts in comparison to measures of emotion. It was concluded that the assessment of daily hassles and uplifts may be a better approach to the prediction of adaptational outcomes than the usual life events approach.Writing of this paper was supported in part by a research grant from the National Institute on Aging (AG 00799).     

Health and hassles in older and younger men

This study compared hassles and uplifts in older and younger chronically ill men in regard to whether they perceived their health as good or poor (N = 50). Hassles are irritating and frustrating demands (minor stress) that characterize everyday transaction with the environment, such as losing things or being in traffic jams. Uplifts are positive events that could help counteract the effects of stress. Men in the study rated 40 potential hassles and 40 uplifts on 1 to 4 scales for the preceding month. These were compared by multivariate analysis of variance between older (age 65 and over) and younger (ages 45 through 64) men and between good vs. poor perceptions of health. Uplifts did not discriminate significantly between ages or health perceptions. In addition, hassles were similar between old and young; however, they differed significantly by good and poor assessments of health. Those who viewed their health as poor reported more hassles, mostly from events that were related to their physical health care. Because of the confounding effects with health in individuals who are already ill, hassles may not be good predictors of future health status, but they can help health professionals understand the kinds of demands that produce stress in management of diseases.     

Towards an idiothetic understanding of the role of social problem solving in daily event,mood and health experiences: A prospective daily diary approach

Objectives. Utilising D'Zurilla's (1986, 1990) transactional social problem solving model as the theoretical framework, the present study sought to examine the dynamics of the social problem solving process in relation to intraindividual experiences of events, mood, and physical health in daily life. Design. The study incorporated both idiographic and nomothetic strategies, combining a daily diary approach within a prospective design. As such, each individual's experience of events, mood, and health were assessed on a daily basis, and the prospective relations between social problem solving and these day‐to‐day experiences examined. Methods. Participants' (university students) completed a measure of social problem solving at baseline followed, approximately 5 weeks later, by daily self‐reports of mood (positive & negative), events (hassles & uplifts), and physical health (health status & URI symptoms) for a period of 14 days. The data were analysed using multilevel hierarchical modelling. Results. Days on which individuals had greater than their average hassles were associated with higher negative and lower positive mood (i.e. domain specific & cross‐over effects), whilst greater uplifts were linked to positive mood only. With regard to health, individuals reported worse status and more URI symptoms on days with greater than their average negative (hassles, negative mood) but not positive influences (uplifts, positive mood). Both social problem solving orientations and skills dimensions were associated prospectively with daily health outcomes, and these relationships were not moderated by day‐to‐day experiences of mood or events. Conclusions. The data clarify the importance of social problem solving to within‐person daily event, mood, and health experiences. The implications of these findings for contemporary transactional social problem solving models are discussed.     

Relationship of hassles, uplifts, and life events to psychological well-being of freshman medical students

Hassles, uplifts, and life events were related to psychological well-being with a representative sample of 55 (of 179) freshman medical students. Students were sent measures of hassles, uplifts, and affect-moods measures for 9 consecutive months and a measure of life stress at the beginning and middle of the school year. The hassles measure was found to be a better predictor of concurrent and subsequent negative mood than was the life stress measure, whereas life stress was found to be a better predictor of subsequent positive mood than hassles. On the whole, uplifts were unrelated to mood. The relationship between life stress and hassles was also investigated. The implications of the findings for future stress and health outcome research are discussed.     

A Daily Diary Approach to the Examination of Chronic Stress,Daily Hassles and Safety Perceptions in Hospital Nursing

Purpose

Stress is a significant concern for individuals and organisations. Few studies have explored stress, burnout and patient safety in hospital nursing on a daily basis at the individual level. This study aimed to examine the effects of chronic stress and daily hassles on safety perceptions, the effect of chronic stress on daily hassles experienced and chronic stress as a potential moderator.

Method

Utilising a daily diary design, 83 UK hospital nurses completed three end-of-shift diaries, yielding 324 person days. Hassles, safety perceptions and workplace cognitive failure were measured daily, and a baseline questionnaire included a measure of chronic stress. Hierarchical multivariate linear modelling was used to analyse the data.

Results

Higher chronic stress was associated with more daily hassles, poorer perceptions of safety and being less able to practise safely, but not more workplace cognitive failure. Reporting more daily hassles was associated with poorer perceptions of safety, being less able to practise safely and more workplace cognitive failure. Chronic stress did not moderate daily associations. The hassles reported illustrate the wide-ranging hassles nurses experienced.

Conclusion

The findings demonstrate, in addition to chronic stress, the importance of daily hassles for nurses’ perceptions of safety and the hassles experienced by hospital nurses on a daily basis. Nurses perceive chronic stress and daily hassles to contribute to their perceptions of safety. Measuring the number of daily hassles experienced could proactively highlight when patient safety threats may arise, and as a result, interventions could usefully focus on the management of daily hassles.

     

Effects of perceived stress and uplifts on inflammation and coagulability

We investigated whether depressed mood and chronic hassles and uplifts predicted levels of hemostasis markers D-Dimer and type-1 plasminogen activator inhibitor (PAI-1), as well as the proinflammatory markers interleukin-6 (IL-6) and soluble intercellular adhesion molecule-1 (sICAM-1) in 108 healthy individuals. One hundred eight African-American and Euro-American men and women were studied (58 men, 50 women; mean age = 36.5 +/- 8 years). D-Dimer, PAI-1, IL-6, and sICAM-1 plasma levels were analyzed from fasting venous blood samples. Data were analyzed via hierarchical linear regression and followed with partial correlation analysis. Regression analyses combined with partial correlation analyses suggested that increases in hassle frequency predicted elevated levels of sICAM-1 (p= .034), and increases in hassle severity predicted elevated levels of D-Dimer (p= .017). Increases in uplift intensity predicted lower levels of PAI-1 (p= .004) as well as showed a trend for decreased IL-6 (p= .069). Depressed mood did not significantly predict any dependent variable. These results were independent of sociodemographic, biological, and other related mood variables. The findings suggest that for even relatively healthy persons, increased perceptions of hassles are independently associated with greater inflammation and hypercoagulability, whereas increased perceptions of uplifts are independently associated with decreased hypercoagulability.     

Do hassles and uplifts trajectories predict mortality? Longitudinal findings from the VA Normative Aging Study

We examined whether longitudinal patterns of hassles and uplifts trajectories predicted mortality, using a sample of 1315 men from the VA Normative Aging Study (mean age = 65.31, SD = 7.6). In prior work, we identified different trajectory classes of hassles and uplifts exposure and intensity scores over a period of 16 years. In this study, we used the probabilities of these exposure and intensity class memberships to examine their ability to predict mortality. Men with higher probabilities of high hassle intensity trajectory class and high uplift intensity class had higher mortality risks. In a model combining the probabilities of hassle and uplift intensities, the probability of high intensity hassle class membership significantly increased the risk of mortality. This suggests that appraisals of hassles intensity are better predictors of mortality than simple exposure measures, and that uplifts have no independent effects.     

Uplifts and sleep

Recently, there has been a growth of interest in factors that play a protective role in sleep. This study is an exploratory analysis investigating relations between daily hassles and uplifts (events appraised as pleasant) and measures of subjective and polysomnography (PSG)-assessed sleep in a group of healthy adults (N = 135). Hassles and uplifts were assessed with the Combined Hassles and Uplifts Scale (CHUS), subjective sleep was assessed with the Pittsburgh Sleep Quality Index (PSQI), and objective sleep was assessed with standard PSG. After controlling for covariates, uplifts intensity was associated with subjective sleep and PSG-assessed sleep. Specifically, increased uplifts intensity was associated with better subjective sleep, decreased time slept in Stage 2 sleep, and increased time slept in slow wave sleep (SWS). One's perception of the magnitude of positive events may play a role in sleep and should be examined in future investigations.     

Parental risk and resistance factors among children with juvenile rheumatic disease: A four-year predictive study

Examined the extent to which baseline functioning and parental risk and resistance factors predicted disease-related (functional disability and pain) and psychosocial functioning (social competence and behavior problems) 4 years later among 172 children with juvenile rheumatic disease. The study also examined the extent to which fathers' risk and resistance factors explained patients' adaptation, above and beyond maternal factors. Poorer baseline functioning was a strong risk factor that predicted poorer functioning 4 years later. In addition, parental risk and resistance factors at baseline predicted patients' adjustment after patients' age and baseline functioning were controlled. Mothers' and fathers' personal strain and depressed mood, and fathers' drinking problems, were associated with poorer patient adjustment; mothers' and fathers' social functioning appeared to aid patients' adjustment. Fathers' risk and resistance factors contributed independently from those of mother, to predict patients' outcomes.This research was supported by Multipurpose Arthritis Center Grant AM20610 from the National Institute of Health and Department of Veterans Affairs Medical and Health Services Research and Development Services research funds.     

Quality of life and psychological functioning of pediatric and young adult patients with Gaucher disease,type 1

This study examined the health‐related quality of life (HRQoL) and psychological functioning of children and young adults with Gaucher disease, type 1 (GD1). Thirty‐two (17 pediatric, 15 young adult) patients with GD1 and one parent completed age‐appropriate assessments of HRQoL, emotional, and behavioral health. The HRQoL of children with GD1 was compared with a healthy sample and to children diagnosed with Fabry disease (FD; another lysosomal storage disease), while young adults were compared to a healthy sample and to patients with self‐reported chronic illnesses. Children with GD1 reported significantly lower HRQoL across all domains relative to healthy counterparts yet comparable HRQoL compared to children with FD. Young adults reported mildly lower physical functioning than healthy peers, but no differences in HRQoL relative to the chronic illness sample. Parent‐reported symptom severity was associated with poorer HRQOL in children but not young adults. Few group differences in psychological functioning were observed, except young children showed more school problems than the normative average and there was a trend toward internalizing symptoms. Overall, results consistently identified younger patients with GD1 as more affected than older patients in HRQoL and psychological domains. Implementation of psychosocial interventions may be particularly beneficial during early childhood.     

Neurocognitive development of young children with sickle cell disease through three years of age

OBJECTIVE: To determine (1) the neurocognitive development of children with sickle cell disease (SCD) from 6 months through 36 months of age, (2) the independent and combined contributions of biomedical risk and parenting risk to child neurocognitive functioning, and (3) the independent and combined contributions of biomedical risk, parent cognitive processes, and family functioning to parent adjustment. METHOD: The study sample included 89 African American children and their parents served through the Duke University-University of North Carolina Comprehensive Sickle Cell Center. Measures of cognitive and psychomotor development were obtained at 6, 12, 24, and 36 months of age, and parents completed self-report measures of the cognitive processes of daily stress and attributional style, psychological adjustment, and family functioning. RESULTS: There was no significant decrease in psychomotor functioning (PDI) over time but cognitive functioning (MDI) declined, with a significant decrease occurring between the 12- and 24-month assessment points. At 24 months, poorer cognitive functioning was associated with parenting risk, in terms of a learned-helplessness attributional style, and biomedical risk, in terms of HbSS phenotype. Levels of psychological distress within the clinical range were reported by 24% of the parents, and poorer parent adjustment was associated with high levels of daily stress, less knowledge about child development, lower expectations of efficacy, and HbSC phenotype. CONCLUSIONS: The findings indicate that young children with SCD are at risk for neurocognitive impairment and provide support for the initiation of early intervention studies to promote neurocognitive development.     

Life problems,social supports,and psychological functioning of emotionally disturbed and well low-income women

The relationship between stressful life events, social supports, and psychological functioning was examined in a low-income population of schizophrenic, depressed, and well mothers of young children. It was expected that the disturbed populations and those rated lowest on psychological functioning would have the most problems and the fewest resources. A buffering effect was hypothesized such that for the individuals with many problems, those with many resources would show better functioning than those with few resources. The results indicated that neither number of problems nor number of resources was related significantly to levels of psychological functioning. For disturbed women, having fewer problems may be associated with higher functioning. Both schizophrenic and depressed women reported more problems, but also more resources, than well women. Finally, having many resources did not affect the level of functioning of those with many stressful life events. Results were interpreted as failing to support the buffering hypothesis. Alternative explanations are proposed in terms of factors predisposing to vulnerability (e.g., low self-esteem) and alternative conceptualizations of social support.     

Daily hassles and social support as predictors of adjustment in children with pediatric rheumatic disease

OBJECTIVE: To test hypotheses that social support moderates the effects of microstressors on the psychosocial adjustment of children with pediatric rheumatic diseases (PRDs) and that among multiple sources of support, classmate and parent support are significant predictors of adjustment, after controlling for demographic and disease severity variables. METHODS: Children with PRDs (N = 160 children; 8-17 years) were recruited from three pediatric rheumatology centers and completed measures of daily hassles, social support, depressive symptoms, and state and trait anxiety; their parents completed measures of internalizing and externalizing behaviors. RESULTS: Fewer daily hassles and higher social support predicted fewer adjustment problems. Among the sources of support, classmate and parent support were significant predictors. Tests for moderation were significant only for a Hassles x Classmate Support interaction in the prediction of depression. A plot of the interaction between hassles and classmate support showed that children with high classmate support had lower levels of depression than children with low classmate support under high or low levels of daily hassles. Furthermore, children with high classmate support had lower levels of depression under conditions of low versus high daily hassles. DISCUSSION: Results are consistent with a main effect rather than buffering model for social support. CONCLUSIONS: Interventions should focus on management of daily hassles and increasing social support for children with PRDs.     

Moderation of physiological stress responses by personality traits and daily hassles: less flexibility of immune system responses

Previously we demonstrated that stressors varying on the dimension of mental effort and controllability have distinctive effects on cardiovascular, endocrine and immune system responses. The purpose of the present study was to relate individual differences in physiological stress responsivity to task appraisal and stress-induced mood changes (issue 1), trait characteristics (issue 2) and daily hassles (issue 3). Appraisal and mood changes did not mediate the differential effects of the stressors. The trait characteristics, aggression and external locus of control and daily hassles moderated the effect of the stressor on physiological parameters, especially immune parameters. Moreover, the moderation effect was different in the high versus the low effort stress task. High aggression, high external locus of control and more daily hassles were associated with increased reactivity in the low effort condition and decreased reactivity in the high effort condition, which is suggested to reflect less differentiated responding to changing task demands and hence, less flexibility in the immune system.     

Functioning among mothers and fathers of children with juvenile rheumatic disease: a longitudinal study.

Examined the adaptation of mothers and fathers of children with juvenile rheumatic disease on two occasions, 1 year apart, using 159 married couples at Time 1, and 111 of these couples at Time 2. A stress and coping model was tested in which parental functioning is determined by ongoing life stressors (patient and spouse dysfunction), family resources, and parents' illness-related coping. Mothers reported more depression than fathers did. However, poorer concurrent functioning among both mothers and fathers was explained partly by patients having more functional disability, pain, and psychosocial problems. In addition, spouse's dysfunction and the parent's use of avoidance coping were related to poorer parental adaptation, both concurrently and 1 year later. The implications of the findings for developing stress and coping models of parental adaptation to having a chronically ill child, and for intervention strategies with parents, patients, and families, are discussed.     

Elevated blood pressure and self-reported symptom complaints, daily hassles, and defensiveness

The association between elevated blood pressure and low rates of self-reported problems has been hypothesized to be mediated by defensiveness. In a population screening study in which 1,120 women and 903 men between 20 and 55 years of age participated, multiple resting home blood pressure measurements were performed and questionnaires were administered measuring symptom complaints, daily hassles, and defensiveness. In women, after control for potential confounders, a low number of self-reported symptoms was associated with elevated blood pressure. However, this effect was not mediated by defensiveness, although repressive defensiveness predicted independently elevated blood pressure in women. In men, no significant associations were obtained. Furthermore, no relations emerged between daily hassles and elevated blood pressure. In conclusion, although defensiveness was more prevalent among women with elevated blood pressure, it does not provide a good explanation for the low rates of self-reported symptoms found in these women.     

Coping Responses and Adaptational Outcomes of Children Undergoing Orthopedic Surgery

I examined the relationships between coping responses and adaptational outcomes of children undergoing elective orthopedic surgery. A sample of 27 children, aged 6 through 17 years, participated in the study. Children's coping responses, surgical adaptation, premorbid adjustment and cognitive functioning were assessed using repeated measures. Results' indicated that (a) premorbid adjustment was a powerful predictor of surgical adaptation, (b) children who used coping responses characterized by constructive limit setting exhibited better surgical adaptation, and (c) children who used greater numbers of coping responses exhibited less anxiety and withdrawal after surgery. The results suggested that the majority of children demonstrated "stress resistance." Variables contributing to such resistance and implications for children at risk for development psychological complications are discussed.     

Urban Adolescents' Exposure to Community Violence: The Role of Support,School Safety,and Social Constraints in a School-Based Sample of Boys and Girls

This study examined recent exposure to violence in the community and in other settings, protective factors, and current psychological functioning among 349 young adolescents from 9 urban middle schools. The majority (76%) of adolescents reported witnessing or being victimized by at least 1 violent event in the prior 6 months. Nearly half of adolescents who had talked about their experience of a violent event reported feeling constrained from sharing their thoughts or feelings because of others' reactions. After controlling for daily hassles, more exposure to violence was associated with more self-reported posttraumatic stress disorder (PTSD) and depressive symptoms. Exposure to violence was not a significant predictor of teachers' ratings of adaptive functioning or internalizing symptoms. Support from specific individuals, perceived school safety, and lower constraints for discussing violence showed protective effects in the relation between exposure to violence and specific dimensions of psychological functioning. The implications of this research for school-based interventions are discussed.     

Behavioral changes after closed head injury in children

This study provides a longitudinal follow-up of the behavioral adjustment of 45 children with mild, moderate, and severe closed head injuries. Two measures of behavioral adjustment, the Child Behavior Checklist (CBCL) and the Vineland Adaptive Behavior Scales (VABS), were obtained from a parent at the time of injury and at 6 and 12 months postinjury. The severely injured children obtained significantly poorer VABS scores than children with mild and moderate injuries over the year-long follow-up. In addition, on the CBCL, severely injured children had more school problems and engaged in fewer social activities than mild and moderately injured children. These results show that severe head injury in children was associated with declines in adaptive functioning, whereas scores for children with mild and moderate injuries did not differ, nor did they deviate from average levels at any follow-up interval.     

What It's Like to Be Me (Book)

Examined family moderators of the relation between everyday stressors (hassles) and behavior problems in 99 inner-city children (ages 8-12 years, M = 10.7) and their caregivers. In separate home interviews children reported on their everyday stress, perceived support from mother, and adjustment problems; mothers reported on family demographics, major life stressors, family interaction patterns, and child adjustment difficulties. Higher levels of cohesion and routines attenuated the relation between hassles and both internalizing and externalizing problem behaviors, whereas high family conflict exacerbated the risk for adjustment difficulties. For externalizing behavior, higher levels of family adaptability protected children from the impact of daily hassles. Social support from the mother did not moderate the hassle-adjustment association. Implications for interventions with families are discussed.