The role of coping humor in the physical and mental health of older adults

Objectives: This study examined the associations among coping humor, other personal/social factors and the health status of community-dwelling older adults.

Method: Survey questionnaires were completed with 73 community-dwelling older adults. Included were measures of coping humor, spirituality, self-efficacy, social support and physical and mental health status.

Results: Correlations across all variables showed coping humor to be significantly associated with social support, self-efficacy, depression and anxiety. Forward stepwise regression analyses showed that coping humor and self-efficacy contributed to outcome variance in measures of mental health status. Contrary to expectation, neither social support nor spirituality contributed to the total outcome variance on any of the dependant measures.

Conclusion: The importance of social support, self-efficacy and spirituality in determining the quality of life of older adults is well supported in the literature. Coping humor as a mechanism for managing the inevitable health stresses of aging has received less attention. This study shows that coping humor and self efficacy are important factors for explaining health status in older adults. Correlations among coping humor, self efficacy and social support suggest that a sense of humor may play an important role in reinforcing self-efficacious approaches to the management of health issues.     

The important role of sense of coherence in relation to depressive symptoms for Taiwanese family caregivers of cancer patients at the end of life

OBJECTIVE: To determine whether the strength of personal coping capability, the sense of coherence (SOC), makes a unique contribution in explaining the extent of depressive symptoms experienced by family caregivers of terminally ill cancer patients. METHODS: A total of 253 Taiwanese family caregivers of terminally ill cancer patients participated in this survey. Caregiver depressive symptoms were assessed using the CES-D. Potential correlates of depressive symptoms were categorized as: (1) characteristics of the caregivers; (2) demographics and disease-related characteristics of the patients; (3) objective caregiving loads; (4) confidence in end-of-life caregiving; (5) subjective caregiving burden; and (6) SOC. RESULTS: Family caregivers scored high on the CES-D [mean (S.D.)=22.24 (11.36)]. Results from the R(2) change in the hierarchical multiple regression model indicated that the incremental variance explained by each block of variables for (1) the characteristics of family caregivers, (2) the characteristics of cancer patients, (3) objective caregiving loads, (4) confidence in caregiving, and (5) subjective caregiving burden was 20.5%, 6.8%, 1.5%, 3.7%, and 11.9%, respectively. In the final step of regression, SOC of caregivers increases the explained variation in depressive symptoms by 21.5%. CONCLUSIONS: This study confirms that, among the independent variables examined in this study, variations in SOC are comparatively important in explaining the variation of depressive symptoms experienced by Taiwanese family caregivers. Developments and evaluations of the effectiveness of clinical interventions aimed at augmenting caregivers' coping capability (such as SOC) to facilitate positive appraisal and finding meaning, to improve understanding of the demands and challenges of caregiving, and to mobilize resources available to manage caregiving tasks are highly recommended.     

Severe acute respiratory syndrome-related psychiatric and posttraumatic morbidities and coping responses in medical staff within a primary health care setting in Singapore

BACKGROUND: Severe acute respiratory syndrome (SARS) is a major new infectious disease of this century that is unique in its high morbidity and concentration in health care settings. We aimed to determine the level of psychological impact and coping styles among the medical staff in a primary health care setting. METHOD: Using a structured questionnaire, we conducted a cross-sectional survey of the doctors and nurses working within a public, primary health care setting in mid-July 2003. The main outcome measures were rates of psychiatric morbidity, level of posttraumatic stress symptoms, and coping strategies. RESULTS: The response rate was 92.0%. Of the 277 respondents (91 doctors and 186 nurses), psychiatric morbidity and posttraumatic morbidity were found in 20.6% and 9.4%, respectively. Both psychiatric and posttraumatic morbidities were associated with higher scores on coping efforts including self-distraction, behavioral disengagement, social support, venting, planning, and self-blame (all p <.001), but not with direct exposure factors such as contact with suspected SARS patients or working in fever rooms/tentages. Multivariate analysis showed that psychiatric morbidity was associated with post-traumatic morbidity (p =.02) and denial (p =.03), whereas posttraumatic morbidity was associated with younger age (p =.007), being married (p =.02), psychiatric morbidity (p =.02), self-distraction (p =.02), behavioral disengagement (p =.01), religion (p =.003), less venting (p =.04), less humor (p =.04), and less acceptance (p =.02). CONCLUSION: SARS-related psychiatric and posttraumatic morbidities were present in the medical staff within a primary health care setting. Specific coping efforts, age, and marital status, not direct exposure factors, were associated with psychological morbidity. These findings provide possible foci for early identification and psychological support.     

Coping style and health-related quality of life in caregivers of epilepsy patients

Epilepsy has a significant impact on health-related quality of life (HRQOL) of patients and personal coping style is an important determinant. Less is known about home caregivers. This study investigates HRQOL and coping style of both patients and caregivers and their interaction. Epilepsy patients attending the outpatient clinic of the University Medical Centre in Utrecht and their caregivers were sent EQ5D and RAND-36 questionnaires. The Utrecht Coping List was used to chart personal coping styles. HRQOL scores of patients and caregivers were compared to the general Dutch population. The association between patient and caregiver HRQOL scores was calculated. A stepwise backward multivariate linear regression analysis was used to explain variances in caregiver HRQOL. Eighty-six couples (49%) returned all questionnaires. Caregiver HRQOL scores were comparable to the general Dutch population (EQ5D: 0.88-0.88; p?=?0.90, RAND-36 MCS: -2 points; p?=?0.16), while patients HRQOL scores were lower (EQ5D: 0.79; p?相似文献   

Associations between coping and survival time of adult leukemia patients receiving allogeneic bone marrow transplantation: results of a prospective study

BACKGROUND: To investigate associations between coping strategies and length of survival in a sample of 52 adult leukemia patients receiving allogeneic bone marrow transplantation (BMT). METHODS: 52 adult patients, diagnosed with acute (AML) and chronic myeloid leukemia (CML) admitted for allogeneic BMT to a university hospital BMT unit in preparation for a transplantation of genotypically matched HLA donor marrow, were interviewed immediately after informed consent and prior to preparatory treatment for transplantation. Semistructured interviews were conducted and recorded for analysis to assess coping styles and were evaluated by a new content analytic coping measure [Ulm Coping Manual (UCM)]. Patients were a random sample of all eligible patients on the BMT unit between May 1990 and May 1994. RESULTS: Complete audiotaped interviews were rated by blind raters, employing a newly developed content analysis for the identification of patients' coping strategies. Multivariate analysis using a Cox model revealed three pretransplant variables that demonstrated a statistically significant influence on 5-year survival: Stage of Disease at transplant (P < .012), Distraction (P < .007), and Fighting Spirit as coping modalities (P < .013). CONCLUSIONS: The results of this prospective study document the impact of certain psychological variables, notably coping style on survival with BMT. This suggests the necessity of utilizing psychosocial interventions to address stress and anxiety in patients awaiting transplantation in order to reduce anxieties and to employ more effective coping techniques to deal more appropriately with their situation and to enhance Fighting Spirit. The effects on survival of such psychosocial interventions need to be tested in a randomized controlled study.     

Finding meaning in parenting a child with Asperger syndrome: correlates of sense making and benefit finding

This study explored the nature of two construals of meaning, benefit finding and sense making, in parents of a child with Asperger syndrome, and examined relations between both meaning constructs and the Double ABCX family stress model variables (initial stressor and pile-up of demands, appraisal, social support, coping strategies and adjustment) [H.I. McCubbin, J.M. Patterson, Social Stress and the Family: Advances and Developments in Family Stress Theory and Research, Haworth, New York, 1983, pp. 7-37]. A total of 59 parents completed questionnaires. Content analyses of parents' responses to questions inquiring about gains and sense making explanations revealed 8 benefit and 12 sense making themes. Results of correlations indicated that one or more of the meaning variables were related to each of the Double ABCX model predictors of parental adjustment. The meaning variables were positively related to adaptive coping processes: social support, self-efficacy, and problem-focused and emotional approach coping strategies.     

Resilience and coping as predictors of general well-being in the elderly: a structural equation modeling approach

Objectives: The aims of this article are: (a) to test for the validity of the three constructs involved in the structural model; (b) to test for the effects of both coping strategies and resilient coping on well-being in a sample of elderly, by means of a structural model with latent variables; (c) to empirically study whether a brief scale of resilient coping could predict well-being over and above that predicted by the coping resources.

Methods: The research is a survey design. The sample consisted of 225 non-institutionalized elderly people living in the city of Valencia (Spain). The three constructs measured were: well-being, resilient coping, and coping strategies.

Results: The analyses consist of a series of alternative structural models with latent variables with resilience, problem-focused coping, and emotion-focused coping as the potential predictors of well-being as measured by Ryff's well-being scales. Due to parsimony reasons, the model retained is that with a single predictor of well-being: resilient coping.

Conclusion: A latent variable measuring resilient coping is able to predict a significant and large part of the variance in well-being, without the need of including coping strategies. Results impact on well-being literature of the elderly is discussed.     

The therapeutic use of humor for psychiatric disturbances of adolescents and adults

The use of humor in psychiatric care and treatment is examined within a lifespan-development context, comparing its utility in late adolescence with that in early adulthood. The literature of the past two decades, based on careful experimental research as well as on more subjective clinical experience, tend to support the following conclusions: A well-developed sense of humor provides a beneficial ingredient to the patient's coping or adjustive ability. The salutary physiological effects of laughter are the same for adolescents and adults. In terms of psychosocial factors,individual rather than developmental stage differences in the patient's personality, psychopathology and humor preference will alter the effectiveness of humor application. According to a cognitive-behavioral analysis, the mechanism by which positive emotions (including laughter) operate to reduce or eliminate the undesirable negative emotions resides in the interplay of the physiological and psychological processes involved in thestress reaction and its management. Finally, to be optimally effective the psychiatrist should undertake formal training in the use of humor techniques comparable to the traditional training in the usual assessment and therapeutic procedures.     

Factors associated with perceived health in elderly medical inpatients: a particular focus on personal coping recourses

Aim: We wanted to unveil associations between perceived health and physical health, function in activity of daily living, anxiety, depression and coping resources in terms of sense of coherence (SOC) in elderly (≥65 years) in-hospital patients without cognitive impairment.

Method: In a cross-sectional study, we evaluated 217 hospitalized elderly patients with an age range 65–95 (mean 77.9) years. Perceived health was rated on a four-point scale. Physical health was measured with the Charlson index; functional status was rated using the Lawton and Brody's scale for self-maintaining and instrumental activities of daily living; and, anxiety and depression were rated using the Hospital Anxiety and Depression scale. Finally, the 13-item version of the SOC scale was used to assess coping, and cognitive state was assessed using the Mini-mental State Examination.

Results: In all, 40% of the patients reported good perceived health. In an adjusted logistic regression analysis, the main outcome good perceived health was associated with increasing age: odds ratio (OR) 1.06 (95% CI 1.01–1.11); good physical health: OR 2.49 (95% CI 1.22–5.07); and, medium high and high SOC: OR 2.48 (95% CI 1.20–5.13), and OR 2.43 (95% CI 1.11–5.28), respectively. Explained variance was 22.2%.

Conclusion: Good coping resources and low severity of co-morbid disorders are the two most important factors that explain why elderly inpatients rate their health as good. Since coping may be equally important as poor physical health for perception of health, coping should be recognized and measured in clinical practice.     

Humor coping, health status, and life satisfaction among older adults residing in assisted living facilities

The present study examined the relationships between humor coping, health status, and life satisfaction among older residents of assisted living facilities. A structural equation model with latent variables was specified for the three variables. Health status was expected to directly affect humor coping and life satisfaction. Humor coping was hypothesized to have a direct association with life satisfaction and indirectly affect the relationship between health status and life satisfaction. Participants completed the Multidimensional Functional Assessment Questionnaire, Coping Humor Scale, and Life Satisfaction Index A. The relationships between health status and humor coping and health status and life satisfaction were statistically significant. Both the direct association of humor coping on life satisfaction and the intervening role between health status and life satisfaction were not supported. Humor as a coping strategy seems to be available to older adults who are in better health.     

Capturing coping with symptoms in people with a diagnosis of schizophrenia: introducing the MACS‐24

In order to assess coping with psychotic symptoms, the Maastricht Assessment of Coping Strategies (MACS), 24 symptom version, was developed as a refinement of the previous MACS‐13. Associations between type of coping and the experienced level of control over psychotic symptoms were examined using MACS‐24. MACS‐24 was administered to 32 individuals with a diagnosis of schizophrenia. For each of 24 symptoms, experience of distress, type of coping and the resulting degree of perceived control were assessed. Coping types were reduced to two contrasting coping factors: symptomatic coping and non‐symptomatic coping (combining active problem solving, passive illness behaviour, active problem avoiding, and passive problem avoiding). Mean level of distress and perceived control (range: 1–7) were, respectively, 4.2 [standard deviation (SD) = 1.9] and 4.2 (SD = 1.9). The association between distress and perceived control was negative [β = ?0.28; 95% confidence interval (95%CI) = ?0.41 to ?0.15]. Type of coping interacted with perceived control (p = 0.005), in that symptomatic coping was negatively associated with perceived control [odds ratio (OR) over seven levels = 0.82, 95%CI = 0.71–0.94], whereas for non‐symptomatic coping a positive association was apparent (OR over seven levels = 1.10, 95% CI = 1.03–1.19). Previous contrasts between symptomatic and non‐symptomatic coping were replicated using MACS‐24, suggesting clinical validity and utility. Copyright © 2009 John Wiley & Sons, Ltd.     

Sense of humor, hassles, and immunoglobulin A: evidence for a stress-moderating effect of humor

This study was designed to investigate whether sense of humor moderates immunosuppressive effects of stress. At two time periods one and one-half months apart, forty subjects completed the Daily Hassles Scale and provided saliva samples for determining secretory immunoglobulin A (S-IgA) levels. Four scales were used to assess different aspects of the sense of humor. A negative correlation was obtained between frequency of hassles at time 1 and S-IgA levels at time 2 (r = -.32, p less than .05), suggesting an immunosuppressive effect of hassles. In support of our hypothesis, hierarchical multiple regression analyses revealed significant moderating effects of three of the four humor measures on this relationship between hassles and S-IgA. Subjects with low scores on the humor scales revealed a stronger negative relationship between hassles and S-IgA than did those with high humor scores. These results are discussed in terms of other research examining psychological influences on immune function.     

Coping and survival in lung cancer: a 10-year follow-up

OBJECTIVE: Little evidence is available to clarify the influence of psychological variables on the outcome of cancer. The authors studied whether style of coping was predictive of survival in lung cancer. METHOD: A cohort of 103 patients newly diagnosed with cancer was followed for 10 years. Coping was assessed before treatment by using both self-reports and interviewer ratings. RESULTS: In a survival analysis with adjustment for known biomedical prognostic factors such as tumor stage, histological classification, and Karnofsky performance status, a depressive coping style, assessed by patients' self-reports, was linked with shorter survival (relative risk=1.91), and an active coping style, as assessed by interviewers' ratings, was linked with longer survival (relative risk=0.72). CONCLUSIONS: These results support the hypothesis that style of coping predicts survival in lung cancer. The observational design of the study, however, precludes any causal interpretation.     

Coping, distress, and survival among patients with lung cancer.

BACKGROUND: This study addresses the question of whether coping and emotional state are predictors of survival among patients with lung cancer. The hypotheses were (1) active coping is linked with longer survival time and (2) depressive coping, emotional distress, and depression are linked with shorter survival. METHODS: The study was based on a sample of 103 patients who were investigated after their diagnosis and before the beginning of primary treatment. The psychological variables were assessed by means of self-reports and interviewer ratings. After follow-up of 7 to 8 years, 92 patients had died; survival data were censored for the remaining 11 patients. The prediction of the survival time was performed by the Cox regression, while adjusting for biomedical risk factors (tumor stage, histological classification, and Karnofsky performance status). RESULTS: The self-reported depressive coping (P = .007) and the interviewer-rated emotional distress (P = .04) were significantly associated with shorter survival, independent of the influence of the biomedical prognostic factors. CONCLUSIONS: Both coping and emotional distress had a statistically independent effect on survival among patients with lung cancer. However, the naturalistic design of the study does not allow for any causal interpretation. Thus, the nature of this relationship warrants further investigation.     

Survival of a cohort of elderly patients with advanced dementia: nasogastric tube feeding as a risk factor for mortality

OBJECTIVES: To evaluate and identify factors determining survival in elderly patients with advanced dementia. METHODS: A prospective, follow-up, observational analysis in a cohort of 67 community-based patients aged 65 years or older with dementia defined by DSM-IV and stage 7A or above on the FAST scale. Data were recorded on socio-demographic variables, FAST, Katz index, language, swallowing ability, diet, nutritional status (from anthropometric and laboratory data), associated diseases and medical complications during the previous 12 months. Survival was analyzed by the Kaplan-Meier method. Prognostic factors for survival were identified by the Cox proportional hazards regression model. RESULTS: The median follow-up was 832 days. The mean age was 82.2+/-6.7 years and 92.5% were women. A comorbid condition was present in 71.6%, most frequently hypertension (22.4%). A clinical event had occurred in 52 (77.6%) patients during the previous year (pneumonia, urinary infection, stroke, pressure sore, dehydration, sepsis or others). A total of 25 (37.3%) patients died. The mean survival was 676 days (95% confidence interval, 600-752 days). Cox proportional hazards model showed that independent prognostic factors for mortality were having pneumonia within the previous year (RR:3.7; p=0.001), a permanent nasogastric tube (RR:3.5; p=0.003) and serum albumin values below 3.5 g/dL (RR:2.9; p=0.028). CONCLUSIONS: In patients with advanced dementia, hypoalbuminemia and pneumonia are strongly and positively associated with mortality. Artificial nutrition via a nasogastric tube reduces survival in these patients.     

Predictors of health-related quality of life and participation after brain injury rehabilitation: The role of neuropsychological factors

The aims of this longitudinal study were: (1) to assess associations between neuropsychological factors and health-related quality of life (HRQoL) and participation three months after discharge from inpatient acquired brain injury (ABI) rehabilitation; and (2) to determine the best neuropsychological predictor of HRQoL and participation after controlling for demographic and injury-related factors. Patients with ABI (n?=?100) were assessed within approximately two weeks of enrolment in inpatient rehabilitation. Predictor variables included demographic and injury-related characteristics and the following neuropsychological factors: active and passive coping, attention, executive functioning, verbal memory, learning potential, depressive symptoms, motivation, extraversion, neuroticism and self-awareness. Bivariate analyses revealed that passive coping, executive functioning, depressive symptoms, extraversion, and neuroticism were significantly associated with HRQoL and/or participation. Neuropsychological factors significantly explained additional variance in HRQoL (18.1–21.6%) and participation (6.9–20.3%) after controlling for demographic and injury-related factors. However, a higher tendency towards passive coping was the only significant neuropsychological predictor (β?=??0.305 to ?0.464) of lower HRQoL and participation. This study shows that neuropsychological functioning, and in particular passive coping, plays a role in predicting HRQoL and participation after inpatient ABI rehabilitation and emphasises the importance of addressing patients’ coping styles in an early phase of ABI rehabilitation.     

Oncologist Assisted Spiritual Intervention Study (OASIS): patient acceptability and initial evidence of effects

PURPOSE: Individuals with serious illness often desire to discuss spiritual concerns with their physician, yet substantial barriers exist to doing so, including limited evidence of value. This study evaluated acceptability, impact on satisfaction with care and on quality of life (QOL) of a brief (5-7 minute) semi-structured exploration of spiritual/religious concerns. PATIENTS AND METHODS: 118 consecutive patients of four oncologist-hematologists (95% recruitment; 55.1% female, 91.5% Caucasian, 81.3% Christian) with mixed diagnoses, duration (51.7% diagnosed within 2 years) and prognosis (54.2% in active treatment) were alternately assigned to receive the intervention or usual care during an office visit. Assessment occurred just prior to the visit, immediately after, and after 3 weeks. Measures included the FACT-G QOL and FACIT-Sp (Spiritual Well-Being) Scales; BSI Depression Scale; the PCAS Interpersonal and Communication scales; and ratings of acceptability. RESULTS: Oncologists rated themselves as comfortable during the inquiry with 85% of patients. Of patients, 76% felt the inquiry was "somewhat" to "very" useful. At 3 weeks, the intervention group had greater reductions in depressive symptoms (F= 7.57,p < .01), more improvement in QOL (F = 4.04, p < .05), and an improved sense of interpersonal caring from their physician (F = 4.79, p < .05) relative to control patients. Effects on QOL remained after adjusting for other variables, including relationship to physician. Improvement on Functional Well-being was accounted for primarily by patients lower on baseline spiritual well-being (beta = .293, p < .001). CONCLUSIONS: This study supports the acceptability of a semi-structured inquiry into spiritual concerns related to coping with cancer; furthermore, the inquiry appears to have a positive impact on perception of care and well-being.     

Adolescent Humor and its Relationship to Coping,Defense Strategies,Psychological Distress,and Well-Being

Objective This study investigated the psychometric properties of the Humor Styles Questionnaire (HSQ) in measuring adolescent humor, including the relationship between humor and coping style, defense style, depressive symptoms, and adjustment in a non-clinical sample of adolescents. Method Humor, coping, defense strategies, depressive symptoms, and adjustment were investigated in 94 adolescents aged 12–15. Results The HSQ demonstrated adequate internal consistency. Inter-scale correlational patterns and scale means were similar for adolescents and adults. Convergent validity for the HSQ was supported by its relationship to: an adolescent-standardized humor defense scale; coping and defense strategies; and depressive symptoms and adjustment. Clinical utility of the HSQ was demonstrated by its unique contribution in predicting both depressive symptoms and adjustment above and beyond contributions from coping and defense composites. Discussion The HSQ appears to be a psychometrically sound and clinically useful measure to assess humor dimensions in adolescents.     

Improving survival in a large French ALS center cohort

The aim of this work was to determine whether survival changed during 2002-2009 at a French amyotrophic lateral sclerosis (ALS) center. We included all patients with ALS who were seen consecutively at the center from January 2002-May 2009. Participants were followed from date of first visit through death, date of censoring, or December 31, 2009, whichever occurred first. Cox proportional hazard models computed hazard ratios (HR; 95% confidence interval CI) of death, and flexible modeling of continuous predictors (splines) assessed trends in survival. We analyzed a total of 2,037 ALS patients, of whom 1,471 died before the end of follow-up. Median survival was 2.83?years from onset and 1.65?years from first visit. Compared to patients first seen before 2004, the HR of death was 0.97 (95% CI?=?0.85-1.11, p?=?0.6721) for patients first seen in 2004-2005, 0.96 (95% CI?=?0.83-1.10, p?=?0.5125) for 2006-2007, and 0.56 (95% CI?=?0.46-0.69, p?相似文献