Life event stress and coping style as contributors to psychopathology

Despite the nearly universal finding that life event stress is related to psychopathology, the strength of these relationships is weak. In an attempt to increase the strength of the correlation between life event stress and psychopathology, this study evaluated the simultaneous contribution of life event stress and coping style, as well as the independent contribution of each, to psychopathology. Seventy-six male and 74 female college students served as primary subjects, while an additional 57 male and 60 female college students served as a cross validation sample. Each subject completed the Life Experiences Survey, the Coping Strategies Inventory, and the MMPI. Sex differences were found in the type of coping style related to psychopathology, the relative contributions of coping style and negative life stress to psychopathology, and the percentage of variance accounted for in psychopathology. Future research was recommended to include other variables, such as chronic life stress and physiological reactivity, and to control better for such methodological problems as response sets.     

Physicians' explanatory behaviours and legal liability in decided medical malpractice litigation cases in Japan

Background

A physician's duty to provide an adequate explanation to the patient is derived from the doctrine of informed consent and the physician's duty of disclosure. However, findings are extremely limited with respect to physicians' specific explanatory behaviours and what might be regarded as a breach of the physicians' duty to explain in an actual medical setting. This study sought to identify physicians' explanatory behaviours that may be related to the physicians' legal liability.

Methods

We analysed legal decisions of medical malpractice cases between 1990 and 2009 in which the pivotal issue was the physician's duty to explain (366 cases). To identify factors related to the breach of the physician's duty to explain, an analysis was undertaken based on acknowledged breaches with regard to the physician's duty to explain to the patient according to court decisions. Additionally, to identify predictors of physicians' behaviours in breach of the duty to explain, logistic regression analysis was performed.

Results

When the physician's explanation was given before treatment or surgery (p = 0.006), when it was relevant or specific (p = 0.000), and when the patient's consent was obtained (p = 0.002), the explanation was less likely to be deemed inadequate or a breach of the physician's duty to explain. Patient factors related to physicians' legally problematic explanations were patient age and gender. One physician factor was related to legally problematic physician explanations, namely the number of physicians involved in the patient's treatment.

Conclusion

These findings may be useful in improving physician-patient communication in the medical setting.     

Appraisal of the Event as a Factor in Coping with Malpractice Litigation

Abstract

The authors designed a study to explore medical malpractice litigation as a stressor, factors that contribute to doctors' appraisal of it, how they actually cope with it, and the potential effects on them and on their mode of practice. We interviewed 51 physicians who had been sued for medical malpractice. Those who identified litigation as their most stressful life event (Group 1, N = 11) experienced significantly more physical and emotional symptoms, especially those suggestive of a major depressive disorder, and used more emotion-focused coping mechanisms than those who identified some other event in life as being most stressful (Group 2, N = 39). The appraisal of litigation as one's most stressful life experience may be a useful predictor of coping response, with previous life experiences as a major contributing factor to this appraisal.     

Appraisal and coping with daily stressors by pediatric patients with chronic abdominal pain

OBJECTIVE: To test the hypothesis that pain patients differ from well children in their appraisal and coping with daily stressors and to test a model of the relation of stress appraisal and coping to symptoms and disability. METHODS: Pediatric patients with chronic abdominal pain (n = 143) and well children (n = 104) completed a 5-day diary study regarding their appraisal and coping with daily stressors. Somatic symptoms, depressive symptoms, and functional disability were assessed 2 months later. RESULTS: Compared to well children, pain patients were less confident of their ability either to change or to adapt to stress and were less likely to use accommodative coping strategies. Different patterns of stress appraisal were associated with active, passive, and accommodative coping. Both appraisals and coping were significantly related to symptoms and disability. CONCLUSIONS: The relation between stress and symptoms in pediatric pain patients may be explained in part by their appraisal and coping with stressors. The relation between appraisal and coping was consistent with Lazarus, R. S., & Folkman, S. (1984). Stress, Appraisal, and Coping. New York: Springer.     

Cancer recurrence as a traumatic event

The authors hypothesized that cancer recurrence can be understood and therefore treated as a traumatic event that places patients at risk for stress response symptoms. To test this, they gave 40 patients with recurrent malignancies of mixed sites the Impact of Event Scale (a measure of response to specific stressors), the Psychosocial Adjustment to Illness Scale-Self-Report version (a measure of general adjustment to illness), and a semi-structured interview in which the patients were asked about their reactions to and experiences surrounding the recurrence, compared with those surrounding their initial diagnosis. In self-report measures and in the interview, patients clearly perceived that adjustment to recurrence is more problematic than adjustment to initial diagnosis. The findings were consistent with an expectation derived from the stress-disorder literature: patients who reported having been completely surprised by the recurrence and those undergoing their first recurrence showed significantly more intrusive and avoidant stress response symptoms. Given the heterogeneity of the patient population and the relatively limited sample size, further study is needed to assess the contribution of other important mediating factors in the development of stress disorders. Because the predictors in this study (extent of surprise and number of previous recurrences) can be identified before or immediately following a recurrence, primary and secondary interventions might help prevent stress disorders in patients who may have had unrealistic expectations.     

Effects of coping behavior on gastric lesions in rats as a function of the complexity of coping tasks

In fixed ratio (FR) 2 coping task condition, experimental rats which could avoid and/or escape shock by emitting a disk-pulling operant response developed less stomach ulceration than did yoked "helpless" rats which had exactly the same shock but which had no control over shock. In variable ratio (VR) 5 coping task condition, however, the experimental rats developed more lesions than did the matched yoked rats. Neither the VR 2- nor the FR 5-experimental group was significantly different from its yoked group. Ulceration of non-shock control group was negligible compared to experimental and yoked rats in each of the four coping task conditions. The level of a complexity or difficulty of coping response tasks required has a detrimental effect on ulcerogenesis for "coping" experimental rats. The effectiveness of a coping behavior covaries with the nature or ease of the coping tasks in a stressful situation.     

A factor analysis of coping behaviors

Undertook factor analysis on questionnaire data that deal with ways of diminishing tension. Data were obtained on 132 college students. Seven patterns of coping were identified tentatively: seeking social support, dysfunctional behavior, narcotizing anxiety, problem solving, reliance on professionals, bearing with discomfort, and escape.     

Factors affecting the designation of cerebrovascular diseases as work-related in administrative litigation

The purpose of this study was to identify factors that could be used as standardized criteria for evaluating occupational diseases in initial assessments or requests for examination. Using 100 administrative litigation cases on the work-relatedness of cerebrovascular diseases (CVDs) by the Seoul Branch of the Korea Labor Welfare Corporation (KLWC) from 1997 to 2002, we estimated the relationship between the investigated variables and designation of the work-relatedness of the CVD. As for the age, the odds ratio of the acceptance rate of a case as work-related in subjects over 60 yr of age was 0.08 (95% CI, 0.01-0.75), which was compared to subjects under 30 yr of age. Regarding working hours, the odds ratio of the acceptance rate of a case as work-related in CVDs in those over 56 hr was 9.50 (95% CI, 1.92-47.10) when compared to those less than 56 hr. As for the benefit type, the odds ratio of the acceptance rate of a case as work-related in medical benefits was 5.74 (95% CI, 1.29-25.54), compared to survivor benefits. As for the criteria for defining situations as work overload, the odds ratio of the acceptance rate of a case as work-related in injured workers was 12.06 (95% CI, 3.12-46.62), compared to that in non-injured workers. Our findings show that the criteria for defining situations of work overload played an important role in assessing the work-relatedness of CVDs in administrative litigation, and it is necessary to make the scientific evidence on judgement of work-relatedness on overwork.     

Moving as a stressful life event for adolescents

In this study, 15 stressful elements and 18 supportive elements relating to moving house were identified based on the reports of 69 male and 71 female adolescents and pre-adolescents. Three primary stress factors and three basic support factors were found. It seems that pre-adolescent girls represent the group most sensitive to the level of stress and to the amount of received support surrounding a move. Adolescents who move from one city to another report greater stress than do those who move house within the same city.     

Ethnicity as a factor in the expression of pain

Ethnicity is often assumed to play a role in response to pain, and previous studies have tended to support this general concept. To assess the impact of learned ethnic attitudes to ward pain, the authors surveyed 75 women who had just delivered a baby and had an episiotomy. Interviewers administered self–assessment measures and made behavioral observations. No significant difference in pain response to the episiotomy was found among the five ethnic groups–Black, Italian, Jewish, Irish, and Anglo-Saxon Protestant patients.     

Papillary muscle rupture as a first event in acute myocardial infarction

Cardiogenic shock caused by papillary muscle rupture in acute myocardial infarction is potentially reversible by surgical treatment. A case of inferior myocardial infarction in a 56-year-old previously healthy man is reported, in which the first event was papillary muscle rupture. The patient was in shock and had a mitral insufficiency murmur. The diagnosis was made by echocardiography and ventriculography. A St. Jude valve was implanted, and the patient was discharged in good health. It is suggested that routine echocardiography be carried out on patients with sudden cardiogenic shock, when a mitral murmur is present.     

Mental Health of Mothers of Children with Juvenile Rheumatoid Arthritis: Appraisal as a Mediator

Examined direct and mediated relations between condition parametersand maternal mental health for 53 mothers of 2- to 11-year-oldchildren with juvenile rheumatoid arthritis (JRA). Multivariateanalyses revealed that when considered simultaneously, indicesof both biological severity and functional severity were associatedsignificantly with maternal mental health. Further, mother'sappraisals of the impact of the child's illness on the familypartially mediated the effects of medication type and child'sfunctional status on mother's mental health. Results providesupport for conceptual models that emphasize the cognitive mechanismsby which condition parameters such as biological and functionalseverity might affect maternal mental health. Explicating theprocesses by which a child's JRA might lead to psychologicaladjustment problems in the parent has implications for developingpreventive and treatment interventions.     

Personality variables in coping with the stress of a spouse's chronic illness

Identified systematically those spouses of male VA hemodialysis patients who are at risk for experiencing difficulties in adapting to their husband's chronic kidney failure and hemodialysis treatment. To this end, an exploration was made of personality variables that might enhance a spouse's ability to cope with the unique stress of living with chronic illness. Fifty-six wives of VA dialysis patients were administered the Rotter Internal-External Locus of Control Scale (I-E), the Multidimensional Locus of Control Scale (MLC), the Multidimensional Health Locus of Control Scale (MHLC), the State-Trait Anxiety Inventory (STAI), and the Beck Depression Inventory (BDI). Significant relationships were found between I-E scores and all measures of emotional adjustment (state anxiety, trait anxiety, and depression) for the entire sample of spouses in general, and also for a subgroup of home dialysis spouses who were analyzed separately. Results were discussed in terms of the role that locus of control orientation plays in mediating the stress of living with chronic illness, as well as the failure to find relationships between adjustment and the MLC or the area-specific MHLC.