抑郁症患者主观幸福感与复原力的对照研究

目的 研究抑郁症患者与正常对照之间主观幸福感及复原力的差异,并探讨幸福感及复原力之间的关系.方法 对门诊及病房的抑郁症患者及正常对照组的被试者进行幸福感指数问卷及Connor- Davidson韧性量表的测评,得分进行两组间的比较.结果 抑郁症患者幸福感指数及复原力得分明显低于正常对照组(P＜0.01);正常被试者复原力与幸福感水平存在正相关关系(r=0.493,P＜0.01),而抑郁症组二者之间无显著相关(r=0.149,P＞0.05).结论 抑郁症患者的幸福感及复原力均明显低于正常人;在正常成年人群中,复原力与主观幸福感呈正相关,而本研究的抑郁症患者中并未发现此二者存在相关关系.     

Effects of College Students’ Perceived Stress on Anxiety in the Time of COVID-19: The Chain Mediation Role of Psychological Resilience and Regulatory Emotional Self-Efficacy

COVID-19 has changed the way of learning and life of college students. The purpose is to explore the relationship between perceived stress and anxiety, and the mediating effect of resilience and regulatory emotional self-efficacy in college students during COVID-19. 309 students from three colleges were selected as research participants (average age 19.79 ± 1.11 years). SPSS was used to measure the correlation between variables. Amos was used to test the path coefficient and mediating effect of the hypothetical model. The results show that: Firstly, perceived stress has a significantly and positively predictive effect on anxiety. Secondly, psychological resilience and regulatory emotional self-efficacy independently played a significant and partially mediating effect between perceived stress and anxiety. Among them, perceived stress had a negative predictive effect on psychological resilience and regulatory emotional self-efficacy. Psychological resilience and regulatory emotional self-efficacy had a negative predictive effect on anxiety. Thirdly, psychological resilience and regulatory emotional self-efficacy play a chain mediation role between psychological stress and anxiety. Regulatory emotional self-efficacy cannot only directly predict the level of anxiety, but also indirectly predict the level of anxiety by regulating psychological resilience. This study reveals the relationship between college students’ perceived stress and anxiety, and the mediating effect of psychological resilience and regulatory emotional self-efficacy in the new time of COVID-19. The chain mediation role of psychological resilience and regulatory emotional self-efficacy reminds college mental health educators that improving students’ regulatory emotional self-efficacy is an important way to promote students’ mental health.     

Resilience in relation to personality and intelligence

Resilience is a construct of increasing interest, but validated scales measuring resilience factors among adults are scarce. Here, a scale named the Resilience Scale for Adults (RSA) was crossvalidated and compared with measures of personality (Big Five/5PFs), cognitive abilities (Raven's Advanced Matrices, Vocabulary, Number series), and social intelligence (TSIS). All measures were given to 482 applicants for the military college. Confirmatory factor analyses confirmed the fit of the five-factor model, measuring 'personal strength', 'social competence', 'structured style', 'family cohesion' and 'social resources'. Using Big Five to discriminate between well adjusted and more vulnerable personality profiles, all resilience factors were positively correlated with the well adjusted personality profile. RSA-personal strength was most associated with 5PFs-emotional stability, RSA-social competence with 5PFs-extroversion and 5PFs-agreeableness, as well as TSIS-social skills, RSA-structured style with 5PFs-conscientiousness. Unexpectedly but interestingly, measures of RSA-family cohesion and RSA-social resources were also related to personality. Furthermore, the RSA was unrelated to cognitive abilities. This study supported the convergent and discriminative validity of the scale, and thus the inference that individuals scoring high on this scale are psychologically healthier, better adjusted, and thus more resilient.     

The Impact of Emotional Exhaustion on Psychological Factors in Workers with Secondary Traumatic Experiences: A Multi-Group Path Analysis

Objective The objective of the present study was to explore causal pathways to understand how second traumatic experiences could affect the development of emotional exhaustion and psychiatric problems. Methods A total of 582 workers who had jobs vulnerable to secondary traumatic experiences were enrolled for this study. Emotional exhaustion, secondary trauma, resilience, perceived stress, depression, anxiety, and sleep problems were evaluated. A model with pathways from secondary traumatic experience score to depression and anxiety was proposed. The participants were divided into three groups according to the resilience: the low, middle and high resilience group. Results Resilience was a meaningful moderator between secondary traumatic experiences and psychiatric problems. In the path model, the secondary trauma and perceived stress directly and indirectly predicted perceived stress, emotional exhaustion, depression, anxiety, and sleep problems in all three groups. Direct effects of perceived stress on depression and anxiety were the largest in the low resilience group. However, direct effects of secondary trauma on perceived stress and emotional exhaustion were the largest in the high resilience group. Conclusion Understanding the needs of focusing for distinct psychological factors offers a valuable direction for the development of intervention programs to prevent emotional exhaustion among workers with secondary traumatic experiences.     

Perceived stress and resilience in Alzheimer's disease caregivers: testing moderation and mediation models of social support

Objective: The study examined whether social support functioned as a protective, resilience factor among Alzheimer's disease (AD) caregivers. Moderation and mediation models were used to test social support amid stress and resilience. Method: A cross-sectional analysis of self-reported data was conducted. Measures of demographics, perceived stress, family support, friend support, overall social support, and resilience were administered to caregiver attendees (N = 229) of two AD caregiver conferences. Hierarchical regression analysis showed the compounded impact of predictors on resilience. Odds ratios generated probability of high resilience given high stress and social supports. Social support moderation and mediation were tested via distinct series of regression equations. Path analyses illustrated effects on the models for significant moderation and/or mediation. Results: Stress negatively influenced and accounted for most variation in resilience. Social support positively influenced resilience, and caregivers with high family support had the highest probability of elevated resilience. Moderation was observed among all support factors. No social support fulfilled the complete mediation criteria. Conclusion: Evidence of social support as a protective, moderating factor yields implications for health care practitioners who deliver services to assist AD caregivers, particularly the promotion of identification and utilization of supportive familial and peer relations.     

A new rating scale for adult resilience: what are the central protective resources behind healthy adjustment?

Resources that protect against the development of psychiatric disturbances are reported to be a significant force behind healthy adjustment to life stresses, rather than the absence of risk factors. In this paper a new scale for measuring the presence of protective resources that promote adult resilience is validated. The preliminary version of the scale consisted of 45 items covering five dimensions: personal competence, social competence, family coherence, social support and personal structure. The Resilience Scale for Adults (RSA), the Sense of Coherence scale (SOC) and the Hopkins Symptom Checklist (HSCL) were given to 59 patients once, and to 276 normal controls twice, separated by four months. The factor structure was replicated. The respective dimensions had Cronbach's alphas of 0.90, 0.83, 0.87, 0.83 and 0.67, and four-month test-retest correlations of 0.79, 0.84, 0.77, 0.69 and 0.74. Construct validity was supported by positive correlations with SOC and negative correlations with HSCL. The RSA differentiated between patients and healthy control subjects. Discriminant validity was indicated by differential positive correlations between RSA subscales and SOC. The RSA-scale might be used as a valid and reliable measurement in health and clinical psychology to assess the presence of protective factors important to regain and maintain mental health.     

Severe and persistent mental illness: a useful definition for prioritizing community-based mental health service interventions

OBJECTIVE: There is a lack of consensus on the identification of seriously mentally ill patients (SMI). This study investigates the external and predictive validity of an operationalized definition for the severity and persistency of mental illness applied to a sample of service users attending a community mental health service. METHOD: The definition is based on the fulfilment of dysfunction (GAF < or = 50) and illness duration (> or = 2 yrs) criteria. The study was conducted with a two-year longitudinal design. External and predictive validity of the SMI definition were assessed against the diagnosis of psychosis. RESULTS: Our data show evidence for an overall high predictive and external validity of the SMI definition and high sensitivity in predicting those with high burden of mental illness. CONCLUSIONS: In order to identify people with high levels of psychiatric burden, the SMI working definition seems to be more useful than that simply based on diagnostic criteria.     

Acute stress disorder and posttraumatic stress disorder in victims of violent crime

OBJECTIVE: In a group of crime victims recruited from the community, the authors investigated the ability of both a diagnosis of acute stress disorder and its component symptoms to predict posttraumatic stress disorder (PTSD) at 6 months. METHOD: A mixed-sex group of 157 victims of violent assaults were interviewed within 1 month of the crime. At 6-month follow-up 88% were reinterviewed by telephone and completed further assessments generating estimates of the prevalence of PTSD. RESULTS: The rate of acute stress disorder was 19%, and the rate of subsequent PTSD was 20%. Symptom clusters based on the DSM-IV criteria for acute stress disorder were moderately strongly interrelated. All symptom clusters predicted subsequent PTSD, but not as well as an overall diagnosis of acute stress disorder, which correctly classified 83% of the group. Similar predictive power could be achieved by classifying the group according to the presence or absence of at least three reexperiencing or arousal symptoms. Logistic regression indicated that both a diagnosis of acute stress disorder and high levels of reexperiencing or arousal symptoms made independent contributions to predicting PTSD. CONCLUSIONS: This exploratory study provides evidence for the internal coherence of the new acute stress disorder diagnosis and for the symptom thresholds proposed in DSM-IV. As predicted, acute stress disorder was a strong predictor of later PTSD, but similar predictive power may be possible by using simpler criteria.     

Positive affect as a factor of resilience in the pain-negative affect relationship in patients with rheumatoid arthritis

OBJECTIVE: The purpose of this study is to examine positive affect (PA) as a factor of resilience in the relationships between pain and negative affect (NA) in a sample of patients with rheumatoid arthritis. METHODS: Forty-three patients (30 women; mean age, 57 years) were interviewed weekly by telephone for 8 weeks. Multilevel modeling was applied to study the within-week relationships among the variables. RESULTS: There was a Pain x PA interaction effect on NA (beta=-0.05, P<.01) indicating a weaker relationship between pain and NA in weeks with more PA. Pain (beta=0.37, P<.002), interpersonal stress (beta=2.42, P<.001), depression (beta=0.26, P<.01), average perceived stress (beta=10.80, P<.001), and also weekly PA (beta=-0.1, P<.01) had a main effect upon NA. CONCLUSION: Positive affect is most influential in reducing NA during weeks of higher pain and may be a factor of resilience, helping patients experiencing pain fluctuations as less distressful than at lower levels of PA.     

Community Workers’ Social Support and Sleep Quality during the Coronavirus Disease 2019 (COVID-19): A Moderated Mediation Model

To explore the relationship between social support and sleep quality of community workers in Wuhan during the coronavirus disease 2019 (the COVID-19 infection epidemic), this research constructed a mediating effect model to explore the mediating psychological mechanism of social support influencing sleep quality of front-line community workers. A total of 500 front-line community workers in Wuhan were investigated. We used the perceived social support scale (PSSS), the Connor-Davidson Resilience Scale (CD-RISC), the perceived stress scale (PSS), and the Pittsburgh sleep quality index (PSQI) to measure social support, psychological resilience, perceived stress and sleep quality. Specifically, the higher the PSQI, the worse the sleep quality. Pearson correlation structural equation model was used to analyze the relationship between these factors. The results showed that: (1) There was a significant negative correlation between social support, psychological resilience, and perceived stress of community workers and PSQI, that means, the higher the level of social support, psychological resilience, and perceived stress, the higher the sleep quality. (2) Social support positively predicted psychological resilience and perceived stress, and perceived stress negatively predicted PSQI. (3) Social support can affect sleep quality through the mediating role of psychological resilience and perceived stress, and the mediating role includes two paths: the single mediating role of perceived stress and the chain mediating role of psychological resilience-perceived stress. (4) Gender moderates the relationship between social support and perceived stress, and the influence of social support on perceived stress of women is higher than that of men. Gender moderates the relationship between psychological resilience and PSQI, and only women’s psychological resilience had a negatively predictive effect on PSQI, while men did not, which means that psychological resilience of female frontline community workers can positively predict sleep quality. This research reveals the relationship between social support and sleep quality and its mechanism and verifies that social support can indirectly affect physical health through psychological resilience and perceived stress. It provides reference suggestions and intervention guidance for improving the sleep quality of community workers.     

Development of a new resilience scale: the Connor-Davidson Resilience Scale (CD-RISC)

Resilience may be viewed as a measure of stress coping ability and, as such, could be an important target of treatment in anxiety, depression, and stress reactions. We describe a new rating scale to assess resilience. The Connor-Davidson Resilience scale (CD-RISC) comprises of 25 items, each rated on a 5-point scale (0-4), with higher scores reflecting greater resilience. The scale was administered to subjects in the following groups: community sample, primary care outpatients, general psychiatric outpatients, clinical trial of generalized anxiety disorder, and two clinical trials of PTSD. The reliability, validity, and factor analytic structure of the scale were evaluated, and reference scores for study samples were calculated. Sensitivity to treatment effects was examined in subjects from the PTSD clinical trials. The scale demonstrated good psychometric properties and factor analysis yielded five factors. A repeated measures ANOVA showed that an increase in CD-RISC score was associated with greater improvement during treatment. Improvement in CD-RISC score was noted in proportion to overall clinical global improvement, with greatest increase noted in subjects with the highest global improvement and deterioration in CD-RISC score in those with minimal or no global improvement. The CD-RISC has sound psychometric properties and distinguishes between those with greater and lesser resilience. The scale demonstrates that resilience is modifiable and can improve with treatment, with greater improvement corresponding to higher levels of global improvement.     

Quelles échelles utiliser pour mesurer la résilience en psychiatrie adulte ?

This communication based on a literature review, summarizes the most appropriate evaluation scales which measure resilience in adult psychiatry, and lists the principal clinical dimensions studied in the articles on the topic. The objective of this communication is to provide psychiatric institutions which receive adult patients with a list of resilience evaluation scales we consider to be the most pertinent to measure resilience in that sector.MethodThe review was done using Pubmed on articles written between 2016 and 2019, using the terms “resilience scales in psychiatry” and “resilience scales in psychology”. Two hundred and seventy-eight articles were found. Fifty articles concerning mental health in adult psychiatry more precisely were kept, and we looked at which resilience evaluation scales were most used in those researches, and which associated clinical dimensions were studied. We started by defining resilience, as defined originally in physics, and how it was then derived in psychology, notably introduced in France by Boris Cyrulnik. We then looked at how resilience is measured in adult psychiatry. Some researchers such as Wagnild used instruments specifically designed to measure resilience. Ionescu & Jourdan-Ionescu did an inventory of the instruments, and Windle, Bennett & Noyes a review.ResultAfter briefly defining what resilience is, particularly in the psychological field, we succinctly summarized the 6 scales we consider to be the most adapted for researches on resilience in adult psychiatry and listed the main clinical dimensions that have been researched in the articles we kept. These six scales, are widely used, validated and adapted to clinical psychiatry. This communication is therefore a mini guide of the most adapted resilience evaluation scales for potential future researches in adult psychiatry. The Wagnild & Young Resilience scale was validated among women aged 53 to 95 and it has a French version widely used to measure resilience among the general and clinical population. The Fryborg et al. RSA also measures adult resilience and is useful to measure protective factors against psychological disorders. The Ponce-Garcia, Madwell & Kennison SPF apprehends a complete measure of resilience and is a reliable scale among survivors of violent trauma. The Roussow & Roussow Predictive 6-Factor Resilience Scale was based on a neurobiological basis of resilience and has also a good consistence with health hygiene scores. It is considered an efficient measure to use in improving resilience. Finally, The Resilience Questionnaire for Bipolar Disorder from Echezarraga, Las Hayas, González-Pinto & Jones specifically measures resilience among a bipolar disorders population. The main clinical dimensions which figured in researches on resilience were varied and numerous. Many refer to post-traumatic stress disorder (PTSD), especially among American veterans. Besides PTSD, dimensions linked to stress, depression and psychiatric disorders were also researched. Scales are the same as those used in general population. However, some are validated for a clinical population. These scales can measure the link between resilience and various clinical dimensions and disorders. This opens the door for researches in adult psychiatry using one or more of the scales described in this article.     

Resilient but addicted: The impact of resilience on the relationship between smoking withdrawal and PTSD

Nicotine use is common among people with posttraumatic stress disorder (PTSD). Resilience, which is reflected in one's ability to cope with stress, has been shown to be associated with lower cigarette smoking and posttraumatic stress symptoms, but relationships among these three variables have not been examined. This study investigates the relationships of resilience and nicotine withdrawal with each other and in relation to PTSD symptoms. Participants were 118 cigarette smokers with PTSD seeking treatment for PTSD and nicotine use. Data were randomly cross-sectionally sampled from three time points: week 0, week 12, and week 27 of the study. Hierarchical multiple regression analyses revealed main effects of both resilience and nicotine withdrawal symptoms on PTSD severity, controlling for the sampled time point, negative affect, and expired carbon monoxide concentration. Consistent with prior research, PTSD severity was higher among individuals who were less resilient and for those who had greater nicotine withdrawal. There was an interaction between resilience and nicotine withdrawal on self-reported PTSD severity, such that greater resilience was associated with lower PTSD severity only among participants with low nicotine withdrawal symptoms. Among individuals with high nicotine withdrawal, PTSD severity was high, regardless of resilience level. These results suggest that resilience is a protective factor for PTSD severity for those with low levels of nicotine withdrawal, but at high levels of nicotine withdrawal, the protective function of resilience is mitigated.     

Neuroendocrine and blood pressure responses to rectal distensions in individuals with high and low visceral pain sensitivity

BACKGROUND: The mechanisms of interindividual variations in visceral pain sensitivity remain poorly understood. We characterized the neuroendocrine responses to rectal distensions in healthy individuals with high vs. low rectal pain sensitivity. METHODS: Rectal sensory and pain thresholds were determined, and a series of random painful distensions was carried out. Eighteen subjects were stratified into groups with a low rectal pain threshold ("High Sensitivity" group) vs. a high rectal pain threshold ("Low Sensitivity" group) by median split, and were compared with regard to adrenocorticotropic hormone (ACTH) and cortisol, cardiovascular, and emotional responses. RESULTS: Distensions led to an anticipatory stress response, reflected by elevated baseline anxiety, and increased baseline ACTH and cortisol in both groups. In response to distensions, the "Low Sensitivity" group showed significantly greater ACTH and cortisol concentrations analysis of variance (ANOVA time x group for ACTH: p<.05; for cortisol: p<.01), and elevated diastolic blood pressures (BP) (ANOVA group: p<.01) when compared to the "High Sensitivity" group. CONCLUSIONS: Painful rectal distensions are associated with a pronounced anticipatory stress response, reflected by elevated anxiety and elevated stress hormones. Individuals with high rectal pain sensitivity differ from those with low pain sensitivity in distension-induced hormonal and blood pressure responses, suggesting that neuroendocrine responses may be relevant to the pathophysiology of visceral hyperalgesia.     

Validity of clinical criteria for the diagnosis of dementia with Lewy bodies

OBJECTIVE: To assess the clinical validity of clinical diagnostic criteria for dementia with Lewy bodies (DLB). METHODS: We assessed the sensitivity, specificity, and positive and negative predictive values of the clinical criteria of the Consortium on dementia with Lewy Bodies (CDLB) in 18 patients with autopsy-proven DLB and in 76 patients with dementia not associated with Lewy bodies, using postmortem diagnosis as a gold standard. RESULTS: CDLB criteria had either high sensitivity or high specificity, but no set of criteria simultaneously provided both high sensitivity and high specificity. Clinical criteria had higher predictive validity in patients with pure DLB than in patients with DLB and AD. Seventy-eight percent of patients with pure DLB had two or more major criteria, compared with 44% of patients with DLB and AD (p<0.02). If the nine patients with DLB and AD were excluded from the DLB group, the CDLB criteria for probable DLB had sensitivity of 78% and specificity of 85%. CDLB criteria for probable DLB (two or more major criteria) distinguished DLB from AD with a sensitivity of 78% and a specificity of 64%. CONCLUSIONS: The proposed CDLB criteria have high negative predictive value and thus do well at excluding patients with DLB. Positive predictive value of 75% can be achieved by a combination of any three major or minor criteria, providing the analysis is confined to patients with mild to moderate dementia. Criteria were most accurate if confined to patients with pure DLB who had mild to moderate dementia.     

Assessing the reliability,predictive and construct validity of historical,clinical and risk management-20 (HCR-20) in Mexican psychiatric inpatients

Introduction: Assessing dangerousness to gauge the likelihood of future violent behaviour has become an integral part of clinical mental health practice in forensic and non-forensic psychiatric settings, one of the most effective instruments for this being the Historical, Clinical and Risk Management-20 (HCR-20). Objective: To examine the HCR-20 factor structure in Mexican psychiatric inpatients and to obtain its predictive validity and reliability for use in this population. Method: In total, 225 patients diagnosed with psychotic, affective or personality disorders were included. The HCR-20 was applied at hospital admission and violent behaviours were assessed during psychiatric hospitalization using the Overt Aggression Scale (OAS). Construct validity, predictive validity and internal consistency were determined. Results: Violent behaviour remains more severe in patients classified in the high-risk group during hospitalization. Fifteen items displayed adequate communalities in the original designated domains of the HCR-20 and internal consistency of the instruments was high. Conclusion: The HCR-20 is a suitable instrument for predicting violence risk in Mexican psychiatric inpatients.     

Heart period and variability findings in preschool children with posttraumatic stress symptoms.

BACKGROUND: Traumatic experiences for young children might result in profound neurodevelopmental changes, compared with adults. Our aim was to examine autonomic control of heart rate in traumatized young children. METHODS: Sixty-two children who had suffered traumas and 62 nontraumatized control children, aged 20 months to 6 years, were assessed for posttraumatic stress disorder (PTSD) symptoms, interbeat interval, respiratory sinus arrhythmia (RSA), family rehearsal of the trauma, and parent-child relationship quality. RESULTS: Traumatized children with PTSD and traumatized children without PTSD both had decreased heart period in response to a trauma stimulus relative to the nontraumatized group (both p < .0167). there was no main effect for RSA change scores, however, there was a significant interaction effect between parental positive discipline with PTSD symptoms and RSA. The most sympathetic children had decreased RSA during the trauma stimulus when they had caregivers with less positive discipline during a clean-up nd family rehearsal with PTSD symptoms. CONCLUSIONS: These findings underscore that psychopathology in young children ought to be assessed in the context of psychophysiology and parent-child relationship to optimally understand the mechanisms of maladaptation during this complex developmental period.     

Psychometric evaluation of the shortened resilience scale among Alzheimer's caregivers

The purpose of this study was to evaluate psychometric properties of the shortened Resilience Scale (15-item version RS15) among a sample of Alzheimer's caregivers. Self-reported data were collected from 229 participants at 2 Alzheimer's caregiver conferences. RS15 principal axis factoring indicated a single-dimensional solution with all items loaded. Reliability was strong. Convergent validity for the RS15 was suggested through its correlations with stress, family support, and friend support. Odds ratios showed significant likelihoods of high resilience given low stress and high social support. The results confirmed the RS15 to be a psychometrically sound measure that can be used to appraise the efficacy of adaptability among Alzheimer's caregivers.     

Vagal modulation of responses to mental challenge in posttraumatic stress disorder.

BACKGROUND: Studies of the autonomic nervous system in posttraumatic stress syndrome (PTSD) have focused on the sympathetic modulation of arousal and have neglected the parasympathetic contribution. This study addresses the parasympathetic control of heart rate in individuals who have survived traumatic events. METHODS: Twenty-nine survivors, 14 with current PTSD and 15 without, participated in the study. The groups were comparable with regard to age, type of trauma, time since the latest traumatic event, and lifetime exposure to traumatic events. Electrocardiograms were recorded during rest and an arithmetic task. Heart period, respiratory sinus arrhythmia (RSA), and the amplitude of the Traube-Hering-Mayer wave were quantified. RESULTS: The groups did not differ on resting measures. During the arithmetic task, the past trauma group showed a significant increase in RSA (p <.007), whereas the PTSD group did not. In the past trauma group only, RSA and heart period were highly correlated (r =.75), thereby suggesting that the response to challenge was under vagal control. CONCLUSIONS: Trauma survivors who develop PTSD differ from those who do not in the extent to which their heart rate response to challenge is controlled by vagal activity. Responses to challenge in PTSD may be mediated by nonvagal, possibly sympathetic mechanisms.