The moderating effects of coping strategies on major depression in the general population.

OBJECTIVES: To evaluate the moderating effects of various coping strategies on the association between stressors and the prevalence of major depression in the general population. METHODS: Subjects from the Alberta buy-in component of the 1994-1995 National Population Health Survey (NPHS) were included in the analysis (n = 1039). Each subject was asked 8 questions about coping strategies that dealt with unexpected stress from family problems and personal crises. Major depression was measured using the World Health Organization's (WHO) Composite International Diagnostic Interview-Short Form (CIDI-SF) for major depression. The impacts of coping strategies in relation to psychological stressors on the prevalence of major depression were determined by examining interactions between coping and life stress on major depression using logistic regression modelling. RESULTS: No robust impact of coping strategies in relation to various categories of stress evaluated in the NPHS was observed. There was evidence that the use of "pray and seek religious help" and "talks to others about the situations" as coping strategies by women moderated the risk of major depression in the presence of financial stress and relationship stress (with a partner). Using emotional expression as a coping strategy by women might decrease the risk of major depression in the presence of 1 or more recent life events, personal stress, relationship stress (with a partner), and environmental stress. CONCLUSION: Different coping strategies may have a differential impact on the prevalence of major depression in specific circumstances. These findings may be important both to prevent and to treat depressive disorders.     

Impact de la gestion dyadique du stress sur l’ajustement à une reconstruction mammaire différée après cancer

In France, breast cancer is the most frequent cancer women suffer from. One of the surgical treatments consists in taking out the whole breast. Several studies have explored the strategies people elaborate to cope with this illness and with anticancer treatments, but few studies have dealt on the manner couples face such events. The aim of this study is to evaluate the influence of the dyadic coping process (the manner in which couples usually manage with stress) on the adjustment strategies by 29 patients having been subject to a delayed breast reconstruction. Each subject completed three questionnaires: the FDCT-N (Bodenmann, 1997) which evaluates the dyadic coping process (stress communication, dyadic coping itself, feelings of effectiveness and satisfaction with the way of coping with stress), the WHOQOL-26 from the WHO (2000) which measures the quality of life and the QIC (Bruchon-Schweitzer, 1990) which evaluates the body image. The results point out the importance of stress communication within couples, of the use of (positive) dyadic coping and of a high feeling of effectiveness and satisfaction with the way they have coped with the stress of the adjustment to breast reconstruction, in terms of quality of life and body satisfaction.     

Reduction of cancer-specific thought intrusions and anxiety symptoms with a stress management intervention among women undergoing treatment for breast cancer

OBJECTIVE: After surgery for breast cancer, many women experience anxiety relating to the cancer that can adversely affect quality of life and emotional functioning during the year postsurgery. Symptoms such as intrusive thoughts may be ameliorated during this period with a structured, group-based cognitive behavior intervention. METHOD: A 10-week group cognitive behavior stress management intervention that included anxiety reduction (relaxation training), cognitive restructuring, and coping skills training was tested among 199 women newly treated for stage 0-III breast cancer. They were then followed for 1 year after recruitment. RESULTS: The intervention reduced reports of thought intrusion, interviewer ratings of anxiety, and emotional distress across 1 year significantly more than was seen with the control condition. The beneficial effects were maintained well past the completion of adjuvant therapy. CONCLUSIONS: Structured, group-based cognitive behavior stress management may ameliorate cancer-related anxiety during active medical treatment for breast cancer and for 1 year following treatment. Group-based cognitive behavior stress management is a clinically useful adjunct to offer to women treated for breast cancer.     

Impact of breast cancer recurrence and cancer-specific stress on spouse health and immune function

Spouses of cancer patients are at-risk for poor psychological and physical health as they cope with the complex nature of the disease and fears of losing their partner. Moreover, spouses often serve as patients' primary informal caregivers, a group that evidences poor outcomes across a variety of domains. The present study examines the relative contributions of cancer recurrence - a cancer-specific stressful event - and the subjective experience of cancer-specific stress (IES) in a sample of male spouses of breast cancer survivors. We hypothesized that stress would contribute to poorer physical health and compromised immune function. Spouses (recurrence; n=16) of patients who were coping with their first recurrence were matched to spouses of patients with no evidence of disease (disease-free; n=16). Self-reported physical health (physical symptoms and fatigue) and immune function [T-cell blastogenic response to the mitogens Concanavalin A (ConA) and phytohemagglutanin (PHA) and T3 monoclonal antibody (T3 Mab)] were included as outcomes. Results indicated that patient recurrence status was not a significant unique predictor of physical health or immune function; rather, among all spouses, cancer-specific stress symptoms were associated with increased physical symptoms and altered T-cell blastogenesis. These data suggest that the health implications of caregiving for spouses of cancer survivors is more strongly linked to their subjective experience of cancer as stressful, rather than simply the patients' disease status.     

Influences on the psychosocial adjustment of siblings of children with autism spectrum disorder in Taiwan and the United Kingdom

BackgroundThe present paper examined the psychosocial adjustment of typically developing (TD) siblings of children with ASD and the extent to which this is impacted by key demographic and psychosocial variables. A cross-cultural perspective was adopted to compare influences on coping and adjustment in Taiwan and the United Kingdom (UK).Method155 mother-TD sibling dyads participated, 80 in Taiwan and 75 in the UK. Participants reported by questionnaire on family demographics, symptom severity of the child with ASD, TD siblings’ life events, subjective well-being, social support, coping strategies, parent and sibling Broader Autism Phenotype (BAP) level and adjustment outcome.ResultsAccording to their self-report, TD siblings’ in Taiwan were fairly well adjusted, while slightly elevated difficulties were found in the UK sample, with peer problems the biggest concern. Impact of life experience, sibling coping, and social support were related to adjustment in both countries, but with different coping styles important in the two countries. In the UK, parents’ coping style and siblings’ own BAP level also contributed to outcome. Some differences between Taiwan and the UK samples may result from culturally-specific patterns in evaluation of child behaviours.ConclusionsThe findings from this large-scale questionnaire study have implications for clinical practice. UK siblings’ adjustment might be enhanced via intervention on parent coping style, while Taiwanese siblings may be better supported through promotion of their own coping. Health professionals should be aware of the influence of BAP levels in parents and TD siblings, which might change the way they experience stress and respond under pressure.     

Body change stress for women with breast cancer: The breast-impact of treatment scale

Background: Body change stress refers to subjective psychological stress that accompanies women’s negative and distressing thoughts, emotions, and behaviors resultant from breast cancer and breast surgeries. Body change stress is manifest with traumatic stress-like symptoms.Purpose: The development of the Breast-Impact of Treatment Scale (BITS) is described. The construct is assessed with 13 items that comprise a one-factor solution.Methods and Results: Tests of convergent validity demonstrate the relationship, but not overlap, of the BITS with measures of stress, emotional distress, and sexuality. The BITS distinguishes between women receiving segmental mastectomy (lumpectomy) versus mastectomy. Incremental validity is shown with comparison to ratings of body satisfaction.Conclusions: An early psychometric foundation enables use of the BITS to assess a common and distressing quality of life outcome for women with breast cancer. Georita Frierson is now at the Cooper Institute, Dallas, Texas. Debora Thiel is now at the Madigan Army Medical Center, Behavioral Health Department, Tacoma, Washington. This research was supported by grants from the American Cancer Society (PBR-89), the Longaberger Company-American Cancer Society (PBR-89A), the U.S. Army Medical Research Acquisition Activity (DAMD17-94-J-4165, DAMD17-96-1-6294, and DAMD17-97-1-7062), the National Institute of Mental Health (RO1MH51487), the National Cancer Institute (RO1CA92704, KO5 CA098133), the Ohio State University Comprehensive Cancer Center (NCI: P30 CA16058), and the Clinical Research Center grant from the National Institutes of Health, Department of Health and Human Services (MO1-RR0034). We thank the patients for their participation and continued commitment. In addition, we thank the research and professional staff of the Stress and Immunity Breast Cancer Project, William B. Farrar, M.D. and other referring surgical oncologists, and Timothy Crespin, Ph.D. and Hae-Chung Yang, Ph.D., for data analyses.     

Cognitive-behavioral stress management increases benefit finding and immune function among women with early-stage breast cancer

OBJECTIVE: This study examined the effect of a cognitive-behavioral stress management (CBSM) intervention on emotional well-being and immune function among women in the months following surgery for early-stage breast cancer. METHOD: Twenty-nine women were randomly assigned to receive either a 10-week CBSM intervention (n=18) or a comparison experience (n=11). The primary psychological outcome measure was benefit finding. The primary immune function outcome measure was in vitro lymphocyte proliferative response to anti CD3. RESULTS: Women in the CBSM intervention reported greater perceptions of benefit from having breast cancer compared to the women in the comparison group. At 3-month follow-up, women in the CBSM group also had improved lymphocyte proliferation. Finally, increases in benefit finding after the 10-week intervention predicted increases in lymphocyte proliferation at the 3-month follow-up. CONCLUSION: A CBSM intervention for women with early-stage breast cancer facilitated positive emotional responses to their breast cancer experience in parallel with later improvement in cellular immune function.     

Stress, Coping, and Circadian Disruption Among Women Awaiting Breast Cancer Surgery

Background

Psychological distress and coping related to a breast cancer diagnosis can profoundly affect psychological adjustment, possibly resulting in the disruption of circadian rest/activity and cortisol rhythms, which are prognostic for early mortality in metastatic colorectal and breast cancers, respectively.

Purpose

This study aims to explore the relationships of cancer-specific distress and avoidant coping with rest/activity and cortisol rhythm disruption in the period between diagnosis and breast cancer surgery.

Methods

Fifty-seven presurgical breast cancer patients provided daily self-reports of cancer-specific distress and avoidant coping as well as actigraphic and salivary cortisol data.

Results

Distress and avoidant coping were related to rest/activity rhythm disruption (daytime sedentariness, inconsistent rhythms). Patients with disrupted rest/activity cycles had flattened diurnal cortisol rhythms.

Conclusions

Maladaptive psychological responses to breast cancer diagnosis were associated with disruption of circadian rest/activity rhythms. Given that circadian cycles regulate tumor growth, we need greater understanding of possible psychosocial effects in cancer-related circadian disruption.     

Predicting stress-related problems in long-term breast cancer survivors

IntroductionLittle is known about the early clinical and psychosocial factors associated with subsequent stress-related problems in breast cancer survivors.MethodsWe used data collected at 3, 7, 11, and 15 months post-diagnosis to predict stress-related problems in 86 breast cancer survivors at 6 years post-diagnosis. We examined two common stress-related problems: (a) emotional distress and (b) intrusion and avoidance. Hypothesized risk factors included perceived stressfulness of the cancer; fear of the future; poor perceived health; initial stress-related problems; avoidance coping; and second cancer experience. Hypothesized protective factors included active coping (seeking social support; positive problem solving); optimism; and social support.ResultsHierarchical multiple regression analyses, controlling for age and education, indicated that positive problem-solving coping at 3 months and emotional distress at 7 months significantly predicted 6-year emotional distress (R²=.24, P<.01). Second cancer experience and 3-month intrusion and avoidance significantly predicted 6-year intrusion and avoidance (R²=.38, P<.001). In both cases, risk and/or protective factors measured at 11 and 15 months did not add significantly to the regression equations.Discussion/ConclusionSymptoms of intrusion and avoidance should be monitored carefully during the first 3 months following diagnosis because they signal the risk that these symptoms will persist in the long-term. Elevated emotional distress at 7-months post-diagnosis and second-cancer experiences may signal the need for psychosocial intervention. Overreliance on positive problem solving to cope early in the disease trajectory may be detrimental in the longer term.     

Cognitive behavioral stress management effects on psychosocial and physiological adaptation in women undergoing treatment for breast cancer

BackgroundA diagnosis of breast cancer and treatment are psychologically stressful events, particularly over the first year after diagnosis. Women undergo many demanding and anxiety-arousing treatments such as surgery, radiation and chemotherapy. Psychosocial interventions that promote psychosocial adaptation to these challenges may modulate physiological processes (neuroendocrine and immune) that are relevant for health outcomes in breast cancer patients.MethodsWomen with Stages 1–3 breast cancer recruited 4–8 weeks after surgery were randomized to either a 10-week group-based cognitive behavioral stress management (CBSM) intervention or a 1-day psychoeducational control group and completed questionnaires and late afternoon blood samples at study entry and 6 and 12 months after assignment to experimental condition.ResultsOf 128 women initially providing psychosocial questionnaire and blood samples at study entry, 97 provided complete data for anxiety measures and cortisol analysis at all time points, and immune assays were run on a subset of 85 of these women. Those assigned to a 10-week group-based CBSM intervention evidenced better psychosocial adaptation (lower reported cancer-specific anxiety and interviewer-rated general anxiety symptoms) and physiological adaptation (lower cortisol, greater Th1 cytokine [interleukin-2 and interferon-γ] production and IL-2:IL-4 ratio) after their adjuvant treatment compared to those in the control group. Effects on psychosocial adaptation indicators and cortisol appeared to hold across the entire 12-month observation period. Th1 cytokine regulation changes held only over the initial 6-month period.ConclusionsThis intervention may have facilitated a “recovery or maintenance” of Th1 cytokine regulation during or after the adjuvant therapy period. Behavioral interventions that address dysregulated neuroendocrine function could play a clinically significant role in optimizing host immunologic resistance during a vulnerable period.     

Longitudinal assessment of coping abilities at exacerbation and stabilization in schizophrenia

BACKGROUND: Coping strategies play an important role in one's ability to adapt to stressful life conditions such as schizophrenia. To better understand the nature of various coping mechanisms at various stages in schizophrenia, this study examined task-, emotion-, and avoidance-oriented coping strategies and explored associated clinical factors at exacerbation and stabilization phases of the illness. METHOD: Patients with schizophrenia were examined twice (at exacerbation phase, N = 237 and at stabilization phase, N = 148) with the Coping Inventory for Stressful Situations, and standardized measures of psychopathology and emotional distress severity, side effects, insight, self-constructs, social support, and quality of life. Multiple regression analysis was performed with coping strategies as dependent variables at exacerbation and stabilization including analysis of any change during the 16-month follow-up period. RESULTS: Analysis indicated that emotion coping strategies were used more at exacerbation than at stabilization phase. Regression analysis demonstrated emotional distress to be a strong predictor of emotion-oriented coping, with self-efficacy and social support being the best predictors of task and avoidance coping strategies, respectively. Individual changes in these variables also appear to be important predictors for fluctuations of these coping strategies over time. Severity of symptoms accounted for 3.5% and 5.5% to 9% of the total variance of emotion- and task-oriented coping strategies, respectively. CONCLUSIONS: Emotion, task, and avoidance coping strategies and their predictors are influenced and may vary over the course of schizophrenia illness. Experienced emotional distress, self-efficacy, and social support are the best predictors of coping strategies both at exacerbation and stabilization phases of illness.     

Stress and Quality of Life in Breast Cancer Recurrence: Moderation or Mediation of Coping?

Background/Purpose Diagnosis with breast cancer recurrence often brings high levels of stress. Successful coping to alleviate stress could improve patients’ quality of life (QoL). The intervening role coping plays between stress and QoL may depend on the types of stress encountered and the types of coping strategies used. The present study investigates the longitudinal relationships between stress, coping, and mental health QoL. Methods Breast cancer patients recently diagnosed with recurrence (N = 65) were assessed shortly after the diagnosis and 4 months later. Four moderation and four mediation models were tested using hierarchical multiple regressions and path analyses. In the models, either traumatic stress or symptom-related stress at recurrence diagnosis was a predictor of mental health QoL at follow-up. Both engagement and disengagement coping strategies were tested as moderators or mediators between stress and QoL. Results Engagement coping moderated the effect of symptom stress on mental health QoL, whereas disengagement coping mediated the effects of both traumatic stress and symptom stress on mental health QoL. Conclusion The findings imply that interventions teaching engagement coping strategies would be important for patients experiencing high symptom stress, while discouraging the use of disengagement coping strategies would be important for all patients.     

Family attributions and coping in the prediction of emotional adjustment in family members of patients with first-episode schizophrenia

OBJECTIVE: This study used a stress and coping framework to examine family members' emotional adjustment to caring for a patient with a first episode of schizophrenia. METHOD: One family member providing primary assistance to each of 63 patients with a first episode of schizophrenia or schizoaffective disorder was interviewed shortly after patient hospitalization. RESULTS: Overall, family members showed evidence of reasonably good emotional adjustment. Select indices of poorer emotional adjustment by family members were linked to (i) attributions in which the patient's psychiatric problems were viewed as a result of the patient's moral failings or psychological problems from earlier life, (ii) coping that was avoidant and (iii) patient management strategies that involved conflict avoidance and authoritarianism/reasoning. CONCLUSION: These findings are consistent with psychoeducational interventions that educate family members about psychiatric illness and assist them in their efforts to cope with and manage patient problems at home.     

Reductions in depressed mood and denial coping during cognitive behavioral stress management with hiv-positive gay men treated with haart

Background: Stress management interventions for HIV-positive persons have been designed to enhance coping skills and encourage health-promoting behaviors with the hope of decreasing distress and slowing disease progression.Purpose: We examined the efficacy of a cognitive behavioral stress management (CBSM) intervention in combination with medication adherence training (MAT) in 130 gay and bisexual men living with HIV infection.Methods: Participants were randomized to either a 10-week CBSM+MAT intervention (n = 76) or a MAT-only condition (n = 54). Measures of self-reported adherence, active cognitive coping (i.e., acceptance and positive reinterpretation), avoidant coping (i.e., denial and behavioral disengagement), and depressed mood were examined over the 10-week intervention period.Results: Men in CBSM+MAT reported reductions in depressed mood and denial coping during the 10-week intervention period, but no changes in active cognitive coping or self-reported adherence were observed. Using path analysis, greater reliance on denial coping at baseline was associated with decreased depressed mood at 10 weeks. We also determined that CBSM+MAT may decrease depressed mood by reducing reliance on denial coping over the 10-week intervention period.Conclusions: Although denial may be an effective means of distress reduction in the short term, reliance on this coping strategy may result in a decreased capacity to effectively manage a variety of disease-related stressors in the long term. CBSM+MAT addresses this potentially detrimental pattern by teaching stress reduction skills that may decrease depressed mood via reduced reliance on denial coping. This research was supported by National Institute of Mental Health Grants P01 MH49548 and T32 MH18917.     

Social networks and health-related quality of life in breast cancer survivors: a prospective study

PURPOSE: To examine prospectively the influence of social networks on health-related quality of life (HRQoL) among breast cancer survivors. METHODS: Social networks and HRQoL were assessed among women free of breast cancer in the Nurses' Health Study (NHS). Women who developed breast cancer over a 4-year follow-up (n=708) completed detailed questions related to treatment together with an assessment of general and cancer-specific HRQoL. RESULTS: On average, socially isolated women were more adversely affected by breast cancer--their role function was lower by 14 points, vitality lower by 7 points, and physical function lower by 6 points compared to the most socially integrated women. CONCLUSION: Prediagnosis level of social integration is an important factor in future HRQoL among breast cancer survivors, and appears to explain more of the variance in HRQoL than treatment or tumor characteristics. Rehabilitation programs should incorporate interventions that address the availability of adequate social support among breast cancer survivors.     

Coping with stress by children and adolescents with cancer

Children and adolescents with cancer not only have to cope with everyday stressors and developmental tasks, as do their healthy peers, but also with illness-related stressors. Thus, it can be assumed, that children and adolescents with cancer differ from healthy peers in coping. Stress reactions and adjustment have been investigated in recent studies. In contrast, coping styles have not often been in the focus of research. In this study, the coping of children and adolescents with cancer (n = 60, 8-13 years of age) was compared to the norm, measured by the German Coping Questionnaire for Children and Adolescents (SVF-KJ; Hampel et al. 2001). The results indicated that the subjects with cancer used more positive and less negative coping strategies when confronted with school-related or social stressors. The results are discussed with respect to the experience with disease-related stress and the possibility of repressive coping.     

A randomized pilot study of cognitive-behavioral therapy versus basic health education for smoking cessation among cancer patients

Background: Previously, we have linked theoretically based cognitive and emotional variables to the ability of cancer patients to quit smoking.Purpose: In this study, we evaluated the impact of cognitive-behavioral therapy (CBT), which addressed these theoretically derived cognitive and emotional variables linked to tobacco use in this population, for promoting smoking cessation in a sample of cancer patients and assessed longitudinal predictors of smoking cessation.Methods: Cancer patients (N=109) were randomized to either the theoretically based CBT intervention or to a general health education (GHE) condition, and all patients received nicotine replacement therapy.Results: Contrary to our expectation, no significant difference in 30-day point-prevalence abstinence between the CBT and GHE conditions was detected at either a 1-month (44.9% vs. 47.3%, respectively) or 3-month (43.2% vs. 39.2%, respectively) follow-up evaluation. Higher quit motivation and lower cons of quitting were related to smoking cessation.Conclusions: Implications for the implementation of smoking cessation behavioral treatments in the oncologic context are discussed, as are directions for future research in this area. National Institutes of Health grants CA88610 and CA95678 provided support for this study.     

Emotional control and autonomic arousal in breast cancer patients

Thirty breast cancer patients and 27 “healthy” controls were compared for differences in personality, reported emotional state and autonomic responses occurring under conditions of acute experimental stress. The data indicated that breast cancer patients were more likely than a control group to report a tendency to control emotional reactions, particularly anger, and to respond to stress using a repressive coping style. Emotional state reported at different points throughout the procedure suggested that the breast cancer group experienced more anxiety and disturbance but were more inclined to inhibit their reaction. There were no differences between the groups on autonomic measures but within the breast cancer group increased electrodermal activity was significantly associated with a tendency to respond to stress using a repressive coping style. The results are discussed in relation to psychobiological models of cancer.     

Effets de la maltraitance sur la régulation émotionnelle des enfants et des adolescents confiés à l’Aide Sociale à l’Enfance

ObjectivesThis research aims to compare coping strategies (strategies developed to cope with stress) and temperamental dimensions used by children and adolescents have not been maltreated and those who have been. The aim of these analyzes is to identify the effects of age as well as vulnerabilities and resources for children and adolescents who have been maltreated.Materials and methodsA total of 232 children and adolescents aged 7 to 16 years participated in this study including 115 who have never been maltreated (control group) and 117 have been maltreated and are living in foster care (placed group). Each young people responded to a scale measuring the frequency of coping strategies (Kidcope) as well as a questionnaire of temperament (questionnaire d’auto- et d’hétéro-évaluation du tempérament en sept facteurs pour l’enfant d’âge scolaire et l’adolescent).ResultsAn analysis of variance (ANOVA) was performed for each coping strategy and temperamental dimension to evaluate the consequence of maltreatment on the emotional regulation, according to the slice of age. The age-based comparison of control and placed groups reveals major differences in the use of certain coping strategies as well as in the temperamental dimensions of maltreated children and adolescents. This confirms that the child's life experience influences his way of understanding his environment and affects his individual resources.ConclusionsThe results show vulnerabilities of emotional regulation for children and adolescents who have been maltreated. These aspects underline the importance to think about supports in order to promote the development of some coping strategies and to reduce the stressors. These points will be discussed with preventive and therapeutic used to improve coping skills and emotional regulation.