Coping with caring for someone with dementia: reviewing the literature about men

As the demographics of the population change, men are assuming increasingly important roles as caregivers, despite caregiving often being perceived as a feminine activity. Research to date has described sex differences in caregiving and psychological outcomes. However, there appears to be little understanding of varying ways men may cope with the strains of caregiving. To this end, a systematic literature search was carried out to determine what is known about men coping with caring for someone with dementia. The search process elicited 93 articles, reviewed and categorised by their content. The majority of articles reported research and interventions with little detailed analysis of gender as a mediating variable for coping. Four articles reported finding no sex-differences in coping and burden. Of the nine articles that reported exclusively on men caregivers, only one generated quantitative data within an explicit framework of stress, appraisal and coping. Conclusions suggest that future research requires refinement and sophistication to address the role of gender in mediating appraisals of strain and coping responses to familial dementia care. The limitations of gender difference research and self-report methodologies are discussed along with their implications for interventions and suggestions for future research.     

Gender-specific mechanisms associated with outcome of depression: perception of emotions, coping and interpersonal functioning.

We proposed that a negative bias in the perception of facial expressions would affect the way in which deficient coping and interpersonal functioning influenced the risk of persistent depression. Furthermore, we hypothesised that cognitions, coping strategies, and interpersonal functioning would be more likely to contribute to the prediction of outcome of depression among women than among men. At admission, 60 in-patients with major depression judged 12 schematic faces with respect to the emotions that they expressed (fear, happiness, anger, sadness, disgust, surprise, rejection and invitation). In addition, difficulty in assertiveness and social distress, and coping strategies for dealing with stressful events were measured with self-report questionnaires. At admission and 6 weeks later, the severity of depression was evaluated with the Beck Depression Inventory. Women who were inclined to perceive high levels of negative emotions from facial expressions and who reported high levels of social distress at admission were less likely to be improved after 6 weeks. Among women, these high levels of perception of negative emotions and high levels of social distress tended to predict the persistence of depression independently. A propensity to perceive negative facial expressions may underlie the unfavourable course of depression, especially among women.     

Religious Coping Style and Cultural Worldview are Associated with Suicide Ideation Among African American Adults

The purpose of this study was to examine whether specific religious coping styles and cultural worldview would be associated with thoughts of suicide given higher levels of stress in a community-based sample of African American adults. African American men and women (n?=?134) completed measures of religious coping, cultural worldview, stressful life events, depression symptoms, and suicide ideation. Higher ratings of suicide ideation were observed for African Americans who endorsed a more self-directing religious coping style. The self-directing religious coping was more frequently endorsed by participants who identified with a more Eurocentric cultural worldview that espouses an individualist philosophy. Together, these findings provide some insight to how religious coping and culture are related to suicide vulnerability for African Americans who are not in clinical care.     

Police contacts and stress among African American college students

Attitudes toward police rarely are studied in investigations of race-related stress among communities of color. African American undergraduates (66 women, 35 men) rated the frequency and stressfulness of 83 general, college-related, race-related, and police-related events. Although respondents described police contacts as stressful, multivariate analyses of variance indicated that mean stress scores for nonpolice items were higher than for police items. Men reported significantly greater stressfulness of police contacts, and women reported slightly greater stressfulness of nonpolice situations. Further analyses confirmed significant differences in police contact stress scores as a function of the type of contacts (benign vs. malignant), gender of respondent (men greater than women), and frequency of contact. Limited differences were observed as a function of immediacy of contact (personal, witnessed, contacts of a loved one, or loved one telling of another person's contact) and individual differences in ethnic identity. No differences were observed as a function of general affective intensity. Results suggest that the stress associated with police contact is specific and distinct from other elements of African American life in this college student sample and thus underscores the need for research on the effects of such stress in less advantaged, community-based populations.     

Is life stress more likely to provoke depressive episodes in women than in men?

One of the most consistent findings in psychiatric research is that rates of major depression are at least twofold higher among women than among men. Although there is considerable agreement in the literature that life events play a role in producing, triggering, or maintaining episodes of depression, less is known about the relationship among gender, life events, and depression. In the present study, we compared the rates, focus (“interpersonal” vs. “noninterpersonal”), and timing of stressful life experiences reported in rigorous interviews of male and female patients with unipolar recurrent depression and nondepressed contrast subjects. Consistent with hypotheses, female patients were more likely to experience stressful life experiences than their male counterparts; rates of stressful life experiences did not differ between female and male controls. Unexpectedly, rates of interpersonal stress did not differ among males and females regardless of patient or control status. We also found no significant differences in the timing of pre-onset events: stressful events were generally concentrated in the period immediately preceding onset for both men and women. Thus, although these data suggest that life stress may play a larger role in the provocation of recurrent episodes of depression for women than for men, there do not seem to be sex differences in the extent to which interpersonal vs. noninterpersonal events and difficulties are associated with depression onset or in the temporal distribution of events. Implications of these results are discussed in the context of research on other putative factors contributing to gender differences in rates of depression. Depression and Anxiety 6:95–105, 1997. © 1997 Wiley-Liss, Inc.     

The psychological effects of Intifada Al Aqsa: acute stress disorder and distress in Palestinian-Israeli students

The study assesses the effects of exposure to nationality-related and personal stressful events, threat appraisal and coping strategies on level of distress of Palestinian Israeli students. One hundred forty-eight Palestinian Israeli students filled out a battery of questionnaires that tapped their exposure to stressful life events, terrorism and political related violence, their primary and secondary appraisals, and coping strategies. Level of distress was evaluated by (1) acute stress disorder, and (2) psychiatric symptomatology. Results reveal relatively low exposure to terrorism-related traumatic events, yet considerable exposure (35.8%) to nationality-related stressful events during the last two years. Twenty-five percent of the students suffered from acute stress disorder, and their levels of psychiatric symptomatology exceeded norms for the general population. Primary appraisal processes and emotion-focused coping strategies made unique contribution to the respondents' level of (1) acute stress disorder and (2) psychiatric symptomatology. The implications of these findings are discussed.     

Sex differences in emotional and physiological responses to the Trier Social Stress Test

Women are more likely than men to be diagnosed with depression and anxiety-related disorders, and it has been hypothesized that this difference is related to sex differences in stress reactivity. Women typically report higher levels of negative affect than men in response to psychosocial stressors, but the evidence for sex differences in physiological reactivity to stressful situations is not consistent. The present study sought to expand this work by evaluating sex differences in reactivity to a social stress challenge across neuroendocrine, autonomic and affective response domains. Participants (32 women, 30 men) completed a standardized psychosocial stress challenge (i.e., the Trier Social Stress Test (TSST)), during which several physiological (e.g., cortisol reactivity, heart rate) and psychological (e.g., depression, irritability, anger, fear) measures were assessed. The findings demonstrated that cortisol reactivity and the magnitude of autonomic responding failed to reliably discriminate between women and men. However, women reported more fear, irritability, confusion and less happiness immediately following the TSST compared to men. The broader implications of these results and how they relate to sex differences in the etiology and clinical presentation of anxiety and mood disorders are discussed.     

Emotion appraisal is modulated by the genetic polymorphism of the serotonin transporter

We investigated the relationship between the genetic polymorphism of the promoter of the serotonin transporter gene (SLC64A) and emotion appraisal profiles for fear, sadness, and joy in 114 healthy volunteers. Results revealed that carriers of the s-allele achieved higher scores than non-carriers for unpleasantness and goal-hindrance but scored lower for coping ability in the case of fear and sadness. There were no such differences in the case of joy. These results indicate that the s-allele of the serotonin transporter gene is associated with a vulnerable cognitive style related to the appraisal of negative emotions.     

Predictors of parenting stress among Malaysian mothers of children with Down syndrome

Background Having children with intellectual disability can be stressful for most parents. Currently there are very few studies focusing on parenting stress among mothers of children with Down syndrome (DS) in Asia. The present study examined the level of parenting stress experienced by Malaysian mothers of children with DS and evaluated the child and maternal factors that contributed to parenting stress based on Hill's ABC‐X Model (Hill 1949). Methods We conducted a cross‐sectional study of mothers of children with DS between the ages of 2–12 years during February–June 2008 in Kedah, a state in Peninsular Malaysia. We used self‐administered questionnaires to gather data on parenting stress, child's birth history and current behavioural problems, as well as the maternal sociodemographic characteristics, coping styles and psychological well‐being. Parental Stress Scale (PSS) was used to assess parenting stress. Measures of child's behavioural problem using Pediatric Symptom Checklist, mother's coping style using Carver et al. (1989 ) COPE inventory and their psychological well‐being using Lovibond and Lovibond (1995 ) DASS21, a scale assessing depression, anxiety and stress were also carried out. Results The 147 mothers who participated in the study had an average age of 43.1 years (SD = 7.6 years), of whom 94.6% were married, 57.1% had secondary level education and 28.6% were working outside their home. Based on PSS, mean parenting stress was 37.6 (SD = 8.1). Parenting stress was significantly higher among mothers who reported having children with behavioural problems. However, parenting stress was modified by positive coping styles and negative maternal psychological well‐being. The final model based on hierarchical regression analysis identified maternal depression and lack of acceptance as significant predictors of parenting stress rather than child's behavioural problems. Conclusion Mean parenting stress among mothers of children with DS significantly differed by behavioural problems in their children. Parenting stress is also significantly correlated with frequent use of acceptance, religious and optimist coping styles, and presence of maternal depressive, anxiety and stress symptoms. However, hierarchical regression analysis identified maternal depression and lack of acceptance of having a child with DS as the most significant predictors of parenting stress in these mothers.     

Gender related correlates of posttraumatic stress symptoms in a World Trade Center tragedy sample

Previous research has documented that women are more susceptible to developing posttraumatic stress disorder than men. This study examines the relationships between gender, ruminative coping, traditional gender role characteristics, trauma-related cognitions, and posttraumatic stress symptoms. Participants were 123 victims of the September 11, 2001, terrorist attacks, including 72 males and 51 females. Results indicated that female victims had more posttraumatic stress symptoms than male victims. Ruminative coping was positively correlated with posttraumatic stress symptoms. Victims who were categorized as 'feminine' had significantly higher levels of posttraumatic stress symptoms than victims categorized as 'androgynous.' Multiple regression and path analyses were used to determine whether ruminative coping, traditional gender role characteristics, and trauma-related cognitions mediated the gender difference in posttraumatic stress symptoms. The mediational model was not supported by these data.     

Gender differences in depression

BACKGROUND: While there is ample evidence that the prevalence rates for major depressive disorder (MDD) in the general population are higher in women than in men, there is little data on gender differences as regard to symptoms, causal attribution, help-seeking, coping, or the consequences of depression. METHOD: The large DEPRES Study dataset covering representative population samples of six European countries (wave I: 38,434 men and 40,024 women; wave II: 563 men and 1321 women treated for depression) was analyzed for gender differences. RESULTS: In wave I marked gender differences were found in the six-month prevalence rate for major depression but less so for minor depression; the gender differences for major depression persisted across all age groups. Even after stratification by clinically significant impairment and paid employment status, men reported fewer symptoms than women; as a consequence, men reached the diagnostic threshold less often. In wave II there were clear gender differences in causal attribution and in coping. Men coped by increasing their sports activity and consumption of alcohol and women through emotional release and religion. Women felt the effects of depression in their quality of sleep and general health, whereas men felt it more in their ability to work. LIMITATIONS: The second wave of the study comprises treated depressives only and may be less representative than the first wave.     

Cardiovascular reactivity to stress in men. Effects of masculine gender role stress appraisal and masculine performance challenge

Previous research has shown that excessive cardiovascular reactivity may be important in the development of coronary heart disease. The present study examined the role of masculine cognitive appraisal of stress as a mediator of cardiovascular reactivity in men. The reactivity of men who differed on a measure of individual differences in men's cognitive appraisal of masculine gender role stress (MGRS) were compared on the cold-pressor test under conditions of high and low masculine performance challenge. Under conditions of minimal challenge, it was predicted that high- and low-MGRS men would not differ on reactivity. Under high challenge, high-MGRS men were expected to show greater reactivity than were low-MGRS men. Analysis of results for systolic blood pressure confirmed the major predictions. High-MGRS men showed greater systolic blood pressure reactivity than did low-MGRS men under high but not low masculine challenge. The implications of MGRS appraisal for men's health are discussed.     

The mesoaccumbens dopamine in coping with stress

Mesoaccumbens dopamine (DA) is involved in the stress response. Although neural mechanisms involved in stress are of paramount importance for both clinical and preclinical research, the results of studies on the stress response by mesoaccumbens DA have received little attention. Therefore, we aimed to review these results and propose a role for mesoaccumbens DA in coping with stress.The data reviewed support the view that fluctuations of tonic levels characterize the mesoaccumbens DA stress response. Stress-induced increase of tonic DA levels in nucleus accumbens (NAc) supports expression of responses aimed at removing and avoiding the stressor through activation of DA D2 receptors, whereas inhibition of DA is associated with cessation of active defensive responses.In novel unescapable/uncontrollable stressful conditions tonic levels of DA in NAc show an initial increase followed by a decrease below pre-stress levels that lasts as long as the stressful situation. This biphasic response fits with the dynamics of the primary and secondary appraisal of a stressor that cannot be removed, escaped or controlled by the organism. In fact, NAc DA fluctuations are controlled by the medial pre-frontal cortex, which is involved in stress appraisal.We propose that enhanced mesoaccumbens DA supports expression of active coping strategies against an event appraised as a stressor and that inhibition of DA is required for passive coping with stressful situations appraised as unescapable/uncontrollable.     

Depressive symptoms in intellectual disability: does gender play a role?

Background Gender issues remain largely unaddressed in the dual diagnosis arena, even in the area of depression where there is a 2 : 1 female to male ratio in the general population. This paper argues that women with intellectual disability (ID) report higher levels of depressive symptoms than men with ID and that risk factors for depression identified for women in the general population are relevant to this group. Method Findings are based on structured interviews with 99 men and women with ID, with corroborative information provided from caregivers and casebook reviews. Results Overall, women reported higher levels of depression than men. Individuals with higher depression scores were more lonely and had higher stress levels than individuals with lower scores. Women with higher depression scores were more likely to report coming from abusive situations, to have poor social support from family and to be unemployed when compared to women with lower scores, but similar differences were not found when comparing men with higher and lower depression scores. Conclusion Men and women who report experiencing these psychosocial correlates of depression should be a target group for future prevention efforts, taking gender specific concerns into consideration.     

Stress and avoidance in Pseudoseizures: testing the assumptions

Twenty women and 10 men with Pseudoseizures were matched by age and gender with an epilepsy- and a healthy-control group. In response to clinical and research evidence of a relationship between Pseudoseizures and the experience of stress, it was hypothesised that people with Pseudoseizures would perceive their ongoing lives as more stressful, and use more avoidant and distancing coping, and less problem-focused coping, than people in the two control groups. Using the Perceived Stress Scale (Cohen et al., J. Health Soc. Behav. 24, 1983, 385-396) and the Ways of Coping, revised version (Folkman and Lazarus, Manual for Ways of Coping Questionnaire, Consulting Psychologist Press, Paola Alto, CA, 1988) the study found that people with Pseudoseizures: (1) perceived their ongoing lives as significantly more stressful; (2) were significantly more likely to use a maladaptive (escape-avoidant) coping strategy; and (3) were significantly less likely to use an adaptive (planful problem solving) approach to coping than healthy controls. The study findings indicate that people with Pseudoseizures experience lives as stressful as do people with epilepsy, and are likely to employ maladaptive coping responses. Implications for diagnosis, intervention and future research are discussed.     

Gender differences in delayed-type hypersensitivity response: Effects of stress and coping in first-year law students

Law students show significant deficits in emotional and physical well-being compared with groups of students in other areas of higher education. Furthermore, evidence suggests that these effects may be worse for women than for men. The use of active coping can positively affect immunity under stress, but this may be most true for men in the context of law school. The current study examined the delayed-type hypersensitivity (DTH) skin responses of first-year law students (n = 121) and a comparison group (n = 30). Students’ health behaviors, self-evaluative emotions, and coping strategies were also reported. Male law students had larger DTH responses than females, but this gender effect was not present in the comparison group. Endorsement of perseverance under stress (n = 19), an active coping strategy, moderated the gender effect on immunity. Perseverance associated with larger DTH responses and more positive self-evaluative emotion, but only among men. These results indicate that active coping may be less efficacious for women than for men in law school, which in turn may limit women’s opportunities to attenuate negative effects of law school.     

Psychological factors associated with acute and chronic central serous chorioretinopathy

Background: Central serous chorioretinopathy (CSC) has been associated with several psychological factors. But previous psychological data are limited and mainly restricted to male patients and small sample size. In this study we investigated psychosomatic complaints, personality factors, life events, and stress coping in acute and chronic recurrent CSC patients. Methods: Ninety-five patients (71 men, 24 women) with either acute or chronic CSC were evaluated regarding critical life events before diagnosis, psychosomatic complaints, personality traits and coping style. The characteristics of CSC patients were compared with a control group comprising 75 patients (46 men, 29 women) suffering from acute or chronic ophthalmic disorders other than CSC. Results: Compared with patients of the control group, CSC patients reported more psychosomatic problems, unfavourable stress coping strategies and critical life events as well as elevated tension, aggression, strain, emotional instability and achievement orientation. Except for aggression the observed characteristics were more pronounced in acute than in chronic CSC patients. Conclusions: The appearance of CSC may be associated with an accumulation of stressful life events with an unfavourable coping style and distinctive personality factors. Acute CSC is related to more unfavourable stress coping and more physical complaints compared to its chronic course. Elevated aggression may imply one potential risk factor for CSC manifestation and also may have an adverse effect with its chronification.     

Loneliness and neuroendocrine, cardiovascular, and inflammatory stress responses in middle-aged men and women

Loneliness is a psychological experience related to social isolation and perceived lack of companionship, and may be relevant to health risk. The revised UCLA loneliness scale was completed by 240 working men and women aged 47-59 years, and related to affective state and neuroendocrine, cardiovascular, and inflammatory responses. Loneliness scores were not associated with gender, age or socioeconomic position, but were lower in married than single or divorced participants, and were positively related to social isolation, low emotional support, ratings of depression, hopelessness and low self-esteem, and to reported sleep problems. Diastolic blood pressure reactions to acute mental stress were positively correlated with loneliness in women but not men, independently of age, socioeconomic status, smoking, body mass and marital status (p = 0.014). Lonely individuals also displayed significantly greater fibrinogen (p = 0.038) and natural killer cell responses (p = 0.042) to stress, independently of covariates. The cortisol response over the first 30 min following waking was positively associated with loneliness after adjusting for waking cortisol value, sex, socioeconomic status, smoking, time of waking, and body mass (p = 0.046). We conclude that loneliness is a psychological experience with potentially adverse effects on biological stress processes that may be relevant to health.     

Caregiver burden: gender and the psychological costs of caregiving.

The psychological costs of providing care for a parent with Alzheimer's disease are examined, together with the consequences of depression, anxiety, guilt, and resentment in relation to the caregiver's coping style, social support, and sense of control. The use of fantasy by women as a coping mechanism was associated with greater anxiety and depression, adequate social support was somewhat more helpful for men, and a sense of control was more helpful for women.     

Mental symptoms,hostility features and stressful life events in people with cancer

Hostility features, mental symptoms, and stressful life events were investigated in 100 patients (59 men and 41 women) suffering from cancer. Fifty-seven healthy men (n= 26) and women (n= 31) were used for comparison purposes. The assessment instruments were the Hostility and Direction of Hostility Questionnaire, the Delusions Symptoms States Inventory/states of anxiety and depression and a modified version of the Schedule of Life Experiences. Women patients reported lower scores than healthy women on total hostility, but men patients reported higher scores than healthy men. Introverted hostility was increased in both male and female patients, but due to different patterns: in women due to lower scores on extroverted hostility subscales, especially acting-out hostility, whereas in men due to higher scores on introverted hostility subscales, especially guilt. Female patients, compared with healthy women, reported significantly higher scores on the depressive and anxiety subscales, whereas in the man the differences were not statistically significant even though patients reported higher scores than normals. On the Schedule of Life Experiences, female patients reported statistically significant higher scores than healthy women.