The Role of Illness, Resources, Appraisal, and Coping Strategies in Adjustment to HIV/AIDS: The Direct and Buffering Effects

This study examined the utility of a stress and coping model of adjustment to HIV/AIDS. A total of 114 HIV-infected gay or bisexual men were interviewed and they completed self-administered scales. Predictors included illness variables (disease stage and number of symptoms), coping resources (optimism and social support), appraisal (threat, challenge, and controllability), and coping strategies (problem- and emotion-focused). Adjustment outcomes were depression, global distress, social adjustment, and subjective health status. Results from hierarchical regression analyses indicated that better adjustment was related to an asymptomatic illness stage, fewer HIV-related symptoms, greater social support, challenge and controllability appraisals, problem-focused coping, and lower threat appraisals and reliance on emotion-focused coping. There was limited support for the stress-buffering effects of optimism. Findings support the utility of a stress and coping model of adjustment to HIV/AIDS.     

What Coping Functions are Served when Health Behaviours are Used as Coping Strategies?

The aim was to clarify what coping functions are served by certain health behaviours when used as coping strategies. A preliminary questionnaire was used to identify individuals scoring high on eating (unhealthily), exercise or self- care as a coping strategy. These individuals completed a further questionnaire to elucidate the specific coping functions being served by their eating, exercise or self-care. Principal components analysis produced five coping function variables: Problem Solving, Feeling Better, Avoidance, Time Out and Prevention. Discriminant analysis (coping functions predicting coping strategy group) produced a Prevention with Problem Solving function, on which the exercise and self- care groups were high compared with the eating group; and a Time Out without Problem Solving function, on which the exercise group was high compared with the self- care group, the eating group being intermediate. Thus health behaviours used as coping strategies can serve not only problem-focused, emotion- focused and avoidance functions, but also time out and prevention functions.     

Predictors of psychological well-being in a diverse sample of HIV-positive patients receiving highly active antiretroviral therapy

The purpose of the present study was to identify variables relevant to psychological well-being in HIV patients receiving highly active antiretroviral therapy (HAART). Multiple stressors accompany living with HIV while managing a HAART regimen. However, a variety of cognitive and behavioral variables can protect against or augment the deleterious effects of stress in this population. The authors hypothesized that satisfaction with social support, coping styles, and maladaptive attributions about HIV would explain more variance in psychological well-being than stressful life events per se. Participants were individuals with HIV receiving antiretroviral therapy-either starting a new HAART regimen or having difficulties adhering to their current regimen. Satisfaction with social support, coping styles, and punishment beliefs about HIV were uniquely associated with depression, quality of life, and self-esteem over and above the effects of stressful life events. These results provide support for continued psychosocial interventions that target these variables among patients with HIV.     

A comprehensive model of stress. the roles of experienced stress and neuroticism in explaining the stress-distress relationship

BACKGROUND: In this study, a complex theoretical model regarding the stress-distress relationship was evaluated. The various components in the model included experienced stress (daily hassles), psychological distress, neuroticism, problem-focused coping, avoidant coping, satisfaction with received social support and unassertiveness. On the basis of various previous findings, experienced stress was assumed to have a direct effect on psychological distress. In addition, neuroticism was assumed to have a direct effect on psychological distress as well as an indirect effect through its association with experienced stress, problem-focused coping, avoidant coping, satisfaction with social support and unassertiveness. Further, both problem-focused and avoidant coping were assumed to affect the level of psychological distress directly as well as indirectly through their influence on experienced stress. Similarly, satisfaction with social support was assumed to have a direct beneficial effect on psychological distress in addition to an indirect effect through its association with coping and experienced stress. Finally, unassertiveness was assumed to have a direct effect on psychological distress as well as an indirect effect through its influence on experienced stress and coping. METHODS: A covariance path analysis technique (LISREL) was used. RESULTS: A considerable predictive power of the model could be demonstrated. Experienced stress and neuroticism turned out to be most predictive of psychological distress. The effects of social support, coping and unassertiveness on psychological distress were seriously attenuated by their common association with neuroticism. CONCLUSION: Above all, the present findings underscore the need to investigate all variables that are expected to play a role simultaneously so as to be able to take their interdependency into account. It is argued that although such comprehensive models may be more difficult to interpret as of yet, they are likely to more closely resemble reality.     

Identification of stress and coping risk and protective factors associated with changes in adjustment to caring for an adult with mental illness

There is a paucity of theory guided longitudinal research into how carers of an adult with mental illness adapt to caregiving. This study examined changes in carer adjustment over 12 months and identified risk and protective factors using stress/coping theory. Eighty-seven carers completed questionnaires at Time 1 and 12 months later (Time 2). The risk/protective factors were background variables, coping resources, appraisals, and coping strategies. Adjustment outcomes were stable over 12 months. Stress/coping variables were associated with one or more Time 2 adjustment outcomes when controlling for initial adjustment and the direction of these associations were consistent with predictions. Findings support the application of stress/coping theory to guide identification of modifiable risk and protective factors associated with caregiver adjustment.     

Moderating effects of coping on the relationship between stress and the development of new brain lesions in multiple sclerosis

OBJECTIVE: Many patients with multiple sclerosis (MS) report that stress can trigger disease exacerbations. Considerable research has supported a relationship between stress and both clinical exacerbation and the development of new brain lesions. However, these relationships are not always consistent either within patients or across patients, suggesting the presence of moderators. This study examined the hypothesis that coping moderates the subsequent relationship between stress and the development of new brain lesions in MS. METHODS: Thirty-six patients (mean age = 44.4; 22 women, 14 men) with relapsing forms of MS were assessed once every 4 weeks for 28-100 weeks. New brain lesions were identified using monthly Gd+ MRI. Stress was measured within 24 hours before MRI using a modified version of the Social Readjustment Rating Scale that assessed Conflict and Disruption in Routine. Coping was measured at baseline using the Coping with Health Injuries and Problems questionnaire, which produces four scales: distraction, instrumental, palliative, and emotional preoccupation. Data were analyzed using mixed effects logistic regression to account for within-subject correlations. Analyses were lagged such that stress assessments predicted new Gd+ MRI brain lesions 8 weeks later. RESULTS: As reported previously, stress was significantly related to the development of new Gd+ brain lesions 8 weeks later (OR = 1.62, p =.009). Greater use of distraction was found to be a significant moderator of the relationship between stress and new Gd+ lesions (OR = 0.69, p =.037) such that greater use of distraction was associated with a decreased relationship between stress and new Gd+ lesions. Increased instrumental coping was marginally associated with a decreased relationship between stress and new Gd+ lesions (OR = 0.77, p =.081), while increased emotional preoccupation was marginally associated with an increased relationship between stress and new Gd+ lesions (OR = 1.46, p =.088). There was no significant moderating effect for palliative coping (p =.27) and no significant main effects for any coping variables and the subsequent development of new Gd+ brain lesions (p values >.21). CONCLUSIONS: These findings provide modest support for the hypothesis that coping can moderate the relationship between stress and the MS disease activity. Several limitations in this study are discussed. While these findings suggest areas of potentially fruitful research, readers are cautioned that these are preliminary results; inferences regarding the clinical importance of these findings are premature.     

Multiple assessment of coping strategies used by volunteer blood donors: Implications for preparatory training

The coping strategies used by volunteer blood donors were assessed in two studies. A general trait measure and a specific process measure of coping were administered in both studies. A state measure of coping was added in the second study. The relationships among these measures and their relationships with anxiety measures and demographic variables [e.g., sex and prior donation frequency] were examined. Moderate correspondence was found among the coping indices, but the process measure was most predictive of anxiety ratings. An avoidant coping strategy appeared to be most effective in terms of managing the stress of blood donation. Implications of the results for the conceptualization and assessment of coping are noted, and suggestions are made regarding factors which may affect the preparation of patients for stressful medical or dental treatment.The investigations were supported, in part, by a grant from the Ministere de l'Education du Quebec (FCAC 1444).Portions of this paper were presented at the annual meeting of the Association for Advancement of Behavior Therapy, Los Angeles, November 1982.     

Airflow and autonomic responses to stress and relaxation in asthma: the impact of stressor type.

The impact of stress on respiratory airflow in asthmatics is unclear. Part of the uncertainty may spring from the different physiological effects of different stressors. Given their potential to elicit increases in parasympathetic vagal activity, stressful situations that present few opportunities for coping (passive coping stressors) may be particularly problematic for people with asthma. Thirty-one adult asthmatics participated in a protocol including a widely used passive coping stressor (the cold pressor test), an active coping stressor (mental arithmetic), an interview about an upsetting asthma-related incident (viewed as a potential passive coping stressor given the exposure to unpleasant memories), and progressive muscle relaxation. Repeated measurements of airflow (via peak expiratory flow), vagal tone (via heart rate variability), and other variables were obtained. The cold pressor test, asthma interview and progressive muscle relaxation produced significant decreases in airflow compared to the baseline period. The cold pressor test and progressive muscle relaxation produced significant, complementary increases in vagal tone. These results suggest that passive coping stressors and other stimuli (e.g., certain forms of relaxation) that elicit increased vagal tone may be associated with poorer asthma control, a view consistent with a significant negative correlation between the participant's mean vagal tone response to the tasks and score on a measure of asthma self-efficacy.     

Development of a preliminary questionnaire to assess parental response to children's food allergies.

BACKGROUND: Food allergy affects up to 8% of children. Unintentional exposure may result in minor to potentially fatal episodes. Management of allergies depends on strict allergen avoidance and emergency preparedness. The demands of allergy management and concerns for the child's safety may place parents at risk of developing emotional distress or difficulties in coping. OBJECTIVE: To develop a brief condition-specific measure to evaluate parental adjustment to and coping with children's food allergy. METHODS: A total of 221 parents of children 18 year or younger with food allergy were recruited from a private allergy practice and local food allergy support groups. Parents completed an 18-item questionnaire, the Food Allergy Parent Questionnaire (FAPQ), that assessed parental coping with a child's food allergy and questions related to their child's food allergy diagnosis and course. RESULTS: Factor analysis of the items on the FAPQ suggested 4 factors that accounted for 53.6% of the variance: parental anxiety/distress, psychosocial impact of allergies, parental coping/competence, and family support. Medical variables (greater number of food allergies, positive history of anaphylaxis) were associated with higher scores on the anxiety/distress and psychosocial impact subscales. Internal consistency was good for the anxiety/distress and psychosocial impact subscales (Cronbach alpha = .80 and .77, respectively) but lower for the parental coping/competence and family support subscales (alpha = .57 and .32, respectively). CONCLUSIONS: Although further psychometric data for the FAPQ is needed, preliminary findings suggest that the measure may be useful in screening for parental anxiety, perceived impact of food allergies, level of family support, and coping skills.     

Personality and the occupational stressor-strain relationship: the role of the Big Five

The role of the Big Five traits in the occupational stressor-strain relationship was investigated among 211 managers. Direct, mediated, and moderated effect models were used to investigate whether the Big Five affect strain directly (independently of stress), indirectly (via stress and coping), or interactively with stress. Personality, stress, coping, and strain variables were measured and analyzed with path analysis and hierarchical regression. The Neuroticism-physical strain relationship was partially mediated by perceived role conflict and substance use, and the Neuroticism-psychological strain relationship was mediated by perceived stress. Extraversion had a direct, positive effect on physical and psychological strain, and there was preliminary support for a moderating role of Conscientiousness in the perceived stressor-strain relationship. Agreeableness and Openness were unrelated to strain.     

Predicting the impact of child sexual abuse on women: the role of abuse severity, parental support, and coping strategies.

Female Navy recruits (N = 5,226) completed surveys assessing history of childhood sexual abuse (CSA), childhood strategies for coping with CSA, childhood parental support, and current psychological adjustment. Both CSA and parental support independently predicted later adjustment. In analyses examining whether CSA victims' functioning was associated with CSA severity (indexed by 5 variables), parental support (indexed by 3 variables), and coping (constructive, self-destructive, and avoidant), the negative coping variables were the strongest predictors. A structural equation model revealed that the effect of abuse severity on later functioning was partially mediated by coping strategies. However. contrary to predictions, the model revealed that childhood parental support had little direct or indirect impact on adult adjustment.     

Predictors of posttraumatic stress disorder symptomatology following bone marrow transplantation for cancer

This study examined the prevalence and predictors of posttraumatic stress disorder (PTSD) symptoms in 70 men and women treated with bone marrow transplantation for cancer. Findings indicated that the number of symptoms present ranged from 0 to a possible high of 17 (M = 3.0, SD = 3.9). As predicted. lower social support and higher avoidance coping I month pretransplant predicted greater PTSD symptom severity an average of 7 months posttransplant. These variables remained significant predictors of symptom severity even after accounting for pretransplant levels of psychological distress. Additional analyses indicated the presence of a significant interaction between social support and avoidance coping, with patients high in avoidance coping and low in social support reporting the most severe symptoms. These findings identify patients at risk for psychological disturbance posttransplant and can serve to guide future intervention efforts.     

Predictors of posttraumatic stress among victims of motor vehicle accidents

OBJECTIVE: This study identified factors that predict individual vulnerability to psychological trauma by examining the relationships among situation and person variables and symptoms of posttraumatic stress disorder (PTSD) 1, 6, and 12 months after a serious motor vehicle accident (MVA). METHODS: Background characteristics, exposure variables (ie, injury severity and accident characteristics), and psychosocial variables (ie, perceived loss of control, social support, and coping) were used to predict symptoms of PTSD and recovery in 115 injured MVA victims. All participants were injured during the MVA and provided data prospectively over the course of a year after their accidents. RESULTS: Along with background and exposure variables, use of wishful thinking coping distinguished between victims with and without symptoms of PTSD. CONCLUSIONS: Psychosocial variables such as wishful thinking coping can be used to identify MVA victims who are at risk of developing chronic posttraumatic stress and warrant further investigation.     

A factorial analysis of a compound measure of social support

A confirmatory factor analysis of an internally consistent compound measure of social support is presented for a volunteer sample of 740 low-income, predominantly single, young mothers. Five factors with eigen values greater than one emerged and accounted for 55% of the variance. The convergent validity of the empirically identified factors of estrangement, confidant, short-term help, support/encouragement, and crisis intervention was explored through intercorrelations with five variables theoretically related to family and child well being. Level of depressive symptomology correlated most significantly and consistently with low levels of social support. The results of the analysis are discussed in light of previous psychometric analyses of comparable measure of social support and what is known of the coping response of young mothers to stress.     

Relations between social support, appraisal and coping and both positive and negative outcomes in young carers

This study examined a stress/coping model of adjustment in early caregiving. It was hypothesized that better adjustment would be related to higher social support and approach coping, and lower stress appraisals and avoidant coping. One hundred young carers aged 10-25 years completed questionnaires. Predictors included choice in caregiving, social support, stress appraisal and coping. Dependent variables were global distress and positive outcomes (life satisfaction, positive affect, benefits). Correlations supported all hypothesized relations between the stress/coping predictors and adjustment outcomes. Regression analyses showed social support as the strongest predictor of adjustment, whereas coping and choice in caregiving emerged as weaker predictors and stress appraisal was unrelated to adjustment. The stress/coping framework and findings have the potential to inform interventions designed to promote well-being in young carers.     

Coping variables that mediate the relation between intimate partner violence and mental health outcomes among low-income, African American women

Coping variables that mediate the relation between intimate partner violence (IPV) and mental health outcomes among African American women were investigated. The study sample included 143 economically disadvantaged African American women ranging in age from 21 to 64 years old who were receiving services at an urban public health system. Sixty-five had experienced IPV within the past year and 78 had never experienced IPV. Results indicated that (a) the IPV status-depressive symptoms link was mediated by multiple ways of coping, spiritual well-being, and social support; (b) the IPV status-anxiety symptoms link was mediated by multiple ways of coping, social support, and ability to access resources; and (c) the IPV status-parenting stress link was mediated by multiple ways of coping, spiritual well-being, and social support. Implications of these findings for clinical practice with abused women are discussed.     

Stress, social support and coping in pregnancy: taking gender and ethnicity into account

The social support literature, despite its focus on women's strengths in relationships, has not fully addressed the social realities of women of diverse ethnic backgrounds and socio economic conditions. Specifically, the emphasis on marital relationships as primary sources of support during pregnancy marginalizes those women for whom these partnerships are unhelpful or unavailable. In addition, women's greater use of social support as a coping strategy is often portrayed in the coping literature as an ineffective approach to stress. Data from two studies of pregnant women are presented to illustrate these points and to present a new model of coping that reframes women's coping as prosocial, active and effective. Our article is designed to challenge researchers to examine the relevance of work on social support and coping to women of varying ethnicities and economic circumstances.     

Women's life strains,social support,coping, and positive and negative affect: Cross-sectional and longitudinal tests of the tko-factor theory of emotional wefi-being

This research examined the relationships between life strains, social support, coping, and positive and negative affect among 90 women at three different interviews over an 18-month period. Predictions were derived from previous research and the two-factor theory of emotional well-being. Two-factor theory asserts that positive affect and negative affect are relatively independent dimensions and that they have distinctly different correlates. It was predicted that life strains would be related to negative affect, but not to positive affect. However, life strains were related to both of these variables. As predicted, enacted support and coping were correlated with positive affect, but not with negative affect. Cross-sectional and longitudinal regression analyses showed that life strains, social support, and coping combined in additive models to predict positive affect, suggesting that support and coping have a “health-enhancing” effect on positive affect. However, life strains interacted with support and coping to predict negative affect. In these analyses, both support and coping buffered the effects of life strains, suggesting that social support has a “health-protecting” effect on negative affect. Overall, the results demonstrated the utility of two-factor theory for research on women's life strains, support, coping, and affect.     

The relationship between psychosocial factors and breast cancer: some unexpected results

A growing body of research suggests a link between psychosocial factors and breast cancer. Research in this area often contains methodological problems, however, such as small sample size, inadequate comparison groups, omission of important control variables, inclusion of only a few psychosocial variables, and failure to analyze moderating effects. To overcome these problems, the present study examined the link between breast cancer and multiple psychosocial variables (life events, coping, Type A behavior pattern, availability of social support) among 1,052 women with and without breast cancer. After controlling for history of breast cancer and age, we found very few significant relationships between psychosocial variables and breast cancer. Furthermore, the relationship between life events and breast cancer was not moderated by coping, Type A, or availability of social support. Methodological and substantive reasons for these findings are discussed.     

职业驾驶员心理应激及其相关变量分析

目的 :了解职业驾驶员心理应激状况及相关因素 ,为减少事故的发生提供资料。方法 :采用LES、应对、成人内外控制、SSRS、EPQ、SCL -90等量表对 2 40名职业驾驶员进行测试。结果 :①驾驶员的主要应激源是工作学习问题、家庭有关问题 ;应对方式上 ,更趋向于积极应对 ;社会支持上 ,主观支持分明显高于客观支持分 ;在心理控制感上 ,明显趋于外控 ;EPQ得分与普通人群相比 ,E分较高 ,N分较低 ;SCL -90各因子分均值与全国常模相比 ,除躯体化、强迫、焦虑等项因子均值较高外 ,其他无显著差异。②事故组与安全组驾驶员在生活事件、相关变量、应激反应上 ,均存在显著差异。③行车事故与应激性生活事件呈正相关 (P <0 0 1)、与EPQ -N ,SCL -90诸因子呈负相关 (P <0 0 1)。结论 :生活事件引起的情绪应激 ,与驾驶操作、交通违章和事故发生有一定相关关系。